COMSAE Phase 1 Form 114 Practice Exam
Questions And Correct Answers (Verified Answers)
Plus Rationales 2025|2026 Q&A | Instant
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1. A 65-year-old male with a history of hypertension and smoking presents with
sudden-onset "tearing" chest pain radiating to his back. His blood pressure is
180/100 mmHg in the right arm and 140/90 mmHg in the left arm. What is the
most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Tension pneumothorax
Aortic dissection classically presents with sudden, severe "tearing" chest pain
radiating to the back, often accompanied by a blood pressure differential between
the arms due to involvement of the subclavian artery. Myocardial infarction
typically produces pressure-like pain without inter-arm BP discrepancy. Pulmonary
embolism causes pleuritic pain and hypoxemia. Tension pneumothorax produces
respiratory distress with absent breath sounds and tracheal deviation.
2. A 24-year-old female presents with a "velvety" patch of darkened skin on the
back of her neck. She has a BMI of 34. This skin finding is most commonly
associated with which of the following?
A) Vitamin B12 deficiency
B) Hypothyroidism
C) Insulin resistance
D) Excess sun exposure
, Acanthosis nigricans is a clinical sign of insulin resistance, frequently seen in
Type 2 diabetes mellitus, metabolic syndrome, and polycystic ovary syndrome. It
presents as hyperpigmented, velvety plaques typically in intertriginous areas such
as the posterior neck and axillae. Vitamin B12 deficiency causes glossitis and
neurologic deficits, not acanthosis nigricans.
3. During a structural examination, a patient's T4 vertebra is found to be rotated
right and sidebent right. The dysfunction improves in extension and worsens in
flexion. What is the diagnosis?
A) T4 Neutral Sidebent Left Rotated Right
B) T4 Flexed Sidebent Right Rotated Right
C) T4 Extended Sidebent Right Rotated Right
D) T4 Neutral Sidebent Right Rotated Right
Improvement in extension identifies the dysfunction as "Extended" (E). Same-
side rotation and sidebending (RRSR) follows Fryette Type II mechanics, which
occur in a non-neutral (flexed or extended) spine. Fryette Type I mechanics involve
group curves with opposite sidebending and rotation (neutral mechanics).
4. Which of the following Chapman points is located on the lateral aspect of the
middle-to-lower humerus?
A) Bladder
B) Eye
C) Ear
D) Sinuses
The anterior Chapman point for the eye is located on the surgical neck/lateral
aspect of the humerus. Chapman points are anterior and posterior tender points
used in osteopathic diagnosis to identify visceral dysfunction. The bladder point is
located on the perineum, the ear point near the mastoid process, and sinus points
on the upper ribs.
,5. A 4-year-old boy presents with a "barking" cough and inspiratory stridor. A neck
X-ray shows subglottic narrowing (steeple sign). What is the most likely causative
agent?
A) Respiratory syncytial virus (RSV)
B) Haemophilus influenzae type b
C) Parainfluenza virus
D) Bordetella pertussis
Parainfluenza virus is the most common cause of croup
(laryngotracheobronchitis), which presents with a barking cough, hoarseness, and
inspiratory stridor. The steeple sign on AP neck radiograph reflects subglottic
edema. RSV causes bronchiolitis, Hib causes epiglottitis (thumb sign), and
Bordetella pertussis causes whooping cough.
6. A 24-year-old man develops severe diarrhea after returning from a camping
trip. Laboratory studies show serum sodium 138 mEq/L and serum osmolality 290
mOsm/kg. Urine osmolality is 600 mOsm/kg. Which mechanism best explains the
maintenance of serum osmolality despite significant fluid loss?
A) Increased secretion of atrial natriuretic peptide
B) Decreased secretion of antidiuretic hormone
C) Increased renal sodium excretion
D) Increased antidiuretic hormone secretion
Volume depletion stimulates ADH release, which increases water reabsorption
through aquaporin-2 channels in the collecting ducts. Although ADH is primarily
regulated by plasma osmolality, significant hypovolemia can strongly stimulate its
secretion even when osmolality is normal, conserving water and preserving
circulating volume.
, 7. A child presents with recurrent fasting hypoglycemia, lactic acidosis,
hyperuricemia, and hepatomegaly. Laboratory evaluation reveals impaired
conversion of glucose-6-phosphate to free glucose. Which enzyme is most likely
deficient?
A) Lysosomal acid α-glucosidase
B) Muscle glycogen phosphorylase
C) Glucose-6-phosphatase
D) Branching enzyme
Glucose-6-phosphatase deficiency causes von Gierke disease (glycogen storage
disease type I). The liver cannot convert glucose-6-phosphate to free glucose,
resulting in severe fasting hypoglycemia, lactic acidosis, hyperuricemia, and
hepatomegaly. Lysosomal acid α-glucosidase deficiency causes Pompe disease
(GSD II), and branching enzyme deficiency causes Andersen disease (GSD IV).
8. A 67-year-old man with COPD develops fever, productive cough, and lobar
pneumonia. Sputum Gram stain reveals gram-positive lancet-shaped diplococci
that are α-hemolytic and optochin-sensitive. Which virulence factor most directly
inhibits phagocytosis?
A) Protein A
B) M protein
C) Lipopolysaccharide
D) Polysaccharide capsule
Streptococcus pneumoniae is an encapsulated, gram-positive, lancet-shaped
diplococcus that causes community-acquired pneumonia. Its polysaccharide
capsule inhibits phagocytosis and is a major virulence factor and the basis for its
conjugate and polysaccharide vaccines. Protein A is a virulence factor of
Staphylococcus aureus, and M protein is found in Streptococcus pyogenes.
Questions And Correct Answers (Verified Answers)
Plus Rationales 2025|2026 Q&A | Instant
Download Pdf
1. A 65-year-old male with a history of hypertension and smoking presents with
sudden-onset "tearing" chest pain radiating to his back. His blood pressure is
180/100 mmHg in the right arm and 140/90 mmHg in the left arm. What is the
most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Tension pneumothorax
Aortic dissection classically presents with sudden, severe "tearing" chest pain
radiating to the back, often accompanied by a blood pressure differential between
the arms due to involvement of the subclavian artery. Myocardial infarction
typically produces pressure-like pain without inter-arm BP discrepancy. Pulmonary
embolism causes pleuritic pain and hypoxemia. Tension pneumothorax produces
respiratory distress with absent breath sounds and tracheal deviation.
2. A 24-year-old female presents with a "velvety" patch of darkened skin on the
back of her neck. She has a BMI of 34. This skin finding is most commonly
associated with which of the following?
A) Vitamin B12 deficiency
B) Hypothyroidism
C) Insulin resistance
D) Excess sun exposure
, Acanthosis nigricans is a clinical sign of insulin resistance, frequently seen in
Type 2 diabetes mellitus, metabolic syndrome, and polycystic ovary syndrome. It
presents as hyperpigmented, velvety plaques typically in intertriginous areas such
as the posterior neck and axillae. Vitamin B12 deficiency causes glossitis and
neurologic deficits, not acanthosis nigricans.
3. During a structural examination, a patient's T4 vertebra is found to be rotated
right and sidebent right. The dysfunction improves in extension and worsens in
flexion. What is the diagnosis?
A) T4 Neutral Sidebent Left Rotated Right
B) T4 Flexed Sidebent Right Rotated Right
C) T4 Extended Sidebent Right Rotated Right
D) T4 Neutral Sidebent Right Rotated Right
Improvement in extension identifies the dysfunction as "Extended" (E). Same-
side rotation and sidebending (RRSR) follows Fryette Type II mechanics, which
occur in a non-neutral (flexed or extended) spine. Fryette Type I mechanics involve
group curves with opposite sidebending and rotation (neutral mechanics).
4. Which of the following Chapman points is located on the lateral aspect of the
middle-to-lower humerus?
A) Bladder
B) Eye
C) Ear
D) Sinuses
The anterior Chapman point for the eye is located on the surgical neck/lateral
aspect of the humerus. Chapman points are anterior and posterior tender points
used in osteopathic diagnosis to identify visceral dysfunction. The bladder point is
located on the perineum, the ear point near the mastoid process, and sinus points
on the upper ribs.
,5. A 4-year-old boy presents with a "barking" cough and inspiratory stridor. A neck
X-ray shows subglottic narrowing (steeple sign). What is the most likely causative
agent?
A) Respiratory syncytial virus (RSV)
B) Haemophilus influenzae type b
C) Parainfluenza virus
D) Bordetella pertussis
Parainfluenza virus is the most common cause of croup
(laryngotracheobronchitis), which presents with a barking cough, hoarseness, and
inspiratory stridor. The steeple sign on AP neck radiograph reflects subglottic
edema. RSV causes bronchiolitis, Hib causes epiglottitis (thumb sign), and
Bordetella pertussis causes whooping cough.
6. A 24-year-old man develops severe diarrhea after returning from a camping
trip. Laboratory studies show serum sodium 138 mEq/L and serum osmolality 290
mOsm/kg. Urine osmolality is 600 mOsm/kg. Which mechanism best explains the
maintenance of serum osmolality despite significant fluid loss?
A) Increased secretion of atrial natriuretic peptide
B) Decreased secretion of antidiuretic hormone
C) Increased renal sodium excretion
D) Increased antidiuretic hormone secretion
Volume depletion stimulates ADH release, which increases water reabsorption
through aquaporin-2 channels in the collecting ducts. Although ADH is primarily
regulated by plasma osmolality, significant hypovolemia can strongly stimulate its
secretion even when osmolality is normal, conserving water and preserving
circulating volume.
, 7. A child presents with recurrent fasting hypoglycemia, lactic acidosis,
hyperuricemia, and hepatomegaly. Laboratory evaluation reveals impaired
conversion of glucose-6-phosphate to free glucose. Which enzyme is most likely
deficient?
A) Lysosomal acid α-glucosidase
B) Muscle glycogen phosphorylase
C) Glucose-6-phosphatase
D) Branching enzyme
Glucose-6-phosphatase deficiency causes von Gierke disease (glycogen storage
disease type I). The liver cannot convert glucose-6-phosphate to free glucose,
resulting in severe fasting hypoglycemia, lactic acidosis, hyperuricemia, and
hepatomegaly. Lysosomal acid α-glucosidase deficiency causes Pompe disease
(GSD II), and branching enzyme deficiency causes Andersen disease (GSD IV).
8. A 67-year-old man with COPD develops fever, productive cough, and lobar
pneumonia. Sputum Gram stain reveals gram-positive lancet-shaped diplococci
that are α-hemolytic and optochin-sensitive. Which virulence factor most directly
inhibits phagocytosis?
A) Protein A
B) M protein
C) Lipopolysaccharide
D) Polysaccharide capsule
Streptococcus pneumoniae is an encapsulated, gram-positive, lancet-shaped
diplococcus that causes community-acquired pneumonia. Its polysaccharide
capsule inhibits phagocytosis and is a major virulence factor and the basis for its
conjugate and polysaccharide vaccines. Protein A is a virulence factor of
Staphylococcus aureus, and M protein is found in Streptococcus pyogenes.
