COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Cardiovascular and Hematologic Systems Questions and Answers

Question 1

A 72-year-old male presents with exertional dyspnea and a harsh, crescendo-decrescendo systolic murmur best heard at the right upper sternal border.
Which of the following physical exam findings would be most consistent with severe aortic stenosis?

Accepted Answer

A low-amplitude and delayed carotid upstroke

Answer

A brisk, collapsing carotid pulse

Answer

A widely split S2 that increases with inspiration

Answer

A holosystolic murmur radiating to the axilla

Question 2

A 55-year-old male with a history of ST-elevation myocardial infarction (STEMI) is being discharged. In addition to aspirin and a P2Y12 inhibitor, which of the following medication classes provides a mortality benefit and should be initiated prior to discharge for secondary prevention?

Accepted Answer

Beta-blockers

Answer

Nitrates

Answer

Calcium channel blockers

Answer

Loop diuretics

Question 3

A 68-year-old female is diagnosed with multiple myeloma. Her initial lab work shows a hemoglobin of 9.2 g/dL, serum creatinine of 2.5 mg/dL, and serum calcium of 12.1 mg/dL. An X-ray reveals multiple lytic lesions in the vertebrae. Which of these findings is NOT part of the classic CRAB criteria for diagnosing symptomatic multiple myeloma?

Accepted Answer

Thrombocytosis (Platelets > 450,000/µL)

Answer

Hypercalcemia (Calcium > 11 mg/dL)

Answer

Renal insufficiency (Creatinine > 2 mg/dL)

Answer

Anemia (Hemoglobin < 10 g/dL)

Question 4

A patient is hospitalized and receives unfractionated heparin for a deep vein thrombosis. Five days later, their platelet count drops from 250,000/µL to 90,000/µL, and a new pulmonary embolism is suspected. What is the most likely underlying pathophysiology of this condition?

Accepted Answer

Autoantibody formation against the heparin-platelet factor 4 (PF4) complex

Answer

Direct heparin-induced platelet aggregation

Answer

Vitamin K antagonism leading to decreased platelet production

Answer

Bone marrow suppression from a direct toxic effect of heparin

Question 5

A 22-year-old male of Mediterranean descent presents with fatigue, jaundice, and dark urine after being treated with a sulfonamide antibiotic for a urinary tract infection. A complete blood count reveals normocytic anemia, and a peripheral smear shows Heinz bodies and bite cells. This presentation is most characteristic of a deficiency in which of the following enzymes?

Accepted Answer

Glucose-6-phosphate dehydrogenase

Answer

Pyruvate kinase

Answer

Fibrinogen

Answer

Factor VIII

Question 6

Which of the following coagulation factors are dependent on Vitamin K for their synthesis and function?

Accepted Answer

Factors II, VII, IX, and X

Answer

Factors V, VIII, and XI

Answer

Factors I (Fibrinogen), V, and XIII

Answer

Factors XI, XII, and prekallikrein