COMSAE PHASE 2 PRACTICE EXAM
(FORM 118) QUESTIONS AND VERIFIED
ANSWERS
1. A 68-year-old male presents with exertional syncope and chest pain. Physical exam reveals
a harsh, crescendo-decrescendo systolic murmur at the right second intercostal space that
radiates to the carotids. Which of the following is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Pulmonic Stenosis
D. Aortic Regurgitation
Answer: B
Conceptual Explanation: Aortic stenosis typically presents with the triad of syncope,
angina, and dyspnea (SAD). The classic murmur is a systolic crescendo-decrescendo
murmur at the right upper sternal border radiating to the carotids.
2. Osteopathic exam of a 45-year-old female reveals a sacral diagnosis where the seated
flexion test is positive on the right, the deep sulcus is on the left, and the posterior inferior
ILA is on the right. What is the diagnosis?
A. Left-on-Left Forward Torsion
,B. Right-on-Left Backward Torsion
C. Left-on-Right Backward Torsion
D. Right-on-Right Forward Torsion
Answer: B
Conceptual Explanation: In a backward torsion (Right-on-Left), the seated flexion is
positive on the side opposite the axis (Right). The deep sulcus is opposite the posterior ILA,
and the spring test at the lumbosacral junction would be positive (poor spring).
3. A 32-year-old patient presents with episodes of headache, palpitations, and diaphoresis.
Blood pressure is 190/110 mmHg. What is the most appropriate initial diagnostic test?
A. Renal artery ultrasound
B. 24-hour urine metanephrines
C. Plasma aldosterone/renin ratio
D. CT scan of the head
Answer: B
Conceptual Explanation: The classic triad of headache, palpitations, and sweating in the
setting of hypertension suggests Pheochromocytoma. Screening involves measuring 24-
hour urine metanephrines or plasma free metanephrines.
, 4. A 72-year-old male with a history of constipation presents with left lower quadrant pain
and fever. Physical exam reveals localized tenderness. What is the best imaging modality to
confirm the diagnosis?
A. CT scan with oral and IV contrast
B. Barium Enema
C. Colonoscopy
D. Abdominal X-ray
Answer: A
Conceptual Explanation: Acute diverticulitis is best diagnosed with a CT scan.
Colonoscopy and Barium Enema are contraindicated in the acute phase due to the risk of
perforation.
5. A 24-year-old male is brought to the ED by police. He claims the government is monitoring
him through his toaster and hears voices calling him a traitor. Symptoms have persisted for 7
months. What is the diagnosis?
A. Schizoaffective disorder
B. Delusional disorder
C. Schizophreniform disorder
D. Schizophrenia
Answer: D
(FORM 118) QUESTIONS AND VERIFIED
ANSWERS
1. A 68-year-old male presents with exertional syncope and chest pain. Physical exam reveals
a harsh, crescendo-decrescendo systolic murmur at the right second intercostal space that
radiates to the carotids. Which of the following is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Pulmonic Stenosis
D. Aortic Regurgitation
Answer: B
Conceptual Explanation: Aortic stenosis typically presents with the triad of syncope,
angina, and dyspnea (SAD). The classic murmur is a systolic crescendo-decrescendo
murmur at the right upper sternal border radiating to the carotids.
2. Osteopathic exam of a 45-year-old female reveals a sacral diagnosis where the seated
flexion test is positive on the right, the deep sulcus is on the left, and the posterior inferior
ILA is on the right. What is the diagnosis?
A. Left-on-Left Forward Torsion
,B. Right-on-Left Backward Torsion
C. Left-on-Right Backward Torsion
D. Right-on-Right Forward Torsion
Answer: B
Conceptual Explanation: In a backward torsion (Right-on-Left), the seated flexion is
positive on the side opposite the axis (Right). The deep sulcus is opposite the posterior ILA,
and the spring test at the lumbosacral junction would be positive (poor spring).
3. A 32-year-old patient presents with episodes of headache, palpitations, and diaphoresis.
Blood pressure is 190/110 mmHg. What is the most appropriate initial diagnostic test?
A. Renal artery ultrasound
B. 24-hour urine metanephrines
C. Plasma aldosterone/renin ratio
D. CT scan of the head
Answer: B
Conceptual Explanation: The classic triad of headache, palpitations, and sweating in the
setting of hypertension suggests Pheochromocytoma. Screening involves measuring 24-
hour urine metanephrines or plasma free metanephrines.
, 4. A 72-year-old male with a history of constipation presents with left lower quadrant pain
and fever. Physical exam reveals localized tenderness. What is the best imaging modality to
confirm the diagnosis?
A. CT scan with oral and IV contrast
B. Barium Enema
C. Colonoscopy
D. Abdominal X-ray
Answer: A
Conceptual Explanation: Acute diverticulitis is best diagnosed with a CT scan.
Colonoscopy and Barium Enema are contraindicated in the acute phase due to the risk of
perforation.
5. A 24-year-old male is brought to the ED by police. He claims the government is monitoring
him through his toaster and hears voices calling him a traitor. Symptoms have persisted for 7
months. What is the diagnosis?
A. Schizoaffective disorder
B. Delusional disorder
C. Schizophreniform disorder
D. Schizophrenia
Answer: D
