COMSAE PHASE 1 ADVANCED
PRACTICE SET QUESTIONS AND
VERIFIED ANSWERS
1. A 45-year-old male presents with chronic cough and hemoptysis. A chest X-ray shows a
central lung mass. Laboratory results reveal hypercalcemia. Which of the following is the
most likely histological finding on biopsy?
A. Small round blue cells
B. Large pleomorphic cells with prominent nucleoli
C. Glandular formation with mucin production
D. Keratin pearls and intercellular bridges
Answer: D
Conceptual Explanation: Squamous cell carcinoma of the lung is often centrally located
and is known for producing parathyroid hormone-related protein (PTHrP), leading to
hypercalcemia. Histologically, it is characterized by keratin pearls and intercellular bridges.
2. A patient presents with restricted motion of the right 4th rib. On inhalation, the rib moves
freely, but it stops moving early during exhalation. What is the diagnosis and the ‘key rib’ for
muscle energy treatment?
A. Exhalation dysfunction, 12th rib
,B. Exhalation dysfunction, 4th rib
C. Inhalation dysfunction, 1st rib
D. Inhalation dysfunction, 4th rib
Answer: D
Conceptual Explanation: A rib that moves better in inhalation and is restricted in
exhalation is an inhalation dysfunction. In an inhalation dysfunction, the key rib is the
bottom rib of the group (here, only one rib is mentioned, so the 4th rib).
3. A 24-year-old female presents with fever, malaise, and a ‘butterfly’ rash on her face.
Laboratory testing shows positive anti-dsDNA antibodies. Which of the following renal
findings is most characteristic of the most severe form of this disease?
A. Linear IgG deposits along the basement membrane
B. Wire-loop glomerular capillary lesions
C. Subepithelial ‘humps’ on electron microscopy
D. Effacement of podocyte foot processes
Answer: B
Conceptual Explanation: Systemic Lupus Erythematosus (SLE) can cause Diffuse
Proliferative Glomerulonephritis (Class IV), characterized by ‘wire-loop’ lesions due to
subendothelial immune complex deposition.
, 4. An osteopathic physician evaluates a patient and finds a L on R sacral torsion. Which of the
following findings is most consistent with this diagnosis?
A. Positive seated flexion test on the right
B. Deep right sacral sulcus
C. Posterior right inferior lateral angle (ILA)
D. Decreased lumbosacral spring
Answer: D
Conceptual Explanation: A L on R sacral torsion is a forward torsion. Forward torsions
(neutral) have a negative seated flexion test (or it may be positive on the side opposite the
axis, though traditionally described as negative or symmetric), and a negative spring test at
the lumbosacral junction (meaning spring is present). Wait, correction: Forward torsions
have present spring (negative spring test). A L on R torsion has a left rotation on a right
oblique axis. Findings include a deep L sulcus and a posterior R ILA. The spring test is
negative (spring is present). Option D is correct as decreased spring occurs in backward
torsions.
5. A 60-year-old male with a history of atrial fibrillation presents with sudden onset of severe
abdominal pain out of proportion to physical exam findings. What is the most likely
diagnosis?
A. Mesenteric ischemia
B. Acute cholecystitis
PRACTICE SET QUESTIONS AND
VERIFIED ANSWERS
1. A 45-year-old male presents with chronic cough and hemoptysis. A chest X-ray shows a
central lung mass. Laboratory results reveal hypercalcemia. Which of the following is the
most likely histological finding on biopsy?
A. Small round blue cells
B. Large pleomorphic cells with prominent nucleoli
C. Glandular formation with mucin production
D. Keratin pearls and intercellular bridges
Answer: D
Conceptual Explanation: Squamous cell carcinoma of the lung is often centrally located
and is known for producing parathyroid hormone-related protein (PTHrP), leading to
hypercalcemia. Histologically, it is characterized by keratin pearls and intercellular bridges.
2. A patient presents with restricted motion of the right 4th rib. On inhalation, the rib moves
freely, but it stops moving early during exhalation. What is the diagnosis and the ‘key rib’ for
muscle energy treatment?
A. Exhalation dysfunction, 12th rib
,B. Exhalation dysfunction, 4th rib
C. Inhalation dysfunction, 1st rib
D. Inhalation dysfunction, 4th rib
Answer: D
Conceptual Explanation: A rib that moves better in inhalation and is restricted in
exhalation is an inhalation dysfunction. In an inhalation dysfunction, the key rib is the
bottom rib of the group (here, only one rib is mentioned, so the 4th rib).
3. A 24-year-old female presents with fever, malaise, and a ‘butterfly’ rash on her face.
Laboratory testing shows positive anti-dsDNA antibodies. Which of the following renal
findings is most characteristic of the most severe form of this disease?
A. Linear IgG deposits along the basement membrane
B. Wire-loop glomerular capillary lesions
C. Subepithelial ‘humps’ on electron microscopy
D. Effacement of podocyte foot processes
Answer: B
Conceptual Explanation: Systemic Lupus Erythematosus (SLE) can cause Diffuse
Proliferative Glomerulonephritis (Class IV), characterized by ‘wire-loop’ lesions due to
subendothelial immune complex deposition.
, 4. An osteopathic physician evaluates a patient and finds a L on R sacral torsion. Which of the
following findings is most consistent with this diagnosis?
A. Positive seated flexion test on the right
B. Deep right sacral sulcus
C. Posterior right inferior lateral angle (ILA)
D. Decreased lumbosacral spring
Answer: D
Conceptual Explanation: A L on R sacral torsion is a forward torsion. Forward torsions
(neutral) have a negative seated flexion test (or it may be positive on the side opposite the
axis, though traditionally described as negative or symmetric), and a negative spring test at
the lumbosacral junction (meaning spring is present). Wait, correction: Forward torsions
have present spring (negative spring test). A L on R torsion has a left rotation on a right
oblique axis. Findings include a deep L sulcus and a posterior R ILA. The spring test is
negative (spring is present). Option D is correct as decreased spring occurs in backward
torsions.
5. A 60-year-old male with a history of atrial fibrillation presents with sudden onset of severe
abdominal pain out of proportion to physical exam findings. What is the most likely
diagnosis?
A. Mesenteric ischemia
B. Acute cholecystitis
