Page 1 of 79
COMSAE FORM 113 PRACTICE EXAM VERSION
1 | QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | PLUS RATIONALES (3
SECTIONS)
Course Name: Comprehensive Osteopathic Medical Licensure
Preparation
Subject: Osteopathic Medical Principles and Clinical Practice
SECTION 1: Questions 1-50
1. A 45-year-old male presents with acute onset of severe, tearing
chest pain that radiates to his back. His blood pressure is 180/95
mmHg in the right arm and 140/80 mmHg in the left arm. Which of
the following is the most appropriate next step?
A) Administer sublingual nitroglycerin
B) Obtain emergent CT angiography of the chest
C) Order a stat echocardiogram
D) Perform a 12-lead ECG
❖ Rationale: The presentation of tearing chest pain with asymmetric
blood pressures between arms is classic for acute aortic dissection.
CT angiography is the gold standard for diagnosis and should be
obtained emergently. Nitroglycerin would be appropriate for acute
coronary syndrome but could worsen hemodynamics in dissection.
,Page 2 of 79
Echocardiography may be useful but CT is more definitive. ECG is
important but not the next step in this scenario.
2. A 68-year-old female with a history of hypertension and type 2
diabetes presents with progressive shortness of breath and
orthopnea. On examination, she has jugular venous distension,
crackles at both lung bases, and 2+ pitting edema in her lower
extremities. Which of the following medications is most appropriate
for immediate symptom relief?
A) Metoprolol succinate
B) Furosemide
C) Lisinopril
D) Spironolactone
❖ Rationale: This patient presents with signs of acute
decompensated heart failure with volume overload. Intravenous
furosemide is the first-line therapy for immediate symptom relief
through diuresis. Metoprolol is beneficial for chronic management
but not for acute symptom relief. Lisinopril would be appropriate
for long-term management but does not provide immediate
diuresis. Spironolactone is a weak diuretic and not appropriate for
acute volume overload.
3. A 32-year-old woman presents with sudden onset of severe
headache, fever, and neck stiffness. She has been camping in the
northeastern United States. On examination, she is confused and has
a petechial rash on her trunk. Which of the following is the most likely
causative organism?
A) Streptococcus pneumoniae
B) Haemophilus influenzae type b
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C) Neisseria meningitidis
D) Listeria monocytogenes
❖ Rationale: The classic triad of fever, headache, and neck stiffness
with petechial rash is characteristic of meningococcal meningitis.
Neisseria meningitidis is a common cause of bacterial meningitis in
young adults and is associated with petechial rash. S. pneumoniae
typically presents without rash. H. influenzae type b is more
common in children. Listeria monocytogenes is more common in
immunocompromised patients and the elderly.
4. A 55-year-old male with a history of chronic alcohol use presents
with jaundice, abdominal distension, and confusion. Laboratory
studies reveal elevated AST and ALT with AST > ALT, elevated bilirubin,
and prolonged prothrombin time. Which of the following is the most
likely diagnosis?
A) Viral hepatitis
B) Alcoholic hepatitis
C) Primary biliary cirrhosis
D) Wilson's disease
❖ Rationale: The constellation of chronic alcohol use, jaundice,
abdominal distension (likely ascites), and confusion (hepatic
encephalopathy) with AST > ALT (typically >2:1) is classic for
alcoholic hepatitis. Viral hepatitis does not typically show AST >
ALT. Primary biliary cirrhosis is more common in women and is
associated with antimitochondrial antibodies. Wilson's disease
presents with Kayser-Fleischer rings and low ceruloplasmin.
5. A 28-year-old woman presents with palpitations, heat intolerance,
and weight loss despite increased appetite. On examination, she has a
, Page 4 of 79
fine tremor and exophthalmos. Which of the following laboratory
findings would be most consistent with her presentation?
A) Elevated TSH, low free T4
B) Elevated TSH, elevated free T4
C) Low TSH, elevated free T4
D) Low TSH, low free T4
❖ Rationale: This patient presents with signs and symptoms of
hyperthyroidism (palpitations, heat intolerance, weight loss,
tremor, exophthalmos). Laboratory findings in primary
hyperthyroidism show low TSH due to negative feedback and
elevated free T4. Elevated TSH with low free T4 indicates primary
hypothyroidism. Elevated TSH with elevated free T4 is inconsistent
with normal physiology. Low TSH with low free T4 suggests
secondary hypothyroidism (pituitary dysfunction).
6. A 72-year-old male with a history of benign prostatic hyperplasia
presents with acute urinary retention. A Foley catheter is placed and
800 mL of urine is drained. Which of the following is the most
appropriate next step in management?
A) Perform immediate transurethral resection of the prostate
B) Schedule urology follow-up for evaluation and management
C) Initiate antibiotic therapy
D) Order a CT urogram
❖ Rationale: Acute urinary retention secondary to BPH should be
managed initially with catheterization followed by scheduled
urology follow-up for further evaluation and definitive
management. Immediate surgery is not indicated unless
complications arise. Antibiotics are not indicated unless there is
COMSAE FORM 113 PRACTICE EXAM VERSION
1 | QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | PLUS RATIONALES (3
SECTIONS)
Course Name: Comprehensive Osteopathic Medical Licensure
Preparation
Subject: Osteopathic Medical Principles and Clinical Practice
SECTION 1: Questions 1-50
1. A 45-year-old male presents with acute onset of severe, tearing
chest pain that radiates to his back. His blood pressure is 180/95
mmHg in the right arm and 140/80 mmHg in the left arm. Which of
the following is the most appropriate next step?
A) Administer sublingual nitroglycerin
B) Obtain emergent CT angiography of the chest
C) Order a stat echocardiogram
D) Perform a 12-lead ECG
❖ Rationale: The presentation of tearing chest pain with asymmetric
blood pressures between arms is classic for acute aortic dissection.
CT angiography is the gold standard for diagnosis and should be
obtained emergently. Nitroglycerin would be appropriate for acute
coronary syndrome but could worsen hemodynamics in dissection.
,Page 2 of 79
Echocardiography may be useful but CT is more definitive. ECG is
important but not the next step in this scenario.
2. A 68-year-old female with a history of hypertension and type 2
diabetes presents with progressive shortness of breath and
orthopnea. On examination, she has jugular venous distension,
crackles at both lung bases, and 2+ pitting edema in her lower
extremities. Which of the following medications is most appropriate
for immediate symptom relief?
A) Metoprolol succinate
B) Furosemide
C) Lisinopril
D) Spironolactone
❖ Rationale: This patient presents with signs of acute
decompensated heart failure with volume overload. Intravenous
furosemide is the first-line therapy for immediate symptom relief
through diuresis. Metoprolol is beneficial for chronic management
but not for acute symptom relief. Lisinopril would be appropriate
for long-term management but does not provide immediate
diuresis. Spironolactone is a weak diuretic and not appropriate for
acute volume overload.
3. A 32-year-old woman presents with sudden onset of severe
headache, fever, and neck stiffness. She has been camping in the
northeastern United States. On examination, she is confused and has
a petechial rash on her trunk. Which of the following is the most likely
causative organism?
A) Streptococcus pneumoniae
B) Haemophilus influenzae type b
,Page 3 of 79
C) Neisseria meningitidis
D) Listeria monocytogenes
❖ Rationale: The classic triad of fever, headache, and neck stiffness
with petechial rash is characteristic of meningococcal meningitis.
Neisseria meningitidis is a common cause of bacterial meningitis in
young adults and is associated with petechial rash. S. pneumoniae
typically presents without rash. H. influenzae type b is more
common in children. Listeria monocytogenes is more common in
immunocompromised patients and the elderly.
4. A 55-year-old male with a history of chronic alcohol use presents
with jaundice, abdominal distension, and confusion. Laboratory
studies reveal elevated AST and ALT with AST > ALT, elevated bilirubin,
and prolonged prothrombin time. Which of the following is the most
likely diagnosis?
A) Viral hepatitis
B) Alcoholic hepatitis
C) Primary biliary cirrhosis
D) Wilson's disease
❖ Rationale: The constellation of chronic alcohol use, jaundice,
abdominal distension (likely ascites), and confusion (hepatic
encephalopathy) with AST > ALT (typically >2:1) is classic for
alcoholic hepatitis. Viral hepatitis does not typically show AST >
ALT. Primary biliary cirrhosis is more common in women and is
associated with antimitochondrial antibodies. Wilson's disease
presents with Kayser-Fleischer rings and low ceruloplasmin.
5. A 28-year-old woman presents with palpitations, heat intolerance,
and weight loss despite increased appetite. On examination, she has a
, Page 4 of 79
fine tremor and exophthalmos. Which of the following laboratory
findings would be most consistent with her presentation?
A) Elevated TSH, low free T4
B) Elevated TSH, elevated free T4
C) Low TSH, elevated free T4
D) Low TSH, low free T4
❖ Rationale: This patient presents with signs and symptoms of
hyperthyroidism (palpitations, heat intolerance, weight loss,
tremor, exophthalmos). Laboratory findings in primary
hyperthyroidism show low TSH due to negative feedback and
elevated free T4. Elevated TSH with low free T4 indicates primary
hypothyroidism. Elevated TSH with elevated free T4 is inconsistent
with normal physiology. Low TSH with low free T4 suggests
secondary hypothyroidism (pituitary dysfunction).
6. A 72-year-old male with a history of benign prostatic hyperplasia
presents with acute urinary retention. A Foley catheter is placed and
800 mL of urine is drained. Which of the following is the most
appropriate next step in management?
A) Perform immediate transurethral resection of the prostate
B) Schedule urology follow-up for evaluation and management
C) Initiate antibiotic therapy
D) Order a CT urogram
❖ Rationale: Acute urinary retention secondary to BPH should be
managed initially with catheterization followed by scheduled
urology follow-up for further evaluation and definitive
management. Immediate surgery is not indicated unless
complications arise. Antibiotics are not indicated unless there is
