COMSAE Phase 1 (Form 115) Mastery: Questions and
Answers (MCQ) Integrated Study Set | Comprehensive
Review of OMM, Clinical Pathology, and Medical
Ethics | pdf
This diagnostic and preparatory bank. We have integrated the high-
yield Osteopathic Manipulative Medicine (OMM) standards with the Foundational
Sciences and Clinical Reasoning patterns specific to the NBOME COMSAE Form
115.
1. A 45-year-old male presents with epigastric pain that radiates to the back.
Physical exam reveals a tender point at the right 5th intercostal space. Which
organ is likely involved?
A. Appendix
B. Gallbladder
C. Liver/Gallbladder (Anterior Chapman Point)
D. Stomach (Acid)
Explanation: The anterior Chapman point for the Liver/Gallbladder is the right 5th
ICS (Liver) and 6th ICS (Gallbladder). The 5th on the left is the Stomach (Acid).
2. A 24-year-old female presents with a "velvety" patch of skin on her neck. Lab
work shows elevated fasting insulin. What is the most likely diagnosis?
A. Scleroderma
B. Acanthosis Nigricans
C. Erythema Nodosum
D. Psoriasis
Explanation: This is a classic "visual" diagnosis for insulin resistance/Diabetes
Mellitus. On COMSAE, look for this in PCOS or Metabolic Syndrome cases.
3. During a cranial exam, the sphenoid and occiput move superiorly at the SBS,
decreasing the AP diameter of the skull. This describes:
A. Flexion
B. Extension
C. Torsion
D. Sidebending Rotation
,Explanation: In cranial flexion, the SBS rises (moves superiorly), the midline bones
flex, and the head widens (decreased AP diameter).
4. A patient with a history of IV drug use presents with a new holosystolic
murmur at the left lower sternal border that increases with inspiration.
Diagnosis?
A. Mitral Regurgitation
B. Tricuspid Regurgitation
C. Aortic Stenosis
D. Ventricular Septal Defect
Explanation: "Increases with inspiration" (Carvallo’s sign) distinguishes Right-sided
murmurs (Tricuspid) from Left-sided (Mitral).
5. What is the viscerosomatic reflex level for the Kidneys?
A. T5–T9
B. T10–T11
C. T10–L1
D. T12–L2
Explanation: Kidneys are T10–L1. Remember: Upper ureters are T10–L1, Lower
ureters are L1–L2.
6. A 30-year-old male presents with a "painless" chancre on his penis. What is the
causative organism?
A. Haemophilus ducreyi
B. Treponema pallidum
C. Chlamydia trachomatis
D. Herpes Simplex Virus 2
Explanation: Syphilis (Treponema) is painless. Ducreyi (Chancroid) is "painful" (You
"do cry" with Ducreyi).
7. A patient has a positive seated flexion test on the right. Deep sulcus is on the
left. Posterior ILA is on the right. Diagnosis?
A. Right-on-Right Forward Torsion
B. Left-on-Right Backward Torsion
C. Right-on-Left Backward Torsion
D. Left-on-Left Forward Torsion
Explanation: Positive seated flexion = side of the axis (Right). Sulcus/ILA are
opposite = Backward Torsion. Result: Left rotation on Right axis.
,8. Which medication is the first-line treatment for a patient with HTN and
Proteinuria?
A. ACE Inhibitor (Lisinopril)
B. Thiazide Diuretic
C. Calcium Channel Blocker
D. Beta-Blocker
Explanation: ACE inhibitors are renoprotective in diabetics and those with chronic
kidney disease (CKD).
9. A 60-year-old male presents with sudden onset "curtain dropping" over his
right eye that resolved in 10 minutes. This is most likely:
A. Retinal Detachment
B. Amaurosis Fugax (TIA)
C. Glaucoma
D. Temporal Arteritis
Explanation: Transient, painless vision loss is classic for embolic TIA from the
carotid artery.
10. What is the Chapman point for the Appendix?
A. Right 5th ICS
B. Tip of the Right 12th Rib
C. Left 6th ICS
D. Umbilicus
Explanation: Appendix anterior point = Tip of 12th rib. Posterior point = T11
transverse process.
11. A 3-year-old boy presents with a "barking" cough and inspiratory stridor. X-
ray shows subglottic narrowing (Steeple Sign). Diagnosis?
A. Croup (Parainfluenza virus)
B. Epiglottitis
C. Bronchiolitis
D. Pertussis
Explanation: Parainfluenza causes Croup. Epiglottitis (H. influenzae) shows a
"Thumbprint sign."
12. An 80-year-old male with a history of smoking presents with painless
hematuria. Most likely diagnosis?
A. Nephrolithiasis
, B. Cystitis
C. Bladder Cancer (Transitional Cell Carcinoma)
D. Renal Cell Carcinoma
Explanation: Painless hematuria in an elderly smoker is Bladder Cancer until
proven otherwise.
13. In Muscle Energy for an Exhalation rib 4 dysfunction, what is the primary
muscle used?
A. Scalenes
B. Pectoralis Minor
C. Serratus Anterior
D. Latissimus Dorsi
Explanation: Ribs 3–5 use Pectoralis Minor. Ribs 1–2 use Scalenes. Ribs 6–8 use
Serratus Anterior.
14. A patient presents with hypercalcemia, renal stones, and "brown tumors" in
the bone. Labs show high PTH and low Phosphorus. Diagnosis?
A. Primary Hyperparathyroidism
B. Secondary Hyperparathyroidism
C. Hypoparathyroidism
D. Paget's Disease
Explanation: "Stones, bones, abdominal groans, and psychic overtones" with high
PTH = Primary Hyperparathyroidism (usually an adenoma).
15. Which nerve is most likely injured in a patient with "wrist drop"?
A. Median Nerve
B. Radial Nerve
C. Ulnar Nerve
D. Axillary Nerve
Explanation: Radial nerve innervates the extensors. Injury (often via midshaft
humerus fracture) leads to inability to extend the wrist.
16. A patient presents with "Right-Sided Heart Failure" symptoms and a history of
rheumatic fever. Murmur is diastolic at the apex. Diagnosis?
A. Mitral Stenosis
B. Mitral Regurgitation
C. Aortic Stenosis
D. Tricuspid Stenosis
Answers (MCQ) Integrated Study Set | Comprehensive
Review of OMM, Clinical Pathology, and Medical
Ethics | pdf
This diagnostic and preparatory bank. We have integrated the high-
yield Osteopathic Manipulative Medicine (OMM) standards with the Foundational
Sciences and Clinical Reasoning patterns specific to the NBOME COMSAE Form
115.
1. A 45-year-old male presents with epigastric pain that radiates to the back.
Physical exam reveals a tender point at the right 5th intercostal space. Which
organ is likely involved?
A. Appendix
B. Gallbladder
C. Liver/Gallbladder (Anterior Chapman Point)
D. Stomach (Acid)
Explanation: The anterior Chapman point for the Liver/Gallbladder is the right 5th
ICS (Liver) and 6th ICS (Gallbladder). The 5th on the left is the Stomach (Acid).
2. A 24-year-old female presents with a "velvety" patch of skin on her neck. Lab
work shows elevated fasting insulin. What is the most likely diagnosis?
A. Scleroderma
B. Acanthosis Nigricans
C. Erythema Nodosum
D. Psoriasis
Explanation: This is a classic "visual" diagnosis for insulin resistance/Diabetes
Mellitus. On COMSAE, look for this in PCOS or Metabolic Syndrome cases.
3. During a cranial exam, the sphenoid and occiput move superiorly at the SBS,
decreasing the AP diameter of the skull. This describes:
A. Flexion
B. Extension
C. Torsion
D. Sidebending Rotation
,Explanation: In cranial flexion, the SBS rises (moves superiorly), the midline bones
flex, and the head widens (decreased AP diameter).
4. A patient with a history of IV drug use presents with a new holosystolic
murmur at the left lower sternal border that increases with inspiration.
Diagnosis?
A. Mitral Regurgitation
B. Tricuspid Regurgitation
C. Aortic Stenosis
D. Ventricular Septal Defect
Explanation: "Increases with inspiration" (Carvallo’s sign) distinguishes Right-sided
murmurs (Tricuspid) from Left-sided (Mitral).
5. What is the viscerosomatic reflex level for the Kidneys?
A. T5–T9
B. T10–T11
C. T10–L1
D. T12–L2
Explanation: Kidneys are T10–L1. Remember: Upper ureters are T10–L1, Lower
ureters are L1–L2.
6. A 30-year-old male presents with a "painless" chancre on his penis. What is the
causative organism?
A. Haemophilus ducreyi
B. Treponema pallidum
C. Chlamydia trachomatis
D. Herpes Simplex Virus 2
Explanation: Syphilis (Treponema) is painless. Ducreyi (Chancroid) is "painful" (You
"do cry" with Ducreyi).
7. A patient has a positive seated flexion test on the right. Deep sulcus is on the
left. Posterior ILA is on the right. Diagnosis?
A. Right-on-Right Forward Torsion
B. Left-on-Right Backward Torsion
C. Right-on-Left Backward Torsion
D. Left-on-Left Forward Torsion
Explanation: Positive seated flexion = side of the axis (Right). Sulcus/ILA are
opposite = Backward Torsion. Result: Left rotation on Right axis.
,8. Which medication is the first-line treatment for a patient with HTN and
Proteinuria?
A. ACE Inhibitor (Lisinopril)
B. Thiazide Diuretic
C. Calcium Channel Blocker
D. Beta-Blocker
Explanation: ACE inhibitors are renoprotective in diabetics and those with chronic
kidney disease (CKD).
9. A 60-year-old male presents with sudden onset "curtain dropping" over his
right eye that resolved in 10 minutes. This is most likely:
A. Retinal Detachment
B. Amaurosis Fugax (TIA)
C. Glaucoma
D. Temporal Arteritis
Explanation: Transient, painless vision loss is classic for embolic TIA from the
carotid artery.
10. What is the Chapman point for the Appendix?
A. Right 5th ICS
B. Tip of the Right 12th Rib
C. Left 6th ICS
D. Umbilicus
Explanation: Appendix anterior point = Tip of 12th rib. Posterior point = T11
transverse process.
11. A 3-year-old boy presents with a "barking" cough and inspiratory stridor. X-
ray shows subglottic narrowing (Steeple Sign). Diagnosis?
A. Croup (Parainfluenza virus)
B. Epiglottitis
C. Bronchiolitis
D. Pertussis
Explanation: Parainfluenza causes Croup. Epiglottitis (H. influenzae) shows a
"Thumbprint sign."
12. An 80-year-old male with a history of smoking presents with painless
hematuria. Most likely diagnosis?
A. Nephrolithiasis
, B. Cystitis
C. Bladder Cancer (Transitional Cell Carcinoma)
D. Renal Cell Carcinoma
Explanation: Painless hematuria in an elderly smoker is Bladder Cancer until
proven otherwise.
13. In Muscle Energy for an Exhalation rib 4 dysfunction, what is the primary
muscle used?
A. Scalenes
B. Pectoralis Minor
C. Serratus Anterior
D. Latissimus Dorsi
Explanation: Ribs 3–5 use Pectoralis Minor. Ribs 1–2 use Scalenes. Ribs 6–8 use
Serratus Anterior.
14. A patient presents with hypercalcemia, renal stones, and "brown tumors" in
the bone. Labs show high PTH and low Phosphorus. Diagnosis?
A. Primary Hyperparathyroidism
B. Secondary Hyperparathyroidism
C. Hypoparathyroidism
D. Paget's Disease
Explanation: "Stones, bones, abdominal groans, and psychic overtones" with high
PTH = Primary Hyperparathyroidism (usually an adenoma).
15. Which nerve is most likely injured in a patient with "wrist drop"?
A. Median Nerve
B. Radial Nerve
C. Ulnar Nerve
D. Axillary Nerve
Explanation: Radial nerve innervates the extensors. Injury (often via midshaft
humerus fracture) leads to inability to extend the wrist.
16. A patient presents with "Right-Sided Heart Failure" symptoms and a history of
rheumatic fever. Murmur is diastolic at the apex. Diagnosis?
A. Mitral Stenosis
B. Mitral Regurgitation
C. Aortic Stenosis
D. Tricuspid Stenosis
