COMSAE PHASE 2 FORM 114
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 65-year-old male presents with acute onset of crushing substernal chest pain and
diaphoresis. An EKG shows ST-segment elevation in leads II, III, and aVF. During an
osteopathic physical examination, at which vertebral level would you most likely find a
viscerosomatic reflex?
A. T1-T4 on the left
B. T5-T9 on the right
C. T10-T11 on the left
D. T12-L2 on the right
Answer: A
Conceptual Explanation: The patient is experiencing an inferior myocardial infarction.
The viscerosomatic reflex for the heart is located at T1-T4/T5, typically found on the left
side.
,2. A 24-year-old female presents with primary amenorrhea. Physical exam reveals normal
breast development but absent pubic hair. Pelvic ultrasound shows a blind-ending vaginal
pouch and absent uterus. Karyotype is 46,XY. What is the most likely diagnosis?
A. Androgen insensitivity syndrome
B. Mullerian agenesis
C. Turner syndrome
D. Polycystic ovary syndrome
Answer: A
Conceptual Explanation: Androgen insensitivity syndrome (46,XY) presents with female
phenotype, absent pubic hair due to lack of androgen effect, and absent uterus due to MIF
production by testes.
3. An osteopathic physician is treating a patient with a rib 2 inhalation dysfunction using
Muscle Energy. In which position should the patient’s head and neck be placed to facilitate
the treatment?
A. Rotated 30 degrees away from the side of dysfunction
B. Rotated 30 degrees toward the side of dysfunction
C. Flexed and rotated 30 degrees away
D. Extended and rotated 30 degrees toward
Answer: A
, Conceptual Explanation: For ribs 1-2 inhalation dysfunction, the patient is treated in
exhalation. For a rib 2 dysfunction using the posterior scalene, the head is turned 30
degrees away from the affected side.
4. A 45-year-old male with a history of alcohol abuse presents with severe epigastric pain
radiating to the back. Lipase is 1500 U/L. What is the most sensitive early imaging modality to
confirm the diagnosis?
A. CT scan with intravenous contrast
B. Plain abdominal radiograph
C. Right upper quadrant ultrasound
D. MRI/MRCP
Answer: A
Conceptual Explanation: While diagnosis of pancreatitis is clinical/biochemical, CT with
contrast is the most sensitive for assessing pancreatic inflammation and complications if
the diagnosis is in doubt.
5. A patient presents with L5 rotated right and sidebent right. According to Fryette’s laws,
how would the sacrum most likely be positioned?
A. Left on right backward torsion
B. Left on left forward torsion
C. Right on left backward torsion
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 65-year-old male presents with acute onset of crushing substernal chest pain and
diaphoresis. An EKG shows ST-segment elevation in leads II, III, and aVF. During an
osteopathic physical examination, at which vertebral level would you most likely find a
viscerosomatic reflex?
A. T1-T4 on the left
B. T5-T9 on the right
C. T10-T11 on the left
D. T12-L2 on the right
Answer: A
Conceptual Explanation: The patient is experiencing an inferior myocardial infarction.
The viscerosomatic reflex for the heart is located at T1-T4/T5, typically found on the left
side.
,2. A 24-year-old female presents with primary amenorrhea. Physical exam reveals normal
breast development but absent pubic hair. Pelvic ultrasound shows a blind-ending vaginal
pouch and absent uterus. Karyotype is 46,XY. What is the most likely diagnosis?
A. Androgen insensitivity syndrome
B. Mullerian agenesis
C. Turner syndrome
D. Polycystic ovary syndrome
Answer: A
Conceptual Explanation: Androgen insensitivity syndrome (46,XY) presents with female
phenotype, absent pubic hair due to lack of androgen effect, and absent uterus due to MIF
production by testes.
3. An osteopathic physician is treating a patient with a rib 2 inhalation dysfunction using
Muscle Energy. In which position should the patient’s head and neck be placed to facilitate
the treatment?
A. Rotated 30 degrees away from the side of dysfunction
B. Rotated 30 degrees toward the side of dysfunction
C. Flexed and rotated 30 degrees away
D. Extended and rotated 30 degrees toward
Answer: A
, Conceptual Explanation: For ribs 1-2 inhalation dysfunction, the patient is treated in
exhalation. For a rib 2 dysfunction using the posterior scalene, the head is turned 30
degrees away from the affected side.
4. A 45-year-old male with a history of alcohol abuse presents with severe epigastric pain
radiating to the back. Lipase is 1500 U/L. What is the most sensitive early imaging modality to
confirm the diagnosis?
A. CT scan with intravenous contrast
B. Plain abdominal radiograph
C. Right upper quadrant ultrasound
D. MRI/MRCP
Answer: A
Conceptual Explanation: While diagnosis of pancreatitis is clinical/biochemical, CT with
contrast is the most sensitive for assessing pancreatic inflammation and complications if
the diagnosis is in doubt.
5. A patient presents with L5 rotated right and sidebent right. According to Fryette’s laws,
how would the sacrum most likely be positioned?
A. Left on right backward torsion
B. Left on left forward torsion
C. Right on left backward torsion
