COMSAE PHASE 5 ADVANCED
CLINICAL ASSESSMENT QUESTIONS
AND VERIFIED ANSWERS
1. A 65-year-old male presents with acute onset substernal chest pain and shortness of
breath. EKG reveals ST-segment elevation in leads II, III, and aVF. Which of the following is
the most appropriate next step in management?
A. Immediate administration of oral beta-blockers
B. Emergent cardiac catheterization for percutaneous coronary intervention
C. Intravenous thrombolytic therapy within 12 hours
D. Observation and serial troponin monitoring
Answer: B
Conceptual Explanation: The patient is presenting with an inferior wall STEMI. The gold
standard for management is immediate PCI within 90 minutes of arrival at a PCI-capable
facility.
2. A 45-year-old female presents with recurrent episodes of vertigo, tinnitus, and hearing loss
in the right ear. Which of the following is the most likely diagnosis?
A. Meniere Disease
B. Vestibular Neuritis
,C. Benign Paroxysmal Positional Vertigo
D. Labyrinthitis
Answer: A
Conceptual Explanation: Meniere disease is characterized by the triad of episodic vertigo,
tinnitus, and sensorineural hearing loss, typically caused by endolymphatic hydrops.
3. During an osteopathic examination, a patient is found to have a sacral torsion. Examination
shows a positive seated flexion test on the left, a deep right sacral sulcus, and a posterior left
inferior lateral angle. Which of the following is the correct diagnosis?
A. Left-on-left forward torsion
B. Left-on-right backward torsion
C. Right-on-left backward torsion
D. Right-on-right forward torsion
Answer: C
Conceptual Explanation: A positive seated flexion test on the left indicates the
dysfunction is on the left. A deep right sulcus and posterior left ILA with a left-sided flexion
test suggests the sacrum is rotated right on a left oblique axis (Right-on-Left).
, 4. A 28-year-old G1P0 at 34 weeks gestation presents with a blood pressure of 165/110
mmHg and 3+ proteinuria. She complains of a severe headache. What is the most appropriate
medication to prevent seizures?
A. Magnesium sulfate
B. Phenytoin
C. Diazepam
D. Hydralazine
Answer: A
Conceptual Explanation: Magnesium sulfate is the first-line treatment for seizure
prophylaxis in patients with severe preeclampsia.
5. A 50-year-old male with a history of cirrhosis presents with increasing abdominal girth and
confusion. Physical exam shows shifting dullness and asterixis. Paracentesis shows a
neutrophil count of 300 cells/mm3. What is the most appropriate treatment?
A. Cefotaxime
B. Lactulose
C. Furosemide
D. Ceftriaxone
Answer: A
CLINICAL ASSESSMENT QUESTIONS
AND VERIFIED ANSWERS
1. A 65-year-old male presents with acute onset substernal chest pain and shortness of
breath. EKG reveals ST-segment elevation in leads II, III, and aVF. Which of the following is
the most appropriate next step in management?
A. Immediate administration of oral beta-blockers
B. Emergent cardiac catheterization for percutaneous coronary intervention
C. Intravenous thrombolytic therapy within 12 hours
D. Observation and serial troponin monitoring
Answer: B
Conceptual Explanation: The patient is presenting with an inferior wall STEMI. The gold
standard for management is immediate PCI within 90 minutes of arrival at a PCI-capable
facility.
2. A 45-year-old female presents with recurrent episodes of vertigo, tinnitus, and hearing loss
in the right ear. Which of the following is the most likely diagnosis?
A. Meniere Disease
B. Vestibular Neuritis
,C. Benign Paroxysmal Positional Vertigo
D. Labyrinthitis
Answer: A
Conceptual Explanation: Meniere disease is characterized by the triad of episodic vertigo,
tinnitus, and sensorineural hearing loss, typically caused by endolymphatic hydrops.
3. During an osteopathic examination, a patient is found to have a sacral torsion. Examination
shows a positive seated flexion test on the left, a deep right sacral sulcus, and a posterior left
inferior lateral angle. Which of the following is the correct diagnosis?
A. Left-on-left forward torsion
B. Left-on-right backward torsion
C. Right-on-left backward torsion
D. Right-on-right forward torsion
Answer: C
Conceptual Explanation: A positive seated flexion test on the left indicates the
dysfunction is on the left. A deep right sulcus and posterior left ILA with a left-sided flexion
test suggests the sacrum is rotated right on a left oblique axis (Right-on-Left).
, 4. A 28-year-old G1P0 at 34 weeks gestation presents with a blood pressure of 165/110
mmHg and 3+ proteinuria. She complains of a severe headache. What is the most appropriate
medication to prevent seizures?
A. Magnesium sulfate
B. Phenytoin
C. Diazepam
D. Hydralazine
Answer: A
Conceptual Explanation: Magnesium sulfate is the first-line treatment for seizure
prophylaxis in patients with severe preeclampsia.
5. A 50-year-old male with a history of cirrhosis presents with increasing abdominal girth and
confusion. Physical exam shows shifting dullness and asterixis. Paracentesis shows a
neutrophil count of 300 cells/mm3. What is the most appropriate treatment?
A. Cefotaxime
B. Lactulose
C. Furosemide
D. Ceftriaxone
Answer: A
