COMAT-SE (Self-Assessment Examination) V3
COMAT-SE (Self-Assessment Examination) V3
COMAT-SE (Self-Assessment Examination) V3
1. A 45-year-old male presents with mid-back pain. Physical examination reveals that during
inspiration, ribs 3 through 5 on the right move cephalad but fail to move caudad during
exhalation. Which rib should be the primary focus of muscle energy treatment for this
patient?
A. Rib 1
B. Rib 3
C. Rib 5
D. Rib 12
Correct Answer: C
Explanation: In an inhalation dysfunction, the affected ribs are stuck in a position of
inhalation and move easily upward. For a group inhalation rib dysfunction, the key rib is
the bottom rib of the group because it prevents the others from moving down. Muscle
energy for this condition involves using the patient’s exhalation and specific muscle groups
to pull the key rib (Rib 5) inferiorly.
,2. A 62-year-old female with a history of heart failure with reduced ejection fraction presents
for follow-up. She reports a persistent, dry, non-productive cough that began two weeks after
starting lisinopril. Which of the following is the best next step in management?
A. Increase the dose of lisinopril
B. Switch lisinopril to valsartan
C. Add diphenhydramine to her regimen
D. Order a chest X-ray to rule out pneumonia
Correct Answer: B
Explanation: The dry cough associated with ACE inhibitors like lisinopril is caused by the
accumulation of bradykinin in the lungs. Angiotensin II receptor blockers (ARBs), such as
valsartan, do not affect bradykinin metabolism and are the appropriate substitute for
patients who develop this side effect. Clinicians must distinguish this medication side effect
from pulmonary edema or infection to avoid unnecessary testing.
3. A 28-year-old pregnant female at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache and visual changes.
Which of the following is the most appropriate immediate medication to prevent seizures in
this patient?
A. Phenytoin
B. Diazepam
C. Magnesium sulfate
,D. Valproic acid
Correct Answer: C
Explanation: Magnesium sulfate is the gold standard for seizure prophylaxis in patients
with severe preeclampsia or eclampsia. It acts by decreasing acetylcholine release at the
neuromuscular junction and providing neuroprotection. Maintaining therapeutic levels is
critical, and monitoring for signs of magnesium toxicity, such as loss of deep tendon
reflexes, is a common clinical requirement.
4. A 4-year-old boy presents with a high fever for six days, bilateral conjunctival injection, a
‘strawberry tongue,’ and edema of the hands and feet. What is the most serious potential
complication of this condition if left untreated?
A. Rheumatic heart disease
B. Coronary artery aneurysm
C. Glomerulonephritis
D. Splenic rupture
Correct Answer: B
Explanation: Kawasaki disease is a medium-vessel vasculitis that primarily affects
children under five years old. The most feared complication is the development of coronary
artery aneurysms, which can lead to myocardial infarction. Treatment with intravenous
immunoglobulin (IVIG) and high-dose aspirin significantly reduces the risk of these
vascular complications.
, 5. A 32-year-old female complains of persistent sadness, loss of interest in activities, and
sleep disturbance for the past three weeks. She is diagnosed with major depressive disorder
and started on sertraline. Which of the following side effects should she be most immediately
warned about?
A. Weight gain
B. Sexual dysfunction
C. Hypertensive crisis
D. Agranulocytosis
Correct Answer: B
Explanation: Selective serotonin reuptake inhibitors (SSRIs) like sertraline are first-line
treatments for depression but are frequently associated with sexual dysfunction, including
decreased libido and anorgasmia. This side effect is a common reason for patient non-
adherence to therapy. While weight gain is possible over time, sexual side effects often
manifest early in the treatment course.
6. A 19-year-old male presents with right lower quadrant abdominal pain, nausea, and a low-
grade fever. Physical exam reveals pain when the patient’s right hip is passively extended
while he is lying on his left side. Which physical exam sign is being described?
A. Rovsing sign
B. Obturator sign
C. Psoas sign
COMAT-SE (Self-Assessment Examination) V3
COMAT-SE (Self-Assessment Examination) V3
1. A 45-year-old male presents with mid-back pain. Physical examination reveals that during
inspiration, ribs 3 through 5 on the right move cephalad but fail to move caudad during
exhalation. Which rib should be the primary focus of muscle energy treatment for this
patient?
A. Rib 1
B. Rib 3
C. Rib 5
D. Rib 12
Correct Answer: C
Explanation: In an inhalation dysfunction, the affected ribs are stuck in a position of
inhalation and move easily upward. For a group inhalation rib dysfunction, the key rib is
the bottom rib of the group because it prevents the others from moving down. Muscle
energy for this condition involves using the patient’s exhalation and specific muscle groups
to pull the key rib (Rib 5) inferiorly.
,2. A 62-year-old female with a history of heart failure with reduced ejection fraction presents
for follow-up. She reports a persistent, dry, non-productive cough that began two weeks after
starting lisinopril. Which of the following is the best next step in management?
A. Increase the dose of lisinopril
B. Switch lisinopril to valsartan
C. Add diphenhydramine to her regimen
D. Order a chest X-ray to rule out pneumonia
Correct Answer: B
Explanation: The dry cough associated with ACE inhibitors like lisinopril is caused by the
accumulation of bradykinin in the lungs. Angiotensin II receptor blockers (ARBs), such as
valsartan, do not affect bradykinin metabolism and are the appropriate substitute for
patients who develop this side effect. Clinicians must distinguish this medication side effect
from pulmonary edema or infection to avoid unnecessary testing.
3. A 28-year-old pregnant female at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache and visual changes.
Which of the following is the most appropriate immediate medication to prevent seizures in
this patient?
A. Phenytoin
B. Diazepam
C. Magnesium sulfate
,D. Valproic acid
Correct Answer: C
Explanation: Magnesium sulfate is the gold standard for seizure prophylaxis in patients
with severe preeclampsia or eclampsia. It acts by decreasing acetylcholine release at the
neuromuscular junction and providing neuroprotection. Maintaining therapeutic levels is
critical, and monitoring for signs of magnesium toxicity, such as loss of deep tendon
reflexes, is a common clinical requirement.
4. A 4-year-old boy presents with a high fever for six days, bilateral conjunctival injection, a
‘strawberry tongue,’ and edema of the hands and feet. What is the most serious potential
complication of this condition if left untreated?
A. Rheumatic heart disease
B. Coronary artery aneurysm
C. Glomerulonephritis
D. Splenic rupture
Correct Answer: B
Explanation: Kawasaki disease is a medium-vessel vasculitis that primarily affects
children under five years old. The most feared complication is the development of coronary
artery aneurysms, which can lead to myocardial infarction. Treatment with intravenous
immunoglobulin (IVIG) and high-dose aspirin significantly reduces the risk of these
vascular complications.
, 5. A 32-year-old female complains of persistent sadness, loss of interest in activities, and
sleep disturbance for the past three weeks. She is diagnosed with major depressive disorder
and started on sertraline. Which of the following side effects should she be most immediately
warned about?
A. Weight gain
B. Sexual dysfunction
C. Hypertensive crisis
D. Agranulocytosis
Correct Answer: B
Explanation: Selective serotonin reuptake inhibitors (SSRIs) like sertraline are first-line
treatments for depression but are frequently associated with sexual dysfunction, including
decreased libido and anorgasmia. This side effect is a common reason for patient non-
adherence to therapy. While weight gain is possible over time, sexual side effects often
manifest early in the treatment course.
6. A 19-year-old male presents with right lower quadrant abdominal pain, nausea, and a low-
grade fever. Physical exam reveals pain when the patient’s right hip is passively extended
while he is lying on his left side. Which physical exam sign is being described?
A. Rovsing sign
B. Obturator sign
C. Psoas sign
