COMSAE PHASE 4 PREPARATION -
MEDICAL BOARD REVIEW QUESTIONS
AND VERIFIED ANSWERS
1. A 24-year-old male presents with sharp right lower quadrant pain. Physical examination
reveals tenderness at the tip of the right 12th rib. Which of the following organs is most likely
affected based on this reflex point?
A. Bladder
B. Appendix
C. Ovaries
D. Colon
Answer: B
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the 12th rib on the right. This is a classic osteopathic board presentation for
appendicitis.
2. A 45-year-old female presents with hypertension and hypokalemia. Imaging shows a 1.5
cm adrenal mass. Laboratory testing reveals elevated aldosterone and suppressed renin.
What is the definitive treatment for this patient?
A. Laparoscopic adrenalectomy
,B. Spironolactone therapy
C. High-dose salt diet
D. Radiofrequency ablation
Answer: A
Conceptual Explanation: The patient has Conn syndrome (primary hyperaldosteronism)
due to an adrenal adenoma. Unilateral adrenalectomy is the curative treatment for solitary
adenomas.
3. During a structural exam, a patient is found to have a sacral diagnosis of a Left-on-Left
forward torsion. Which of the following findings is consistent with this diagnosis?
A. Positive seated flexion test on the right
B. Negative spring test
C. Posterior ILA on the right
D. Deep right sacral sulcus
Answer: B
Conceptual Explanation: Forward torsions (like L on L) result in a negative spring test
because the sacral base has moved anteriorly. A positive spring test indicates a backward
torsion or extension.
, 4. A 68-year-old man with a history of chronic atrial fibrillation presents with sudden onset
severe abdominal pain out of proportion to physical exam findings. What is the most likely
diagnosis?
A. Acute cholecystitis
B. Perforated peptic ulcer
C. Diverticulitis
D. Acute mesenteric ischemia
Answer: D
Conceptual Explanation: Sudden, severe pain out of proportion to exam in a patient with
a source of emboli (AFib) is classic for acute mesenteric ischemia.
5. A 32-year-old pregnant woman at 34 weeks gestation presents with a BP of 165/110 mmHg
and 4+ proteinuria. She begins to have a tonic-clonic seizure. What is the first-line medication
to manage her seizures?
A. Phenytoin
B. Lorazepam
C. Magnesium sulfate
D. Valproic acid
Answer: C
MEDICAL BOARD REVIEW QUESTIONS
AND VERIFIED ANSWERS
1. A 24-year-old male presents with sharp right lower quadrant pain. Physical examination
reveals tenderness at the tip of the right 12th rib. Which of the following organs is most likely
affected based on this reflex point?
A. Bladder
B. Appendix
C. Ovaries
D. Colon
Answer: B
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the 12th rib on the right. This is a classic osteopathic board presentation for
appendicitis.
2. A 45-year-old female presents with hypertension and hypokalemia. Imaging shows a 1.5
cm adrenal mass. Laboratory testing reveals elevated aldosterone and suppressed renin.
What is the definitive treatment for this patient?
A. Laparoscopic adrenalectomy
,B. Spironolactone therapy
C. High-dose salt diet
D. Radiofrequency ablation
Answer: A
Conceptual Explanation: The patient has Conn syndrome (primary hyperaldosteronism)
due to an adrenal adenoma. Unilateral adrenalectomy is the curative treatment for solitary
adenomas.
3. During a structural exam, a patient is found to have a sacral diagnosis of a Left-on-Left
forward torsion. Which of the following findings is consistent with this diagnosis?
A. Positive seated flexion test on the right
B. Negative spring test
C. Posterior ILA on the right
D. Deep right sacral sulcus
Answer: B
Conceptual Explanation: Forward torsions (like L on L) result in a negative spring test
because the sacral base has moved anteriorly. A positive spring test indicates a backward
torsion or extension.
, 4. A 68-year-old man with a history of chronic atrial fibrillation presents with sudden onset
severe abdominal pain out of proportion to physical exam findings. What is the most likely
diagnosis?
A. Acute cholecystitis
B. Perforated peptic ulcer
C. Diverticulitis
D. Acute mesenteric ischemia
Answer: D
Conceptual Explanation: Sudden, severe pain out of proportion to exam in a patient with
a source of emboli (AFib) is classic for acute mesenteric ischemia.
5. A 32-year-old pregnant woman at 34 weeks gestation presents with a BP of 165/110 mmHg
and 4+ proteinuria. She begins to have a tonic-clonic seizure. What is the first-line medication
to manage her seizures?
A. Phenytoin
B. Lorazepam
C. Magnesium sulfate
D. Valproic acid
Answer: C
