COMSAE PHASE 2 FORM 116
COMPREHENSIVE CLINICAL AND
OSTEOPATHIC REVIEW QUESTIONS
AND ANSWERS
1. A 65-year-old male presents with acute onset chest pain radiating to the left arm. EKG
shows ST-segment elevation in leads V1-V4. What is the most appropriate next step in
management?
A. Observation and serial troponins
B. Administration of oral beta-blockers
C. Immediate coronary angiography and PCI
D. Emergent echocardiogram
Answer: C
Conceptual Explanation: ST-segment elevation in V1-V4 indicates an anterior wall
myocardial infarction, requiring immediate reperfusion therapy, preferably Percutaneous
Coronary Intervention (PCI) within 90 minutes.
,2. A 45-year-old female presents with pelvic pain. Examination shows a positive seated
flexion test on the left, a deep right sacral sulcus, and a posterior left inferior lateral angle
(ILA). What is the sacral diagnosis?
A. Left-on-left forward torsion
B. Right-on-left backward torsion
C. Left-on-right backward torsion
D. Right-on-right forward torsion
Answer: B
Conceptual Explanation: A positive seated flexion test on the left indicates the
dysfunction is on the left. A deep right sulcus and posterior left ILA indicate a right-rotated
sacrum. The findings are consistent with a Right-on-Left backward torsion.
3. A 24-year-old G1P0 at 32 weeks gestation presents with sudden onset painless vaginal
bleeding. Ultrasound confirms placenta previa. What is the most important contraindication
in her management?
A. Transabdominal ultrasound
B. Digital pelvic examination
C. Bed rest
D. Intravenous hydration
Answer: B
, Conceptual Explanation: Digital pelvic exams are strictly contraindicated in placenta
previa as they can cause massive hemorrhage by disrupting the placenta.
4. A 10-year-old boy presents with a barking cough, inspiratory stridor, and a low-grade fever.
An X-ray of the neck shows subglottic narrowing (steeple sign). What is the most likely
pathogen?
A. Haemophilus influenzae type b
B. Parainfluenza virus
C. Staphylococcus aureus
D. Respiratory syncytial virus
Answer: B
Conceptual Explanation: Laryngotracheobronchitis (Croup) is most commonly caused by
the parainfluenza virus and presents with a barking cough and the steeple sign on X-ray.
5. A 52-year-old male with a history of chronic alcoholism presents with confusion, ataxia,
and ophthalmoplegia. What is the most likely vitamin deficiency?
A. Vitamin B12 (Cobalamin)
B. Vitamin B1 (Thiamine)
C. Vitamin B6 (Pyridoxine)
D. Vitamin B3 (Niacin)
Answer: B
COMPREHENSIVE CLINICAL AND
OSTEOPATHIC REVIEW QUESTIONS
AND ANSWERS
1. A 65-year-old male presents with acute onset chest pain radiating to the left arm. EKG
shows ST-segment elevation in leads V1-V4. What is the most appropriate next step in
management?
A. Observation and serial troponins
B. Administration of oral beta-blockers
C. Immediate coronary angiography and PCI
D. Emergent echocardiogram
Answer: C
Conceptual Explanation: ST-segment elevation in V1-V4 indicates an anterior wall
myocardial infarction, requiring immediate reperfusion therapy, preferably Percutaneous
Coronary Intervention (PCI) within 90 minutes.
,2. A 45-year-old female presents with pelvic pain. Examination shows a positive seated
flexion test on the left, a deep right sacral sulcus, and a posterior left inferior lateral angle
(ILA). What is the sacral diagnosis?
A. Left-on-left forward torsion
B. Right-on-left backward torsion
C. Left-on-right backward torsion
D. Right-on-right forward torsion
Answer: B
Conceptual Explanation: A positive seated flexion test on the left indicates the
dysfunction is on the left. A deep right sulcus and posterior left ILA indicate a right-rotated
sacrum. The findings are consistent with a Right-on-Left backward torsion.
3. A 24-year-old G1P0 at 32 weeks gestation presents with sudden onset painless vaginal
bleeding. Ultrasound confirms placenta previa. What is the most important contraindication
in her management?
A. Transabdominal ultrasound
B. Digital pelvic examination
C. Bed rest
D. Intravenous hydration
Answer: B
, Conceptual Explanation: Digital pelvic exams are strictly contraindicated in placenta
previa as they can cause massive hemorrhage by disrupting the placenta.
4. A 10-year-old boy presents with a barking cough, inspiratory stridor, and a low-grade fever.
An X-ray of the neck shows subglottic narrowing (steeple sign). What is the most likely
pathogen?
A. Haemophilus influenzae type b
B. Parainfluenza virus
C. Staphylococcus aureus
D. Respiratory syncytial virus
Answer: B
Conceptual Explanation: Laryngotracheobronchitis (Croup) is most commonly caused by
the parainfluenza virus and presents with a barking cough and the steeple sign on X-ray.
5. A 52-year-old male with a history of chronic alcoholism presents with confusion, ataxia,
and ophthalmoplegia. What is the most likely vitamin deficiency?
A. Vitamin B12 (Cobalamin)
B. Vitamin B1 (Thiamine)
C. Vitamin B6 (Pyridoxine)
D. Vitamin B3 (Niacin)
Answer: B
