1 | Page
Family Medicine COMAT Questions and
Answers
A 56-year-old female complains of palpitations and an
unintentional 20 lb weight loss in the past six months. History
reveals that her menstrual periods stopped approximately 7 years
ago. Vital signs include a blood pressure of 135/85 and a heart
rate of 110. Physical examination reveals a non-tender enlarged
thyroid gland without nodules. Structural examination reveals
tissue texture changes at T2 associated with an upper thoracic
flexion hump. Laboratory studies reveal the following
TSH: 0.05
free T3: 380
free T4: 22
A thyroid stimulating immunoglobulin test is positive. The most
appropriate initial management is
A. levothyroxine
B. methimazole
C. proylthiouracil
D. radioactive iodine ablation
E. thyroidectomy
Ans: B (although treatment with methimazole, proylthiouracil,
radioactive iodine, and surgical removal of the thyroid gland are
plausible treatments for Grave's disease, methimazole is recommnded as
a first line agent over propylthiouracil due to potential hepatotoxicity)
A 66-year old female complains that the nail of her right great toe
is discolored and brittle. She states that she first noticed it 4
months ago during a pedicure. Physical examination reveals the
right great toenail to be yellowed, thickened, and has white
© 2025 All rights reserved
, 2 | Page
subungual debris. The most appropriate modality to confirm the
most likely diagnosis is
A. bacterial culture of nail clippings
B. culture of toenail scrapings on Sabouraud's medium
C. histopathologic examination of nail clippings under periodic
acid-Schiff stain
D. microscopic evaluation of toenail scrapings using KOH prep
E. one month terbinafine to confirm resolution
Ans: D (the most likely diagnosis is onychomycosis - microscopic
evaluation is the best first step to make the diagnosis) (A; bacterial
infection is less likely than fungal) (B; Sabouraud's agar is used to grow
fungal specimens - culture results usually return after weeks, a
microscopic evaluation would be faster - culturing would be indicated if
the initial KOH prep shows absent fungi) (C; this procedure stains fungal
cell walls and helps in visualization - however, while this test is more
sensitive, it is more expensive) (E; empiric treatment is not
recommended due to side effects - additionally, treatment usually lasts 3
months, not 1, due to the slow growing nature of toenails)
A 70-year-old female who is 3 days status-post urologic surgery
develops a fever overnight in the hospital. She has an indwelling
Foley catheter with good urine output. Her past medical history
includes hypertension and urinary incontinence. She has no
significant family history. Vitals reveal her temperature to be
102.2F, pulse 82, respirations 15, and blood pressure 134/85.
Physical examination is remarkable for mild suprapubic
tenderness. You note a tender nodule on the lateral border of the
umbilicus. Urinalysis reveals 60 WBC/hpf, trace protein, positive
leukocyte esterase, positive nitrites, and no casts. A reflex culture
grows motile, gram-negative rods with a dark green appearance
and fruity odor. The most appropriate pharmacologic therapy
includes
A. amoxicillin
B. cefotaxime
C. ceftriaxone
D. ciprofloxacin
© 2025 All rights reserved
, 3 | Page
E. trimethoprim-sulfamethoxazole
Ans: D (indwelling catheter can cause a UTI with Pseudomonas
aeruginosa - the indicated treatment is with a fluoroquinolone like
ciprofloxacin or levofloxacin) (none of the other answer choices have
action against Pseudomonas)
A 32-year-old G1P0 female at 16 weeks' gestation presents with
vaginal bleeding. History reveals she had pelvic inflammatory
disease of unknown etiology prior to conception. Pelvic
examination reveals the cervical os to be closed. The most likely
diagnosis is
A. complete abortion
B. incomplete abortion
C. inevitable abortion
D. partial abortion
E. threatened abortion
Ans: E (threatened abortion is used to describe any vaginal bleeding that
occurs within the first 20 weeks of pregnancy) (A; a complete abortion is
when the products of conception have completely evacuated the uterus
and the cervical os is closed) (B; an incomplete abortion is when the
products of conception can be seen or palpated in the cervical canal, and
the cervical os is open) (C; an inevitable abortion is when the products of
conception can be seen or palpated within the uterus through the dilated
cervical os) (D; partial abortion is not an appropriate or defined medical
term)
A 32-year-old G1P0 female at 16 weeks' gestation presents with
vaginal bleeding. History reveals she had pelvic inflammatory
disease of unknown etiology prior to conception. Pelvic
examination reveals the cervical os to be closed. The patient
ultimately has a miscarriage and undergoes a successful dilation
and curettage. You explain that she is likely to experience another
miscarriage because she has a history of
A. advanced maternal age
B. nulliparity
C. pelvic inflammatory disease
© 2025 All rights reserved
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D. spontaneous abortion
E. uterine instrumentation
Ans: D (the most documented causes of miscarriages are maternal age,
history of previous miscarriage, and maternal smoking) (A; risk of
miscarriage according to maternal age is 20% for 35 years, 40% for 40
years, and 80% for 45 years) (B; miscarriages can be related to increased
gravidity but not nulliparity) (C; PID increases a patient's risk for
infertility, but not miscarriage unless there is an active infection) (E;
there are no studies to indicate that this is a significant contributor)
A 30-year-old female presents to the office for a health
maintenance examination. She states she feels healthy and wants a
routine check as she is planning to become pregnant in the near
future. Physical exam is normal and osteopathic structural exam
reveals only mild anterior innominate rotation on the left without
significant TART changes throughout the spine. A urinalysis is
obtained and dipstick reveals the following
Color: yellow
Specific gravity: 1.012
pH: 5.5
Blood: none
Protein: none
Glucose: none
Leukocyte esterase: none
Nitrite: none
Bacteria: occult
RBC: 2/hpf
WBC: 5/hpf
A follow-up urine culture is obtained revealing two different types
of bacteria with 10^3 CFU/mL. The most likely diagnosis is
A. contaminated specimen
B. cystitis
C. pyelonephritis
D. pyuria
E. urinary tract infection
© 2025 All rights reserved
Family Medicine COMAT Questions and
Answers
A 56-year-old female complains of palpitations and an
unintentional 20 lb weight loss in the past six months. History
reveals that her menstrual periods stopped approximately 7 years
ago. Vital signs include a blood pressure of 135/85 and a heart
rate of 110. Physical examination reveals a non-tender enlarged
thyroid gland without nodules. Structural examination reveals
tissue texture changes at T2 associated with an upper thoracic
flexion hump. Laboratory studies reveal the following
TSH: 0.05
free T3: 380
free T4: 22
A thyroid stimulating immunoglobulin test is positive. The most
appropriate initial management is
A. levothyroxine
B. methimazole
C. proylthiouracil
D. radioactive iodine ablation
E. thyroidectomy
Ans: B (although treatment with methimazole, proylthiouracil,
radioactive iodine, and surgical removal of the thyroid gland are
plausible treatments for Grave's disease, methimazole is recommnded as
a first line agent over propylthiouracil due to potential hepatotoxicity)
A 66-year old female complains that the nail of her right great toe
is discolored and brittle. She states that she first noticed it 4
months ago during a pedicure. Physical examination reveals the
right great toenail to be yellowed, thickened, and has white
© 2025 All rights reserved
, 2 | Page
subungual debris. The most appropriate modality to confirm the
most likely diagnosis is
A. bacterial culture of nail clippings
B. culture of toenail scrapings on Sabouraud's medium
C. histopathologic examination of nail clippings under periodic
acid-Schiff stain
D. microscopic evaluation of toenail scrapings using KOH prep
E. one month terbinafine to confirm resolution
Ans: D (the most likely diagnosis is onychomycosis - microscopic
evaluation is the best first step to make the diagnosis) (A; bacterial
infection is less likely than fungal) (B; Sabouraud's agar is used to grow
fungal specimens - culture results usually return after weeks, a
microscopic evaluation would be faster - culturing would be indicated if
the initial KOH prep shows absent fungi) (C; this procedure stains fungal
cell walls and helps in visualization - however, while this test is more
sensitive, it is more expensive) (E; empiric treatment is not
recommended due to side effects - additionally, treatment usually lasts 3
months, not 1, due to the slow growing nature of toenails)
A 70-year-old female who is 3 days status-post urologic surgery
develops a fever overnight in the hospital. She has an indwelling
Foley catheter with good urine output. Her past medical history
includes hypertension and urinary incontinence. She has no
significant family history. Vitals reveal her temperature to be
102.2F, pulse 82, respirations 15, and blood pressure 134/85.
Physical examination is remarkable for mild suprapubic
tenderness. You note a tender nodule on the lateral border of the
umbilicus. Urinalysis reveals 60 WBC/hpf, trace protein, positive
leukocyte esterase, positive nitrites, and no casts. A reflex culture
grows motile, gram-negative rods with a dark green appearance
and fruity odor. The most appropriate pharmacologic therapy
includes
A. amoxicillin
B. cefotaxime
C. ceftriaxone
D. ciprofloxacin
© 2025 All rights reserved
, 3 | Page
E. trimethoprim-sulfamethoxazole
Ans: D (indwelling catheter can cause a UTI with Pseudomonas
aeruginosa - the indicated treatment is with a fluoroquinolone like
ciprofloxacin or levofloxacin) (none of the other answer choices have
action against Pseudomonas)
A 32-year-old G1P0 female at 16 weeks' gestation presents with
vaginal bleeding. History reveals she had pelvic inflammatory
disease of unknown etiology prior to conception. Pelvic
examination reveals the cervical os to be closed. The most likely
diagnosis is
A. complete abortion
B. incomplete abortion
C. inevitable abortion
D. partial abortion
E. threatened abortion
Ans: E (threatened abortion is used to describe any vaginal bleeding that
occurs within the first 20 weeks of pregnancy) (A; a complete abortion is
when the products of conception have completely evacuated the uterus
and the cervical os is closed) (B; an incomplete abortion is when the
products of conception can be seen or palpated in the cervical canal, and
the cervical os is open) (C; an inevitable abortion is when the products of
conception can be seen or palpated within the uterus through the dilated
cervical os) (D; partial abortion is not an appropriate or defined medical
term)
A 32-year-old G1P0 female at 16 weeks' gestation presents with
vaginal bleeding. History reveals she had pelvic inflammatory
disease of unknown etiology prior to conception. Pelvic
examination reveals the cervical os to be closed. The patient
ultimately has a miscarriage and undergoes a successful dilation
and curettage. You explain that she is likely to experience another
miscarriage because she has a history of
A. advanced maternal age
B. nulliparity
C. pelvic inflammatory disease
© 2025 All rights reserved
, 4 | Page
D. spontaneous abortion
E. uterine instrumentation
Ans: D (the most documented causes of miscarriages are maternal age,
history of previous miscarriage, and maternal smoking) (A; risk of
miscarriage according to maternal age is 20% for 35 years, 40% for 40
years, and 80% for 45 years) (B; miscarriages can be related to increased
gravidity but not nulliparity) (C; PID increases a patient's risk for
infertility, but not miscarriage unless there is an active infection) (E;
there are no studies to indicate that this is a significant contributor)
A 30-year-old female presents to the office for a health
maintenance examination. She states she feels healthy and wants a
routine check as she is planning to become pregnant in the near
future. Physical exam is normal and osteopathic structural exam
reveals only mild anterior innominate rotation on the left without
significant TART changes throughout the spine. A urinalysis is
obtained and dipstick reveals the following
Color: yellow
Specific gravity: 1.012
pH: 5.5
Blood: none
Protein: none
Glucose: none
Leukocyte esterase: none
Nitrite: none
Bacteria: occult
RBC: 2/hpf
WBC: 5/hpf
A follow-up urine culture is obtained revealing two different types
of bacteria with 10^3 CFU/mL. The most likely diagnosis is
A. contaminated specimen
B. cystitis
C. pyelonephritis
D. pyuria
E. urinary tract infection
© 2025 All rights reserved
