COMSAE PHASE 3 FORM 118
COMPREHENSIVE ASSESSMENT
QUESTIONS AND VERIFIED ANSWERS
1. A 68-year-old male with a history of heart failure with reduced ejection fraction presents
with worsening shortness of breath and peripheral edema. Physical exam reveals jugular
venous distention and a third heart sound. Which of the following is the most appropriate
next step in management to reduce mortality?
A. Addition of an aldosterone antagonist
B. Intravenous furosemide
C. Daily aspirin therapy
D. Digoxin initiation
E. Acute fluid bolus
Answer: A
Conceptual Explanation: In patients with HFrEF already on ACE inhibitors and beta-
blockers, aldosterone antagonists (e.g., spironolactone) have been shown to significantly
reduce mortality. Furosemide improves symptoms but not mortality.
,2. An osteopathic examination of a 45-year-old patient reveals L2 is rotated left and sidebent
left. Which of the following is true regarding this segment?
A. It follows Fryette Type I mechanics
B. Sidebending and rotation occur to the same side
C. The segment is neutral
D. This is a group curve finding
Answer: B
Conceptual Explanation: L2 rotated and sidebent to the same side indicates Fryette Type
II mechanics, which typically occurs at a single segment and is associated with flexion or
extension.
3. A 24-year-old female at 34 weeks gestation presents with a blood pressure of 165/110
mmHg and 3+ proteinuria. She complains of a severe headache and visual blurring. What is
the most appropriate immediate management?
A. Expectant management until 37 weeks
B. Bed rest and repeat labs in 24 hours
C. Oral nifedipine and discharge
D. Administration of Magnesium sulfate and delivery
Answer: D
, Conceptual Explanation: Preeclampsia with severe features (headache, vision changes, BP
>160/110) requires seizure prophylaxis with magnesium sulfate and stabilization followed
by delivery, regardless of gestational age if the condition is severe.
4. A 4-year-old boy presents with a high fever for 6 days, conjunctival injection, a ‘strawberry
tongue,’ and swelling of the hands and feet. What is the most serious potential complication
of this condition?
A. Coronary artery aneurysm
B. Rheumatic heart disease
C. Glomerulonephritis
D. Splenic rupture
Answer: A
Conceptual Explanation: This patient has Kawasaki disease. The most serious
complication is the development of coronary artery aneurysms, which is mitigated by
treatment with IVIG and aspirin.
5. A patient presents with a sacral diagnosis where the seated flexion test is positive on the
right, the right sacral base is deep, and the right ILA is posterior/inferior. What is the
diagnosis?
A. Left on Left forward torsion
B. Right unilateral sacral extension
C. Right unilateral sacral flexion
COMPREHENSIVE ASSESSMENT
QUESTIONS AND VERIFIED ANSWERS
1. A 68-year-old male with a history of heart failure with reduced ejection fraction presents
with worsening shortness of breath and peripheral edema. Physical exam reveals jugular
venous distention and a third heart sound. Which of the following is the most appropriate
next step in management to reduce mortality?
A. Addition of an aldosterone antagonist
B. Intravenous furosemide
C. Daily aspirin therapy
D. Digoxin initiation
E. Acute fluid bolus
Answer: A
Conceptual Explanation: In patients with HFrEF already on ACE inhibitors and beta-
blockers, aldosterone antagonists (e.g., spironolactone) have been shown to significantly
reduce mortality. Furosemide improves symptoms but not mortality.
,2. An osteopathic examination of a 45-year-old patient reveals L2 is rotated left and sidebent
left. Which of the following is true regarding this segment?
A. It follows Fryette Type I mechanics
B. Sidebending and rotation occur to the same side
C. The segment is neutral
D. This is a group curve finding
Answer: B
Conceptual Explanation: L2 rotated and sidebent to the same side indicates Fryette Type
II mechanics, which typically occurs at a single segment and is associated with flexion or
extension.
3. A 24-year-old female at 34 weeks gestation presents with a blood pressure of 165/110
mmHg and 3+ proteinuria. She complains of a severe headache and visual blurring. What is
the most appropriate immediate management?
A. Expectant management until 37 weeks
B. Bed rest and repeat labs in 24 hours
C. Oral nifedipine and discharge
D. Administration of Magnesium sulfate and delivery
Answer: D
, Conceptual Explanation: Preeclampsia with severe features (headache, vision changes, BP
>160/110) requires seizure prophylaxis with magnesium sulfate and stabilization followed
by delivery, regardless of gestational age if the condition is severe.
4. A 4-year-old boy presents with a high fever for 6 days, conjunctival injection, a ‘strawberry
tongue,’ and swelling of the hands and feet. What is the most serious potential complication
of this condition?
A. Coronary artery aneurysm
B. Rheumatic heart disease
C. Glomerulonephritis
D. Splenic rupture
Answer: A
Conceptual Explanation: This patient has Kawasaki disease. The most serious
complication is the development of coronary artery aneurysms, which is mitigated by
treatment with IVIG and aspirin.
5. A patient presents with a sacral diagnosis where the seated flexion test is positive on the
right, the right sacral base is deep, and the right ILA is posterior/inferior. What is the
diagnosis?
A. Left on Left forward torsion
B. Right unilateral sacral extension
C. Right unilateral sacral flexion
