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COMSAE Phase 1 Form 111 Q&A Breakdown
Questions And Well Graded Solutions With
Rationales Updated 2026- 2027
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- This premium resource includes practice questions paired with high-yield rationales. Ace complex topics like Chapman points, sacral torsions, autonomic pathways, and emergency triage protocols. Designed to help osteopathic medical students clear school mandates, bypass testing bottlenecks, and hit a 25 0+ passing baseline score. Download today to optimize your board study routine! A 6-year-old girl develops bloody diarrhea and abdominal cramps after eating an undercooked hamburger at a family picnic. Three days later, she becomes lethargic with low platelets and acute kidney injury. What is the mechanism of action of the toxin causing her current condition? A) Adenylate cyclase stimulation via G-protein ADP-ribosylation B) Inhibition of protein synthesis by cleaving 28S rRNA C) Disruption of cellular membranes via phospholipase C cleavage D) Inactivation of elongation factor 2 (EF-2) Rationale: This child has Hemolytic Uremic Syndrome (HUS) caused by Shiga-like toxin from enterohemorrhagic E. coli (EHEC O157:H7). Shiga-like toxin enters host cells and enzymatically cleaves the 28S rRNA of the 60S ribosomal subunit, halting protein synthesis and causing endothelial death. A 34-year-old HIV-positive male with a CD4 count of 80/mm³ presents with a fever, dry cough, and exertional dyspnea. Silver staining of a bronchoalveolar lavage sample shows crushed ping-pong ball- shaped cysts. What is the first-line pharmacotherapeutic agent for this infection? A) Amphotericin B B) Azithromycin C) Trimethoprim-sulfamethoxazole D) Fluconazole Rationale: The clinical and microscopic presentation describes Pneumocystis jirovecii pneumonia (PCP), a common opportunistic fungal pathogen in advanced AIDS. Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for both prophylaxis and acute treatment. A 62-year-old female undergoing chemotherapy for breast cancer develops a high fever and a severe drop in absolute neutrophil count. She is started on empiric antipseudomonal monotherapy with a beta-lactam antibiotic that is structurally resistant to traditional beta-lactamases and lacks cross- reactivity with penicillin allergies. Which medication was selected? A) Piperacillin-tazobactam
B) Ceftazidime C) Imipenem D) Aztreonam Rationale: Aztreonam is a monobactam antibiotic. Its unique monocyclic beta-lactam ring avoids cross-reactivity with other beta-lactam allergies (except ceftazidime) and provides targeted Gram- negative coverage against Pseudomonas aeruginosa in penicillin-allergic patients. A 45-year-old male with Type 2 Diabetes is started on a medication that works by activating peroxisome proliferator-activated receptor-gamma (PPAR- ). Which side effect profile is most closely linked to this class of medication? A) Lactic acidosis and gastrointestinal distress B) Severe hypoglycemia and weight loss C) Fluid retention, weight gain, and peripheral edema D) Vitamin B12 deficiency and acute pancreatitis Rationale: Thiazolidinediones (such as pioglitazone) activate the nuclear receptor PPAR- , which upregulates GLUT-4 transporters. A notable side effect is increased sodium reabsorption in the renal collecting ducts, causing fluid retention, peripheral edema, and potential exacerbation of heart failure. A 19-year-old female presents with a painless, indurated ulcer on her vulva. Dark-field microscopy reveals motile, corkscrew-shaped spirochetes. What is the drug of choice for treating this infection, and what cellular structure does it target? A) Doxycycline; 30S ribosomal subunit B) Penicillin G; bacterial transpeptidases C) Azithromycin; 50S ribosomal subunit D) Ciprofloxacin; DNA topoisomerases Rationale: The presentation is primary syphilis caused by Treponema pallidum. Intramuscular Benzathine Penicillin G is the gold-standard treatment, operating via cell wall synthesis inhibition by binding and inactivating transpeptidases. A 55-year-old male with deep vein thrombosis is initiated on continuous intravenous heparin infusion. Five days later, his platelet count drops by 55%. Which of the following antibodies drives the pathogenesis of this drug reaction? A) Antibodies against GP IIb/IIIa receptors B) Antibodies against heparin-platelet factor 4 complexes C) Antibodies against ADAMTS13 metalloproteinase
Rationale: The radial nerve travels directly within the spiral groove of the mid-shaft humerus. Fractures at this site often injure the nerve, causing loss of function in the wrist and finger extensors (wrist drop) and sensory loss on the posterior forearm/dorsum of the hand. A 62-year-old female presents with persistent fatigue and cold intolerance. Lab evaluations demonstrate an elevated Serum Thyroid-Stimulating Hormone (TSH) level and low free thyroxine ( ) levels. What histopathological feature is characteristic of the autoimmune condition causing her symptoms? A) Diffuse hyperplasia of follicular epithelial cells B) Lymphocytic infiltrate with germinal centers and Hürthle cells C) Granulomatous inflammation with multinucleated giant cells D) Extensive dense fibrous tissue replacing thyroid parenchyma Rationale: Primary hypothyroidism alongside high TSH in an adult female points directly to Hashimoto's thyroiditis. Histology shows widespread lymphocytic inflammation forming germinal centers, along with follicular epithelial cells modified by pink, granular cytoplasm (Hürthle cells). A 45-year-old male with a history of chronic smoking presents with a persistent cough and weight loss. Imaging identifies a large central lung mass. Laboratory tests reveal a serum sodium level of 118 mEq/L, along with high urine osmolality. What is the underlying endocrine mechanism of this paraneoplastic disorder? A) Ectopic production of Adrenocorticotropic Hormone (ACTH) B) Ectopic secretion of Antidiuretic Hormone (ADH) C) Autonomous secretion of Parathyroid Hormone-related Peptide (PTHrP) D) Excess production of thyroid-stimulating immunoglobulins Rationale: This patient has Small Cell Lung Carcinoma causing SIADH. Ectopic ADH secretion forces excessive water reabsorption in the renal collecting ducts, causing dilutional hyponatremia and highly concentrated urine. A 22-year-old female evaluation for primary amenorrhea reveals a 45,X karyotype. Which of the following internal anatomical developments is most consistent with this patient’s genetic condition? A) Malformed, obstructed uterus B) Normal ovaries with early follicle depletion C) Streak gonads with absent oocytes D) Hyperplastic male internal wolffian structures Rationale: Turner syndrome (45,X) causes accelerated oocyte atresia during embryonic development. By birth, the ovaries are reduced to fibrous bands of tissue lacking follicles (streak gonads), leading to primary amenorrhea and low estrogen.
A 53-year-old male undergoes a screening colonoscopy. A 1.5-cm pedunculated polyp is identified in the sigmoid colon and excised. Histological evaluation shows a branching, tree-like architecture lined by neoplastic glandular epithelium with high-grade dysplasia. What type of polyp was removed? A) Hyperplastic polyp B) Tubular adenoma C) Villous adenoma D) Peutz-Jeghers polyp Rationale: Adenomatous colonic polyps carry malignant risk. Villous adenomas display long, finger- like or tree-like projections lined by dysplastic epithelium and carry a higher risk of transforming into colorectal adenocarcinoma compared to tubular adenomas. A newborn male is examined in the nursery. The physician notes that the urethral meatus opens on the ventral surface of the penis, rather than at the tip of the glans. This congenital anomaly stems from a failure of which embryonic structure to fuse properly? A) Urogenital folds B) Genital tubercle C) Labioscrotal swellings D) Urogenital sinus Rationale: Hypospadias occurs when the urethral meatus opens on the ventral surface of the penis due to incomplete fusion of the urogenital folds. Epispadias (dorsal opening) is instead linked to abnormal positioning of the genital tubercle. A 33-year-old female presents with severe pelvic pain that worsens significantly during her menstrual cycle. Laparoscopy reveals small, dark "powder-burn" lesions scattered across the pelvic peritoneum. What is the primary cellular mechanism that explains the monthly cyclic pain seen in this condition? A) Malignant proliferation of smooth muscle cells B) Cyclic proliferation and bleeding of ectopic endometrial tissue C) Chronic pelvic infection by atypical intracellular organisms D) Thrombosis of the internal iliac venous branches Rationale: Endometriosis is characterized by the presence of functional endometrial glands and stroma outside the uterine cavity. This ectopic tissue responds to cyclic ovarian hormones, proliferating and bleeding monthly into the peritoneum, which drives localized inflammation and pelvic pain. A 26-year-old female presents with amenorrhea, hirsutism, and severe acne. Ultrasound of the pelvis demonstrates bilateral enlarged ovaries with multiple subependymal peripheral cysts. Which of the following laboratory ratios is classically elevated in this endocrine disorder? A) TSH to free T4 ratio B) LH to FSH ratio
microscopy characteristically demonstrates large subepithelial electron-dense deposits or "humps" representing immune complexes. A 67-year-old male with a history of severe congestive heart failure is admitted with worsening peripheral edema. He is placed on a high-dose loop diuretic medication. Two days later, an arterial blood gas is obtained. Which of the following acid-base profiles is most likely to be present? A) pH 7.21, 55 mmHg, 22 mEq/L B) pH 7.32, 30 mmHg, 15 mEq/L C) pH 7.48, 46 mmHg, 33 mEq/L D) pH 7.52, 25 mmHg, 20 mEq/L Rationale: Loop diuretics cause contraction alkalosis by inhibiting the cotransporter in the thick ascending limb. This leads to increased delivery of sodium to the distal tubule, augmenting and
excretion, resulting in a metabolic alkalosis (elevated pH and elevated ) with appropriate compensatory respiratory hypoventilation (elevated ). A 45-year-old female presents to the emergency department complaining of severe muscle weakness. Laboratory values show a serum potassium level of 2.6 mEq/L, a serum bicarbonate level of 14 mEq/L, and a urinary pH of 6.5. Genetic testing reveals a defect in the ATPase pump in the alpha-intercalated cells of the collecting duct. What is the diagnosis? A) Type 1 Distal Renal Tubular Acidosis B) Type 2 Proximal Renal Tubular Acidosis C) Type 4 Hyperkalemic Renal Tubular Acidosis D) Fanconi Syndrome Rationale: Type 1 Renal Tubular Acidosis (RTA) is caused by an inability of the alpha-intercalated cells to secrete into the lumen. This manifests as a normal anion gap metabolic acidosis accompanied by hypokalemia and an inappropriately high urinary pH (>5.5), as the kidneys cannot acidify the urine. A 5-year-old boy is brought to the pediatrician due to generalized swelling. Urinalysis demonstrates heavy proteinuria (4+), and a 24-hour urine collection shows 4.2 grams of protein. No red blood cells or casts are noted. What is the fundamental pathogenetic mechanism responsible for this patient’s presentation? A) Deposition of anti-GBM antibodies B) Loss of the negative charge barrier due to cytokine-mediated injury C) Nodular glomerulosclerosis from non-enzymatic glycosylation D) Immune complex deposition in the subendothelial space Rationale: The clinical scenario describes Minimal Change Disease, the most common cause of nephrotic syndrome in children. It is mediated by cytokines that damage podocytes, causing foot process effacement and a loss of the negatively charged polyanionic barrier (heparan sulfate), allowing albumin to leak into the urine. A 28-year-old male is brought to the emergency department after being trapped under heavy debris for 8 hours following an industrial accident. Urinalysis shows a reddish-brown color, but microscopic evaluation reveals no red blood cells. Which of the following areas of the nephron is most susceptible to ischemic and toxic injury in this condition? A) Glomerulus and Bowman's capsule
duration of at least 6 months. For durations between 1 and 6 months, the diagnosis would be schizophreniform disorder. A 19-year-old male is evaluated in the emergency department after a diving accident. Neurological examination reveals complete loss of pain and temperature sensation below the T10 dermatomal level, but his vibration and proprioception sensations remain completely intact bilaterally. Which spinal cord syndrome explains these findings? A) Brown-Séquard syndrome B) Anterior cord syndrome C) Central cord syndrome D) Posterior cord syndrome Rationale: Anterior cord syndrome typically results from occlusion of the anterior spinal artery or trauma. It damages the spinothalamic tracts (loss of pain/temperature) and corticospinal tracts (motor function loss), while sparing the dorsal columns (proprioception and vibration). A 29-year-old female presents to her primary care physician complaining of a two-week history of depressed mood, daily crying spells, severe insomnia, a 10-pound weight loss, and an inability to concentrate at work. She denies any past psychiatric history. Which of the following cellular changes is the primary target of first-line pharmacotherapy for this patient? A) Antagonism of postsynaptic dopamine D2 receptors B) Inhibition of the presynaptic serotonin reuptake transporter C) Inhibition of the monoamine oxidase enzyme D) Potenuation of GABA-A receptor chloride influx Rationale: The patient meets criteria for a Major Depressive Episode. First-line pharmacological management consists of Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs work by blocking the presynaptic serotonin transporter (SERT), thereby increasing synaptic serotonin concentrations. A 62-year-old male presents with a resting tremor that worsens when his hands are placed in his lap. Physical examination reveals a slow, shuffling gait, cogwheel rigidity, and an expressionless face. The underlying pathology involves a loss of dopaminergic neurons in which brain region? A) Caudate nucleus B) Putamen C) Substantia nigra pars compacta D) Subthalamic nucleus Rationale: Parkinson's disease is a neurodegenerative disorder clinically identified by the acronym TRAP (Tremor, Rigidity, Akinesia/bradykinesia, Postural instability). It stems directly from the loss of dopaminergic neurons in the substantia nigra pars compacta within the basal ganglia system.
Questions 91–100: Endocrine & Metabolic Disorders
A 45-year-old female presents with progressive weight gain, easy bruising, and proximal muscle weakness. Physical examination reveals a rounded "moon" face, a dorsocervical fat pad, and wide purple striae across her abdomen. Laboratory evaluation shows elevated low-dose dexamethasone suppression test cortisol levels, but her cortisol suppresses normally during a high-dose dexamethasone suppression test. What is the source of her pathology? A) Functional adrenal adenoma B) ACTH-secreting pituitary adenoma C) Small cell lung carcinoma ectopically producing ACTH D) Exogenous corticosteroid administration Rationale: The patient exhibits Cushing's syndrome symptoms. When cortisol does not suppress with a low-dose dexamethasone test but does suppress by more than 50% during a high-dose dexamethasone suppression test, the diagnosis points specifically to Cushing's disease, caused by an ACTH-secreting pituitary adenoma. A 10-month-old infant is brought to the emergency department lethargic and vomiting. His parents state he has been sick with a mild viral illness and has not eaten for 16 hours. Laboratory values reveal severe hypoglycemia, a serum pH of 7.25, and an absence of ketones in the urine. Blood work reveals elevated dicarboxylic acids. Which enzyme is most likely deficient? A) Glucose- 6 - phosphatase B) Medium-chain acyl-CoA dehydrogenase (MCAD) C) Pyruvate carboxylase ) Carnitine palmitoyltransferase I Rationale: MCAD deficiency is an autosomal recessive disorder of fatty acid beta-oxidation. It classically presents during periods of fasting or illness with hypoketotic hypoglycemia. Without functional beta-oxidation, the liver cannot produce ketone bodies for fuel, leading to the alternative omega-oxidation path producing dicarboxylic acids. A 54-year-old male with a history of severe alcoholism is brought to the emergency department after being found unresponsive on a park bench. On exam, he is confused, has horizontal nystagmus, and displays an uncoordinated, ataxic gait. Administration of which of the following substances must occur before or alongside glucose infusion to prevent irreversible neurological damage? A) Pyridoxine (Vitamin B6) B) Thiamine (Vitamin B1) C) Cyanocobalamin (Vitamin B12) D) Folic acid (Vitamin B9) Rationale: The patient is presenting with Wernicke encephalopathy (triad of confusion, ophthalmoplegia/nystagmus, and ataxia). Giving glucose to a severely thiamine-deficient individual can deplete any remaining thiamine stores because thiamine is an essential cofactor for glucose metabolism (pyruvate dehydrogenase), causing permanent damage (Korsakoff syndrome).
uric acid concentration. This condition is caused by a deficiency in an enzyme involved in which metabolic pathway? A) Pyrimidine synthesis B) Purine salvage pathway C) Urea cycle D) Glycogenolysis Rationale: Lesch-Nyhan syndrome is an X-linked recessive disorder characterized by a complete deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT) in the purine salvage pathway. This causes an accumulation of uric acid and leads to severe self-mutilating behavior, choreoathetosis, and gout. A 38-year-old female presents with persistent diarrhea, wheezing, and episodic flushing of her face and neck. An echocardiogram reveals plaque-like fibrous endocardial thickening involving the tricuspid valve and right ventricle. Measurement of which metabolite in a 24-hour urine collection would confirm the diagnosis? A) Homovanillic acid (HVA) B) 5-hydroxyindoleacetic acid (5-HIAA) C) Metanephrine D) Cortisol Rationale: The patient has carcinoid syndrome, typically caused by a neuroendocrine tumor that has metastasized to the liver and is secreting large amounts of serotonin into the systemic circulation. Serotonin is metabolized by monoamine oxidase into 5-HIAA, which is excreted in the urine. A 60-year-old female presents to her physician complaining of severe bone pain and multiple fractures from minor falls. Lab results show markedly elevated serum calcium, decreased serum phosphorus, and elevated parathyroid hormone (PTH) levels. Which of the following renal findings is most likely to develop as a result of this metabolic state? A) Glomerulosclerosis B) Nephrolithiasis C) Minimal change disease D) Lipoid nephrosis Rationale: Primary hyperparathyroidism leads to hypercalcemia and hypercalciuria. The classic clinical phrase "stones, bones, groans, and psychiatric overtones" highlights the tendency of these patients to develop calcium oxalate or calcium phosphate kidney stones (nephrolithiasis) due to high filtered loads of calcium. A 35-year-old male presents with visual changes. Physical examination reveals a loss of peripheral vision in both eyes (bitemporal hemianopsia). A brain MRI confirms a mass lesion arising within the sella turcica. If this tumor originates from the anterior pituitary gland, which embryological structure did it develop from?
A) Neuroectoderm of the floor of the diencephalon B) Rathke's pouch (an evagination of oral ectoderm) C) Neural crest cells of the branchial arches D) Mesoderm of the first pharyngeal arch Rationale: A pituitary adenoma compression of the optic chiasm causes bitemporal hemianopsia. The anterior pituitary gland (adenohypophysis) develops from Rathke's pouch, an upward ectodermal invagination of the primitive roof of the mouth, whereas the posterior pituitary (neurohypophysis) develops from neuroectoderm.
Questions 101–110: Hematology & Musculoskeletal A 65-year-old male presents with lower back pain and fatigue. Laboratory testing shows a corrected serum calcium of 11.2 mg/dL and a serum creatinine of 2.1 mg/dL. A peripheral blood smear demonstrates rouleaux formation of red blood cells, and serum protein electrophoresis (SPEP) shows a distinct M-spike. What would a bone marrow biopsy most likely reveal? A) Over 20% myeloblasts with Auer rods B) Sheets of atypical plasma cells with eccentric nuclei and clock-face chromatin C) Proliferation of small, mature-looking B-lymphocytes D) Hypersegmented neutrophils and megaloblasts Rationale: Multiple Myeloma is a plasma cell dyscrasia characterized by the CRAB tetrad (hypercalcemia, renal insufficiency, anemia, bone lesions). Bone marrow biopsy characteristically demonstrates a clonal proliferation of atypical plasma cells (>10%) featuring an eccentric nucleus with a "clock-face" or "spoke-wheel" chromatin pattern. A 4-year-old boy is brought to the emergency department due to a swollen, painful right knee after a minor fall at the playground. His parents report that he bruises easily and experienced prolonged bleeding after a circumcision as an infant. Lab results indicate a normal platelet count, normal bleeding time, normal prothrombin time (PT), but a significantly prolonged activated partial thromboplastin time (aPTT). This condition is caused by a deficiency in which clotting factor? A) Factor VII B) Factor VIII or Factor IX C) Factor X D) von Willebrand factor Rationale: The presentation is hemophilia (either Hemophilia A [Factor VIII deficiency] or Hemophilia B [Factor IX deficiency]), which are X-linked recessive disorders. Because these factors belong to the intrinsic pathway, a deficiency selectively prolongs the aPTT, leaving PT and bleeding parameters normal. A 23-year-old female presents with persistent fatigue. A complete blood count reveals a microcytic anemia with a hemoglobin of 10.5 g/dL and an MCV of 68 fL. Iron studies, including ferritin and total
Rationale: The clinical history describing morning stiffness lasting >1 hour in a symmetrical distribution of small joints describes Rheumatoid Arthritis (RA). While Rheumatoid Factor (RF) is sensitive, anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for diagnosing RA and predicting aggressive disease progression. A 35-year-old male presents with an acutely swollen, red, and extremely painful right great toe. He notes the pain began suddenly last night after he attended a seafood dinner and consumed several beers. Polarized light microscopy of fluid aspirated from the first metatarsophalangeal joint would show which characteristic finding? A) Rhomboid-shaped, positively birefringent crystals B) Needle-shaped, negatively birefringent crystals C) Envelope-shaped calcium oxalate crystals D) Amorphous phosphate precipitates Rationale: Acute gouty arthritis frequently targets the first metatarsophalangeal joint (podagra), triggered by alcohol or purine-rich foods. Polarized light microscopy yields monosodium urate crystals, which are needle-shaped and show strong negative birefringence (turning yellow when aligned parallel to the slow wave of the compensator). A 22-year-old male athlete presents with a popping sensation and severe pain in his right shoulder after falling onto an outstretched arm during a football game. On exam, the shoulder contour appears flattened, and he holds the arm in slight abduction and external rotation. Plain radiographs confirm an anterior shoulder dislocation. Which nerve is most at risk of injury from this displacement? A) Radial nerve B) Ulnar nerve C) Axillary nerve D) Musculocutaneous nerve Rationale: Anterior dislocations of the glenohumeral joint are the most common shoulder dislocations. The axillary nerve courses directly around the surgical neck of the humerus and is highly vulnerable to stretching or compression during anterior displacement, which can lead to deltoid paralysis and sensory loss over the lateral shoulder. A 72-year-old female is brought to the clinic following a low-impact fall that resulted in a right hip fracture. Dual-energy X-ray absorptiometry (DEXA) demonstrates a T-score of - 3.1 in the femoral neck. What is the status of serum calcium, phosphorus, and parathyroid hormone (PTH) levels in this patient's metabolic bone disease? A) Low calcium, high phosphorus, high PTH B) High calcium, low phosphorus, low PTH C) Normal calcium, normal phosphorus, normal PTH D) Normal calcium, high phosphorus, high PTH
Rationale: The patient has severe osteoporosis, confirmed by a DEXA T-score below - 2.5 and a fragility fracture. Unlike other metabolic bone disorders like osteomalacia or hyperparathyroidism, uncomplicated osteoporosis features completely normal baseline serum calcium, phosphorus, and PTH levels. A 9-month-old infant is brought to the clinic due to poor motor development. Physical examination reveals frontal bossing of the skull, bowing of the long bones of the lower extremities, and a prominent bead-like enlargement of the costochondral junctions. What is the fundamental cellular defect causing this disease? A) Defective cross-linking of collagen molecules B) Failure of osteoclastic bone resorption C) Impaired mineralization of osteoid matrix due to Vitamin D deficiency D) Defective endochondral ossification at the epiphyseal plate Rationale: Nutritional Rickets is caused by Vitamin D deficiency in growing children. Vitamin D is essential for calcium and phosphorus absorption; its deficiency leads to defective mineralization of the osteoid matrix and growth plate cartilage, manifesting as bowed legs, frontal bossing, and the "rachitic rosary" at the costochondral junctions. A 54-year-old male with a history of intravenous drug use presents with a high fever and severe, throbbing pain in his right lower leg. Imaging reveals an area of periosteal elevation and bone destruction in the tibia. If a bone biopsy is performed, which organism is most likely to be isolated? A) Salmonella enteritidis B) Pseudomonas aeruginosa C) Staphylococcus aureus D) Streptococcus pneumoniae Rationale: Staphylococcus aureus is the overall most common causative organism of acute osteomyelitis across all patient populations, including intravenous drug users and pediatric patients. (Note: while Pseudomonas is associated with puncture wounds through shoes, S. aureus remains the top cause). A 26-year-old female presents to the clinic with dull, aching pelvic pain and heavy menstrual bleeding. Structural examination reveals a positive seated flexion test on the right, a deep sacral sulcus on the left, and a posterior inferior ILA on the right. Spring testing at the lumbosacral junction is positive (poor spring). Which of the following is the most likely sacral diagnosis? A) Right-on-right forward sacral torsion B) Left-on-left forward sacral torsion C) Right-on-left backward sacral torsion D) Left-on-right backward sacral torsion A 4 5 - year-old male with a history of alcohol use disorder presents to the emergency department with severe, stabbing epigastric pain that radiates directly to his back. He is tachycardic and tracking
B) T5 - T
C) T10 - T
D) T12 - L
A 3-year-old boy is brought to the pediatrician by his mother due to a 2-day history of barking cough, inspiratory stridor, and a low-grade fever. The symptoms worsen significantly at night. A frontal neck radiograph reveals classic subglottic narrowing. What is the most common causative organism of this patient's clinical presentation? A) Respiratory syncytial virus B) Parainfluenza virus C) Adenovirus D) Haemophilus influenzae type b A 28-year-old female is undergoing an osteopathic evaluation. Structural examination reveals that her right innominate has a positive standing flexion test, the right ASIS is superior, and the right PSIS is inferior. What is the most appropriate initial setup for treating this patient using Muscle Energy (direct, active) technique? A) The patient lies supine; the physician extends the patient's right hip off the edge of the table B) The patient lies supine; the physician flexes the patient's right hip and knee, applying a cephalad force toward the shoulder C) The patient lies prone; the physician abducts and internally rotates the right lower extremity D) The patient lies lateral recumbent on the left side; the physician hyperextends the right hip A 68-year-old female is brought to the emergency department after slipping on ice and landing heavily on her outstretched right hand. She complains of severe pain in her right wrist. A radiograph reveals a fracture of the distal radius with dorsal displacement of the distal fragment, giving the wrist a characteristic "dinner fork" deformity. Which of the following is the most likely diagnosis? A) Smith fracture B) Colles fracture C) Scaphoid fracture D) Greenstick fracture A 40-year-old female presents to the clinic with complaints of progressive muscle weakness, particularly noticed when brushing her hair or climbing stairs. She also notes a purplish rash around her eyes and scaly, erythematous papules over her metacarpophalangeal joints. Laboratory evaluation reveals elevated serum creatine kinase and positive anti-Jo-1 antibodies. What is the most likely diagnosis? A) Polymyositis B) Dermatomyositis C) Systemic lupus erythematosus
D) Myasthenia gravis During a routine structural exam on a 35-year-old male, the physician notes a restricted cranial somatic dysfunction. When evaluating the sphenobasilar synchondrosis (SBS), the physician observes that during the inhalation phase of the primary respiratory mechanism, the sphenoid and occiput rotate in opposite directions about a single transverse axis, moving the SBS superiorly. This presentation describes which cranial motion pattern? A) Extension B) Flexion C) Torsion D) Sidebending/Rotation A 58-year-old male presents with severe, sudden-onset pain, erythema, and exquisite swelling in his right first metatarsophalangeal joint. Arthrocentesis is performed. Polarized light microscopy reveals needle-shaped, negatively birefringent crystals. What is the first-line medication utilized to manage the acute flare of this patient's condition? A) Allopurinol B) Febuxostat C) Indomethacin D) Probenecid A 29-year-old pregnant female at 34 weeks gestation presents for a routine prenatal visit. She complains of mild, bilateral lower extremity edema and lower back pain. Structural examination reveals an exaggerated lumbar lordosis. Which pelvic diaphragm or structural framework should be evaluated first to maximize lymphatic return from her lower extremities? A) Popliteal fossa B) Inguinal ligament C) Pelvic diaphragm D) Thoracic inlet A 60-year-old male presents to the clinic with a history of progressive resting tremor, bradykinesia, and rigid, cogwheel-like resistance to passive limb movement. His gait is characterized by short, shuffling steps. Depigmentation of which brain region is most characteristically seen upon autopsy in patients with this disease? A) Caudate nucleus B) Putamen C) Substantia nigra pars compacta D) Subthalamic nucleus A 7-year-old girl is brought to the urgent care clinic with a 2-week history of perianal pruritus that is significantly worse at night. The mother mentions that the child has been irritable and restless
