COMSAE Phase 1 (Level 1 Prep) Exam V1 COMSAE
Phase 1 (Level 1 Prep) Exam V1 COMSAE Phase 1
(Level 1 Prep) Exam V1
1. A 45-year-old male presents with chronic low back pain. Physical examination reveals a
positive seated flexion test on the right. In the prone position, the right sacral base is deep
and the left inferior lateral angle is posterior. What is the most likely diagnosis?
A. Left-on-right backward sacral torsion
B. Left-on-left forward sacral torsion
C. Right-on-right forward sacral torsion
D. Right-on-left backward sacral torsion
Correct Answer: C
Explanation: This patient presents with a right-on-right forward sacral torsion. The seated
flexion test identifies the side of the dysfunction (right), and the deep sacral base on the
right combined with a posterior ILA on the left indicates rotation to the right on a right
oblique axis. Understanding sacral axes and the relationship between the seated flexion
test and positional findings is crucial for COMLEX-USA preparation.
,2. A 62-year-old female with a history of hypertension presents with sudden onset weakness
on the right side of her body and difficulty speaking. On exam, she has a right-sided
hemiparesis (face and arm greater than leg) and Broca’s aphasia. Which artery is most likely
occluded?
A. Left Anterior Cerebral Artery
B. Right Middle Cerebral Artery
C. Left Middle Cerebral Artery
D. Left Posterior Cerebral Artery
Correct Answer: C
Explanation: The symptoms of right-sided hemiparesis and Broca’s aphasia localize the
lesion to the left Middle Cerebral Artery (MCA) territory, specifically the superior division.
The MCA supplies the lateral aspect of the cerebral hemispheres, where the motor cortex
for the face and arm as well as speech centers are located. Clinical distinction between MCA
and ACA strokes is a high-yield topic emphasizing neuroanatomical localization.
3. A 34-year-old female presents with fatigue and cold intolerance. Laboratory results show
an elevated Thyroid Stimulating Hormone (TSH) and a low free T4. Which of the following is
the most likely diagnosis?
A. Graves disease
B. Pituitary adenoma
C. Toxic multinodular goiter
,D. Hashimoto thyroiditis
Correct Answer: D
Explanation: Hashimoto thyroiditis is the most common cause of hypothyroidism in
iodine-sufficient regions and typically presents with elevated TSH and low T4. It is
characterized by autoimmune destruction of the thyroid gland, often involving antithyroid
peroxidase (TPO) antibodies. Distinguishing primary hypothyroidism from secondary
causes (like pituitary adenoma) is essential for correct management and board success.
4. A 24-year-old medical student complains of burning epigastric pain that is relieved by
meals. A urea breath test is positive. Which of the following is the most appropriate first-line
treatment?
A. Omeprazole, clarithromycin, and amoxicillin
B. Cimetidine and antacids as needed
C. Metronidazole and lifestyle modifications
D. Misoprostol and avoidance of NSAIDs
Correct Answer: A
Explanation: The patient’s symptoms and positive urea breath test indicate an infection
with Helicobacter pylori, specifically a duodenal ulcer. Triple therapy consisting of a proton
pump inhibitor, clarithromycin, and amoxicillin (or metronidazole) is the standard of care.
Understanding the mechanism of the urea breath test and the pharmacology of triple
therapy is a core internal medicine concept for the COMLEX-USA.
, 5. An 8-year-old boy is brought to the pediatrician for a routine checkup. The physician notes
a palpable mass at the level of the 2nd intercostal space on the left, just lateral to the
sternum. This corresponds to the Chapman reflex point for which organ?
A. Thyroid
B. Lungs
C. Heart
D. Liver
Correct Answer: C
Explanation: The anterior Chapman reflex point for the heart is located in the second
intercostal space, near the sternum. Chapman points are small, smooth, firm, and
exquisitely tender myofascial nodules that reflect visceral dysfunction. Memorizing the
locations of specific Chapman points, such as the heart, appendix (tip of the 12th rib), and
colon, is high-yield for OMM components of the exam.
6. A 55-year-old male with a history of heavy smoking presents with a persistent cough and
hemoptysis. A chest X-ray reveals a central lung mass. Laboratory findings show a serum
calcium of 12.5 mg/dL. What is the most likely histological diagnosis?
A. Squamous cell carcinoma
B. Small cell carcinoma
C. Adenocarcinoma
D. Large cell carcinoma
Phase 1 (Level 1 Prep) Exam V1 COMSAE Phase 1
(Level 1 Prep) Exam V1
1. A 45-year-old male presents with chronic low back pain. Physical examination reveals a
positive seated flexion test on the right. In the prone position, the right sacral base is deep
and the left inferior lateral angle is posterior. What is the most likely diagnosis?
A. Left-on-right backward sacral torsion
B. Left-on-left forward sacral torsion
C. Right-on-right forward sacral torsion
D. Right-on-left backward sacral torsion
Correct Answer: C
Explanation: This patient presents with a right-on-right forward sacral torsion. The seated
flexion test identifies the side of the dysfunction (right), and the deep sacral base on the
right combined with a posterior ILA on the left indicates rotation to the right on a right
oblique axis. Understanding sacral axes and the relationship between the seated flexion
test and positional findings is crucial for COMLEX-USA preparation.
,2. A 62-year-old female with a history of hypertension presents with sudden onset weakness
on the right side of her body and difficulty speaking. On exam, she has a right-sided
hemiparesis (face and arm greater than leg) and Broca’s aphasia. Which artery is most likely
occluded?
A. Left Anterior Cerebral Artery
B. Right Middle Cerebral Artery
C. Left Middle Cerebral Artery
D. Left Posterior Cerebral Artery
Correct Answer: C
Explanation: The symptoms of right-sided hemiparesis and Broca’s aphasia localize the
lesion to the left Middle Cerebral Artery (MCA) territory, specifically the superior division.
The MCA supplies the lateral aspect of the cerebral hemispheres, where the motor cortex
for the face and arm as well as speech centers are located. Clinical distinction between MCA
and ACA strokes is a high-yield topic emphasizing neuroanatomical localization.
3. A 34-year-old female presents with fatigue and cold intolerance. Laboratory results show
an elevated Thyroid Stimulating Hormone (TSH) and a low free T4. Which of the following is
the most likely diagnosis?
A. Graves disease
B. Pituitary adenoma
C. Toxic multinodular goiter
,D. Hashimoto thyroiditis
Correct Answer: D
Explanation: Hashimoto thyroiditis is the most common cause of hypothyroidism in
iodine-sufficient regions and typically presents with elevated TSH and low T4. It is
characterized by autoimmune destruction of the thyroid gland, often involving antithyroid
peroxidase (TPO) antibodies. Distinguishing primary hypothyroidism from secondary
causes (like pituitary adenoma) is essential for correct management and board success.
4. A 24-year-old medical student complains of burning epigastric pain that is relieved by
meals. A urea breath test is positive. Which of the following is the most appropriate first-line
treatment?
A. Omeprazole, clarithromycin, and amoxicillin
B. Cimetidine and antacids as needed
C. Metronidazole and lifestyle modifications
D. Misoprostol and avoidance of NSAIDs
Correct Answer: A
Explanation: The patient’s symptoms and positive urea breath test indicate an infection
with Helicobacter pylori, specifically a duodenal ulcer. Triple therapy consisting of a proton
pump inhibitor, clarithromycin, and amoxicillin (or metronidazole) is the standard of care.
Understanding the mechanism of the urea breath test and the pharmacology of triple
therapy is a core internal medicine concept for the COMLEX-USA.
, 5. An 8-year-old boy is brought to the pediatrician for a routine checkup. The physician notes
a palpable mass at the level of the 2nd intercostal space on the left, just lateral to the
sternum. This corresponds to the Chapman reflex point for which organ?
A. Thyroid
B. Lungs
C. Heart
D. Liver
Correct Answer: C
Explanation: The anterior Chapman reflex point for the heart is located in the second
intercostal space, near the sternum. Chapman points are small, smooth, firm, and
exquisitely tender myofascial nodules that reflect visceral dysfunction. Memorizing the
locations of specific Chapman points, such as the heart, appendix (tip of the 12th rib), and
colon, is high-yield for OMM components of the exam.
6. A 55-year-old male with a history of heavy smoking presents with a persistent cough and
hemoptysis. A chest X-ray reveals a central lung mass. Laboratory findings show a serum
calcium of 12.5 mg/dL. What is the most likely histological diagnosis?
A. Squamous cell carcinoma
B. Small cell carcinoma
C. Adenocarcinoma
D. Large cell carcinoma
