COMSAE PHASE 1 FORM 113
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with low back pain. Physical examination reveals a positive
seated flexion test on the right, a deep right sacral sulcus, and a posterior left inferior lateral
angle (ILA). Which of the following 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
Answer: C
Conceptual Explanation: The positive seated flexion test on the right indicates the side of
the dysfunction. A deep right sulcus and posterior left ILA, combined with a right-sided
flexion test, signifies that the sacrum has rotated right on a right oblique axis (R on R).
,2. A 24-year-old patient presents with a cough and fever. A chest X-ray shows an infiltrate in
the right lower lobe. If this is caused by Streptococcus pneumoniae, what is the mechanism of
resistance most commonly seen against macrolides in this organism?
A. Production of beta-lactamase
B. Efflux pumps for the antibiotic
C. Methylation of the 23S rRNA binding site
D. Alteration of penicillin-binding proteins
Answer: C
Conceptual Explanation: The most common mechanism of high-level macrolide
resistance in S. pneumoniae is the methylation of the 23S rRNA component of the 50S
ribosomal subunit, which prevents the antibiotic from binding.
3. A patient presents with a mid-systolic crescendo-decrescendo murmur heard best at the
right second intercostal space, radiating to the carotids. Which of the following findings
would most likely be associated with this condition?
A. Widened pulse pressure
B. Pulsus parvus et tardus
C. Opening snap
D. Holosystolic murmur at the apex
Answer: B
, Conceptual Explanation: The description is characteristic of aortic stenosis. Pulsus parvus
et tardus (weak and late pulses) is a classic finding in severe aortic stenosis due to the
obstructed outflow from the left ventricle.
4. A 60-year-old female with a history of chronic smoking presents with a new-onset cough
and hemoptysis. Laboratory tests show a serum sodium of 120 mEq/L. Which type of lung
cancer is most likely?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Large cell carcinoma
D. Small cell carcinoma
Answer: D
Conceptual Explanation: Small cell lung cancer is a neuroendocrine tumor frequently
associated with paraneoplastic syndromes, such as the Syndrome of Inappropriate
Antidiuretic Hormone (SIADH), which leads to hyponatremia.
5. In the treatment of a patient with inhalation rib dysfunction of rib 4, which muscle is most
likely used for muscle energy treatment?
A. Anterior scalene
B. Pectoralis minor
C. Serratus anterior
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with low back pain. Physical examination reveals a positive
seated flexion test on the right, a deep right sacral sulcus, and a posterior left inferior lateral
angle (ILA). Which of the following 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
Answer: C
Conceptual Explanation: The positive seated flexion test on the right indicates the side of
the dysfunction. A deep right sulcus and posterior left ILA, combined with a right-sided
flexion test, signifies that the sacrum has rotated right on a right oblique axis (R on R).
,2. A 24-year-old patient presents with a cough and fever. A chest X-ray shows an infiltrate in
the right lower lobe. If this is caused by Streptococcus pneumoniae, what is the mechanism of
resistance most commonly seen against macrolides in this organism?
A. Production of beta-lactamase
B. Efflux pumps for the antibiotic
C. Methylation of the 23S rRNA binding site
D. Alteration of penicillin-binding proteins
Answer: C
Conceptual Explanation: The most common mechanism of high-level macrolide
resistance in S. pneumoniae is the methylation of the 23S rRNA component of the 50S
ribosomal subunit, which prevents the antibiotic from binding.
3. A patient presents with a mid-systolic crescendo-decrescendo murmur heard best at the
right second intercostal space, radiating to the carotids. Which of the following findings
would most likely be associated with this condition?
A. Widened pulse pressure
B. Pulsus parvus et tardus
C. Opening snap
D. Holosystolic murmur at the apex
Answer: B
, Conceptual Explanation: The description is characteristic of aortic stenosis. Pulsus parvus
et tardus (weak and late pulses) is a classic finding in severe aortic stenosis due to the
obstructed outflow from the left ventricle.
4. A 60-year-old female with a history of chronic smoking presents with a new-onset cough
and hemoptysis. Laboratory tests show a serum sodium of 120 mEq/L. Which type of lung
cancer is most likely?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Large cell carcinoma
D. Small cell carcinoma
Answer: D
Conceptual Explanation: Small cell lung cancer is a neuroendocrine tumor frequently
associated with paraneoplastic syndromes, such as the Syndrome of Inappropriate
Antidiuretic Hormone (SIADH), which leads to hyponatremia.
5. In the treatment of a patient with inhalation rib dysfunction of rib 4, which muscle is most
likely used for muscle energy treatment?
A. Anterior scalene
B. Pectoralis minor
C. Serratus anterior
