COMSAE Phase 1 Form 116 Practice Exam
**1. A 45-year-old woman presents with epigastric burning and bloating after meals. On osteopathic
structural exam, you find tenderness and increased tissue texture at the right T6-T8 paraspinal region.
Which viscerosomatic reflex best explains this finding?**
A) Gallbladder
B) Pancreas
C) Stomach
D) Liver
**Answer: A) Gallbladder**
*Rationale:* Viscerosomatic reflexes from the gallbladder typically refer to the right T6-T8 spinal
segments .
**2. According to Fryette's principles, which of the following describes a Type I somatic
dysfunction?**
A) Vertebrae in neutral position with rotation and sidebending in opposite directions
B) Vertebrae in non-neutral position with rotation and sidebending in the same direction
C) Vertebrae in neutral position with rotation and sidebending in the same direction
D) Vertebrae in non-neutral position with rotation and sidebending in opposite directions
**Answer: A) Vertebrae in neutral position with rotation and sidebending in opposite directions**
*Rationale:* Type I mechanics describe a group of vertebrae in a neutral position, with rotation and
sidebending occurring in opposite directions .
**3. A patient with chronic low back pain has a seated flexion test positive on the left. In the prone
position, the left ILA is more posterior than the right. What is the most likely diagnosis?**
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral flexion
D) Bilateral sacral extension
**Answer: A) Left on left sacral torsion**
*Rationale:* A positive seated flexion test indicates the side of the dysfunction (left). A posterior ILA
defines the axis side. In a left on left torsion, the axis and dysfunction are on the same side .
**4. A patient presents with a tender nodule in the second intercostal space, right parasternal region.
This Chapman's point is most likely associated with which condition?**
,A) Mitral valve dysfunction
B) Gastric ulcer
C) Appendicitis
D) Pulmonary congestion
**Answer: A) Mitral valve dysfunction**
*Rationale:* Anterior Chapman's points for the heart are in the 2nd-5th intercostal spaces
parasternally. The mitral valve corresponds to the right 2nd intercostal space .
**5. A 55-year-old male with chronic asthma has paraspinal tenderness and restricted motion at T3-
T5. This viscerosomatic reflex is most consistent with dysfunction of which organ?**
A) Heart
B) Lungs
C) Stomach
D) Liver
**Answer: B) Lungs**
*Rationale:* Viscerosomatic reflexes for the lungs typically manifest at the T1-T4 levels. The
sympathetic innervation of the lungs originates from T1-T4 .
**6. A patient has restriction of sidebending to the right and rotation to the left in the thoracic spine
with neutral mechanics. This is best described as:**
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Type IV dysfunction
**Answer: A) Type I dysfunction**
*Rationale:* Type I dysfunctions are neutral and involve sidebending and rotation in opposite
directions .
**7. A 55-year-old male with a history of COPD presents with low back pain. On examination, you
note a right-sided short leg and a positive standing flexion test on the right. In the prone position, the
right ILA is more anterior than the left. What is the most likely sacral diagnosis?**
A) Right on right sacral torsion
B) Left on left sacral torsion
C) Right unilateral sacral extension
D) Left unilateral sacral flexion
**Answer: C) Right unilateral sacral extension**
*Rationale:* In unilateral sacral extension, the ILA on the affected side is more anterior and superior,
with a positive flexion test on the same side .
,**8. A medical student is studying the complement system. Which of the following complement
proteins is part of the membrane attack complex (MAC)?**
A) C3b
B) C5a
C) C9
D) C1q
**Answer: C) C9**
*Rationale:* The membrane attack complex (MAC) consists of complement proteins C5b, C6, C7, C8,
and multiple C9 molecules. C9 polymerizes to form a pore in the target cell membrane .
**9. A 65-year-old man presents with fatigue, weight loss, and bone pain. Laboratory findings include
anemia, elevated serum protein, and Bence Jones proteins in the urine. A bone marrow biopsy
shows >10% plasma cells. What is the most likely diagnosis?**
A) Monoclonal gammopathy of undetermined significance (MGUS)
B) Multiple myeloma
C) Waldenström macroglobulinemia
D) Acute lymphoblastic leukemia
**Answer: B) Multiple myeloma**
*Rationale:* Multiple myeloma is characterized by clonal plasma cell proliferation (>10%),
monoclonal immunoglobulin (M protein) in serum or urine (Bence Jones), and CRAB criteria:
hyperCalcemia, Renal failure, Anemia, Bone lesions .
**10. A 45-year-old man presents with sudden onset of severe chest pain radiating to his back. Chest
X-ray shows a widened mediastinum. Which layer of the aortic wall is most likely compromised,
leading to this presentation?**
A) Tunica intima
B) Tunica media
C) Tunica adventitia
D) Tunica externa
**Answer: B) Tunica media**
*Rationale:* Aortic dissection involves a tear in the tunica intima, allowing blood to enter and split
the tunica media, creating a false lumen. The weakened media is the layer that fails structurally .
**11. A 68-year-old man presents with exertional chest pain relieved by rest. Which is the most likely
underlying mechanism of stable angina?**
A) Coronary artery plaque rupture with thrombosis
B) Fixed atherosclerotic narrowing of coronary arteries
, C) Coronary artery vasospasm
D) Myocardial infarction
**Answer: B) Fixed atherosclerotic narrowing of coronary arteries**
*Rationale:* Stable angina is caused by fixed atherosclerotic narrowing .
**12. Which electrolyte abnormality is most associated with peaked T waves on ECG?**
A) Hypocalcemia
B) Hyperkalemia
C) Hypokalemia
D) Hypernatremia
**Answer: B) Hyperkalemia**
*Rationale:* Hyperkalemia classically causes peaked T waves .
**13. A patient has a left-sided stroke affecting the middle cerebral artery. Which symptom is most
likely?**
A) Right-sided hemiparesis
B) Left-sided hemiparesis
C) Bilateral leg weakness
D) Loss of hearing only
**Answer: A) Right-sided hemiparesis**
*Rationale:* The motor cortex is contralateral; a left MCA stroke causes right-sided weakness .
**14. Which organism is most commonly associated with urinary tract infections in young women?**
A) Pseudomonas aeruginosa
B) Escherichia coli
C) Staphylococcus saprophyticus
D) Klebsiella pneumoniae
**Answer: B) Escherichia coli**
*Rationale:* E. coli is the most common cause of UTIs in young women .
**15. A 60-year-old male with a history of smoking presents with a central lung mass and
hypercalcemia. Which lung cancer type is most likely?**
A) Small cell carcinoma
B) Squamous cell carcinoma
C) Adenocarcinoma
D) Bronchioloalveolar carcinoma
**Answer: B) Squamous cell carcinoma**
*Rationale:* Squamous cell carcinoma produces PTHrP leading to hypercalcemia .
**1. A 45-year-old woman presents with epigastric burning and bloating after meals. On osteopathic
structural exam, you find tenderness and increased tissue texture at the right T6-T8 paraspinal region.
Which viscerosomatic reflex best explains this finding?**
A) Gallbladder
B) Pancreas
C) Stomach
D) Liver
**Answer: A) Gallbladder**
*Rationale:* Viscerosomatic reflexes from the gallbladder typically refer to the right T6-T8 spinal
segments .
**2. According to Fryette's principles, which of the following describes a Type I somatic
dysfunction?**
A) Vertebrae in neutral position with rotation and sidebending in opposite directions
B) Vertebrae in non-neutral position with rotation and sidebending in the same direction
C) Vertebrae in neutral position with rotation and sidebending in the same direction
D) Vertebrae in non-neutral position with rotation and sidebending in opposite directions
**Answer: A) Vertebrae in neutral position with rotation and sidebending in opposite directions**
*Rationale:* Type I mechanics describe a group of vertebrae in a neutral position, with rotation and
sidebending occurring in opposite directions .
**3. A patient with chronic low back pain has a seated flexion test positive on the left. In the prone
position, the left ILA is more posterior than the right. What is the most likely diagnosis?**
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral flexion
D) Bilateral sacral extension
**Answer: A) Left on left sacral torsion**
*Rationale:* A positive seated flexion test indicates the side of the dysfunction (left). A posterior ILA
defines the axis side. In a left on left torsion, the axis and dysfunction are on the same side .
**4. A patient presents with a tender nodule in the second intercostal space, right parasternal region.
This Chapman's point is most likely associated with which condition?**
,A) Mitral valve dysfunction
B) Gastric ulcer
C) Appendicitis
D) Pulmonary congestion
**Answer: A) Mitral valve dysfunction**
*Rationale:* Anterior Chapman's points for the heart are in the 2nd-5th intercostal spaces
parasternally. The mitral valve corresponds to the right 2nd intercostal space .
**5. A 55-year-old male with chronic asthma has paraspinal tenderness and restricted motion at T3-
T5. This viscerosomatic reflex is most consistent with dysfunction of which organ?**
A) Heart
B) Lungs
C) Stomach
D) Liver
**Answer: B) Lungs**
*Rationale:* Viscerosomatic reflexes for the lungs typically manifest at the T1-T4 levels. The
sympathetic innervation of the lungs originates from T1-T4 .
**6. A patient has restriction of sidebending to the right and rotation to the left in the thoracic spine
with neutral mechanics. This is best described as:**
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Type IV dysfunction
**Answer: A) Type I dysfunction**
*Rationale:* Type I dysfunctions are neutral and involve sidebending and rotation in opposite
directions .
**7. A 55-year-old male with a history of COPD presents with low back pain. On examination, you
note a right-sided short leg and a positive standing flexion test on the right. In the prone position, the
right ILA is more anterior than the left. What is the most likely sacral diagnosis?**
A) Right on right sacral torsion
B) Left on left sacral torsion
C) Right unilateral sacral extension
D) Left unilateral sacral flexion
**Answer: C) Right unilateral sacral extension**
*Rationale:* In unilateral sacral extension, the ILA on the affected side is more anterior and superior,
with a positive flexion test on the same side .
,**8. A medical student is studying the complement system. Which of the following complement
proteins is part of the membrane attack complex (MAC)?**
A) C3b
B) C5a
C) C9
D) C1q
**Answer: C) C9**
*Rationale:* The membrane attack complex (MAC) consists of complement proteins C5b, C6, C7, C8,
and multiple C9 molecules. C9 polymerizes to form a pore in the target cell membrane .
**9. A 65-year-old man presents with fatigue, weight loss, and bone pain. Laboratory findings include
anemia, elevated serum protein, and Bence Jones proteins in the urine. A bone marrow biopsy
shows >10% plasma cells. What is the most likely diagnosis?**
A) Monoclonal gammopathy of undetermined significance (MGUS)
B) Multiple myeloma
C) Waldenström macroglobulinemia
D) Acute lymphoblastic leukemia
**Answer: B) Multiple myeloma**
*Rationale:* Multiple myeloma is characterized by clonal plasma cell proliferation (>10%),
monoclonal immunoglobulin (M protein) in serum or urine (Bence Jones), and CRAB criteria:
hyperCalcemia, Renal failure, Anemia, Bone lesions .
**10. A 45-year-old man presents with sudden onset of severe chest pain radiating to his back. Chest
X-ray shows a widened mediastinum. Which layer of the aortic wall is most likely compromised,
leading to this presentation?**
A) Tunica intima
B) Tunica media
C) Tunica adventitia
D) Tunica externa
**Answer: B) Tunica media**
*Rationale:* Aortic dissection involves a tear in the tunica intima, allowing blood to enter and split
the tunica media, creating a false lumen. The weakened media is the layer that fails structurally .
**11. A 68-year-old man presents with exertional chest pain relieved by rest. Which is the most likely
underlying mechanism of stable angina?**
A) Coronary artery plaque rupture with thrombosis
B) Fixed atherosclerotic narrowing of coronary arteries
, C) Coronary artery vasospasm
D) Myocardial infarction
**Answer: B) Fixed atherosclerotic narrowing of coronary arteries**
*Rationale:* Stable angina is caused by fixed atherosclerotic narrowing .
**12. Which electrolyte abnormality is most associated with peaked T waves on ECG?**
A) Hypocalcemia
B) Hyperkalemia
C) Hypokalemia
D) Hypernatremia
**Answer: B) Hyperkalemia**
*Rationale:* Hyperkalemia classically causes peaked T waves .
**13. A patient has a left-sided stroke affecting the middle cerebral artery. Which symptom is most
likely?**
A) Right-sided hemiparesis
B) Left-sided hemiparesis
C) Bilateral leg weakness
D) Loss of hearing only
**Answer: A) Right-sided hemiparesis**
*Rationale:* The motor cortex is contralateral; a left MCA stroke causes right-sided weakness .
**14. Which organism is most commonly associated with urinary tract infections in young women?**
A) Pseudomonas aeruginosa
B) Escherichia coli
C) Staphylococcus saprophyticus
D) Klebsiella pneumoniae
**Answer: B) Escherichia coli**
*Rationale:* E. coli is the most common cause of UTIs in young women .
**15. A 60-year-old male with a history of smoking presents with a central lung mass and
hypercalcemia. Which lung cancer type is most likely?**
A) Small cell carcinoma
B) Squamous cell carcinoma
C) Adenocarcinoma
D) Bronchioloalveolar carcinoma
**Answer: B) Squamous cell carcinoma**
*Rationale:* Squamous cell carcinoma produces PTHrP leading to hypercalcemia .
