COMSAE PHASE 3 COMPREHENSIVE
REVIEW QUESTIONS AND VERIFIED
ANSWERS
1. A 45-year-old male presents with acute right lower quadrant pain and nausea. Physical
examination reveals tenderness at McBurney’s point. Which of the following describes the
anterior Chapman reflex point for the structure most likely involved?
A. The periumbilical region
B. The superior border of the right 11th rib
C. The lateral aspect of the right T10 transverse process
D. The tip of the right 12th rib
Answer: D
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib. The posterior point is at the transverse process of T11.
2. A 68-year-old female with a history of heart failure with reduced ejection fraction (EF 35%)
is currently taking lisinopril, carvedilol, and furosemide. Despite adherence, she remains
NYHA Class II. Which of the following medications, if added, has been proven to further
reduce mortality in this patient?
A. Isosorbide mononitrate
,B. Digoxin
C. Amlodipine
D. Dapagliflozin
Answer: D
Conceptual Explanation: SGLT2 inhibitors like dapagliflozin and empagliflozin have been
shown to reduce cardiovascular mortality and heart failure hospitalizations in patients
with HFrEF, regardless of diabetes status.
3. An 82-year-old male is brought to the ED for altered mental status. Osteopathic
examination reveals a sacral diagnosis where the right sacral base is anterior and the right ILA
is posterior. The seated flexion test is positive on the left. What is the diagnosis?
A. Right-on-left sacral torsion
B. Left-on-left sacral torsion
C. Left-on-right sacral torsion
D. Right-on-right sacral torsion
Answer: A
Conceptual Explanation: A positive seated flexion test on the left indicates a left axis or
left restriction. A right sacral base anterior and right ILA posterior describes a right
rotation. Since the rotation and axis are opposite, it is a backward torsion: Right-on-left.
, 4. A 32-year-old pregnant female at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache and blurred vision.
What is the most appropriate next step in management?
A. Immediate Cesarean section without stabilization
B. Oral labetalol and follow-up in 1 week
C. Intravenous magnesium sulfate and stabilization for delivery
D. Bed rest and repeat urinalysis in 24 hours
Answer: C
Conceptual Explanation: This patient has preeclampsia with severe features.
Management requires seizure prophylaxis with magnesium sulfate and blood pressure
control followed by delivery.
5. Which of the following legal concepts describes a situation where a physician’s negligence
is so obvious that it ‘speaks for itself’ without the need for expert testimony?
A. Respondeat superior
B. Res ipsa loquitur
C. Volenti non fit injuria
D. Vicarious liability
Answer: B
REVIEW QUESTIONS AND VERIFIED
ANSWERS
1. A 45-year-old male presents with acute right lower quadrant pain and nausea. Physical
examination reveals tenderness at McBurney’s point. Which of the following describes the
anterior Chapman reflex point for the structure most likely involved?
A. The periumbilical region
B. The superior border of the right 11th rib
C. The lateral aspect of the right T10 transverse process
D. The tip of the right 12th rib
Answer: D
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib. The posterior point is at the transverse process of T11.
2. A 68-year-old female with a history of heart failure with reduced ejection fraction (EF 35%)
is currently taking lisinopril, carvedilol, and furosemide. Despite adherence, she remains
NYHA Class II. Which of the following medications, if added, has been proven to further
reduce mortality in this patient?
A. Isosorbide mononitrate
,B. Digoxin
C. Amlodipine
D. Dapagliflozin
Answer: D
Conceptual Explanation: SGLT2 inhibitors like dapagliflozin and empagliflozin have been
shown to reduce cardiovascular mortality and heart failure hospitalizations in patients
with HFrEF, regardless of diabetes status.
3. An 82-year-old male is brought to the ED for altered mental status. Osteopathic
examination reveals a sacral diagnosis where the right sacral base is anterior and the right ILA
is posterior. The seated flexion test is positive on the left. What is the diagnosis?
A. Right-on-left sacral torsion
B. Left-on-left sacral torsion
C. Left-on-right sacral torsion
D. Right-on-right sacral torsion
Answer: A
Conceptual Explanation: A positive seated flexion test on the left indicates a left axis or
left restriction. A right sacral base anterior and right ILA posterior describes a right
rotation. Since the rotation and axis are opposite, it is a backward torsion: Right-on-left.
, 4. A 32-year-old pregnant female at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache and blurred vision.
What is the most appropriate next step in management?
A. Immediate Cesarean section without stabilization
B. Oral labetalol and follow-up in 1 week
C. Intravenous magnesium sulfate and stabilization for delivery
D. Bed rest and repeat urinalysis in 24 hours
Answer: C
Conceptual Explanation: This patient has preeclampsia with severe features.
Management requires seizure prophylaxis with magnesium sulfate and blood pressure
control followed by delivery.
5. Which of the following legal concepts describes a situation where a physician’s negligence
is so obvious that it ‘speaks for itself’ without the need for expert testimony?
A. Respondeat superior
B. Res ipsa loquitur
C. Volenti non fit injuria
D. Vicarious liability
Answer: B
