COMSAE Phase 1 (Level 1 Prep) Exam V2 COMSAE
Phase 1 (Level 1 Prep) Exam V2
1. A 45-year-old male presents with sharp epigastric pain that radiates to his back. Physical
examination reveals tissue texture changes at the T5-T9 levels on the right. Which of the
following is the most likely viscerosomatic reflex association for this patient’s condition?
A. Heart
B. Kidneys
C. Appendix
D. Liver
Correct Answer: D
Explanation: The T5-T9 levels on the right correspond to the liver and gallbladder
viscerosomatic reflex. Understanding these levels is critical for diagnosing visceral
pathology through musculoskeletal findings. A common pitfall is confusing left-sided T5-T9
findings, which would point toward the stomach or spleen instead.
2. A 22-year-old female presents with lower abdominal pain. On examination, a tender
nodule is palpated on the tip of the 12th rib on the right. This Chapman’s point is most
classically associated with which organ?
A. Bladder
B. Appendix
,C. Ovaries
D. Colon
Correct Answer: B
Explanation: The Chapman point for the appendix is located at the tip of the 12th rib on
the right. Recognizing these neurolymphatic points can assist in the diagnosis of acute
surgical conditions like appendicitis. Students often confuse this with the ovary point,
which is located on the pubic bone.
3. A 60-year-old patient with hypertension is started on an ACE inhibitor. Two weeks later,
the patient returns complaining of a dry, hacking cough. This side effect is primarily caused by
the accumulation of which substance?
A. Bradykinin
B. Renin
C. Angiotensin II
D. Aldosterone
Correct Answer: A
Explanation: ACE inhibitors prevent the breakdown of bradykinin, leading to its
accumulation in the lungs and causing a dry cough. This is a high-yield pharmacological
concept for board exams because it dictates switching to an ARB. A common mistake is
attributing the cough to increased angiotensin I levels, which does not directly cause
airway irritation.
, 4. During a routine physical exam, a 30-year-old female is found to have a sacral diagnosis of
a left-on-left forward torsion. What would you expect to find regarding the position of L5?
A. L5 rotated right, sidebent left
B. L5 rotated left, sidebent left
C. L5 rotated right, sidebent right
D. L5 rotated left, sidebent right
Correct Answer: D
Explanation: According to Fryette’s laws as applied to the sacrum, L5 sidebends toward
the side of the oblique axis and rotates opposite to the sacral rotation. For a left-on-left
torsion, the axis is left, so L5 sidebends left and rotates right. Failing to remember that L5
and the sacrum rotate in opposite directions is a frequent error on COMLEX.
5. A 55-year-old obese male presents with polyuria, polydipsia, and a fasting blood glucose of
250 mg/dL. Which of the following mechanisms best explains the primary pathology in Type 2
Diabetes Mellitus?
A. Autoimmune destruction of beta cells
B. Increased glucose absorption in the gut
C. Complete lack of insulin production
D. Insulin resistance in peripheral tissues
Correct Answer: D
Phase 1 (Level 1 Prep) Exam V2
1. A 45-year-old male presents with sharp epigastric pain that radiates to his back. Physical
examination reveals tissue texture changes at the T5-T9 levels on the right. Which of the
following is the most likely viscerosomatic reflex association for this patient’s condition?
A. Heart
B. Kidneys
C. Appendix
D. Liver
Correct Answer: D
Explanation: The T5-T9 levels on the right correspond to the liver and gallbladder
viscerosomatic reflex. Understanding these levels is critical for diagnosing visceral
pathology through musculoskeletal findings. A common pitfall is confusing left-sided T5-T9
findings, which would point toward the stomach or spleen instead.
2. A 22-year-old female presents with lower abdominal pain. On examination, a tender
nodule is palpated on the tip of the 12th rib on the right. This Chapman’s point is most
classically associated with which organ?
A. Bladder
B. Appendix
,C. Ovaries
D. Colon
Correct Answer: B
Explanation: The Chapman point for the appendix is located at the tip of the 12th rib on
the right. Recognizing these neurolymphatic points can assist in the diagnosis of acute
surgical conditions like appendicitis. Students often confuse this with the ovary point,
which is located on the pubic bone.
3. A 60-year-old patient with hypertension is started on an ACE inhibitor. Two weeks later,
the patient returns complaining of a dry, hacking cough. This side effect is primarily caused by
the accumulation of which substance?
A. Bradykinin
B. Renin
C. Angiotensin II
D. Aldosterone
Correct Answer: A
Explanation: ACE inhibitors prevent the breakdown of bradykinin, leading to its
accumulation in the lungs and causing a dry cough. This is a high-yield pharmacological
concept for board exams because it dictates switching to an ARB. A common mistake is
attributing the cough to increased angiotensin I levels, which does not directly cause
airway irritation.
, 4. During a routine physical exam, a 30-year-old female is found to have a sacral diagnosis of
a left-on-left forward torsion. What would you expect to find regarding the position of L5?
A. L5 rotated right, sidebent left
B. L5 rotated left, sidebent left
C. L5 rotated right, sidebent right
D. L5 rotated left, sidebent right
Correct Answer: D
Explanation: According to Fryette’s laws as applied to the sacrum, L5 sidebends toward
the side of the oblique axis and rotates opposite to the sacral rotation. For a left-on-left
torsion, the axis is left, so L5 sidebends left and rotates right. Failing to remember that L5
and the sacrum rotate in opposite directions is a frequent error on COMLEX.
5. A 55-year-old obese male presents with polyuria, polydipsia, and a fasting blood glucose of
250 mg/dL. Which of the following mechanisms best explains the primary pathology in Type 2
Diabetes Mellitus?
A. Autoimmune destruction of beta cells
B. Increased glucose absorption in the gut
C. Complete lack of insulin production
D. Insulin resistance in peripheral tissues
Correct Answer: D
