COMSAE Phase 2 – BSA 118 Practice Exam:
Full Clinical Case Studies, Questions, Verified
Answers, and In-Depth Rationales (2026
Edition)
1. A 68-year-old male with hypertension and stable
angina presents with acute-onset substernal chest
pain. ECG shows ST elevation in leads II, III, and aVF.
Which OMT technique is most appropriate to address
the sympathetic tone contributing to his visceral
pathology?
• A. Suboccipital release
• B. Thoracic paraspinal inhibition (T2–T4)
• C. Sacral rocking
• D. Pedal pump
• Rationale: The sympathetic innervation to the heart
originates from the T1–T5 spinal segments. In an acute
myocardial infarction, there is a hyper-sympathetic state;
inhibition of the paraspinal tissues at these levels helps
normalize autonomic tone and reduce cardiac workload.
2. A 45-year-old female presents with episodic flushing,
diarrhea, and wheezing. A 24-hour urine collection
reveals elevated 5-hydroxyindoleacetic acid (5-HIAA).
What is the primary mediator of this condition?
,• A. Serotonin
• B. Histamine
• C. Acetylcholine
• D. Dopamine
• Rationale: Carcinoid syndrome is caused by the systemic
release of serotonin from neuroendocrine tumors,
typically arising in the GI tract (midgut). 5-HIAA is the
primary metabolite of serotonin excreted in the urine.
3. A 72-year-old male with chronic COPD presents with
worsening dyspnea. ABG: pH 7.28, 65 mmHg, 32
mEq/L. What is the acid-base disturbance?
• A. Partially compensated respiratory acidosis
• B. Fully compensated respiratory acidosis
• C. Acute respiratory acidosis
• D. Metabolic acidosis with respiratory compensation
• Rationale: The pH < 7.35 indicates acidemia. A > 40
mmHg suggests a respiratory cause (COPD). The is
elevated above the normal range (22–26), indicating
that the kidneys are attempting to compensate, but the
pH has not yet returned to normal range (partial
compensation).
4. A 12-year-old boy presents with a 2-day history of
fever, sore throat, and a sandpaper-like rash sparing
the palms and soles. Which of the following is the most
likely pathogen?
,• A. Group A Streptococcus
• B. Staphylococcus aureus
• C. Epstein-Barr virus
• D. Adenovirus
• Rationale: This is Scarlet Fever, caused by the
erythrogenic toxin produced by Streptococcus pyogenes
(Group A Strep). The "sandpaper" texture and
strawberry tongue are classic board exam buzzwords.
5. A 35-year-old female presents with proximal muscle
weakness and a heliotrope rash. Laboratory studies
show elevated creatinine kinase and positive anti-Jo-1
antibodies. What is the most likely diagnosis?
• A. Polymyositis
• B. Dermatomyositis
• C. Inclusion body myositis
• D. Myasthenia gravis
• Rationale: Dermatomyositis presents with inflammatory
muscle disease (proximal weakness) combined with
pathognomonic skin changes like the heliotrope rash
(periorbital) and Gottron papules (knuckles).
6. A 50-year-old male presents with severe epigastric pain
radiating to the back. Serum amylase and lipase are
significantly elevated. Which OMT finding is most
expected at the T5–T9 level?
• A. Tissue texture changes (sympathetic viscerosomatic)
, • B. Vagus nerve somatic dysfunction (parasympathetic)
• C. Sacral base rotation
• D. Hypertonicity of the psoas
• Rationale: The pancreas is part of the upper GI tract,
which receives sympathetic innervation from T5–T9.
Acute pancreatitis triggers a viscerosomatic reflex at
these vertebral levels.
7. A patient with HIV and a CD4 count of 45 cells/µL
presents with progressive dementia. Which of the
following is the most likely diagnosis?
• A. AIDS-dementia complex (HIV-associated
neurocognitive disorder)
• B. Progressive multifocal leukoencephalopathy
• C. Toxoplasmosis
• D. Cryptococcal meningitis
• Rationale: In patients with profound
immunosuppression, direct CNS infection by HIV leading
to cognitive decline (AIDS-dementia complex) is
common. Toxoplasmosis typically presents with focal
neurological deficits, not diffuse dementia.
8. A 2-year-old child presents with a "barking" cough and
inspiratory stridor. What is the most appropriate initial
treatment?
• A. Dexamethasone
• B. Epinephrine
Full Clinical Case Studies, Questions, Verified
Answers, and In-Depth Rationales (2026
Edition)
1. A 68-year-old male with hypertension and stable
angina presents with acute-onset substernal chest
pain. ECG shows ST elevation in leads II, III, and aVF.
Which OMT technique is most appropriate to address
the sympathetic tone contributing to his visceral
pathology?
• A. Suboccipital release
• B. Thoracic paraspinal inhibition (T2–T4)
• C. Sacral rocking
• D. Pedal pump
• Rationale: The sympathetic innervation to the heart
originates from the T1–T5 spinal segments. In an acute
myocardial infarction, there is a hyper-sympathetic state;
inhibition of the paraspinal tissues at these levels helps
normalize autonomic tone and reduce cardiac workload.
2. A 45-year-old female presents with episodic flushing,
diarrhea, and wheezing. A 24-hour urine collection
reveals elevated 5-hydroxyindoleacetic acid (5-HIAA).
What is the primary mediator of this condition?
,• A. Serotonin
• B. Histamine
• C. Acetylcholine
• D. Dopamine
• Rationale: Carcinoid syndrome is caused by the systemic
release of serotonin from neuroendocrine tumors,
typically arising in the GI tract (midgut). 5-HIAA is the
primary metabolite of serotonin excreted in the urine.
3. A 72-year-old male with chronic COPD presents with
worsening dyspnea. ABG: pH 7.28, 65 mmHg, 32
mEq/L. What is the acid-base disturbance?
• A. Partially compensated respiratory acidosis
• B. Fully compensated respiratory acidosis
• C. Acute respiratory acidosis
• D. Metabolic acidosis with respiratory compensation
• Rationale: The pH < 7.35 indicates acidemia. A > 40
mmHg suggests a respiratory cause (COPD). The is
elevated above the normal range (22–26), indicating
that the kidneys are attempting to compensate, but the
pH has not yet returned to normal range (partial
compensation).
4. A 12-year-old boy presents with a 2-day history of
fever, sore throat, and a sandpaper-like rash sparing
the palms and soles. Which of the following is the most
likely pathogen?
,• A. Group A Streptococcus
• B. Staphylococcus aureus
• C. Epstein-Barr virus
• D. Adenovirus
• Rationale: This is Scarlet Fever, caused by the
erythrogenic toxin produced by Streptococcus pyogenes
(Group A Strep). The "sandpaper" texture and
strawberry tongue are classic board exam buzzwords.
5. A 35-year-old female presents with proximal muscle
weakness and a heliotrope rash. Laboratory studies
show elevated creatinine kinase and positive anti-Jo-1
antibodies. What is the most likely diagnosis?
• A. Polymyositis
• B. Dermatomyositis
• C. Inclusion body myositis
• D. Myasthenia gravis
• Rationale: Dermatomyositis presents with inflammatory
muscle disease (proximal weakness) combined with
pathognomonic skin changes like the heliotrope rash
(periorbital) and Gottron papules (knuckles).
6. A 50-year-old male presents with severe epigastric pain
radiating to the back. Serum amylase and lipase are
significantly elevated. Which OMT finding is most
expected at the T5–T9 level?
• A. Tissue texture changes (sympathetic viscerosomatic)
, • B. Vagus nerve somatic dysfunction (parasympathetic)
• C. Sacral base rotation
• D. Hypertonicity of the psoas
• Rationale: The pancreas is part of the upper GI tract,
which receives sympathetic innervation from T5–T9.
Acute pancreatitis triggers a viscerosomatic reflex at
these vertebral levels.
7. A patient with HIV and a CD4 count of 45 cells/µL
presents with progressive dementia. Which of the
following is the most likely diagnosis?
• A. AIDS-dementia complex (HIV-associated
neurocognitive disorder)
• B. Progressive multifocal leukoencephalopathy
• C. Toxoplasmosis
• D. Cryptococcal meningitis
• Rationale: In patients with profound
immunosuppression, direct CNS infection by HIV leading
to cognitive decline (AIDS-dementia complex) is
common. Toxoplasmosis typically presents with focal
neurological deficits, not diffuse dementia.
8. A 2-year-old child presents with a "barking" cough and
inspiratory stridor. What is the most appropriate initial
treatment?
• A. Dexamethasone
• B. Epinephrine
