COMSAE Phase 1 Form 114 Test Bank |
200+ Practice Questions with Correct
Answers & Rationales – NBOME
Osteopathic Medical Knowledge Self-
Assessment Prep
1. A 58-year-old man presents with crushing chest pain radiating to the jaw. His ECG shows ST
elevations in leads V1–V4. Which coronary artery is most likely occluded?
• A. Right coronary artery
• B. Left circumflex
• C. Left anterior descending (LAD)
• D. Posterior descending artery
Rationale: ST elevations in the precordial leads V1-V4 indicate an anterior wall myocardial
infarction. The LAD artery perfuses the anterior wall of the left ventricle, making it the typical
culprit in this presentation.
2. A patient with hypertension is started on an ACE inhibitor. Which electrolyte abnormality is
most important to monitor for?
• A. Hypokalemia
• B. Hyperkalemia
• C. Hyponatremia
• D. Hypercalcemia
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to
decreased aldosterone secretion. Since aldosterone promotes potassium excretion, lower levels
result in potassium retention and a risk for hyperkalemia.
,3. A 65-year-old man presents with a resting tremor in his right hand, bradykinesia, and rigidity.
Which neurotransmitter deficiency is the primary cause of these symptoms?
• A. Serotonin
• B. Acetylcholine
• C. Dopamine
• D. GABA
Rationale: The classic triad of resting tremor, rigidity, and bradykinesia is characteristic of
Parkinson disease. The pathophysiology involves the progressive degeneration of dopaminergic
neurons in the substantia nigra pars compacta, leading to a deficiency of dopamine in the basal
ganglia.
Pulmonology
4. A patient with a 40-pack-year smoking history presents with a chronic cough, dyspnea on
exertion, and a barrel-shaped chest. Spirometry shows an FEV1/FVC ratio of 60%. What is the
most likely diagnosis?
• A. Asthma
• B. COPD
• C. Pulmonary fibrosis
• D. Bronchiectasis
Rationale: COPD is defined by irreversible or partially reversible airflow obstruction, indicated by
a post-bronchodilator FEV1/FVC ratio of less than 0.70. The patient's history of smoking and
physical exam findings (barrel chest from hyperinflation) are highly consistent with this
diagnosis.
5. A patient with a history of DVT suddenly develops sharp, pleuritic chest pain and shortness of
breath. What is the most likely diagnosis?
• A. Myocardial infarction
• B. Pulmonary embolism (PE)
• C. Spontaneous pneumothorax
• D. Pneumonia
,Rationale: The acute onset of pleuritic chest pain and dyspnea in a patient with risk factors for
(or a known history of) deep vein thrombosis is highly suspicious for a pulmonary embolism.
The most common source is an embolus that has traveled from a DVT in the lower extremities
to the pulmonary arteries.
Infectious Disease
6. A child presents with a "barking" cough and inspiratory stridor that is worse at night. What is
the most likely diagnosis?
• A. Epiglottitis
• B. Croup (Laryngotracheobronchitis)
• C. Bacterial tracheitis
• D. Pertussis
Rationale: Croup is a common viral illness in children (typically parainfluenza virus) that causes
inflammation and narrowing of the subglottic larynx. This leads to the characteristic "barking"
cough and inspiratory stridor.
7. A patient presents with fever, sore throat, and a grayish-white pseudomembrane covering the
tonsils and pharynx. Which pathogen is the most likely cause?
• A. Group A Streptococcus
• B. Corynebacterium diphtheriae
• C. Epstein-Barr virus
• D. Arcanobacterium haemolyticum
Rationale: The formation of a tightly adherent pseudomembrane in the setting of pharyngitis is
pathognomonic for respiratory diphtheria. The pseudomembrane is composed of fibrin,
bacteria, and inflammatory cells and can cause airway obstruction.
Endocrinology
8. A 25-year-old woman presents with complaints of weight loss, heat intolerance, palpitations,
and a feeling of "bulging eyes." On exam, you note proptosis and a diffuse, painless goiter.
Which condition is most likely?
• A. Hashimoto thyroiditis
• B. Graves disease
, • C. Subacute thyroiditis
• D. Toxic multinodular goiter
Rationale: The combination of hyperthyroidism symptoms (weight loss, heat intolerance) with
ophthalmologic findings (proptosis, exophthalmos) and a diffuse goiter is classic for Graves
disease. It is an autoimmune disorder caused by TSH receptor-stimulating antibodies.
9. A patient presents with episodic severe headaches, palpitations, sweating, and hypertension.
A CT scan reveals a 4-cm mass in the adrenal medulla. What is the most likely diagnosis?
• A. Adrenal cortical adenoma
• B. Pheochromocytoma
• C. Neuroblastoma
• D. Myelolipoma
Rationale: The episodic "spells" of headache, palpitations, diaphoresis, and hypertension are
the classic triad for a pheochromocytoma. This tumor arises from the chromaffin cells of the
adrenal medulla and secretes excess catecholamines (epinephrine and norepinephrine).
Osteopathic Principles & Practice (OMM)
10. The sympathetic innervation to the heart and lungs originates from which spinal cord levels?
• A. C3-C5
• B. T1-T5
• C. T6-T9
• D. T10-L2
Rationale: The sympathetic preganglionic neurons for the cardiopulmonary region are located in
the intermediolateral cell column of the spinal cord from T1 to T5. These fibers synapse in the
paravertebral ganglia, and postganglionic fibers then travel to the heart and lungs to increase
heart rate, contractility, and bronchodilation.
11. An osteopathic physician performs a "rib raising" technique on a patient with asthma. What
is the primary physiologic goal of this technique?
• A. Increase rib excursion for improved ventilation.
• B. Decrease sympathetic outflow to the pulmonary system.
• C. Increase parasympathetic tone to promote bronchodilation.
200+ Practice Questions with Correct
Answers & Rationales – NBOME
Osteopathic Medical Knowledge Self-
Assessment Prep
1. A 58-year-old man presents with crushing chest pain radiating to the jaw. His ECG shows ST
elevations in leads V1–V4. Which coronary artery is most likely occluded?
• A. Right coronary artery
• B. Left circumflex
• C. Left anterior descending (LAD)
• D. Posterior descending artery
Rationale: ST elevations in the precordial leads V1-V4 indicate an anterior wall myocardial
infarction. The LAD artery perfuses the anterior wall of the left ventricle, making it the typical
culprit in this presentation.
2. A patient with hypertension is started on an ACE inhibitor. Which electrolyte abnormality is
most important to monitor for?
• A. Hypokalemia
• B. Hyperkalemia
• C. Hyponatremia
• D. Hypercalcemia
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to
decreased aldosterone secretion. Since aldosterone promotes potassium excretion, lower levels
result in potassium retention and a risk for hyperkalemia.
,3. A 65-year-old man presents with a resting tremor in his right hand, bradykinesia, and rigidity.
Which neurotransmitter deficiency is the primary cause of these symptoms?
• A. Serotonin
• B. Acetylcholine
• C. Dopamine
• D. GABA
Rationale: The classic triad of resting tremor, rigidity, and bradykinesia is characteristic of
Parkinson disease. The pathophysiology involves the progressive degeneration of dopaminergic
neurons in the substantia nigra pars compacta, leading to a deficiency of dopamine in the basal
ganglia.
Pulmonology
4. A patient with a 40-pack-year smoking history presents with a chronic cough, dyspnea on
exertion, and a barrel-shaped chest. Spirometry shows an FEV1/FVC ratio of 60%. What is the
most likely diagnosis?
• A. Asthma
• B. COPD
• C. Pulmonary fibrosis
• D. Bronchiectasis
Rationale: COPD is defined by irreversible or partially reversible airflow obstruction, indicated by
a post-bronchodilator FEV1/FVC ratio of less than 0.70. The patient's history of smoking and
physical exam findings (barrel chest from hyperinflation) are highly consistent with this
diagnosis.
5. A patient with a history of DVT suddenly develops sharp, pleuritic chest pain and shortness of
breath. What is the most likely diagnosis?
• A. Myocardial infarction
• B. Pulmonary embolism (PE)
• C. Spontaneous pneumothorax
• D. Pneumonia
,Rationale: The acute onset of pleuritic chest pain and dyspnea in a patient with risk factors for
(or a known history of) deep vein thrombosis is highly suspicious for a pulmonary embolism.
The most common source is an embolus that has traveled from a DVT in the lower extremities
to the pulmonary arteries.
Infectious Disease
6. A child presents with a "barking" cough and inspiratory stridor that is worse at night. What is
the most likely diagnosis?
• A. Epiglottitis
• B. Croup (Laryngotracheobronchitis)
• C. Bacterial tracheitis
• D. Pertussis
Rationale: Croup is a common viral illness in children (typically parainfluenza virus) that causes
inflammation and narrowing of the subglottic larynx. This leads to the characteristic "barking"
cough and inspiratory stridor.
7. A patient presents with fever, sore throat, and a grayish-white pseudomembrane covering the
tonsils and pharynx. Which pathogen is the most likely cause?
• A. Group A Streptococcus
• B. Corynebacterium diphtheriae
• C. Epstein-Barr virus
• D. Arcanobacterium haemolyticum
Rationale: The formation of a tightly adherent pseudomembrane in the setting of pharyngitis is
pathognomonic for respiratory diphtheria. The pseudomembrane is composed of fibrin,
bacteria, and inflammatory cells and can cause airway obstruction.
Endocrinology
8. A 25-year-old woman presents with complaints of weight loss, heat intolerance, palpitations,
and a feeling of "bulging eyes." On exam, you note proptosis and a diffuse, painless goiter.
Which condition is most likely?
• A. Hashimoto thyroiditis
• B. Graves disease
, • C. Subacute thyroiditis
• D. Toxic multinodular goiter
Rationale: The combination of hyperthyroidism symptoms (weight loss, heat intolerance) with
ophthalmologic findings (proptosis, exophthalmos) and a diffuse goiter is classic for Graves
disease. It is an autoimmune disorder caused by TSH receptor-stimulating antibodies.
9. A patient presents with episodic severe headaches, palpitations, sweating, and hypertension.
A CT scan reveals a 4-cm mass in the adrenal medulla. What is the most likely diagnosis?
• A. Adrenal cortical adenoma
• B. Pheochromocytoma
• C. Neuroblastoma
• D. Myelolipoma
Rationale: The episodic "spells" of headache, palpitations, diaphoresis, and hypertension are
the classic triad for a pheochromocytoma. This tumor arises from the chromaffin cells of the
adrenal medulla and secretes excess catecholamines (epinephrine and norepinephrine).
Osteopathic Principles & Practice (OMM)
10. The sympathetic innervation to the heart and lungs originates from which spinal cord levels?
• A. C3-C5
• B. T1-T5
• C. T6-T9
• D. T10-L2
Rationale: The sympathetic preganglionic neurons for the cardiopulmonary region are located in
the intermediolateral cell column of the spinal cord from T1 to T5. These fibers synapse in the
paravertebral ganglia, and postganglionic fibers then travel to the heart and lungs to increase
heart rate, contractility, and bronchodilation.
11. An osteopathic physician performs a "rib raising" technique on a patient with asthma. What
is the primary physiologic goal of this technique?
• A. Increase rib excursion for improved ventilation.
• B. Decrease sympathetic outflow to the pulmonary system.
• C. Increase parasympathetic tone to promote bronchodilation.
