FAMILY MEDICINE LATEST
COMAT EXAM
B (Celiac disease can present with anemia and transaminitis - IgA
endomysial antibody is very specific for untreated celiac disease) -
ANSWERS-A 35-year-old female with past medical history of
unspecificed anemia presents with mild generalized fatigue and some
occasional instances of self-limited diarrhea. Physical examination
reveals normoactive bowel sounds without abdominal tenderness and
hepatosplenomegaly. Laboratory studies are obtained and reveal the
following:
Hemoglobin: 11.2
Mean corpuscular volume: 115
Alkaline phosphatase: 205
Alanine aminotransferase: 58
Aspartate aminotransferase: 89
IgA endomysial antibotidy: positive
The most likely diagnosis is
A. alcoholic hepatitis
B. celiac disease
END OF
PAGE
1
, FAMILY MEDICINE LATEST
COMAT EXAM
C. Crohn's disease
D. tropical sprue
E. Whipple's disease
E (family history in father or brother with a heart attack before age 55,
or in mother or sister before age 65, is a risk factor for heart disease) -
ANSWERS-A 54-year-old female presents to the clinic for a routine
wellness examination. Cardiovascular examination is consistent with
normal S1, normal S2, with no murmurs, rubs, or gallops. Vitals include
a blood pressure of 150/80, respiratory rate of 16, heart rate of 72, and a
BMI of 23. She states she lives an active lifestyle and walks about 2
miles daily. She denies any history of diabetes or high cholesterol. She
denies any prior history of smoking or alcohol abuse. This patient would
be placed at significant risk for cardiovascular disease if she has a family
history of a myocardial infarction in her
A. aunt at age 45
B. brother at age 60
C. father at age 55
D. mother at age 65
E. sister at age 60
END OF
PAGE
2
, FAMILY MEDICINE LATEST
COMAT EXAM
B (the stem describes an abdominal aortic aneurysm with rupture - this
is most likely in patients with history of smoking, vasculitis,
hypertension, trauma, and family history - they are usually found in
patients between 65 and 70)
(according to the USPSTF, men who are 65-75 and who have ever
smoked should be screened at least once for abdominal aortic aneurysm
by abdominal ultrasonography) - ANSWERS-An elderly patient presents
to the office for a routine wellness examination. Although a history is
unremarkable, physical examination reveals a pulsatile abdominal mass
with ecchymoses around the umbilicus. Which of the following has the
highest risk for this patient's most likely condition?
A. 62-year-old male with medically managed hypertension
B. 66-year-old male with a 5-pack-year smoking history
C. 67-year-old alcoholic female
D. 77-year-old male with uncontrolled diabetes mellitus type II
E. 78-year-old female with hypertriglyceridemia
B (Goodpasture syndrome typically presents in a male patient in his mid
20s with hemoptysis and hematuria - renal biopsy will reveal linear anti-
glomerular basement membrane deposits) (A; Alport syndrome is a
END OF
PAGE
3
, FAMILY MEDICINE LATEST
COMAT EXAM
hereditary form of glomerulonephritis classically associated with
deafness and basement membrane splitting on renal biopsy) (C; IgA
nephropathy may present as episodiec gross hematuria or persistent
microscopic hematuria - patients will not have pulmonary involvement)
(D; membranoproliferative nephropathy may be nephritic and/or
nephrotic - it may be associated with other conditions such as hepatitis
C, cryoglobulinemia, and autoimmune disorders, which are not present
in this patient - it also does not explain this patient's hemoptysis) (E;
although Wegener's granulomatosis would explain this patient's
hemoptysis and hematuria, it typically affects older patients - further,
although cANCA is present in Wegener's - ANSWERS-A 26-ear-old
Caucasian man presents to the emergency department after experiencing
one episode of blood-tinged sputum that day while coughing. this
episode was associated with chest pain that has not resolved. He has
been feeling fatigued for the past two weeks. During this interval, his
urine has become dark brown. He denies any recent illnesses. He denies
alcohol, tobacco, and recreational drug use. Vitals reveal his temperature
is 100F, pulse is 104, respiratory rate is 24, and blood pressure is 144/88.
Physical examination reveals his conjunctiva are pale. He has 2+ pitting
edema of the upper and lower extremities, as well as periorbital edema.
Respiratory examination reveals bilateral inspiratory crackles over the
lower lung fields. You note paravertebral hypertonicity from T2-6 and
T10-12 bilaterally that is ropy and tender to palpation. Chest radiograph
reveals patchy bilateral pulmonary opacities. Serum laboratory results
are shown.
END OF
PAGE
4
COMAT EXAM
B (Celiac disease can present with anemia and transaminitis - IgA
endomysial antibody is very specific for untreated celiac disease) -
ANSWERS-A 35-year-old female with past medical history of
unspecificed anemia presents with mild generalized fatigue and some
occasional instances of self-limited diarrhea. Physical examination
reveals normoactive bowel sounds without abdominal tenderness and
hepatosplenomegaly. Laboratory studies are obtained and reveal the
following:
Hemoglobin: 11.2
Mean corpuscular volume: 115
Alkaline phosphatase: 205
Alanine aminotransferase: 58
Aspartate aminotransferase: 89
IgA endomysial antibotidy: positive
The most likely diagnosis is
A. alcoholic hepatitis
B. celiac disease
END OF
PAGE
1
, FAMILY MEDICINE LATEST
COMAT EXAM
C. Crohn's disease
D. tropical sprue
E. Whipple's disease
E (family history in father or brother with a heart attack before age 55,
or in mother or sister before age 65, is a risk factor for heart disease) -
ANSWERS-A 54-year-old female presents to the clinic for a routine
wellness examination. Cardiovascular examination is consistent with
normal S1, normal S2, with no murmurs, rubs, or gallops. Vitals include
a blood pressure of 150/80, respiratory rate of 16, heart rate of 72, and a
BMI of 23. She states she lives an active lifestyle and walks about 2
miles daily. She denies any history of diabetes or high cholesterol. She
denies any prior history of smoking or alcohol abuse. This patient would
be placed at significant risk for cardiovascular disease if she has a family
history of a myocardial infarction in her
A. aunt at age 45
B. brother at age 60
C. father at age 55
D. mother at age 65
E. sister at age 60
END OF
PAGE
2
, FAMILY MEDICINE LATEST
COMAT EXAM
B (the stem describes an abdominal aortic aneurysm with rupture - this
is most likely in patients with history of smoking, vasculitis,
hypertension, trauma, and family history - they are usually found in
patients between 65 and 70)
(according to the USPSTF, men who are 65-75 and who have ever
smoked should be screened at least once for abdominal aortic aneurysm
by abdominal ultrasonography) - ANSWERS-An elderly patient presents
to the office for a routine wellness examination. Although a history is
unremarkable, physical examination reveals a pulsatile abdominal mass
with ecchymoses around the umbilicus. Which of the following has the
highest risk for this patient's most likely condition?
A. 62-year-old male with medically managed hypertension
B. 66-year-old male with a 5-pack-year smoking history
C. 67-year-old alcoholic female
D. 77-year-old male with uncontrolled diabetes mellitus type II
E. 78-year-old female with hypertriglyceridemia
B (Goodpasture syndrome typically presents in a male patient in his mid
20s with hemoptysis and hematuria - renal biopsy will reveal linear anti-
glomerular basement membrane deposits) (A; Alport syndrome is a
END OF
PAGE
3
, FAMILY MEDICINE LATEST
COMAT EXAM
hereditary form of glomerulonephritis classically associated with
deafness and basement membrane splitting on renal biopsy) (C; IgA
nephropathy may present as episodiec gross hematuria or persistent
microscopic hematuria - patients will not have pulmonary involvement)
(D; membranoproliferative nephropathy may be nephritic and/or
nephrotic - it may be associated with other conditions such as hepatitis
C, cryoglobulinemia, and autoimmune disorders, which are not present
in this patient - it also does not explain this patient's hemoptysis) (E;
although Wegener's granulomatosis would explain this patient's
hemoptysis and hematuria, it typically affects older patients - further,
although cANCA is present in Wegener's - ANSWERS-A 26-ear-old
Caucasian man presents to the emergency department after experiencing
one episode of blood-tinged sputum that day while coughing. this
episode was associated with chest pain that has not resolved. He has
been feeling fatigued for the past two weeks. During this interval, his
urine has become dark brown. He denies any recent illnesses. He denies
alcohol, tobacco, and recreational drug use. Vitals reveal his temperature
is 100F, pulse is 104, respiratory rate is 24, and blood pressure is 144/88.
Physical examination reveals his conjunctiva are pale. He has 2+ pitting
edema of the upper and lower extremities, as well as periorbital edema.
Respiratory examination reveals bilateral inspiratory crackles over the
lower lung fields. You note paravertebral hypertonicity from T2-6 and
T10-12 bilaterally that is ropy and tender to palpation. Chest radiograph
reveals patchy bilateral pulmonary opacities. Serum laboratory results
are shown.
END OF
PAGE
4
