Page 1 of 72
COMSAE FORM 113 PRACTICE EXAM VERSION
3 | QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | Plus RATIONALES (3
SECTIONS)
Course Name: Osteopathic Medical Comprehensive Assessment
Subject: Osteopathic Principles, Clinical Medicine, and Integrated
Medical Sciences
SECTION 1: QUESTIONS 1-50
1. A 45-year-old male with a history of hypertension presents with
acute-onset severe headache, nausea, and photophobia. Vital signs:
BP 190/110 mmHg, HR 92 bpm, RR 18/min, T 37.0°C. Neurological
examination reveals no focal deficits. Which of the following is the
most appropriate initial diagnostic step?
A) Lumbar puncture
B) Non-contrast head CT
C) MRI brain with contrast
D) Carotid ultrasound
❖ Correct. Non-contrast head CT is the initial imaging study of choice
for suspected subarachnoid hemorrhage, which is a consideration
in this hypertensive patient with thunderclap headache. CT has
high sensitivity within the first 6-12 hours of symptom onset.
,Page 2 of 72
2. A 28-year-old pregnant woman at 32 weeks gestation presents with
right upper quadrant pain, nausea, and vomiting. Lab results: AST 85
U/L, ALT 92 U/L, total bilirubin 3.8 mg/dL, alkaline phosphatase 320
U/L, platelet count 98,000/μL. What is the most likely diagnosis?
A) Acute viral hepatitis
B) HELLP syndrome
C) Intrahepatic cholestasis of pregnancy
D) Acute fatty liver of pregnancy
❖ Correct. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low
Platelets) typically presents in the third trimester with right upper
quadrant pain, elevated liver enzymes, and thrombocytopenia.
The platelet count of 98,000/μL and elevated transaminases are
consistent with this diagnosis.
3. A 55-year-old male with COPD presents with worsening dyspnea
and purulent sputum production. He has been using his albuterol
inhaler every 2 hours without relief. His oxygen saturation is 88% on
room air. Which of the following would be the most appropriate next
step in management?
A) Prescribe oral prednisone 40 mg daily
B) Increase albuterol frequency to every hour
C) Obtain chest X-ray and arterial blood gas
D) Administer supplemental oxygen and initiate antibiotic therapy
❖ Correct. Acute exacerbation of COPD with hypoxia requires
supplemental oxygen. The presence of purulent sputum indicates
,Page 3 of 72
bacterial infection, warranting antibiotic therapy. The history
suggests moderate-to-severe exacerbation requiring
comprehensive management.
4. A 32-year-old woman presents with a 6-month history of fatigue,
joint pain, and a butterfly-shaped rash on her face that worsens with
sun exposure. Laboratory findings: ANA positive (1:640), anti-dsDNA
positive, low C3 and C4 levels. What is the most appropriate
treatment for her cutaneous manifestations?
A) Oral prednisone 60 mg/day
B) Hydroxychloroquine 400 mg/day
C) Methotrexate 15 mg/week
D) Cyclophosphamide 1 g/m² monthly
❖ Correct. Hydroxychloroquine is the first-line treatment for
cutaneous manifestations of systemic lupus erythematosus. It also
helps reduce disease flares and has immunomodulatory effects
without the significant side effects associated with high-dose
corticosteroids.
5. A 68-year-old male with a history of atrial fibrillation on warfarin
presents with acute onset of right-sided weakness and aphasia. His
last known normal was 2 hours ago. CT head shows no hemorrhage
but no clear infarct. INR is 2.8. What is the most appropriate
management?
A) Administer IV tPA immediately
B) Reverse warfarin with vitamin K and fresh frozen plasma
, Page 4 of 72
C) Hold warfarin and consider mechanical thrombectomy
D) Administer aspirin 325 mg
❖ Correct. In patients with acute ischemic stroke and INR > 1.7, IV
tPA is contraindicated. The patient is within the 6-hour window for
mechanical thrombectomy, which can be considered in large vessel
occlusions. Holding warfarin and pursuing mechanical
thrombectomy is the safest approach.
6. A 23-year-old college student presents with a 3-day history of fever,
sore throat, and tender anterior cervical lymphadenopathy. Complete
blood count shows lymphocytes >50% with atypical lymphocytes
present. What is the most appropriate recommendation?
A) Amoxicillin 500 mg TID for 10 days
B) Corticosteroid therapy
C) Rest, hydration, and acetaminophen as needed
D) Referral for tonsillectomy
❖ Correct. This presentation is consistent with infectious
mononucleosis caused by Epstein-Barr virus. The management is
supportive, including rest, hydration, and antipyretics. Amoxicillin
should be avoided due to the risk of maculopapular rash.
7. A 65-year-old female with osteoporosis presents with acute low
back pain after lifting a heavy object. She has point tenderness at the
L2 spinous process without neurologic deficits. X-ray reveals a wedge-
shaped compression fracture. What is the most appropriate initial
management?
COMSAE FORM 113 PRACTICE EXAM VERSION
3 | QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | Plus RATIONALES (3
SECTIONS)
Course Name: Osteopathic Medical Comprehensive Assessment
Subject: Osteopathic Principles, Clinical Medicine, and Integrated
Medical Sciences
SECTION 1: QUESTIONS 1-50
1. A 45-year-old male with a history of hypertension presents with
acute-onset severe headache, nausea, and photophobia. Vital signs:
BP 190/110 mmHg, HR 92 bpm, RR 18/min, T 37.0°C. Neurological
examination reveals no focal deficits. Which of the following is the
most appropriate initial diagnostic step?
A) Lumbar puncture
B) Non-contrast head CT
C) MRI brain with contrast
D) Carotid ultrasound
❖ Correct. Non-contrast head CT is the initial imaging study of choice
for suspected subarachnoid hemorrhage, which is a consideration
in this hypertensive patient with thunderclap headache. CT has
high sensitivity within the first 6-12 hours of symptom onset.
,Page 2 of 72
2. A 28-year-old pregnant woman at 32 weeks gestation presents with
right upper quadrant pain, nausea, and vomiting. Lab results: AST 85
U/L, ALT 92 U/L, total bilirubin 3.8 mg/dL, alkaline phosphatase 320
U/L, platelet count 98,000/μL. What is the most likely diagnosis?
A) Acute viral hepatitis
B) HELLP syndrome
C) Intrahepatic cholestasis of pregnancy
D) Acute fatty liver of pregnancy
❖ Correct. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low
Platelets) typically presents in the third trimester with right upper
quadrant pain, elevated liver enzymes, and thrombocytopenia.
The platelet count of 98,000/μL and elevated transaminases are
consistent with this diagnosis.
3. A 55-year-old male with COPD presents with worsening dyspnea
and purulent sputum production. He has been using his albuterol
inhaler every 2 hours without relief. His oxygen saturation is 88% on
room air. Which of the following would be the most appropriate next
step in management?
A) Prescribe oral prednisone 40 mg daily
B) Increase albuterol frequency to every hour
C) Obtain chest X-ray and arterial blood gas
D) Administer supplemental oxygen and initiate antibiotic therapy
❖ Correct. Acute exacerbation of COPD with hypoxia requires
supplemental oxygen. The presence of purulent sputum indicates
,Page 3 of 72
bacterial infection, warranting antibiotic therapy. The history
suggests moderate-to-severe exacerbation requiring
comprehensive management.
4. A 32-year-old woman presents with a 6-month history of fatigue,
joint pain, and a butterfly-shaped rash on her face that worsens with
sun exposure. Laboratory findings: ANA positive (1:640), anti-dsDNA
positive, low C3 and C4 levels. What is the most appropriate
treatment for her cutaneous manifestations?
A) Oral prednisone 60 mg/day
B) Hydroxychloroquine 400 mg/day
C) Methotrexate 15 mg/week
D) Cyclophosphamide 1 g/m² monthly
❖ Correct. Hydroxychloroquine is the first-line treatment for
cutaneous manifestations of systemic lupus erythematosus. It also
helps reduce disease flares and has immunomodulatory effects
without the significant side effects associated with high-dose
corticosteroids.
5. A 68-year-old male with a history of atrial fibrillation on warfarin
presents with acute onset of right-sided weakness and aphasia. His
last known normal was 2 hours ago. CT head shows no hemorrhage
but no clear infarct. INR is 2.8. What is the most appropriate
management?
A) Administer IV tPA immediately
B) Reverse warfarin with vitamin K and fresh frozen plasma
, Page 4 of 72
C) Hold warfarin and consider mechanical thrombectomy
D) Administer aspirin 325 mg
❖ Correct. In patients with acute ischemic stroke and INR > 1.7, IV
tPA is contraindicated. The patient is within the 6-hour window for
mechanical thrombectomy, which can be considered in large vessel
occlusions. Holding warfarin and pursuing mechanical
thrombectomy is the safest approach.
6. A 23-year-old college student presents with a 3-day history of fever,
sore throat, and tender anterior cervical lymphadenopathy. Complete
blood count shows lymphocytes >50% with atypical lymphocytes
present. What is the most appropriate recommendation?
A) Amoxicillin 500 mg TID for 10 days
B) Corticosteroid therapy
C) Rest, hydration, and acetaminophen as needed
D) Referral for tonsillectomy
❖ Correct. This presentation is consistent with infectious
mononucleosis caused by Epstein-Barr virus. The management is
supportive, including rest, hydration, and antipyretics. Amoxicillin
should be avoided due to the risk of maculopapular rash.
7. A 65-year-old female with osteoporosis presents with acute low
back pain after lifting a heavy object. She has point tenderness at the
L2 spinous process without neurologic deficits. X-ray reveals a wedge-
shaped compression fracture. What is the most appropriate initial
management?
