COMSAE FORM 118 PRACTICE EXAM
QUESTIONS AND VERIFIED ANSWERS
1. A 45-year-old male presents with acute onset right upper quadrant pain radiating to the
right shoulder. Physical exam reveals a positive Murphy sign. Which of the following is the
most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Right-sided pneumonia
Answer: A
Conceptual Explanation: Acute cholecystitis typically presents with RUQ pain and a
positive Murphy sign (inspiratory arrest on deep palpation of the RUQ).
2. A 24-year-old female presents with sharp right lower quadrant pain. Palpation of the right
12th rib tip reveals a tender, pea-sized nodule. This point corresponds to the Chapman reflex
for which organ?
A. Bladder
B. Ovary
C. Appendix
,D. Kidney
Answer: C
Conceptual Explanation: The anterior Chapman reflex point for the appendix is located at
the tip of the right 12th rib.
3. Regarding sacral mechanics, if L5 is sidebent left and rotated left, which of the following
sacral findings is expected?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Left-on-right backward torsion
D. Right-on-left backward torsion
Answer: D
Conceptual Explanation: According to Fryette’s rules for the sacrum: the sacral rotation is
opposite to L5 rotation, and the sacral axis is on the side of L5 sidebending. Thus, L5 SL RL
results in a R on L backward torsion.
4. A 60-year-old male presents with a history of chronic smoking and a new cough. Imaging
shows a central lung mass and laboratory studies show hypercalcemia. What is the most
likely pathology?
A. Small cell carcinoma
B. Squamous cell carcinoma
, C. Adenocarcinoma
D. Large cell carcinoma
Answer: B
Conceptual Explanation: Squamous cell carcinoma is often central and associated with
PTHrP secretion leading to hypercalcemia.
5. When performing the cranial vault hold, where should the physician’s fifth digits (pinkies)
be placed?
A. Greater wing of the sphenoid
B. Zygomatic arch
C. Squamous portion of the temporal bone
D. Lateral angles of the occiput
Answer: D
Conceptual Explanation: In the vault hold, the index finger is on the greater wing of the
sphenoid, the middle finger on the temporal bone, the ring finger on the mastoid, and the
pinky on the lateral angles of the occiput.
6. A patient presents with a history of bipolar disorder and takes medication that causes
polyuria and polydipsia. Which of the following is the most likely medication?
A. Valproate
B. Lithium
QUESTIONS AND VERIFIED ANSWERS
1. A 45-year-old male presents with acute onset right upper quadrant pain radiating to the
right shoulder. Physical exam reveals a positive Murphy sign. Which of the following is the
most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Right-sided pneumonia
Answer: A
Conceptual Explanation: Acute cholecystitis typically presents with RUQ pain and a
positive Murphy sign (inspiratory arrest on deep palpation of the RUQ).
2. A 24-year-old female presents with sharp right lower quadrant pain. Palpation of the right
12th rib tip reveals a tender, pea-sized nodule. This point corresponds to the Chapman reflex
for which organ?
A. Bladder
B. Ovary
C. Appendix
,D. Kidney
Answer: C
Conceptual Explanation: The anterior Chapman reflex point for the appendix is located at
the tip of the right 12th rib.
3. Regarding sacral mechanics, if L5 is sidebent left and rotated left, which of the following
sacral findings is expected?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Left-on-right backward torsion
D. Right-on-left backward torsion
Answer: D
Conceptual Explanation: According to Fryette’s rules for the sacrum: the sacral rotation is
opposite to L5 rotation, and the sacral axis is on the side of L5 sidebending. Thus, L5 SL RL
results in a R on L backward torsion.
4. A 60-year-old male presents with a history of chronic smoking and a new cough. Imaging
shows a central lung mass and laboratory studies show hypercalcemia. What is the most
likely pathology?
A. Small cell carcinoma
B. Squamous cell carcinoma
, C. Adenocarcinoma
D. Large cell carcinoma
Answer: B
Conceptual Explanation: Squamous cell carcinoma is often central and associated with
PTHrP secretion leading to hypercalcemia.
5. When performing the cranial vault hold, where should the physician’s fifth digits (pinkies)
be placed?
A. Greater wing of the sphenoid
B. Zygomatic arch
C. Squamous portion of the temporal bone
D. Lateral angles of the occiput
Answer: D
Conceptual Explanation: In the vault hold, the index finger is on the greater wing of the
sphenoid, the middle finger on the temporal bone, the ring finger on the mastoid, and the
pinky on the lateral angles of the occiput.
6. A patient presents with a history of bipolar disorder and takes medication that causes
polyuria and polydipsia. Which of the following is the most likely medication?
A. Valproate
B. Lithium
