COMPREHENSIVE OSTEOPATHIC MEDICAL
LICENSING EXAM PRACTICE QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALE 2026 Q&A| INSTANT DOWNLOAD PDF
1. A 62-year-old man presents with crushing substernal chest
pain radiating to the left arm. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Rationale: Inferior wall myocardial infarctions are associated
with ST-segment elevations in leads II, III, and aVF. The right
coronary artery supplies the inferior wall in most individuals.
Occlusion results in ischemia of the inferior myocardium and
may also affect the AV node.
2. A patient develops hyperkalemia after starting an
antihypertensive medication. Which drug is the most likely
cause?
A. Hydrochlorothiazide
B. Furosemide
C. Chlorthalidone
D. Spironolactone
Rationale: Spironolactone is a potassium-sparing diuretic that
antagonizes aldosterone receptors. This reduces potassium
,excretion in the distal nephron, increasing the risk of
hyperkalemia, especially in patients with renal impairment.
3. Which cranial nerve is responsible for innervating the
lateral rectus muscle?
A. Oculomotor nerve (CN III)
B. Trochlear nerve (CN IV)
C. Trigeminal nerve (CN V)
D. Abducens nerve (CN VI)
Rationale: The abducens nerve innervates the lateral rectus
muscle, which abducts the eye. Damage to CN VI results in
impaired lateral gaze and horizontal diplopia.
4. A 5-year-old child presents with barking cough, inspiratory
stridor, and hoarseness. What is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Asthma
D. Croup
Rationale: Croup is characterized by a barking cough,
inspiratory stridor, and hoarseness. It is most commonly caused
by parainfluenza virus and results from inflammation of the
upper airway.
5. Which acid-base disturbance is expected in a patient with
prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
,C. Metabolic alkalosis
D. Respiratory alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid,
leading to increased serum bicarbonate concentration and
metabolic alkalosis. Volume depletion often perpetuates the
disorder.
6. A patient with diabetes mellitus develops nephropathy.
Which glomerular change is most characteristic?
A. Crescent formation
B. Wire-loop lesions
C. Nodular glomerulosclerosis
D. Segmental sclerosis only
Rationale: Diabetic nephropathy is characterized by
Kimmelstiel-Wilson nodules, a form of nodular
glomerulosclerosis resulting from chronic hyperglycemia and
advanced glycation end products.
7. Which organism is the most common cause of community-
acquired pneumonia in adults?
A. Mycoplasma pneumoniae
B. Haemophilus influenzae
C. Klebsiella pneumoniae
D. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most
common cause of community-acquired pneumonia in adults. It
typically presents with fever, productive cough, and lobar
consolidation.
, 8. A patient develops sudden unilateral facial paralysis
involving the forehead. What is the most likely diagnosis?
A. Stroke
B. Trigeminal neuralgia
C. Multiple sclerosis
D. Bell palsy
Rationale: Bell palsy is a lower motor neuron lesion of the facial
nerve causing complete ipsilateral facial weakness, including
the forehead. Forehead involvement distinguishes it from most
cortical strokes.
9. Which vitamin deficiency causes megaloblastic anemia and
neurologic deficits?
A. Vitamin C
B. Folate
C. Vitamin B6
D. Vitamin B12
Rationale: Vitamin B12 deficiency causes megaloblastic anemia
and neurologic manifestations such as paresthesias and
subacute combined degeneration due to impaired myelin
synthesis.
10. A patient with atrial fibrillation is at increased risk for
which complication?
A. Pulmonary fibrosis
B. Ventricular septal defect
C. Embolic stroke
D. Aortic dissection
LICENSING EXAM PRACTICE QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALE 2026 Q&A| INSTANT DOWNLOAD PDF
1. A 62-year-old man presents with crushing substernal chest
pain radiating to the left arm. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Rationale: Inferior wall myocardial infarctions are associated
with ST-segment elevations in leads II, III, and aVF. The right
coronary artery supplies the inferior wall in most individuals.
Occlusion results in ischemia of the inferior myocardium and
may also affect the AV node.
2. A patient develops hyperkalemia after starting an
antihypertensive medication. Which drug is the most likely
cause?
A. Hydrochlorothiazide
B. Furosemide
C. Chlorthalidone
D. Spironolactone
Rationale: Spironolactone is a potassium-sparing diuretic that
antagonizes aldosterone receptors. This reduces potassium
,excretion in the distal nephron, increasing the risk of
hyperkalemia, especially in patients with renal impairment.
3. Which cranial nerve is responsible for innervating the
lateral rectus muscle?
A. Oculomotor nerve (CN III)
B. Trochlear nerve (CN IV)
C. Trigeminal nerve (CN V)
D. Abducens nerve (CN VI)
Rationale: The abducens nerve innervates the lateral rectus
muscle, which abducts the eye. Damage to CN VI results in
impaired lateral gaze and horizontal diplopia.
4. A 5-year-old child presents with barking cough, inspiratory
stridor, and hoarseness. What is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Asthma
D. Croup
Rationale: Croup is characterized by a barking cough,
inspiratory stridor, and hoarseness. It is most commonly caused
by parainfluenza virus and results from inflammation of the
upper airway.
5. Which acid-base disturbance is expected in a patient with
prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
,C. Metabolic alkalosis
D. Respiratory alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid,
leading to increased serum bicarbonate concentration and
metabolic alkalosis. Volume depletion often perpetuates the
disorder.
6. A patient with diabetes mellitus develops nephropathy.
Which glomerular change is most characteristic?
A. Crescent formation
B. Wire-loop lesions
C. Nodular glomerulosclerosis
D. Segmental sclerosis only
Rationale: Diabetic nephropathy is characterized by
Kimmelstiel-Wilson nodules, a form of nodular
glomerulosclerosis resulting from chronic hyperglycemia and
advanced glycation end products.
7. Which organism is the most common cause of community-
acquired pneumonia in adults?
A. Mycoplasma pneumoniae
B. Haemophilus influenzae
C. Klebsiella pneumoniae
D. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most
common cause of community-acquired pneumonia in adults. It
typically presents with fever, productive cough, and lobar
consolidation.
, 8. A patient develops sudden unilateral facial paralysis
involving the forehead. What is the most likely diagnosis?
A. Stroke
B. Trigeminal neuralgia
C. Multiple sclerosis
D. Bell palsy
Rationale: Bell palsy is a lower motor neuron lesion of the facial
nerve causing complete ipsilateral facial weakness, including
the forehead. Forehead involvement distinguishes it from most
cortical strokes.
9. Which vitamin deficiency causes megaloblastic anemia and
neurologic deficits?
A. Vitamin C
B. Folate
C. Vitamin B6
D. Vitamin B12
Rationale: Vitamin B12 deficiency causes megaloblastic anemia
and neurologic manifestations such as paresthesias and
subacute combined degeneration due to impaired myelin
synthesis.
10. A patient with atrial fibrillation is at increased risk for
which complication?
A. Pulmonary fibrosis
B. Ventricular septal defect
C. Embolic stroke
D. Aortic dissection
