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All COMSAE Phase 1 Actual Exam
Typology: Exercises
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| Feature | Specification |
| :--- | :--- |
| Total Questions | 176 items |
| Sections | 4 sections ร 44 questions each |
| Question Type | Single-best-answer, multiple-choice |
| Features | Images, visual exhibits, videos (selected forms) |
| Official Forms | ASA 113, 114, 115, 116 (secure browser) / ASA 107i, 110i, 111i (with answer key) |
| Official Cost | $60 per form |
Source: NBOME official website
Question 1
A 65-year-old man with a history of hypertension presents with sudden onset of severe, tearing chest pain radiating to the back. His blood pressure is 190/100 mmHg in the right arm and 110/70 mmHg in the left arm. ECG shows no ST-segment elevation. What is the most appropriate next diagnostic test?
A) Transthoracic echocardiogram
B) CT angiography of the chest
C) Coronary angiography
D) Chest X-ray
E) D-dimer assay
Answer: B) CT angiography of the chest
A 72-year-old woman with atrial fibrillation presents with sudden onset of severe pain in her right leg. On examination, the right leg is pale, cold to the touch, and pulseless. She reports paresthesias and is unable to move her toes. What is the most likely diagnosis?
A) Deep vein thrombosis
B) Acute arterial embolism
C) Cellulitis
D) Neuropathy
E) Venous insufficiency
Answer: B) Acute arterial embolism
Rationale: The 5 P's of acute limb ischemia (Pain, Pallor, Pulselessness, Paresthesia, Paralysis) are classic for acute arterial embolism. In a patient with atrial fibrillation, the most common source is a cardioembolic event (thrombus from left atrium). This is a surgical emergency requiring embolectomy or thrombolysis.
Question 4
A 45-year-old male presents with chronic low back pain. Physical examination reveals an apparent short left leg, a left posterior superior iliac spine (PSIS) that is superior compared to the right, and a left anterior inferior iliac spine (AIIS) that is inferior. What is the most likely sacral diagnosis?
A) Right-on-right torsion
B) Left unilateral flexion
C) Left-on-left torsion
D) Right unilateral flexion
E) Left-on-right torsion
Answer: C) Left-on-left torsion
Rationale: In a sacral torsion, the side of the oblique axis is named first, and the side of the rotation is named second. The findings (deep sulcus on the right, shallow on the left; ILA posterior on the left) indicate rotation around a left oblique axis. A "Left-on-left" torsion means the axis is on the left and the base is rotating anteriorly on the left.
Question 5
A patient has a rib somatic dysfunction where the rib is held in INHALATION โ it rises well but cannot descend adequately. On auscultation there is fullness in the intercostal space. This is called a(n):
A) Exhalation rib restriction
B) Inhalation rib (elevated rib)
C) Torsional rib
D) Exhalation rib dysfunction
Answer: B) Inhalation rib (elevated rib)
Rationale: An inhalation rib restriction occurs when the rib is stuck in the elevated position. It moves well with inhalation but cannot descend adequately during exhalation.
D) Rubella
Answer: B) Scarlet fever
Rationale: Scarlet fever, caused by Group A Streptococcus (Streptococcus pyogenes), is characterized by a sandpaper-like rash and strawberry tongue.
Question 8
A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Labs show TSH 12.0 mIU/L and free T4 0.6 ng/dL. What is the most likely diagnosis?
A) Secondary hypothyroidism
B) Primary hypothyroidism
C) Subclinical hypothyroidism
D) Hyperthyroidism
Answer: B) Primary hypothyroidism
Rationale: Elevated TSH with low free T4 is diagnostic of primary hypothyroidism. The thyroid gland itself is not producing enough thyroid hormone, leading to loss of negative feedback on the pituitary.
Question 9
A 30-year-old woman has exophthalmos, heat intolerance, and weight loss. Which antibody is most likely elevated?
A) Anti-thyroglobulin
B) Anti-thyroid peroxidase
C) TSH receptor-stimulating antibody
D) Anti-nuclear antibody
Answer: C) TSH receptor-stimulating antibody
Rationale: This patient presents with Graves' disease, the most common cause of hyperthyroidism. TSH receptor-stimulating antibodies (TSI) bind to and activate the TSH receptor, causing unregulated thyroid hormone production.
Question 10
In the visual pathway, damage to the optic chiasm results in which visual field defect?
A) Ipsilateral hemianopsia
B) Bitemporal hemianopsia
C) Left homonymous hemianopsia
D) Contralateral superior quadrantanopsia
A) Campylobacter jejuni
B) Salmonella enteritidis
C) Entamoeba histolytica
D) Giardia lamblia
Answer: C) Entamoeba histolytica
Rationale: Entamoeba histolytica is prevalent in developing countries, including Central America, and causes amoebic dysentery characterized by bloody diarrhea ("flask-shaped" ulcers on colonoscopy).
Question 13
Which bacteria is the most common cause of urinary tract infections in women?
A) Proteus mirabilis
B) Klebsiella pneumoniae
C) Escherichia coli
D) Enterococcus faecalis
Answer: C) Escherichia coli
Rationale: E. coli is responsible for the vast majority (80-90%) of community-acquired UTIs due to its virulence factors including P-fimbriae that allow adherence to uroepithelial cells.
Question 14
A 45-year-old male presents with fatigue and jaundice. Labs reveal elevated unconjugated bilirubin, normal liver enzymes, and no evidence of hemolysis. Which of the following is the most likely diagnosis?
A) Dubin-Johnson syndrome
B) Gilbert syndrome
C) Crigler-Najjar syndrome type I
D) Rotor syndrome
Answer: B) Gilbert syndrome
Rationale: Gilbert syndrome is a common, benign condition characterized by a mild decrease in UDP-glucuronosyltransferase activity, leading to isolated unconjugated hyperbilirubinemia often precipitated by stress or fasting.
Question 15
What is the most common cause of acute pancreatitis?
A) Alcohol use
B) Gallstones
C) Hypertriglyceridemia
Question 17
A mutation in the FBN1 gene is associated with which connective tissue disorder?
A) Ehlers-Danlos syndrome
B) Marfan syndrome
C) Osteogenesis imperfecta
D) Alport syndrome
Answer: B) Marfan syndrome
Rationale: FBN1 encodes fibrillin-1, a glycoprotein essential for microfibril formation in the extracellular matrix; defects lead to aortic root dilation and lens dislocation.
Question 18
Which diuretic is associated with hypercalcemia?
A) Furosemide
B) Hydrochlorothiazide
C) Spironolactone
D) Acetazolamide
Answer: B) Hydrochlorothiazide
Rationale: Thiazide diuretics (like HCTZ) decrease urinary calcium excretion by increasing distal tubular reabsorption of calcium, leading to hypercalcemia. This is why thiazides are used to treat calcium-containing kidney stones.
Question 19
What is the mechanism of action of ketamine?
A) GABA-A receptor agonist
B) NMDA receptor antagonist
C) Dopamine receptor antagonist
D) Serotonin reuptake inhibitor
Answer: B) NMDA receptor antagonist
