COMSAE PHASE 2 LEVEL 2 BSA 119 FINAL EXAM WITH
200 QUESTIONS AND ANSWERS WITH RATIONALES
Question 1: A 52-year-old patient with type 2 diabetes presents with foot pain and
numbness. Which diagnostic test is most sensitive for detecting peripheral
neuropathy?
A. Nerve conduction velocity study
B. 10-gram monofilament testing
C. Ankle-brachial index
D. Electromyography
CORRECT ANSWER: B. 10-gram monofilament testing
Rationale: The Semmes-Weinstein 10-gram monofilament test is a highly sensitive,
quick bedside tool for identifying loss of protective sensation in diabetic peripheral
neuropathy and assessing ulcer risk.
Question 2: During osteopathic structural examination, a physician identifies a left
anterior innominate rotation. Which muscle energy technique is indicated?
A. Patient actively extends the hip against resistance
B. Patient actively flexes the hip against resistance
C. Passive sacral rocking
D. High velocity thrust to the lumbar spine
CORRECT ANSWER: B. Patient actively flexes the hip against resistance
Rationale: Anterior innominate rotation dysfunction is corrected by positioning the
hip in flexion to engage the restrictive barrier and using isometric contraction of hip
flexors to restore normal mechanics.
Question 3: Which pharmacologic agent is first-line for rate control in a
hemodynamically stable patient with new-onset atrial fibrillation?
A. Digoxin
B. Metoprolol
C. Adenosine
D. Amiodarone
CORRECT ANSWER: B. Metoprolol
Rationale: Beta-blockers such as metoprolol are preferred initial agents for
Page 1 of 60
,ventricular rate control in atrial fibrillation due to rapid onset and efficacy in
reducing AV nodal conduction.
Question 4: A patient with suspected acute cholecystitis demonstrates a positive
Murphy sign. This finding represents?
A. Inspiratory arrest due to pain in the right upper quadrant
B. Rebound tenderness in the left lower quadrant
C. Pain on passive straight leg raise
D. Costovertebral angle tenderness
CORRECT ANSWER: A. Inspiratory arrest due to pain in the right upper
quadrant
Rationale: Murphy sign is a classic physical finding in acute cholecystitis where
palpation under the right costal margin during inspiration causes abrupt cessation
of inspiration secondary to pain.
Question 5: In cranial osteopathic manipulative treatment, the V-spread technique is
primarily applied to?
A. Improve venous sinus drainage
B. Mobilize the sacrum
C. Release thoracic inlet restrictions
D. Correct rib inhalation dysfunctions
CORRECT ANSWER: A. Improve venous sinus drainage
Rationale: The V-spread applies gentle lifting forces at cranial sutures to facilitate
drainage through the dural venous sinuses and reduce intracranial pressure.
Question 6: A 45-year-old female with proximal muscle weakness, heliotrope rash,
and Gottron papules has which condition?
A. Polymyositis
B. Dermatomyositis
C. Inclusion body myositis
D. Myasthenia gravis
CORRECT ANSWER: B. Dermatomyositis
Rationale: The characteristic heliotrope rash and Gottron papules combined with
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,proximal weakness are pathognomonic for dermatomyositis, an inflammatory
myopathy.
Question 7: Which spinal levels are associated with viscerosomatic reflexes originating
from the pancreas?
A. T5-T9
B. T9-T11
C. T12-L2
D. L3-L5
CORRECT ANSWER: B. T9-T11
Rationale: Sympathetic innervation to the pancreas refers to the T9-T11 spinal
segments, where paraspinal tissue texture changes and tenderness may be
palpated.
Question 8: The initial laboratory test for suspected primary hyperparathyroidism is?
A. Serum calcium and PTH levels
B. Serum phosphate only
C. 24-hour urinary calcium
D. Vitamin D level
CORRECT ANSWER: A. Serum calcium and PTH levels
Rationale: Elevated serum calcium with inappropriately normal or high PTH confirms
the diagnosis of primary hyperparathyroidism.
Question 9: A patient with chronic obstructive pulmonary disease benefits most from
which osteopathic technique to improve respiratory function?
A. Rib raising and diaphragmatic doming
B. Occipitoatlantal decompression
C. Sacral CV4 hold
D. Pedal lymphatic pump
CORRECT ANSWER: A. Rib raising and diaphragmatic doming
Rationale: These techniques enhance thoracic cage mobility, reduce sympathetic
tone, and improve diaphragmatic excursion in patients with restrictive or obstructive
lung disease.
Page 3 of 60
, Question 10: Which organism is the most common cause of bacterial meningitis in
neonates?
A. Group B Streptococcus
B. Neisseria meningitidis
C. Streptococcus pneumoniae
D. Listeria monocytogenes
CORRECT ANSWER: A. Group B Streptococcus
Rationale: Group B Streptococcus (Streptococcus agalactiae) remains the leading
cause of early-onset neonatal bacterial meningitis.
Question 11: In a patient with suspected lumbar disc herniation causing
radiculopathy, the straight leg raise test is positive at 40 degrees. This indicates
irritation of which nerve root?
A. L3
B. L4
C. L5 or S1
D. L2
CORRECT ANSWER: C. L5 or S1
Rationale: Positive straight leg raise between 30-70 degrees reproduces sciatic
nerve tension, most commonly involving the L5 or S1 nerve roots.
Question 12: The mechanism of action of spironolactone is?
A. Aldosterone receptor antagonism
B. Carbonic anhydrase inhibition
C. Loop of Henle sodium reabsorption blockade
D. Thiazide-like distal tubule action
CORRECT ANSWER: A. Aldosterone receptor antagonism
Rationale: As a potassium-sparing diuretic, spironolactone competitively inhibits
aldosterone receptors in the collecting duct.
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200 QUESTIONS AND ANSWERS WITH RATIONALES
Question 1: A 52-year-old patient with type 2 diabetes presents with foot pain and
numbness. Which diagnostic test is most sensitive for detecting peripheral
neuropathy?
A. Nerve conduction velocity study
B. 10-gram monofilament testing
C. Ankle-brachial index
D. Electromyography
CORRECT ANSWER: B. 10-gram monofilament testing
Rationale: The Semmes-Weinstein 10-gram monofilament test is a highly sensitive,
quick bedside tool for identifying loss of protective sensation in diabetic peripheral
neuropathy and assessing ulcer risk.
Question 2: During osteopathic structural examination, a physician identifies a left
anterior innominate rotation. Which muscle energy technique is indicated?
A. Patient actively extends the hip against resistance
B. Patient actively flexes the hip against resistance
C. Passive sacral rocking
D. High velocity thrust to the lumbar spine
CORRECT ANSWER: B. Patient actively flexes the hip against resistance
Rationale: Anterior innominate rotation dysfunction is corrected by positioning the
hip in flexion to engage the restrictive barrier and using isometric contraction of hip
flexors to restore normal mechanics.
Question 3: Which pharmacologic agent is first-line for rate control in a
hemodynamically stable patient with new-onset atrial fibrillation?
A. Digoxin
B. Metoprolol
C. Adenosine
D. Amiodarone
CORRECT ANSWER: B. Metoprolol
Rationale: Beta-blockers such as metoprolol are preferred initial agents for
Page 1 of 60
,ventricular rate control in atrial fibrillation due to rapid onset and efficacy in
reducing AV nodal conduction.
Question 4: A patient with suspected acute cholecystitis demonstrates a positive
Murphy sign. This finding represents?
A. Inspiratory arrest due to pain in the right upper quadrant
B. Rebound tenderness in the left lower quadrant
C. Pain on passive straight leg raise
D. Costovertebral angle tenderness
CORRECT ANSWER: A. Inspiratory arrest due to pain in the right upper
quadrant
Rationale: Murphy sign is a classic physical finding in acute cholecystitis where
palpation under the right costal margin during inspiration causes abrupt cessation
of inspiration secondary to pain.
Question 5: In cranial osteopathic manipulative treatment, the V-spread technique is
primarily applied to?
A. Improve venous sinus drainage
B. Mobilize the sacrum
C. Release thoracic inlet restrictions
D. Correct rib inhalation dysfunctions
CORRECT ANSWER: A. Improve venous sinus drainage
Rationale: The V-spread applies gentle lifting forces at cranial sutures to facilitate
drainage through the dural venous sinuses and reduce intracranial pressure.
Question 6: A 45-year-old female with proximal muscle weakness, heliotrope rash,
and Gottron papules has which condition?
A. Polymyositis
B. Dermatomyositis
C. Inclusion body myositis
D. Myasthenia gravis
CORRECT ANSWER: B. Dermatomyositis
Rationale: The characteristic heliotrope rash and Gottron papules combined with
Page 2 of 60
,proximal weakness are pathognomonic for dermatomyositis, an inflammatory
myopathy.
Question 7: Which spinal levels are associated with viscerosomatic reflexes originating
from the pancreas?
A. T5-T9
B. T9-T11
C. T12-L2
D. L3-L5
CORRECT ANSWER: B. T9-T11
Rationale: Sympathetic innervation to the pancreas refers to the T9-T11 spinal
segments, where paraspinal tissue texture changes and tenderness may be
palpated.
Question 8: The initial laboratory test for suspected primary hyperparathyroidism is?
A. Serum calcium and PTH levels
B. Serum phosphate only
C. 24-hour urinary calcium
D. Vitamin D level
CORRECT ANSWER: A. Serum calcium and PTH levels
Rationale: Elevated serum calcium with inappropriately normal or high PTH confirms
the diagnosis of primary hyperparathyroidism.
Question 9: A patient with chronic obstructive pulmonary disease benefits most from
which osteopathic technique to improve respiratory function?
A. Rib raising and diaphragmatic doming
B. Occipitoatlantal decompression
C. Sacral CV4 hold
D. Pedal lymphatic pump
CORRECT ANSWER: A. Rib raising and diaphragmatic doming
Rationale: These techniques enhance thoracic cage mobility, reduce sympathetic
tone, and improve diaphragmatic excursion in patients with restrictive or obstructive
lung disease.
Page 3 of 60
, Question 10: Which organism is the most common cause of bacterial meningitis in
neonates?
A. Group B Streptococcus
B. Neisseria meningitidis
C. Streptococcus pneumoniae
D. Listeria monocytogenes
CORRECT ANSWER: A. Group B Streptococcus
Rationale: Group B Streptococcus (Streptococcus agalactiae) remains the leading
cause of early-onset neonatal bacterial meningitis.
Question 11: In a patient with suspected lumbar disc herniation causing
radiculopathy, the straight leg raise test is positive at 40 degrees. This indicates
irritation of which nerve root?
A. L3
B. L4
C. L5 or S1
D. L2
CORRECT ANSWER: C. L5 or S1
Rationale: Positive straight leg raise between 30-70 degrees reproduces sciatic
nerve tension, most commonly involving the L5 or S1 nerve roots.
Question 12: The mechanism of action of spironolactone is?
A. Aldosterone receptor antagonism
B. Carbonic anhydrase inhibition
C. Loop of Henle sodium reabsorption blockade
D. Thiazide-like distal tubule action
CORRECT ANSWER: A. Aldosterone receptor antagonism
Rationale: As a potassium-sparing diuretic, spironolactone competitively inhibits
aldosterone receptors in the collecting duct.
Page 4 of 60
