COMSAE CLINICAL ASSESSMENT
PHASE 4 PRACTICE EXAM QUESTIONS
AND VERIFIED ANSWERS
1. A 64-year-old male presents with acute onset substernal chest pain and diaphoresis. An
EKG shows ST-segment elevation in leads II, III, and aVF. Blood pressure is 85/50 mmHg and
heart rate is 55 bpm. There are no rales heard on lung auscultation. What is the most
appropriate next step in management?
A. Intravenous Nitroglycerin
B. Beta-blocker administration
C. Aggressive diuresis with Furosemide
D. Intravenous normal saline bolus
Answer: D
Conceptual Explanation: This patient has an inferior MI with likely right ventricular
involvement (hypotension, clear lungs). RV infarcts are preload dependent; therefore,
nitrates and diuretics are contraindicated. The immediate treatment for hypotension in this
setting is fluid resuscitation.
,2. A 28-year-old female at 34 weeks gestation presents with a headache and blurry vision.
Blood pressure is 165/115 mmHg. Urinalysis shows 3+ protein. The patient suddenly begins to
have a generalized tonic-clonic seizure. What is the first-line medication to prevent further
seizures in this patient?
A. Diazepam
B. Magnesium sulfate
C. Phenytoin
D. Valproic acid
Answer: B
Conceptual Explanation: The patient has eclampsia. Magnesium sulfate is the first-line
agent for both the prevention and treatment of seizures in patients with preeclampsia or
eclampsia.
3. A 45-year-old male presents with epigastric pain that radiates to the back and is relieved by
leaning forward. He admits to heavy alcohol use. Physical exam reveals periumbilical
ecchymosis. Osteopathic exam would most likely reveal a viscerosomatic reflex at which
level?
A. T5-T9 on the right
B. T12-L2 on the left
C. T10-T11 on the right
D. T5-T9 on the left
, Answer: D
Conceptual Explanation: The symptoms describe acute pancreatitis. The viscerosomatic
reflex for the pancreas is T5-T9, primarily on the left side.
4. During a newborn exam, a physician notes that the infant’s right leg appears shorter than
the left. When the hips and knees are flexed, the right knee is lower than the left. Which of
the following is the most appropriate next step?
A. Ultrasound of the hips
B. X-ray of the lower extremities
C. Observation for 6 months
D. Immediate Pavlik harness application
Answer: A
Conceptual Explanation: The Galeazzi sign (asymmetric knee height) suggests
Developmental Dysplasia of the Hip (DDH). In infants under 4-6 months, ultrasound is the
imaging modality of choice as the femoral head is not yet ossified.
5. A 55-year-old male with a history of hypertension and tobacco use presents with sudden
onset of ‘tearing’ chest pain radiating to the back. A CT angiogram confirms a Type B aortic
dissection. Which medication should be initiated first?
A. Sodium nitroprusside
B. Heparin
PHASE 4 PRACTICE EXAM QUESTIONS
AND VERIFIED ANSWERS
1. A 64-year-old male presents with acute onset substernal chest pain and diaphoresis. An
EKG shows ST-segment elevation in leads II, III, and aVF. Blood pressure is 85/50 mmHg and
heart rate is 55 bpm. There are no rales heard on lung auscultation. What is the most
appropriate next step in management?
A. Intravenous Nitroglycerin
B. Beta-blocker administration
C. Aggressive diuresis with Furosemide
D. Intravenous normal saline bolus
Answer: D
Conceptual Explanation: This patient has an inferior MI with likely right ventricular
involvement (hypotension, clear lungs). RV infarcts are preload dependent; therefore,
nitrates and diuretics are contraindicated. The immediate treatment for hypotension in this
setting is fluid resuscitation.
,2. A 28-year-old female at 34 weeks gestation presents with a headache and blurry vision.
Blood pressure is 165/115 mmHg. Urinalysis shows 3+ protein. The patient suddenly begins to
have a generalized tonic-clonic seizure. What is the first-line medication to prevent further
seizures in this patient?
A. Diazepam
B. Magnesium sulfate
C. Phenytoin
D. Valproic acid
Answer: B
Conceptual Explanation: The patient has eclampsia. Magnesium sulfate is the first-line
agent for both the prevention and treatment of seizures in patients with preeclampsia or
eclampsia.
3. A 45-year-old male presents with epigastric pain that radiates to the back and is relieved by
leaning forward. He admits to heavy alcohol use. Physical exam reveals periumbilical
ecchymosis. Osteopathic exam would most likely reveal a viscerosomatic reflex at which
level?
A. T5-T9 on the right
B. T12-L2 on the left
C. T10-T11 on the right
D. T5-T9 on the left
, Answer: D
Conceptual Explanation: The symptoms describe acute pancreatitis. The viscerosomatic
reflex for the pancreas is T5-T9, primarily on the left side.
4. During a newborn exam, a physician notes that the infant’s right leg appears shorter than
the left. When the hips and knees are flexed, the right knee is lower than the left. Which of
the following is the most appropriate next step?
A. Ultrasound of the hips
B. X-ray of the lower extremities
C. Observation for 6 months
D. Immediate Pavlik harness application
Answer: A
Conceptual Explanation: The Galeazzi sign (asymmetric knee height) suggests
Developmental Dysplasia of the Hip (DDH). In infants under 4-6 months, ultrasound is the
imaging modality of choice as the femoral head is not yet ossified.
5. A 55-year-old male with a history of hypertension and tobacco use presents with sudden
onset of ‘tearing’ chest pain radiating to the back. A CT angiogram confirms a Type B aortic
dissection. Which medication should be initiated first?
A. Sodium nitroprusside
B. Heparin
