COMSAE PHASE 2 COMPREHENSIVE
CLINICAL REVIEW QUESTIONS AND
VERIFIED ANSWERS
1. A 65-year-old male presents with acute onset of severe right upper quadrant pain,
jaundice, and a temperature of 102.5F. Physical examination reveals hypotension and altered
mental status. Laboratory studies show leukocytosis and an elevated alkaline phosphatase.
What is the most appropriate next step in management?
A. Laparoscopic cholecystectomy
B. Endoscopic retrograde cholangiopancreatography (ERCP)
C. Hepatobiliary iminodiacetic acid (HIDA) scan
D. Percutaneous transhepatic cholangiography
Answer: B
Conceptual Explanation: The patient presents with Reynolds’ Pentad (Charcot’s triad plus
hypotension and altered mental status), indicating acute cholangitis. Emergent biliary
decompression via ERCP is the treatment of choice.
,2. A 45-year-old female with a history of chronic constipation presents for an osteopathic
evaluation. Structural examination reveals a positive seated flexion test on the right, a deep
sacral sulcus on the left, and a posterior inferior iliac spine (PIIS) on the right. What is the
most likely sacral diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Right-on-left backward torsion
D. Left-on-right backward torsion
Answer: C
Conceptual Explanation: A positive seated flexion test on the right indicates the
dysfunction is on the right side. A deep sulcus on the left and a posterior right ILA suggests
a right-on-left backward torsion, where L5 would be rotated opposite to the sacral rotation.
3. A 28-year-old G1P0 at 34 weeks gestation presents with a blood pressure of 165/115
mmHg and a severe headache. Urinalysis shows 4+ protein. The patient suddenly begins to
have a tonic-clonic seizure. Which of the following is the most appropriate initial medication
to administer?
A. Diazepam
B. Phenytoin
C. Magnesium sulfate
D. Hydralazine
, Answer: C
Conceptual Explanation: Magnesium sulfate is the first-line treatment for seizure
prophylaxis and treatment in eclampsia. While hydralazine manages blood pressure, it
does not treat the seizure.
4. A 2-week-old male is brought to the pediatrician for projectile, non-bilious vomiting after
every feeding. Physical exam reveals an olive-shaped mass in the epigastrium. Which of the
following metabolic disturbances is most likely present?
A. Hyperchloremic metabolic acidosis
B. Hypochloremic hyperkalemic metabolic acidosis
C. Hypochloremic hypokalemic metabolic alkalosis
D. Hypernatremic metabolic alkalosis
Answer: C
Conceptual Explanation: Hypertrophic pyloric stenosis causes loss of gastric hydrochloric
acid and potassium, leading to a classic hypochloremic, hypokalemic metabolic alkalosis.
5. A 52-year-old male with a history of heavy alcohol use presents with hematemesis. Vital
signs show BP 90/60 mmHg and HR 115 bpm. After initiating fluid resuscitation, what is the
most appropriate next step to stabilize the patient?
A. Transjugular intrahepatic portosystemic shunt (TIPS)
B. Barium swallow study
CLINICAL REVIEW QUESTIONS AND
VERIFIED ANSWERS
1. A 65-year-old male presents with acute onset of severe right upper quadrant pain,
jaundice, and a temperature of 102.5F. Physical examination reveals hypotension and altered
mental status. Laboratory studies show leukocytosis and an elevated alkaline phosphatase.
What is the most appropriate next step in management?
A. Laparoscopic cholecystectomy
B. Endoscopic retrograde cholangiopancreatography (ERCP)
C. Hepatobiliary iminodiacetic acid (HIDA) scan
D. Percutaneous transhepatic cholangiography
Answer: B
Conceptual Explanation: The patient presents with Reynolds’ Pentad (Charcot’s triad plus
hypotension and altered mental status), indicating acute cholangitis. Emergent biliary
decompression via ERCP is the treatment of choice.
,2. A 45-year-old female with a history of chronic constipation presents for an osteopathic
evaluation. Structural examination reveals a positive seated flexion test on the right, a deep
sacral sulcus on the left, and a posterior inferior iliac spine (PIIS) on the right. What is the
most likely sacral diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Right-on-left backward torsion
D. Left-on-right backward torsion
Answer: C
Conceptual Explanation: A positive seated flexion test on the right indicates the
dysfunction is on the right side. A deep sulcus on the left and a posterior right ILA suggests
a right-on-left backward torsion, where L5 would be rotated opposite to the sacral rotation.
3. A 28-year-old G1P0 at 34 weeks gestation presents with a blood pressure of 165/115
mmHg and a severe headache. Urinalysis shows 4+ protein. The patient suddenly begins to
have a tonic-clonic seizure. Which of the following is the most appropriate initial medication
to administer?
A. Diazepam
B. Phenytoin
C. Magnesium sulfate
D. Hydralazine
, Answer: C
Conceptual Explanation: Magnesium sulfate is the first-line treatment for seizure
prophylaxis and treatment in eclampsia. While hydralazine manages blood pressure, it
does not treat the seizure.
4. A 2-week-old male is brought to the pediatrician for projectile, non-bilious vomiting after
every feeding. Physical exam reveals an olive-shaped mass in the epigastrium. Which of the
following metabolic disturbances is most likely present?
A. Hyperchloremic metabolic acidosis
B. Hypochloremic hyperkalemic metabolic acidosis
C. Hypochloremic hypokalemic metabolic alkalosis
D. Hypernatremic metabolic alkalosis
Answer: C
Conceptual Explanation: Hypertrophic pyloric stenosis causes loss of gastric hydrochloric
acid and potassium, leading to a classic hypochloremic, hypokalemic metabolic alkalosis.
5. A 52-year-old male with a history of heavy alcohol use presents with hematemesis. Vital
signs show BP 90/60 mmHg and HR 115 bpm. After initiating fluid resuscitation, what is the
most appropriate next step to stabilize the patient?
A. Transjugular intrahepatic portosystemic shunt (TIPS)
B. Barium swallow study
