[COMSAE PHASE 1 FORM 114 PRACTICE EXAM] – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE | STUVIA VERIFIED | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
Course[
COMSAE PHASE 1 FORM 114
1. A 24-year-old man develops sudden right-sided facial weakness involving the forehead,
inability to close his right eye, and decreased taste on the anterior two-thirds of the tongue.
Which nerve is most likely affected?
A. Trigeminal nerve
B. Facial nerve
C. Glossopharyngeal nerve
D. Vagus nerve
Correct Answer: B. Facial nerve
Rationale: The facial nerve (CN VII) innervates the muscles of facial expression and carries
taste sensation from the anterior two-thirds of the tongue through the chorda tympani. A
peripheral CN VII lesion affects both the upper and lower face, distinguishing it from a
supranuclear lesion, which typically spares the forehead because of bilateral cortical innervation.
2. A patient has weakness of the right arm and leg accompanied by loss of vibration and
proprioception on the same side. Which spinal cord structure is most likely damaged?
A. Spinothalamic tract
B. Anterior horn
C. Dorsal columns
D. Anterior corticospinal tract
Correct Answer: C. Dorsal columns
Rationale: The dorsal columns carry vibration, fine touch, and proprioception. Fibers ascend
ipsilaterally in the spinal cord and decussate in the medulla. Damage to these pathways therefore
causes ipsilateral loss of vibration and proprioception below the lesion.
3. A patient has a lesion involving the left posterior cerebral artery. Which deficit is most
likely?
A. Right homonymous hemianopia
B. Left facial paralysis
C. Bilateral hearing loss
D. Right lower motor neuron facial weakness
Correct Answer: A. Right homonymous hemianopia
,Rationale: The posterior cerebral artery supplies the occipital cortex, including the primary
visual cortex. A left occipital lesion produces a right homonymous hemianopia, often with
macular sparing.
4. A 67-year-old man develops resting tremor, bradykinesia, rigidity, and a shuffling gait.
Which neurotransmitter abnormality is most directly associated with these findings?
A. Increased dopamine in the substantia nigra
B. Decreased dopamine in the nigrostriatal pathway
C. Increased serotonin in the raphe nuclei
D. Decreased acetylcholine at the neuromuscular junction
Correct Answer: B. Decreased dopamine in the nigrostriatal pathway
Rationale: Parkinson disease results from degeneration of dopaminergic neurons in the
substantia nigra pars compacta. Reduced dopamine signaling in the nigrostriatal pathway
produces bradykinesia, rigidity, resting tremor, and postural instability.
5. A patient with severe vomiting develops metabolic alkalosis. Which renal response helps
maintain this disturbance?
A. Increased bicarbonate excretion
B. Increased hydrogen ion secretion
C. Decreased bicarbonate reabsorption
D. Increased ammonium excretion
Correct Answer: B. Increased hydrogen ion secretion
Rationale: Vomiting causes loss of gastric hydrochloric acid, producing metabolic alkalosis.
Volume depletion activates the renin-angiotensin-aldosterone system, increasing renal sodium
reabsorption and hydrogen secretion. This contributes to maintenance of the alkalosis.
6. A patient with diabetic ketoacidosis has a serum potassium concentration of 5.8 mEq/L.
Despite the elevated serum potassium, total-body potassium is usually:
A. Increased
B. Normal
C. Decreased
D. Unchanged because insulin has no effect on potassium
Correct Answer: C. Decreased
Rationale: In DKA, insulin deficiency and extracellular acidosis shift potassium from cells into
the extracellular compartment, increasing serum potassium. However, osmotic diuresis causes
substantial urinary potassium loss, resulting in decreased total-body potassium.
7. Which hormone directly increases calcium reabsorption in the distal nephron?
,A. Calcitonin
B. Parathyroid hormone
C. Aldosterone
D. Growth hormone
Correct Answer: B. Parathyroid hormone
Rationale: PTH increases serum calcium by increasing renal calcium reabsorption, stimulating
activation of vitamin D, and increasing bone resorption indirectly. It also decreases proximal
tubular phosphate reabsorption, causing phosphaturia.
8. A patient has increased thyroid hormone production due to Graves disease. Which
finding is most likely?
A. Decreased oxygen consumption
B. Bradycardia
C. Heat intolerance
D. Weight gain
Correct Answer: C. Heat intolerance
Rationale: Thyroid hormones increase basal metabolic rate and oxygen consumption. Excess
thyroid hormone therefore produces heat intolerance, weight loss, tachycardia, tremor, anxiety,
and increased sympathetic activity.
9. A patient develops proximal muscle weakness and a heliotrope rash around the eyes.
Which diagnosis is most likely?
A. Dermatomyositis
B. Osteoarthritis
C. Myasthenia gravis
D. Polymyalgia rheumatica
Correct Answer: A. Dermatomyositis
Rationale: Dermatomyositis produces symmetric proximal muscle weakness accompanied by
characteristic skin findings such as a heliotrope rash and Gottron papules. Muscle injury results
from inflammatory involvement of muscle tissue.
10. A patient has fluctuating muscle weakness that worsens with repeated activity and
improves with rest. Which mechanism best explains this condition?
A. Destruction of presynaptic calcium channels
B. Autoantibodies against postsynaptic acetylcholine receptors
C. Loss of dopamine receptors
D. Autoantibodies against voltage-gated sodium channels
, Correct Answer: B. Autoantibodies against postsynaptic acetylcholine receptors
Rationale: Myasthenia gravis is caused by antibodies against components of the postsynaptic
neuromuscular junction, most commonly the acetylcholine receptor. Weakness worsens with
repeated use and improves with rest.
11. A patient has a somatic dysfunction in which a vertebral segment is rotated left and
sidebent left. According to Fryette principles for a neutral thoracic segment, which motion
relationship is expected?
A. Rotation and sidebending occur in opposite directions
B. Rotation and sidebending occur in the same direction
C. Rotation occurs without sidebending
D. Sidebending occurs without rotation
Correct Answer: B. Rotation and sidebending occur in the same direction
Rationale: For neutral mechanics of the thoracic and lumbar spine, rotation and sidebending
occur in opposite directions. However, the described isolated same-direction pattern corresponds
to nonneutral mechanics. Therefore, the correct interpretation requires identifying whether the
segment is neutral or nonneutral. For a nonneutral segment, rotation and sidebending occur to the
same side.
12. A patient has an inhalation dysfunction of the fifth rib. Which finding is expected?
A. Rib remains elevated during exhalation
B. Rib remains depressed during exhalation
C. Rib moves freely during respiration
D. Rib has restricted inhalation only
Correct Answer: A. Rib remains elevated during exhalation
Rationale: An inhalation rib dysfunction is associated with a rib that is positioned in relative
inhalation and is restricted in exhalation. The rib remains elevated rather than moving
appropriately downward during expiration.
13. A patient has a right-on-right sacral torsion. Which combination is characteristic?
A. Left-on-left axis with anterior sacral base
B. Right-on-right axis with posterior/inferior sacral base on the right
C. Right-on-left axis with anterior/inferior sacral base
D. Left-on-right axis with symmetric sacral landmarks
Correct Answer: B. Right-on-right axis with posterior/inferior sacral base on the right
Rationale: In a right-on-right sacral torsion, the sacrum rotates around a right oblique axis. The
right sacral base becomes posterior/inferior while the left base becomes anterior/superior.
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE | STUVIA VERIFIED | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
Course[
COMSAE PHASE 1 FORM 114
1. A 24-year-old man develops sudden right-sided facial weakness involving the forehead,
inability to close his right eye, and decreased taste on the anterior two-thirds of the tongue.
Which nerve is most likely affected?
A. Trigeminal nerve
B. Facial nerve
C. Glossopharyngeal nerve
D. Vagus nerve
Correct Answer: B. Facial nerve
Rationale: The facial nerve (CN VII) innervates the muscles of facial expression and carries
taste sensation from the anterior two-thirds of the tongue through the chorda tympani. A
peripheral CN VII lesion affects both the upper and lower face, distinguishing it from a
supranuclear lesion, which typically spares the forehead because of bilateral cortical innervation.
2. A patient has weakness of the right arm and leg accompanied by loss of vibration and
proprioception on the same side. Which spinal cord structure is most likely damaged?
A. Spinothalamic tract
B. Anterior horn
C. Dorsal columns
D. Anterior corticospinal tract
Correct Answer: C. Dorsal columns
Rationale: The dorsal columns carry vibration, fine touch, and proprioception. Fibers ascend
ipsilaterally in the spinal cord and decussate in the medulla. Damage to these pathways therefore
causes ipsilateral loss of vibration and proprioception below the lesion.
3. A patient has a lesion involving the left posterior cerebral artery. Which deficit is most
likely?
A. Right homonymous hemianopia
B. Left facial paralysis
C. Bilateral hearing loss
D. Right lower motor neuron facial weakness
Correct Answer: A. Right homonymous hemianopia
,Rationale: The posterior cerebral artery supplies the occipital cortex, including the primary
visual cortex. A left occipital lesion produces a right homonymous hemianopia, often with
macular sparing.
4. A 67-year-old man develops resting tremor, bradykinesia, rigidity, and a shuffling gait.
Which neurotransmitter abnormality is most directly associated with these findings?
A. Increased dopamine in the substantia nigra
B. Decreased dopamine in the nigrostriatal pathway
C. Increased serotonin in the raphe nuclei
D. Decreased acetylcholine at the neuromuscular junction
Correct Answer: B. Decreased dopamine in the nigrostriatal pathway
Rationale: Parkinson disease results from degeneration of dopaminergic neurons in the
substantia nigra pars compacta. Reduced dopamine signaling in the nigrostriatal pathway
produces bradykinesia, rigidity, resting tremor, and postural instability.
5. A patient with severe vomiting develops metabolic alkalosis. Which renal response helps
maintain this disturbance?
A. Increased bicarbonate excretion
B. Increased hydrogen ion secretion
C. Decreased bicarbonate reabsorption
D. Increased ammonium excretion
Correct Answer: B. Increased hydrogen ion secretion
Rationale: Vomiting causes loss of gastric hydrochloric acid, producing metabolic alkalosis.
Volume depletion activates the renin-angiotensin-aldosterone system, increasing renal sodium
reabsorption and hydrogen secretion. This contributes to maintenance of the alkalosis.
6. A patient with diabetic ketoacidosis has a serum potassium concentration of 5.8 mEq/L.
Despite the elevated serum potassium, total-body potassium is usually:
A. Increased
B. Normal
C. Decreased
D. Unchanged because insulin has no effect on potassium
Correct Answer: C. Decreased
Rationale: In DKA, insulin deficiency and extracellular acidosis shift potassium from cells into
the extracellular compartment, increasing serum potassium. However, osmotic diuresis causes
substantial urinary potassium loss, resulting in decreased total-body potassium.
7. Which hormone directly increases calcium reabsorption in the distal nephron?
,A. Calcitonin
B. Parathyroid hormone
C. Aldosterone
D. Growth hormone
Correct Answer: B. Parathyroid hormone
Rationale: PTH increases serum calcium by increasing renal calcium reabsorption, stimulating
activation of vitamin D, and increasing bone resorption indirectly. It also decreases proximal
tubular phosphate reabsorption, causing phosphaturia.
8. A patient has increased thyroid hormone production due to Graves disease. Which
finding is most likely?
A. Decreased oxygen consumption
B. Bradycardia
C. Heat intolerance
D. Weight gain
Correct Answer: C. Heat intolerance
Rationale: Thyroid hormones increase basal metabolic rate and oxygen consumption. Excess
thyroid hormone therefore produces heat intolerance, weight loss, tachycardia, tremor, anxiety,
and increased sympathetic activity.
9. A patient develops proximal muscle weakness and a heliotrope rash around the eyes.
Which diagnosis is most likely?
A. Dermatomyositis
B. Osteoarthritis
C. Myasthenia gravis
D. Polymyalgia rheumatica
Correct Answer: A. Dermatomyositis
Rationale: Dermatomyositis produces symmetric proximal muscle weakness accompanied by
characteristic skin findings such as a heliotrope rash and Gottron papules. Muscle injury results
from inflammatory involvement of muscle tissue.
10. A patient has fluctuating muscle weakness that worsens with repeated activity and
improves with rest. Which mechanism best explains this condition?
A. Destruction of presynaptic calcium channels
B. Autoantibodies against postsynaptic acetylcholine receptors
C. Loss of dopamine receptors
D. Autoantibodies against voltage-gated sodium channels
, Correct Answer: B. Autoantibodies against postsynaptic acetylcholine receptors
Rationale: Myasthenia gravis is caused by antibodies against components of the postsynaptic
neuromuscular junction, most commonly the acetylcholine receptor. Weakness worsens with
repeated use and improves with rest.
11. A patient has a somatic dysfunction in which a vertebral segment is rotated left and
sidebent left. According to Fryette principles for a neutral thoracic segment, which motion
relationship is expected?
A. Rotation and sidebending occur in opposite directions
B. Rotation and sidebending occur in the same direction
C. Rotation occurs without sidebending
D. Sidebending occurs without rotation
Correct Answer: B. Rotation and sidebending occur in the same direction
Rationale: For neutral mechanics of the thoracic and lumbar spine, rotation and sidebending
occur in opposite directions. However, the described isolated same-direction pattern corresponds
to nonneutral mechanics. Therefore, the correct interpretation requires identifying whether the
segment is neutral or nonneutral. For a nonneutral segment, rotation and sidebending occur to the
same side.
12. A patient has an inhalation dysfunction of the fifth rib. Which finding is expected?
A. Rib remains elevated during exhalation
B. Rib remains depressed during exhalation
C. Rib moves freely during respiration
D. Rib has restricted inhalation only
Correct Answer: A. Rib remains elevated during exhalation
Rationale: An inhalation rib dysfunction is associated with a rib that is positioned in relative
inhalation and is restricted in exhalation. The rib remains elevated rather than moving
appropriately downward during expiration.
13. A patient has a right-on-right sacral torsion. Which combination is characteristic?
A. Left-on-left axis with anterior sacral base
B. Right-on-right axis with posterior/inferior sacral base on the right
C. Right-on-left axis with anterior/inferior sacral base
D. Left-on-right axis with symmetric sacral landmarks
Correct Answer: B. Right-on-right axis with posterior/inferior sacral base on the right
Rationale: In a right-on-right sacral torsion, the sacrum rotates around a right oblique axis. The
right sacral base becomes posterior/inferior while the left base becomes anterior/superior.
