COMSAE Phase 1 Form 113 Test Bank | 100+ Direct Content
Questions with Answers & Detailed Rationales – NBOME
Osteopathic Medical Knowledge Self-Assessment – Fact-
Based Review |pdf
Question 1
A patient develops hyperpigmentation of the skin, hypotension, hyponatremia, and
hyperkalemia due to primary adrenal insufficiency. The underlying mechanism involves
destruction of the adrenal cortex leading to decreased cortisol production.
Which of the following hormonal changes is most responsible for the hyperpigmentation
seen in this condition?
A. Increased aldosterone secretion
B. Increased ACTH production
C. Decreased renin activity
D. Increased cortisol levels
Answer: B
Rationale: In Addison disease, low cortisol removes negative feedback on the pituitary,
leading to increased ACTH. ACTH shares a precursor (POMC) with melanocyte-stimulating
hormone (MSH), causing hyperpigmentation.
Question 2
A patient presents with weight loss, heat intolerance, tachycardia, and a fine tremor.
Laboratory studies show decreased TSH and elevated free T4 levels.
Which of the following mechanisms best explains these findings?
A. Autoimmune destruction of thyroid tissue
B. Antibody-mediated stimulation of TSH receptors
C. Decreased iodine uptake by the thyroid
D. Pituitary failure leading to decreased TSH
Answer: B
, Rationale: Graves disease is caused by thyroid-stimulating immunoglobulins that activate
TSH receptors, leading to excess thyroid hormone production.
Question 3
A patient with type 1 diabetes mellitus presents with hyperglycemia, metabolic acidosis,
and ketone production.
Which of the following processes is primarily responsible for ketone body formation in this
condition?
A. Increased glycogen synthesis
B. Increased lipolysis and fatty acid oxidation
C. Decreased gluconeogenesis
D. Increased insulin secretion
Answer: B
Rationale: In DKA, insulin deficiency leads to increased lipolysis. Free fatty acids are
converted in the liver to ketone bodies, causing metabolic acidosis.
Question 4
A patient presents with hypertension, hypokalemia, and metabolic alkalosis due to
excess aldosterone production.
Which of the following best describes the action of aldosterone in the kidney?
A. Decreases sodium reabsorption in the distal tubule
B. Increases potassium reabsorption in the collecting duct
C. Increases sodium reabsorption and potassium excretion
D. Decreases hydrogen ion secretion
Answer: C
Rationale: Aldosterone acts on the distal nephron to increase sodium reabsorption and
potassium/hydrogen excretion, leading to hypokalemia and metabolic alkalosis.
Question 5
A patient presents with fatigue, weight gain, cold intolerance, and bradycardia.
Laboratory studies reveal elevated TSH and decreased T4.
Questions with Answers & Detailed Rationales – NBOME
Osteopathic Medical Knowledge Self-Assessment – Fact-
Based Review |pdf
Question 1
A patient develops hyperpigmentation of the skin, hypotension, hyponatremia, and
hyperkalemia due to primary adrenal insufficiency. The underlying mechanism involves
destruction of the adrenal cortex leading to decreased cortisol production.
Which of the following hormonal changes is most responsible for the hyperpigmentation
seen in this condition?
A. Increased aldosterone secretion
B. Increased ACTH production
C. Decreased renin activity
D. Increased cortisol levels
Answer: B
Rationale: In Addison disease, low cortisol removes negative feedback on the pituitary,
leading to increased ACTH. ACTH shares a precursor (POMC) with melanocyte-stimulating
hormone (MSH), causing hyperpigmentation.
Question 2
A patient presents with weight loss, heat intolerance, tachycardia, and a fine tremor.
Laboratory studies show decreased TSH and elevated free T4 levels.
Which of the following mechanisms best explains these findings?
A. Autoimmune destruction of thyroid tissue
B. Antibody-mediated stimulation of TSH receptors
C. Decreased iodine uptake by the thyroid
D. Pituitary failure leading to decreased TSH
Answer: B
, Rationale: Graves disease is caused by thyroid-stimulating immunoglobulins that activate
TSH receptors, leading to excess thyroid hormone production.
Question 3
A patient with type 1 diabetes mellitus presents with hyperglycemia, metabolic acidosis,
and ketone production.
Which of the following processes is primarily responsible for ketone body formation in this
condition?
A. Increased glycogen synthesis
B. Increased lipolysis and fatty acid oxidation
C. Decreased gluconeogenesis
D. Increased insulin secretion
Answer: B
Rationale: In DKA, insulin deficiency leads to increased lipolysis. Free fatty acids are
converted in the liver to ketone bodies, causing metabolic acidosis.
Question 4
A patient presents with hypertension, hypokalemia, and metabolic alkalosis due to
excess aldosterone production.
Which of the following best describes the action of aldosterone in the kidney?
A. Decreases sodium reabsorption in the distal tubule
B. Increases potassium reabsorption in the collecting duct
C. Increases sodium reabsorption and potassium excretion
D. Decreases hydrogen ion secretion
Answer: C
Rationale: Aldosterone acts on the distal nephron to increase sodium reabsorption and
potassium/hydrogen excretion, leading to hypokalemia and metabolic alkalosis.
Question 5
A patient presents with fatigue, weight gain, cold intolerance, and bradycardia.
Laboratory studies reveal elevated TSH and decreased T4.
