COMSAE FINAL EXAM 2026/2027
QUESTIONS AND VERIFIED ANSWERS
1. A 68-year-old male presents to the emergency department with substernal chest pain
radiating to his left jaw. An ECG reveals ST-segment elevation in leads II, III, and aVF. Which
of the following coronary arteries is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Answer: B
Conceptual Explanation: ST-segment elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction, which is most commonly supplied by the right coronary
artery (RCA) in right-dominant individuals.
2. A 24-year-old female presents with acute onset of lower abdominal pain and vaginal
spotting. Her last menstrual period was 7 weeks ago. Physical exam reveals adnexal
tenderness and a palpable mass. Her beta-hCG is 3,500 mIU/mL. A transvaginal ultrasound
shows an empty uterus. What is the most likely location of the suspected pathology?
A. Ovary
,B. Interstitium of the fallopian tube
C. Ampulla of the fallopian tube
D. Cervix
Answer: C
Conceptual Explanation: Ectopic pregnancy most commonly occurs in the fallopian tube,
specifically the ampulla (approximately 70% of cases).
3. During an osteopathic structural exam, a patient is found to have T5 rotated right and
sidebent right. This somatic dysfunction is worse when the patient extends their spine. What
is the correct diagnosis?
A. T5 Extended, Sidebent Right, Rotated Right (T5 E SR RR)
B. T5 Flexed, Sidebent Right, Rotated Right (T5 F SR RR)
C. T5 Neutral, Sidebent Right, Rotated Left (T5 N SR RL)
D. T5 Flexed, Sidebent Left, Rotated Left (T5 F SL RL)
Answer: B
Conceptual Explanation: Since the dysfunction is worse in extension, it is restricted in
extension and thus ‘named’ for its preference, which is flexion. According to Fryette’s Law
II, a single segment dysfunction in a non-neutral position will sidebend and rotate to the
same side.
, 4. A 45-year-old male with a history of obesity presents for a routine check-up. His fasting
plasma glucose is 135 mg/dL on two separate occasions. His hemoglobin A1c is 7.2%. Which
of the following is the first-line pharmacological treatment for this patient?
A. Glyburide
B. Liraglutide
C. Sitagliptin
D. Metformin
Answer: D
Conceptual Explanation: Metformin is the first-line pharmacological therapy for Type 2
Diabetes Mellitus due to its efficacy, safety profile, and weight-neutral effects.
5. A 3-year-old boy is brought to the pediatrician by his mother because of a ‘barking’ cough
and inspiratory stridor that began last night. He has a low-grade fever and rhinorrhea. An X-
ray of the neck shows subglottic narrowing. What is the most likely causative agent?
A. Haemophilus influenzae type b
B. Parainfluenza virus
C. Respiratory syncytial virus
D. Bordetella pertussis
Answer: B
QUESTIONS AND VERIFIED ANSWERS
1. A 68-year-old male presents to the emergency department with substernal chest pain
radiating to his left jaw. An ECG reveals ST-segment elevation in leads II, III, and aVF. Which
of the following coronary arteries is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Answer: B
Conceptual Explanation: ST-segment elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction, which is most commonly supplied by the right coronary
artery (RCA) in right-dominant individuals.
2. A 24-year-old female presents with acute onset of lower abdominal pain and vaginal
spotting. Her last menstrual period was 7 weeks ago. Physical exam reveals adnexal
tenderness and a palpable mass. Her beta-hCG is 3,500 mIU/mL. A transvaginal ultrasound
shows an empty uterus. What is the most likely location of the suspected pathology?
A. Ovary
,B. Interstitium of the fallopian tube
C. Ampulla of the fallopian tube
D. Cervix
Answer: C
Conceptual Explanation: Ectopic pregnancy most commonly occurs in the fallopian tube,
specifically the ampulla (approximately 70% of cases).
3. During an osteopathic structural exam, a patient is found to have T5 rotated right and
sidebent right. This somatic dysfunction is worse when the patient extends their spine. What
is the correct diagnosis?
A. T5 Extended, Sidebent Right, Rotated Right (T5 E SR RR)
B. T5 Flexed, Sidebent Right, Rotated Right (T5 F SR RR)
C. T5 Neutral, Sidebent Right, Rotated Left (T5 N SR RL)
D. T5 Flexed, Sidebent Left, Rotated Left (T5 F SL RL)
Answer: B
Conceptual Explanation: Since the dysfunction is worse in extension, it is restricted in
extension and thus ‘named’ for its preference, which is flexion. According to Fryette’s Law
II, a single segment dysfunction in a non-neutral position will sidebend and rotate to the
same side.
, 4. A 45-year-old male with a history of obesity presents for a routine check-up. His fasting
plasma glucose is 135 mg/dL on two separate occasions. His hemoglobin A1c is 7.2%. Which
of the following is the first-line pharmacological treatment for this patient?
A. Glyburide
B. Liraglutide
C. Sitagliptin
D. Metformin
Answer: D
Conceptual Explanation: Metformin is the first-line pharmacological therapy for Type 2
Diabetes Mellitus due to its efficacy, safety profile, and weight-neutral effects.
5. A 3-year-old boy is brought to the pediatrician by his mother because of a ‘barking’ cough
and inspiratory stridor that began last night. He has a low-grade fever and rhinorrhea. An X-
ray of the neck shows subglottic narrowing. What is the most likely causative agent?
A. Haemophilus influenzae type b
B. Parainfluenza virus
C. Respiratory syncytial virus
D. Bordetella pertussis
Answer: B
