COMSAE PHASE 2 COMPREHENSIVE
EXAM QUESTIONS AND VERIFIED
ANSWERS
1. A 64-year-old male with a history of tobacco use presents with acute onset chest pain. EKG
shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left main coronary artery
C. Left circumflex artery
D. Right coronary artery
Answer: D
Conceptual Explanation: Leads II, III, and aVF represent the inferior wall of the heart,
which is supplied by the right coronary artery in most individuals.
2. On structural examination of a 30-year-old female, L5 is found to be sidebent left and
rotated left. A seated flexion test is positive on the right. What is the most likely sacral
diagnosis?
A. Right on Left sacral torsion
B. Left on Left sacral torsion
,C. Right on Right sacral torsion
D. Left on Right sacral torsion
Answer: A
Conceptual Explanation: According to Fryette’s laws applied to the sacrum, sacral
sidebending occurs to the same side as L5 sidebending (the axis). Sacral rotation is
opposite to L5 rotation. L5 sidebent left specifies a left axis. L5 rotated left means sacrum
rotated right. Thus, Right on Left (backward torsion).
3. A 45-year-old female with bipolar disorder managed with Lithium presents with polyuria
and polydipsia. Laboratory studies show hypernatremia and low urine osmolality that does
not increase after administration of desmopressin. What is the mechanism of this side effect?
A. Increased ADH secretion
B. Decreased thirst threshold
C. Inhibition of the V1 receptor
D. Collecting duct resistance to ADH
Answer: D
Conceptual Explanation: Lithium causes nephrogenic diabetes insipidus by inducing
resistance to antidiuretic hormone (ADH) in the collecting ducts.
, 4. A 28-year-old G1P0 at 36 weeks gestation presents with a blood pressure of 165/115
mmHg and a 24-hour urine protein of 5g. She complains of a severe headache and blurry
vision. What is the most appropriate next step in management?
A. Intravenous Magnesium Sulfate and delivery
B. Immediate cesarean section
C. Bed rest and weekly follow-up
D. Wait for spontaneous labor
Answer: A
Conceptual Explanation: This patient has preeclampsia with severe features.
Management involves blood pressure control, seizure prophylaxis with Magnesium Sulfate,
and delivery regardless of gestational age.
5. A 2-year-old male presents with a barky cough and inspiratory stridor. An X-ray shows
subglottic narrowing (steeple sign). What is the most common causative agent?
A. Respiratory syncytial virus
B. Parainfluenza virus
C. Haemophilus influenzae type b
D. Adenovirus
Answer: B
EXAM QUESTIONS AND VERIFIED
ANSWERS
1. A 64-year-old male with a history of tobacco use presents with acute onset chest pain. EKG
shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left main coronary artery
C. Left circumflex artery
D. Right coronary artery
Answer: D
Conceptual Explanation: Leads II, III, and aVF represent the inferior wall of the heart,
which is supplied by the right coronary artery in most individuals.
2. On structural examination of a 30-year-old female, L5 is found to be sidebent left and
rotated left. A seated flexion test is positive on the right. What is the most likely sacral
diagnosis?
A. Right on Left sacral torsion
B. Left on Left sacral torsion
,C. Right on Right sacral torsion
D. Left on Right sacral torsion
Answer: A
Conceptual Explanation: According to Fryette’s laws applied to the sacrum, sacral
sidebending occurs to the same side as L5 sidebending (the axis). Sacral rotation is
opposite to L5 rotation. L5 sidebent left specifies a left axis. L5 rotated left means sacrum
rotated right. Thus, Right on Left (backward torsion).
3. A 45-year-old female with bipolar disorder managed with Lithium presents with polyuria
and polydipsia. Laboratory studies show hypernatremia and low urine osmolality that does
not increase after administration of desmopressin. What is the mechanism of this side effect?
A. Increased ADH secretion
B. Decreased thirst threshold
C. Inhibition of the V1 receptor
D. Collecting duct resistance to ADH
Answer: D
Conceptual Explanation: Lithium causes nephrogenic diabetes insipidus by inducing
resistance to antidiuretic hormone (ADH) in the collecting ducts.
, 4. A 28-year-old G1P0 at 36 weeks gestation presents with a blood pressure of 165/115
mmHg and a 24-hour urine protein of 5g. She complains of a severe headache and blurry
vision. What is the most appropriate next step in management?
A. Intravenous Magnesium Sulfate and delivery
B. Immediate cesarean section
C. Bed rest and weekly follow-up
D. Wait for spontaneous labor
Answer: A
Conceptual Explanation: This patient has preeclampsia with severe features.
Management involves blood pressure control, seizure prophylaxis with Magnesium Sulfate,
and delivery regardless of gestational age.
5. A 2-year-old male presents with a barky cough and inspiratory stridor. An X-ray shows
subglottic narrowing (steeple sign). What is the most common causative agent?
A. Respiratory syncytial virus
B. Parainfluenza virus
C. Haemophilus influenzae type b
D. Adenovirus
Answer: B
