COMSAE PHASE 2 LEVEL 2 BSA 117 FINAL EXAM WITH
200 QUESTIONS AND ANSWERS WITH RATIONALES
Question 1: A 48-year-old female presents with fatigue, weight gain, and cold
intolerance. Laboratory results show elevated TSH and low free T4. What is the
diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
CORRECT ANSWER: B. Primary hypothyroidism
Rationale: Elevated TSH with low free T4 indicates thyroid gland failure, consistent
with primary hypothyroidism most commonly due to Hashimoto thyroiditis.
Question 2: During an osteopathic exam, a physician notes a right posterior
innominate rotation. Which muscle energy technique is appropriate?
A. Hip flexion against resistance
B. Hip extension against resistance
C. Sacral rocking only
D. Lumbar sidebending
CORRECT ANSWER: B. Hip extension against resistance
Rationale: Posterior innominate rotation is treated by engaging the anterior
restrictive barrier with hip extension and isometric contraction to reposition the
innominate.
Question 3: Which medication is the first-line agent for a patient with stable angina?
A. Nitroglycerin as needed and beta blocker
B. Calcium channel blocker monotherapy
C. ACE inhibitor
D. Digoxin
CORRECT ANSWER: A. Nitroglycerin as needed and beta blocker
Rationale: Beta blockers reduce myocardial oxygen demand while sublingual
nitroglycerin provides acute relief of anginal symptoms.
Page 1 of 56
,Question 4: A patient with right upper quadrant pain worsened by fatty meals has a
positive sonographic Murphy sign. This is consistent with?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Appendicitis
CORRECT ANSWER: A. Acute cholecystitis
Rationale: Sonographic Murphy sign has high positive predictive value for
gallbladder inflammation when combined with clinical symptoms.
Question 5: In cranial osteopathy, the technique involving gentle lifting at suture lines
to promote drainage is known as?
A. V-spread
B. CV4 compression
C. Temporal rocking
D. Vault hold for torsion
CORRECT ANSWER: A. V-spread
Rationale: The V-spread technique is specifically used to encourage venous and
lymphatic drainage through cranial sutures.
Question 6: A 35-year-old male with migratory polyarthritis, fever, and a new heart
murmur following streptococcal pharyngitis has?
A. Acute rheumatic fever
B. Infective endocarditis
C. Rheumatoid arthritis
D. Lyme disease
CORRECT ANSWER: A. Acute rheumatic fever
Rationale: Jones criteria are met with carditis, arthritis, and evidence of preceding
group A streptococcal infection.
Question 7: Viscerosomatic reflexes from the duodenum refer to which spinal levels?
A. T5-T9
B. T9-T11
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,C. T10-T12
D. L1-L2
CORRECT ANSWER: B. T9-T11
Rationale: Sympathetic innervation from the duodenum leads to tissue texture
abnormalities in the mid-thoracic paraspinal region.
Question 8: The initial diagnostic test for suspected primary aldosteronism is?
A. Plasma aldosterone to renin ratio
B. Serum cortisol
C. 24-hour urinary free cortisol
D. Serum potassium only
CORRECT ANSWER: A. Plasma aldosterone to renin ratio
Rationale: An elevated aldosterone-renin ratio screens for autonomous aldosterone
production in hypertensive patients with hypokalemia.
Question 9: Which osteopathic technique is beneficial for a patient with postoperative
atelectasis?
A. Thoracic lymphatic pump and rib raising
B. Cranial base compression
C. Pelvic counterstrain
D. Lumbar HVLA
CORRECT ANSWER: A. Thoracic lymphatic pump and rib raising
Rationale: These techniques improve ventilation, mobilize secretions, and enhance
lymphatic drainage in the lungs.
Question 10: The most common bacterial cause of meningitis in adolescents and
young adults is?
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Listeria monocytogenes
D. Haemophilus influenzae
Page 3 of 56
, CORRECT ANSWER: A. Neisseria meningitidis
Rationale: Meningococcal meningitis peaks in adolescents and young adults, often
in outbreaks in close quarters.
Question 11: A positive crossed straight leg raise test is highly suggestive of?
A. Large central disc herniation with nerve root compression
B. Mild lumbar strain
C. Sacroiliac dysfunction
D. Hip arthritis
CORRECT ANSWER: A. Large central disc herniation with nerve root
compression
Rationale: Contralateral pain reproduction indicates significant thecal sac or root
impingement.
Question 12: The mechanism of action of hydrochlorothiazide is?
A. Inhibition of sodium reabsorption in the distal convoluted tubule
B. Aldosterone antagonism
C. Carbonic anhydrase inhibition
D. Loop diuretic action
CORRECT ANSWER: A. Inhibition of sodium reabsorption in the distal
convoluted tubule
Rationale: Thiazides block the Na-Cl cotransporter in the distal tubule, leading to
natriuresis and diuresis.
Question 13: For a posterior lumbar tenderpoint at L4, counterstrain positioning
involves?
A. Extension and rotation away from the tenderpoint
B. Flexion with sidebending toward
C. Neutral posture
D. Full traction
CORRECT ANSWER: A. Extension and rotation away from the tenderpoint
Rationale: Posterior tenderpoints are treated by shortening the hypertonic
musculature through extension and contralateral rotation.
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200 QUESTIONS AND ANSWERS WITH RATIONALES
Question 1: A 48-year-old female presents with fatigue, weight gain, and cold
intolerance. Laboratory results show elevated TSH and low free T4. What is the
diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
CORRECT ANSWER: B. Primary hypothyroidism
Rationale: Elevated TSH with low free T4 indicates thyroid gland failure, consistent
with primary hypothyroidism most commonly due to Hashimoto thyroiditis.
Question 2: During an osteopathic exam, a physician notes a right posterior
innominate rotation. Which muscle energy technique is appropriate?
A. Hip flexion against resistance
B. Hip extension against resistance
C. Sacral rocking only
D. Lumbar sidebending
CORRECT ANSWER: B. Hip extension against resistance
Rationale: Posterior innominate rotation is treated by engaging the anterior
restrictive barrier with hip extension and isometric contraction to reposition the
innominate.
Question 3: Which medication is the first-line agent for a patient with stable angina?
A. Nitroglycerin as needed and beta blocker
B. Calcium channel blocker monotherapy
C. ACE inhibitor
D. Digoxin
CORRECT ANSWER: A. Nitroglycerin as needed and beta blocker
Rationale: Beta blockers reduce myocardial oxygen demand while sublingual
nitroglycerin provides acute relief of anginal symptoms.
Page 1 of 56
,Question 4: A patient with right upper quadrant pain worsened by fatty meals has a
positive sonographic Murphy sign. This is consistent with?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Appendicitis
CORRECT ANSWER: A. Acute cholecystitis
Rationale: Sonographic Murphy sign has high positive predictive value for
gallbladder inflammation when combined with clinical symptoms.
Question 5: In cranial osteopathy, the technique involving gentle lifting at suture lines
to promote drainage is known as?
A. V-spread
B. CV4 compression
C. Temporal rocking
D. Vault hold for torsion
CORRECT ANSWER: A. V-spread
Rationale: The V-spread technique is specifically used to encourage venous and
lymphatic drainage through cranial sutures.
Question 6: A 35-year-old male with migratory polyarthritis, fever, and a new heart
murmur following streptococcal pharyngitis has?
A. Acute rheumatic fever
B. Infective endocarditis
C. Rheumatoid arthritis
D. Lyme disease
CORRECT ANSWER: A. Acute rheumatic fever
Rationale: Jones criteria are met with carditis, arthritis, and evidence of preceding
group A streptococcal infection.
Question 7: Viscerosomatic reflexes from the duodenum refer to which spinal levels?
A. T5-T9
B. T9-T11
Page 2 of 56
,C. T10-T12
D. L1-L2
CORRECT ANSWER: B. T9-T11
Rationale: Sympathetic innervation from the duodenum leads to tissue texture
abnormalities in the mid-thoracic paraspinal region.
Question 8: The initial diagnostic test for suspected primary aldosteronism is?
A. Plasma aldosterone to renin ratio
B. Serum cortisol
C. 24-hour urinary free cortisol
D. Serum potassium only
CORRECT ANSWER: A. Plasma aldosterone to renin ratio
Rationale: An elevated aldosterone-renin ratio screens for autonomous aldosterone
production in hypertensive patients with hypokalemia.
Question 9: Which osteopathic technique is beneficial for a patient with postoperative
atelectasis?
A. Thoracic lymphatic pump and rib raising
B. Cranial base compression
C. Pelvic counterstrain
D. Lumbar HVLA
CORRECT ANSWER: A. Thoracic lymphatic pump and rib raising
Rationale: These techniques improve ventilation, mobilize secretions, and enhance
lymphatic drainage in the lungs.
Question 10: The most common bacterial cause of meningitis in adolescents and
young adults is?
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Listeria monocytogenes
D. Haemophilus influenzae
Page 3 of 56
, CORRECT ANSWER: A. Neisseria meningitidis
Rationale: Meningococcal meningitis peaks in adolescents and young adults, often
in outbreaks in close quarters.
Question 11: A positive crossed straight leg raise test is highly suggestive of?
A. Large central disc herniation with nerve root compression
B. Mild lumbar strain
C. Sacroiliac dysfunction
D. Hip arthritis
CORRECT ANSWER: A. Large central disc herniation with nerve root
compression
Rationale: Contralateral pain reproduction indicates significant thecal sac or root
impingement.
Question 12: The mechanism of action of hydrochlorothiazide is?
A. Inhibition of sodium reabsorption in the distal convoluted tubule
B. Aldosterone antagonism
C. Carbonic anhydrase inhibition
D. Loop diuretic action
CORRECT ANSWER: A. Inhibition of sodium reabsorption in the distal
convoluted tubule
Rationale: Thiazides block the Na-Cl cotransporter in the distal tubule, leading to
natriuresis and diuresis.
Question 13: For a posterior lumbar tenderpoint at L4, counterstrain positioning
involves?
A. Extension and rotation away from the tenderpoint
B. Flexion with sidebending toward
C. Neutral posture
D. Full traction
CORRECT ANSWER: A. Extension and rotation away from the tenderpoint
Rationale: Posterior tenderpoints are treated by shortening the hypertonic
musculature through extension and contralateral rotation.
Page 4 of 56
