COMAT Family Medicine Exam V2 | COMAT Family
Medicine | Q&A with Rationale (COMAT Family
Medicine Exam) | National Board of Osteopathic
Medical Examiners (NBOME)
1. A 55-year-old male with a history of obesity presents for a routine check-up. His blood
pressure today is 152/94 mmHg, and his blood pressure two weeks ago was 148/92 mmHg.
He has no other medical conditions. Which of the following is the most appropriate initial
management step?
A. Initiate lifestyle modifications and start a thiazide diuretic
B. Initiate lifestyle modifications only and recheck in 3 months
C. Start lisinopril and tell the patient to return if symptoms develop
D. Refer the patient to a cardiologist for an echocardiogram
Correct Answer: A
Explanation: According to the ACC/AHA guidelines, this patient has Stage 2 hypertension
(BP ≥ 140/90 mmHg). For Stage 2 hypertension, the standard of care is to initiate both
lifestyle modifications and a blood pressure-lowering medication immediately. A common
pitfall is attempting lifestyle changes alone for Stage 2 patients, which delays necessary
pharmacological intervention and increases cardiovascular risk.
,2. A 28-year-old G1P0 at 26 weeks gestation presents for a routine prenatal visit. She has no
significant past medical history. Which of the following screening tests should be performed
at this visit?
A. Group B Streptococcus (GBS) rectovaginal culture
B. One-hour 50-g glucose challenge test
C. Maternal serum alpha-fetoprotein (MSAFP)
D. Amniocentesis for chromosomal analysis
Correct Answer: B
Explanation: Screening for gestational diabetes mellitus (GDM) typically occurs between
24 and 28 weeks of gestation using a glucose challenge test. Group B Strep screening is
performed later, usually at 36-37 weeks, and MSAFP is a second-trimester screen done
between 15-20 weeks. Ensuring timely GDM screening is critical to prevent macrosomia
and other neonatal complications.
3. A 62-year-old female presents with a 3-month history of worsening right knee pain that is
most severe in the evening. She has morning stiffness lasting 15 minutes. Physical exam
shows bony enlargement of the PIP and DIP joints and crepitus in the right knee. Which of the
following is the first-line treatment?
A. Oral methotrexate
B. Intra-articular corticosteroid injection
C. Oral acetaminophen or NSAIDs plus exercise
,D. Total knee arthroplasty
Correct Answer: C
Explanation: The clinical presentation of evening pain, short-duration morning stiffness,
and Heberden/Bouchard nodes is classic for osteoarthritis. Management begins with
conservative measures such as weight loss, physical therapy/exercise, and simple
analgesics like NSAIDs or acetaminophen. Methotrexate is reserved for inflammatory
conditions like rheumatoid arthritis, not osteoarthritis.
4. A 45-year-old male presents with acute onset of low back pain after lifting a heavy box.
Physical examination reveals a tender point in the right iliac fossa, deep to the ASIS. Which
osteopathic counterstrain position is most appropriate for this patient?
A. Hip flexion with sidebending and rotation toward
B. Hip extension with sidebending and rotation toward
C. Hip flexion with sidebending and rotation away
D. Prone position with hip extension
Correct Answer: A
Explanation: The tender point described is the Iliopsoas tender point, located 1/3 of the
distance from the ASIS to the midline. The correct counterstrain position for an Iliopsoas
tender point is bilateral hip flexion (often with the knees crossed) and sidebending toward
the affected side. Clinicians must remember that most anterior tender points are treated
with flexion, while posterior points are treated with extension.
, 5. A 12-year-old boy is brought to the clinic for an asthma follow-up. He uses his albuterol
inhaler 3 days a week and experiences nighttime awakenings due to cough 3 times per
month. His FEV1 is 85% predicted. What is the most appropriate classification of his asthma?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Correct Answer: A
Explanation: This patient meets criteria for Mild Persistent asthma because his symptoms
occur more than 2 days per week but not daily, and nighttime awakenings occur 3-4 times
per month. FEV1 in mild persistent asthma is typically >80% predicted. A key clinical point
is that once a patient moves beyond ‘Intermittent’ status, a daily controller medication like
a low-dose inhaled corticosteroid (ICS) should be initiated.
6. A 65-year-old male smoker with a 40 pack-year history presents for a check-up. He stopped
smoking 5 years ago. According to current USPSTF guidelines, what is the most appropriate
screening for lung cancer?
A. Annual chest X-ray
B. Single low-dose computed tomography (LDCT)
C. Annual low-dose computed tomography (LDCT)
D. Sputum cytology every 6 months
Medicine | Q&A with Rationale (COMAT Family
Medicine Exam) | National Board of Osteopathic
Medical Examiners (NBOME)
1. A 55-year-old male with a history of obesity presents for a routine check-up. His blood
pressure today is 152/94 mmHg, and his blood pressure two weeks ago was 148/92 mmHg.
He has no other medical conditions. Which of the following is the most appropriate initial
management step?
A. Initiate lifestyle modifications and start a thiazide diuretic
B. Initiate lifestyle modifications only and recheck in 3 months
C. Start lisinopril and tell the patient to return if symptoms develop
D. Refer the patient to a cardiologist for an echocardiogram
Correct Answer: A
Explanation: According to the ACC/AHA guidelines, this patient has Stage 2 hypertension
(BP ≥ 140/90 mmHg). For Stage 2 hypertension, the standard of care is to initiate both
lifestyle modifications and a blood pressure-lowering medication immediately. A common
pitfall is attempting lifestyle changes alone for Stage 2 patients, which delays necessary
pharmacological intervention and increases cardiovascular risk.
,2. A 28-year-old G1P0 at 26 weeks gestation presents for a routine prenatal visit. She has no
significant past medical history. Which of the following screening tests should be performed
at this visit?
A. Group B Streptococcus (GBS) rectovaginal culture
B. One-hour 50-g glucose challenge test
C. Maternal serum alpha-fetoprotein (MSAFP)
D. Amniocentesis for chromosomal analysis
Correct Answer: B
Explanation: Screening for gestational diabetes mellitus (GDM) typically occurs between
24 and 28 weeks of gestation using a glucose challenge test. Group B Strep screening is
performed later, usually at 36-37 weeks, and MSAFP is a second-trimester screen done
between 15-20 weeks. Ensuring timely GDM screening is critical to prevent macrosomia
and other neonatal complications.
3. A 62-year-old female presents with a 3-month history of worsening right knee pain that is
most severe in the evening. She has morning stiffness lasting 15 minutes. Physical exam
shows bony enlargement of the PIP and DIP joints and crepitus in the right knee. Which of the
following is the first-line treatment?
A. Oral methotrexate
B. Intra-articular corticosteroid injection
C. Oral acetaminophen or NSAIDs plus exercise
,D. Total knee arthroplasty
Correct Answer: C
Explanation: The clinical presentation of evening pain, short-duration morning stiffness,
and Heberden/Bouchard nodes is classic for osteoarthritis. Management begins with
conservative measures such as weight loss, physical therapy/exercise, and simple
analgesics like NSAIDs or acetaminophen. Methotrexate is reserved for inflammatory
conditions like rheumatoid arthritis, not osteoarthritis.
4. A 45-year-old male presents with acute onset of low back pain after lifting a heavy box.
Physical examination reveals a tender point in the right iliac fossa, deep to the ASIS. Which
osteopathic counterstrain position is most appropriate for this patient?
A. Hip flexion with sidebending and rotation toward
B. Hip extension with sidebending and rotation toward
C. Hip flexion with sidebending and rotation away
D. Prone position with hip extension
Correct Answer: A
Explanation: The tender point described is the Iliopsoas tender point, located 1/3 of the
distance from the ASIS to the midline. The correct counterstrain position for an Iliopsoas
tender point is bilateral hip flexion (often with the knees crossed) and sidebending toward
the affected side. Clinicians must remember that most anterior tender points are treated
with flexion, while posterior points are treated with extension.
, 5. A 12-year-old boy is brought to the clinic for an asthma follow-up. He uses his albuterol
inhaler 3 days a week and experiences nighttime awakenings due to cough 3 times per
month. His FEV1 is 85% predicted. What is the most appropriate classification of his asthma?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Correct Answer: A
Explanation: This patient meets criteria for Mild Persistent asthma because his symptoms
occur more than 2 days per week but not daily, and nighttime awakenings occur 3-4 times
per month. FEV1 in mild persistent asthma is typically >80% predicted. A key clinical point
is that once a patient moves beyond ‘Intermittent’ status, a daily controller medication like
a low-dose inhaled corticosteroid (ICS) should be initiated.
6. A 65-year-old male smoker with a 40 pack-year history presents for a check-up. He stopped
smoking 5 years ago. According to current USPSTF guidelines, what is the most appropriate
screening for lung cancer?
A. Annual chest X-ray
B. Single low-dose computed tomography (LDCT)
C. Annual low-dose computed tomography (LDCT)
D. Sputum cytology every 6 months
