COMSAE Phase 1 Form 114 Test Bank | 200+ Practice
Questions with Bold Italic Answers & Rationales – NBOME
Osteopathic Medical Knowledge Self-Assessment Prep.
1. A 32-year-old woman with a history of migraines presents with acute, severe, retro-orbital
headache, palpitations, and diaphoresis. Blood pressure is 220/130 mm Hg. She is not on any
medications. Which of the following is the most appropriate initial step in management?
A. Administer intravenous labetalol to rapidly lower blood pressure
B. Obtain a CT scan of the head to rule out intracranial hemorrhage
C. Start oral nifedipine and observe in the emergency department
D. Check plasma metanephrines and urine catecholamines before any intervention
Answer: A. Administer intravenous labetalol to rapidly lower blood pressure
2. A 45-year-old man with type 2 diabetes and hypertension complains of bilateral lower
extremity edema and frothy urine. Urinalysis shows 3+ protein and urinary protein-to-creatinine
ratio of 5.2. Which finding on renal biopsy would be most consistent with the diagnosis?
A. Mesangial expansion with Kimmelstiel-Wilson nodules
B. Thickening of the glomerular basement membrane with subepithelial humps
C. Diffuse capillary loop thickening with double contours
D. Focal segmental sclerosis with hyalinosis
Answer: A. Mesangial expansion with Kimmelstiel-Wilson nodules
3. A 68-year-old woman is brought to the emergency department after a fall. She is on warfarin
for atrial fibrillation. Head CT shows a small subdural hematoma. Her INR is 6.8. Which of the
following is the most appropriate management?
A. Administer vitamin K subcutaneously and repeat INR in 6 hours
B. Hold warfarin and give fresh frozen plasma to correct coagulopathy
C. Give prothrombin complex concentrate and intravenous vitamin K
D. Reverse with protamine sulfate and observe closely
Answer: C. Give prothrombin complex concentrate and intravenous vitamin K
4. A 27-year-old medical student presents with fatigue, weight loss, and a rash on his cheeks
after spending time outdoors. He also reports joint pain in his hands. Antinuclear antibody test
is positive. Which of the following autoantibodies is most specific for systemic lupus
erythematosus?
A. Anti-Smith (anti-Sm)
B. Anti-histone
C. Anti-centromere
D. Anti-Jo-1
Answer: A. Anti-Smith (anti-Sm)
5. A 58-year-old man with cirrhosis secondary to alcohol use presents with confusion, asterixis,
and ascites. He has been taking spironolactone and furosemide. Which of the following factors
is most likely to precipitate hepatic encephalopathy in this patient?
A. Hypokalemia from diuretic use
, B. Hypernatremia due to diuretic overuse
C. Metabolic alkalosis from vomiting
D. Hypocalcemia from low dietary intake
Answer: A. Hypokalemia from diuretic use
6. A 22-year-old woman presents with acute onset of severe abdominal pain, vomiting, and
constipation. She has a history of recurrent ear infections and pneumonia. On exam, she has
absent deep tendon reflexes and muscle weakness. Her eyes are sunken. Which of the
following is the most likely underlying defect?
A. Defect in calcium channel function
B. Defect in chloride channel function
C. Defect in sodium channel function
D. Defect in potassium channel function
Answer: A. Defect in calcium channel function
7. A 3-day-old neonate presents with jaundice, lethargy, and poor feeding. The mother had a
previous child with similar symptoms. Which of the following is the most appropriate initial
diagnostic test?
A. Serum bilirubin and liver function tests
B. Direct antiglobulin test (Coombs test)
C. Quantitative glucose-6-phosphate dehydrogenase assay
D. Hemoglobin electrophoresis
Answer: B. Direct antiglobulin test (Coombs test)
8. A 67-year-old man with COPD develops worsening dyspnea and cough with purulent sputum.
He is febrile and has increased work of breathing. Chest x-ray shows no infiltrate. Which of the
following is the most appropriate management?
A. Prescribe a course of oral corticosteroids only
B. Start broad-spectrum intravenous antibiotics
C. Initiate noninvasive positive pressure ventilation
D. Give inhaled bronchodilators and oral antibiotics
Answer: B. Start broad-spectrum intravenous antibiotics
9. A 45-year-old woman with systemic sclerosis presents with a blood pressure of 170/110 mm
Hg, headache, and visual disturbances. Urinalysis shows protein and red blood cell casts.
Which of the following is the most appropriate next step?
A. Start lisinopril
B. Start nifedipine
C. Start losartan
D. Start hydralazine
Answer: A. Start lisinopril
10. A 30-year-old man is brought to the emergency department after a seizure. He has a history
of alcohol abuse and is on phenytoin. His phenytoin level is 8 mcg/mL (therapeutic range
10-20). He also has a low albumin of 2.5 g/dL. What is the best interpretation of his phenytoin
level?
A. The level is therapeutic when corrected for hypoalbuminemia
, B. The level is subtherapeutic and requires a dose increase
C. The level is toxic and requires dose reduction
D. The level is inconclusive and a free phenytoin level is needed
Answer: A. The level is therapeutic when corrected for hypoalbuminemia
11. A 55-year-old woman with atrial fibrillation is started on warfarin. Her INR is measured daily.
What is the primary reason for monitoring INR rather than a fixed dose?
A. To ensure the patient is compliant with medication
B. To adjust for variability in dietary vitamin K intake
C. To determine the risk of bleeding complications
D. To monitor for drug interactions
Answer: B. To adjust for variability in dietary vitamin K intake
12. A 28-year-old man presents with a 2-day history of watery diarrhea, cramping, and
low-grade fever after returning from a camping trip. He drank unfiltered stream water. Stool
examination shows pear-shaped trophozoites with two nuclei. Which of the following is the
most appropriate treatment?
A. Metronidazole
B. Sulfamethoxazole-trimethoprim
C. Ciprofloxacin
D. Nitazoxanide
Answer: A. Metronidazole
13. A 34-year-old woman with systemic lupus erythematosus presents with pleuritic chest pain,
shortness of breath, and a pericardial friction rub. ECG shows diffuse ST-segment elevations.
Which of the following is the most likely manifestation of her disease?
A. Pericarditis
B. Pleuritis
C. Myocarditis
D. Pneumonitis
Answer: A. Pericarditis
14. A 65-year-old man with heart failure is on digoxin, furosemide, and lisinopril. He presents
with nausea, vomiting, and visual halos. His serum potassium is 3.0 mmol/L. Which of the
following is the most appropriate initial step?
A. Administer digoxin immune Fab
B. Withhold digoxin and replete potassium
C. Administer IV potassium and continue digoxin
D. Give phenytoin for dysrhythmia
Answer: B. Withhold digoxin and replete potassium
15. A 23-year-old medical resident is asked to obtain informed consent for a procedure from a
patient who is clearly intoxicated. The resident is concerned about the patient's capacity. Which
of the following is the most appropriate action?
A. Proceed with the procedure because the patient is an adult
B. Delay the procedure until the patient is no longer intoxicated
C. Ask the patient to sign the consent form and proceed
Questions with Bold Italic Answers & Rationales – NBOME
Osteopathic Medical Knowledge Self-Assessment Prep.
1. A 32-year-old woman with a history of migraines presents with acute, severe, retro-orbital
headache, palpitations, and diaphoresis. Blood pressure is 220/130 mm Hg. She is not on any
medications. Which of the following is the most appropriate initial step in management?
A. Administer intravenous labetalol to rapidly lower blood pressure
B. Obtain a CT scan of the head to rule out intracranial hemorrhage
C. Start oral nifedipine and observe in the emergency department
D. Check plasma metanephrines and urine catecholamines before any intervention
Answer: A. Administer intravenous labetalol to rapidly lower blood pressure
2. A 45-year-old man with type 2 diabetes and hypertension complains of bilateral lower
extremity edema and frothy urine. Urinalysis shows 3+ protein and urinary protein-to-creatinine
ratio of 5.2. Which finding on renal biopsy would be most consistent with the diagnosis?
A. Mesangial expansion with Kimmelstiel-Wilson nodules
B. Thickening of the glomerular basement membrane with subepithelial humps
C. Diffuse capillary loop thickening with double contours
D. Focal segmental sclerosis with hyalinosis
Answer: A. Mesangial expansion with Kimmelstiel-Wilson nodules
3. A 68-year-old woman is brought to the emergency department after a fall. She is on warfarin
for atrial fibrillation. Head CT shows a small subdural hematoma. Her INR is 6.8. Which of the
following is the most appropriate management?
A. Administer vitamin K subcutaneously and repeat INR in 6 hours
B. Hold warfarin and give fresh frozen plasma to correct coagulopathy
C. Give prothrombin complex concentrate and intravenous vitamin K
D. Reverse with protamine sulfate and observe closely
Answer: C. Give prothrombin complex concentrate and intravenous vitamin K
4. A 27-year-old medical student presents with fatigue, weight loss, and a rash on his cheeks
after spending time outdoors. He also reports joint pain in his hands. Antinuclear antibody test
is positive. Which of the following autoantibodies is most specific for systemic lupus
erythematosus?
A. Anti-Smith (anti-Sm)
B. Anti-histone
C. Anti-centromere
D. Anti-Jo-1
Answer: A. Anti-Smith (anti-Sm)
5. A 58-year-old man with cirrhosis secondary to alcohol use presents with confusion, asterixis,
and ascites. He has been taking spironolactone and furosemide. Which of the following factors
is most likely to precipitate hepatic encephalopathy in this patient?
A. Hypokalemia from diuretic use
, B. Hypernatremia due to diuretic overuse
C. Metabolic alkalosis from vomiting
D. Hypocalcemia from low dietary intake
Answer: A. Hypokalemia from diuretic use
6. A 22-year-old woman presents with acute onset of severe abdominal pain, vomiting, and
constipation. She has a history of recurrent ear infections and pneumonia. On exam, she has
absent deep tendon reflexes and muscle weakness. Her eyes are sunken. Which of the
following is the most likely underlying defect?
A. Defect in calcium channel function
B. Defect in chloride channel function
C. Defect in sodium channel function
D. Defect in potassium channel function
Answer: A. Defect in calcium channel function
7. A 3-day-old neonate presents with jaundice, lethargy, and poor feeding. The mother had a
previous child with similar symptoms. Which of the following is the most appropriate initial
diagnostic test?
A. Serum bilirubin and liver function tests
B. Direct antiglobulin test (Coombs test)
C. Quantitative glucose-6-phosphate dehydrogenase assay
D. Hemoglobin electrophoresis
Answer: B. Direct antiglobulin test (Coombs test)
8. A 67-year-old man with COPD develops worsening dyspnea and cough with purulent sputum.
He is febrile and has increased work of breathing. Chest x-ray shows no infiltrate. Which of the
following is the most appropriate management?
A. Prescribe a course of oral corticosteroids only
B. Start broad-spectrum intravenous antibiotics
C. Initiate noninvasive positive pressure ventilation
D. Give inhaled bronchodilators and oral antibiotics
Answer: B. Start broad-spectrum intravenous antibiotics
9. A 45-year-old woman with systemic sclerosis presents with a blood pressure of 170/110 mm
Hg, headache, and visual disturbances. Urinalysis shows protein and red blood cell casts.
Which of the following is the most appropriate next step?
A. Start lisinopril
B. Start nifedipine
C. Start losartan
D. Start hydralazine
Answer: A. Start lisinopril
10. A 30-year-old man is brought to the emergency department after a seizure. He has a history
of alcohol abuse and is on phenytoin. His phenytoin level is 8 mcg/mL (therapeutic range
10-20). He also has a low albumin of 2.5 g/dL. What is the best interpretation of his phenytoin
level?
A. The level is therapeutic when corrected for hypoalbuminemia
, B. The level is subtherapeutic and requires a dose increase
C. The level is toxic and requires dose reduction
D. The level is inconclusive and a free phenytoin level is needed
Answer: A. The level is therapeutic when corrected for hypoalbuminemia
11. A 55-year-old woman with atrial fibrillation is started on warfarin. Her INR is measured daily.
What is the primary reason for monitoring INR rather than a fixed dose?
A. To ensure the patient is compliant with medication
B. To adjust for variability in dietary vitamin K intake
C. To determine the risk of bleeding complications
D. To monitor for drug interactions
Answer: B. To adjust for variability in dietary vitamin K intake
12. A 28-year-old man presents with a 2-day history of watery diarrhea, cramping, and
low-grade fever after returning from a camping trip. He drank unfiltered stream water. Stool
examination shows pear-shaped trophozoites with two nuclei. Which of the following is the
most appropriate treatment?
A. Metronidazole
B. Sulfamethoxazole-trimethoprim
C. Ciprofloxacin
D. Nitazoxanide
Answer: A. Metronidazole
13. A 34-year-old woman with systemic lupus erythematosus presents with pleuritic chest pain,
shortness of breath, and a pericardial friction rub. ECG shows diffuse ST-segment elevations.
Which of the following is the most likely manifestation of her disease?
A. Pericarditis
B. Pleuritis
C. Myocarditis
D. Pneumonitis
Answer: A. Pericarditis
14. A 65-year-old man with heart failure is on digoxin, furosemide, and lisinopril. He presents
with nausea, vomiting, and visual halos. His serum potassium is 3.0 mmol/L. Which of the
following is the most appropriate initial step?
A. Administer digoxin immune Fab
B. Withhold digoxin and replete potassium
C. Administer IV potassium and continue digoxin
D. Give phenytoin for dysrhythmia
Answer: B. Withhold digoxin and replete potassium
15. A 23-year-old medical resident is asked to obtain informed consent for a procedure from a
patient who is clearly intoxicated. The resident is concerned about the patient's capacity. Which
of the following is the most appropriate action?
A. Proceed with the procedure because the patient is an adult
B. Delay the procedure until the patient is no longer intoxicated
C. Ask the patient to sign the consent form and proceed
