COMSAE COMPREHENSIVE EXAMINATION
REVIEW: 176 VERIFIED QUESTIONS WITH
ANSWER RATIONALES FOR THE 2026/2027
ACADEMIC YEAR | ALREADY VERIFIED
ANSWERS | LATEST
Section 1: Clinical Medicine & Emergency Presentations
Question 1
A 23-year-old woman presents with dysuria, frequency, and urgency for 2 days. She
has no fever, flank pain, or vaginal discharge. Urinalysis shows leukocyte esterase and
nitrites. What is the best next step in management?
A) Renal ultrasound
B) Blood cultures
C) Oral trimethoprim-sulfamethoxazole
D) IV ceftriaxone
E) Cystoscopy
Correct answer: C. Oral trimethoprim-sulfamethoxazole
Rationale: This presentation is consistent with uncomplicated cystitis in a young
woman. Oral TMP-SMX is first-line therapy unless contraindicated. The absence of
systemic symptoms (fever, flank pain) and the presence of leukocyte esterase and
nitrites on urinalysis support a lower urinary tract infection. No imaging or IV therapy
is indicated for uncomplicated cystitis .
Question 2
A 66-year-old man with hypertension presents with sudden severe tearing chest pain
radiating to his back. BP is 200/110 mmHg in the right arm and 180/100 mmHg in
the left arm. What is the most appropriate next step?
,A) Start IV heparin
B) Order CT angiography of the chest
C) Perform immediate cardiac catheterization
D) Administer nitroglycerin
E) Order transthoracic echocardiogram
Correct answer: B. Order CT angiography of the chest
Rationale: This is the classic presentation of aortic dissection: sudden, severe, tearing
chest pain radiating to the back with a pulse differential between arms. CT
angiography of the chest is the diagnostic study of choice. Heparin and nitroglycerin
are inappropriate, and cardiac catheterization is not indicated for this diagnosis .
Question 3
A 17-year-old boy presents with knee pain after soccer. Exam shows a positive
Lachman test. What structure is most likely injured?
A) Posterior cruciate ligament
B) Medial meniscus
C) Anterior cruciate ligament
D) Medial collateral ligament
E) Lateral collateral ligament
Correct answer: C. Anterior cruciate ligament
Rationale: The Lachman test is the most sensitive physical exam maneuver for
diagnosing an anterior cruciate ligament (ACL) tear. The test assesses anterior
translation of the tibia relative to the femur with the knee in 20-30 degrees of
flexion .
Question 4
A 2-year-old girl has fever, drooling, and difficulty breathing. She is sitting leaning
forward with her neck extended. Stridor is present. What is the next best step?
A) Throat culture
B) Secure airway in the operating room
C) Lateral neck X-ray
,D) IV antibiotics and observation
E) Nebulized epinephrine
Correct answer: B. Secure airway in the operating room
Rationale: The presentation of fever, drooling, and tripod position in a young child is
classic for epiglottitis. This is a medical emergency requiring immediate airway
management in a controlled setting (operating room). The child should not be
agitated, and diagnostic procedures should not delay airway intervention .
Question 5
A 70-year-old woman with a history of osteoporosis presents with acute onset of
severe low back pain after lifting a heavy object. She has point tenderness over L2
and no neurological deficits. What is the most likely diagnosis?
A) Lumbar strain
B) Compression fracture
C) Disc herniation
D) Spinal stenosis
E) Renal colic
Correct answer: B. Compression fracture
Rationale: Acute back pain after minor trauma in an osteoporotic patient should
raise concern for vertebral compression fracture. Point tenderness over the affected
vertebra and absence of neurological deficits are consistent with this diagnosis .
Question 6
A 45-year-old man presents with substernal chest pain relieved by leaning forward.
EKG shows diffuse ST-segment elevations. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pericarditis
C) Aortic dissection
D) Pulmonary embolism
E) Stable angina
, Correct answer: B. Pericarditis
Rationale: Pericarditis classically presents with chest pain that is relieved by leaning
forward and worsened by lying supine. Diffuse ST-segment elevations across multiple
leads without reciprocal changes are characteristic findings. In contrast, myocardial
infarction typically shows localized ST elevations with reciprocal changes .
Question 7
A patient presents with structural exam revealing a restricted T5 segment. The
segment prefers rotation to the right and sidebending to the right. It improves when
the patient slumps forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Neutral RL SL
Correct answer: C. T5 Flexed RR SR
Rationale: Since the dysfunction improves with flexion, the segment is in a flexed
position. According to Fryette's Type II mechanics, rotation and sidebending occur to
the same side in non-neutral positions. Thus, a segment that rotates and sidebends
to the right in a flexed dysfunction is correctly diagnosed as "Flexed RR SR" (Rotates
Right, Sidebends Right) .
Question 8
According to Fryette's first principle (Type I mechanics), when the spine is in a neutral
position (neither flexed nor extended), which of the following occurs?
A) Sidebending and rotation occur to the same side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending
Correct answer: C. Sidebending and rotation occur to opposite sides
REVIEW: 176 VERIFIED QUESTIONS WITH
ANSWER RATIONALES FOR THE 2026/2027
ACADEMIC YEAR | ALREADY VERIFIED
ANSWERS | LATEST
Section 1: Clinical Medicine & Emergency Presentations
Question 1
A 23-year-old woman presents with dysuria, frequency, and urgency for 2 days. She
has no fever, flank pain, or vaginal discharge. Urinalysis shows leukocyte esterase and
nitrites. What is the best next step in management?
A) Renal ultrasound
B) Blood cultures
C) Oral trimethoprim-sulfamethoxazole
D) IV ceftriaxone
E) Cystoscopy
Correct answer: C. Oral trimethoprim-sulfamethoxazole
Rationale: This presentation is consistent with uncomplicated cystitis in a young
woman. Oral TMP-SMX is first-line therapy unless contraindicated. The absence of
systemic symptoms (fever, flank pain) and the presence of leukocyte esterase and
nitrites on urinalysis support a lower urinary tract infection. No imaging or IV therapy
is indicated for uncomplicated cystitis .
Question 2
A 66-year-old man with hypertension presents with sudden severe tearing chest pain
radiating to his back. BP is 200/110 mmHg in the right arm and 180/100 mmHg in
the left arm. What is the most appropriate next step?
,A) Start IV heparin
B) Order CT angiography of the chest
C) Perform immediate cardiac catheterization
D) Administer nitroglycerin
E) Order transthoracic echocardiogram
Correct answer: B. Order CT angiography of the chest
Rationale: This is the classic presentation of aortic dissection: sudden, severe, tearing
chest pain radiating to the back with a pulse differential between arms. CT
angiography of the chest is the diagnostic study of choice. Heparin and nitroglycerin
are inappropriate, and cardiac catheterization is not indicated for this diagnosis .
Question 3
A 17-year-old boy presents with knee pain after soccer. Exam shows a positive
Lachman test. What structure is most likely injured?
A) Posterior cruciate ligament
B) Medial meniscus
C) Anterior cruciate ligament
D) Medial collateral ligament
E) Lateral collateral ligament
Correct answer: C. Anterior cruciate ligament
Rationale: The Lachman test is the most sensitive physical exam maneuver for
diagnosing an anterior cruciate ligament (ACL) tear. The test assesses anterior
translation of the tibia relative to the femur with the knee in 20-30 degrees of
flexion .
Question 4
A 2-year-old girl has fever, drooling, and difficulty breathing. She is sitting leaning
forward with her neck extended. Stridor is present. What is the next best step?
A) Throat culture
B) Secure airway in the operating room
C) Lateral neck X-ray
,D) IV antibiotics and observation
E) Nebulized epinephrine
Correct answer: B. Secure airway in the operating room
Rationale: The presentation of fever, drooling, and tripod position in a young child is
classic for epiglottitis. This is a medical emergency requiring immediate airway
management in a controlled setting (operating room). The child should not be
agitated, and diagnostic procedures should not delay airway intervention .
Question 5
A 70-year-old woman with a history of osteoporosis presents with acute onset of
severe low back pain after lifting a heavy object. She has point tenderness over L2
and no neurological deficits. What is the most likely diagnosis?
A) Lumbar strain
B) Compression fracture
C) Disc herniation
D) Spinal stenosis
E) Renal colic
Correct answer: B. Compression fracture
Rationale: Acute back pain after minor trauma in an osteoporotic patient should
raise concern for vertebral compression fracture. Point tenderness over the affected
vertebra and absence of neurological deficits are consistent with this diagnosis .
Question 6
A 45-year-old man presents with substernal chest pain relieved by leaning forward.
EKG shows diffuse ST-segment elevations. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pericarditis
C) Aortic dissection
D) Pulmonary embolism
E) Stable angina
, Correct answer: B. Pericarditis
Rationale: Pericarditis classically presents with chest pain that is relieved by leaning
forward and worsened by lying supine. Diffuse ST-segment elevations across multiple
leads without reciprocal changes are characteristic findings. In contrast, myocardial
infarction typically shows localized ST elevations with reciprocal changes .
Question 7
A patient presents with structural exam revealing a restricted T5 segment. The
segment prefers rotation to the right and sidebending to the right. It improves when
the patient slumps forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Neutral RL SL
Correct answer: C. T5 Flexed RR SR
Rationale: Since the dysfunction improves with flexion, the segment is in a flexed
position. According to Fryette's Type II mechanics, rotation and sidebending occur to
the same side in non-neutral positions. Thus, a segment that rotates and sidebends
to the right in a flexed dysfunction is correctly diagnosed as "Flexed RR SR" (Rotates
Right, Sidebends Right) .
Question 8
According to Fryette's first principle (Type I mechanics), when the spine is in a neutral
position (neither flexed nor extended), which of the following occurs?
A) Sidebending and rotation occur to the same side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending
Correct answer: C. Sidebending and rotation occur to opposite sides
