COMAT-SE (Self-Assessment Examination) V2
COMAT-SE (Self-Assessment Examination) V2
COMAT-SE (Self-Assessment Examination) V2
1. A 65-year-old male presents with a sudden onset of severe chest pain that radiates to his
back between the shoulder blades. His blood pressure is 180/100 mmHg in the right arm and
150/90 mmHg in the left arm. Physical examination reveals a new early diastolic murmur at
the right sternal border. Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Tension pneumothorax
C. Pulmonary embolism
D. Aortic dissection
Correct Answer: D
Explanation: Aortic dissection typically presents with sudden, tearing chest pain radiating
to the back and a blood pressure discrepancy between arms. The new diastolic murmur
suggests aortic regurgitation, a common complication when the dissection involves the
aortic root. Prompt recognition is critical as this is a surgical emergency.
,2. A 24-year-old female presents for evaluation of a ‘racing heart.’ She notes palpitations,
weight loss despite increased appetite, and heat intolerance over the last two months. On
physical examination, her thyroid is diffusely enlarged and non-tender, and she has a fine
tremor of her outstretched hands. Which of the following findings is most specific for Graves’
disease?
A. Exophthalmos
B. Tachycardia
C. Pretibial myxedema
D. Diffuse goiter
Correct Answer: C
Explanation: While both exophthalmos and pretibial myxedema are specific for Graves’
disease, pretibial myxedema (dermopathy) is a hallmark finding of autoimmune thyroiditis.
Tachycardia and goiter are common in many forms of hyperthyroidism and are not specific.
Clinical management involves antithyroid medications or radioactive iodine.
3. A 45-year-old male presents with a complaint of chronic epigastric pain that is relieved by
eating. He has a history of smoking and heavy alcohol use. A breath test is positive for Urea.
Osteopathic physical examination reveals tissue texture changes at the level of T5-T9 on the
left. Which of the following is the most appropriate initial treatment for this patient?
A. Surgical resection of the antrum
B. High-dose H2 blockers
,C. Liquor and tobacco cessation only
D. Clarithromycin, amoxicillin, and omeprazole
Correct Answer: D
Explanation: The positive urea breath test confirms Helicobacter pylori infection, which is
the most common cause of duodenal ulcers (pain relieved by food). Triple therapy
consisting of two antibiotics and a proton pump inhibitor is the standard of care. The T5-T9
viscerosomatic reflex corresponds to the upper gastrointestinal tract, including the
stomach and duodenum.
4. A 32-year-old pregnant woman at 34 weeks gestation presents with sudden onset of
vaginal bleeding and severe abdominal pain. Her uterus is firm and tender to palpation. Fetal
heart monitoring shows late decelerations. What is the most likely diagnosis?
A. Placenta previa
B. Uterine rupture
C. Vasa previa
D. Placental abruption
Correct Answer: D
Explanation: Placental abruption presents with painful vaginal bleeding and a firm, tender
uterus, often leading to fetal distress. This contrasts with placenta previa, which is
characteristically painless. Immediate stabilization and evaluation for delivery are
necessary to prevent maternal and fetal morbidity.
, 5. A 55-year-old female presents with pain in her right hand, specifically at the base of the
thumb. She notes the pain is worse with activity and improved with rest. Physical exam
shows squared appearance of the joint and a positive grind test. Which joint is most likely
affected?
A. Metacarpophalangeal joint
B. First carpometacarpal joint
C. Distal interphalangeal joint
D. Proximal interphalangeal joint
Correct Answer: B
Explanation: Osteoarthritis of the first carpometacarpal (CMC) joint is very common and
presents with pain at the base of the thumb. The ‘grind test’ involves axial loading and
rotation of the thumb, which elicits pain in this condition. Management typically starts with
conservative measures like splinting and NSAIDs.
6. A 19-year-old male is brought to the emergency department after a motor vehicle accident.
He is alert but complaining of severe pelvic pain. Physical examination shows blood at the
urethral meatus and a high-riding prostate on rectal exam. What is the next best step in
management?
A. Retrograde urethrogram
B. Foley catheter insertion
C. Computed tomography of the pelvis
COMAT-SE (Self-Assessment Examination) V2
COMAT-SE (Self-Assessment Examination) V2
1. A 65-year-old male presents with a sudden onset of severe chest pain that radiates to his
back between the shoulder blades. His blood pressure is 180/100 mmHg in the right arm and
150/90 mmHg in the left arm. Physical examination reveals a new early diastolic murmur at
the right sternal border. Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Tension pneumothorax
C. Pulmonary embolism
D. Aortic dissection
Correct Answer: D
Explanation: Aortic dissection typically presents with sudden, tearing chest pain radiating
to the back and a blood pressure discrepancy between arms. The new diastolic murmur
suggests aortic regurgitation, a common complication when the dissection involves the
aortic root. Prompt recognition is critical as this is a surgical emergency.
,2. A 24-year-old female presents for evaluation of a ‘racing heart.’ She notes palpitations,
weight loss despite increased appetite, and heat intolerance over the last two months. On
physical examination, her thyroid is diffusely enlarged and non-tender, and she has a fine
tremor of her outstretched hands. Which of the following findings is most specific for Graves’
disease?
A. Exophthalmos
B. Tachycardia
C. Pretibial myxedema
D. Diffuse goiter
Correct Answer: C
Explanation: While both exophthalmos and pretibial myxedema are specific for Graves’
disease, pretibial myxedema (dermopathy) is a hallmark finding of autoimmune thyroiditis.
Tachycardia and goiter are common in many forms of hyperthyroidism and are not specific.
Clinical management involves antithyroid medications or radioactive iodine.
3. A 45-year-old male presents with a complaint of chronic epigastric pain that is relieved by
eating. He has a history of smoking and heavy alcohol use. A breath test is positive for Urea.
Osteopathic physical examination reveals tissue texture changes at the level of T5-T9 on the
left. Which of the following is the most appropriate initial treatment for this patient?
A. Surgical resection of the antrum
B. High-dose H2 blockers
,C. Liquor and tobacco cessation only
D. Clarithromycin, amoxicillin, and omeprazole
Correct Answer: D
Explanation: The positive urea breath test confirms Helicobacter pylori infection, which is
the most common cause of duodenal ulcers (pain relieved by food). Triple therapy
consisting of two antibiotics and a proton pump inhibitor is the standard of care. The T5-T9
viscerosomatic reflex corresponds to the upper gastrointestinal tract, including the
stomach and duodenum.
4. A 32-year-old pregnant woman at 34 weeks gestation presents with sudden onset of
vaginal bleeding and severe abdominal pain. Her uterus is firm and tender to palpation. Fetal
heart monitoring shows late decelerations. What is the most likely diagnosis?
A. Placenta previa
B. Uterine rupture
C. Vasa previa
D. Placental abruption
Correct Answer: D
Explanation: Placental abruption presents with painful vaginal bleeding and a firm, tender
uterus, often leading to fetal distress. This contrasts with placenta previa, which is
characteristically painless. Immediate stabilization and evaluation for delivery are
necessary to prevent maternal and fetal morbidity.
, 5. A 55-year-old female presents with pain in her right hand, specifically at the base of the
thumb. She notes the pain is worse with activity and improved with rest. Physical exam
shows squared appearance of the joint and a positive grind test. Which joint is most likely
affected?
A. Metacarpophalangeal joint
B. First carpometacarpal joint
C. Distal interphalangeal joint
D. Proximal interphalangeal joint
Correct Answer: B
Explanation: Osteoarthritis of the first carpometacarpal (CMC) joint is very common and
presents with pain at the base of the thumb. The ‘grind test’ involves axial loading and
rotation of the thumb, which elicits pain in this condition. Management typically starts with
conservative measures like splinting and NSAIDs.
6. A 19-year-old male is brought to the emergency department after a motor vehicle accident.
He is alert but complaining of severe pelvic pain. Physical examination shows blood at the
urethral meatus and a high-riding prostate on rectal exam. What is the next best step in
management?
A. Retrograde urethrogram
B. Foley catheter insertion
C. Computed tomography of the pelvis
