COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Nervous System and Mental Health Questions and Answers — Questions and Answers
Question 1: A 24-year-old graduate student presents with a long history of unstable interpersonal relationships, frantic efforts to avoid real or imagined abandonment, and recurrent suicidal gestures. She describes a chronic feeling of 'emptiness' and has episodes of intense, inappropriate anger. Which of the following personality disorders best fits this clinical presentation?
- Avoidant Personality Disorder
- Borderline Personality Disorder (Correct answer)
- Narcissistic Personality Disorder
- Obsessive-Compulsive Personality Disorder
Correct answer: Borderline Personality Disorder
This combination of symptoms, particularly the frantic efforts to avoid abandonment, identity disturbance (chronic feelings of emptiness), impulsivity (suicidal gestures), and affective instability (intense anger), is the hallmark of Borderline Personality Disorder, which is a Cluster B personality disorder.
Question 2: A 72-year-old right-handed man is brought to the emergency department after a sudden onset of left-sided weakness and sensory loss. His symptoms primarily affect his leg and foot, with relative sparing of his arm and face. He also exhibits abulia (lack of will) and new-onset urinary incontinence. Occlusion of which cerebral artery is the most likely cause of his symptoms?
- Middle Cerebral Artery (MCA)
- Posterior Cerebral Artery (PCA)
- Anterior Cerebral Artery (ACA) (Correct answer)
- Basilar Artery
Correct answer: Anterior Cerebral Artery (ACA)
The anterior cerebral artery (ACA) supplies the medial portions of the frontal and parietal lobes. This territory includes the motor and sensory cortices for the contralateral leg and foot. Therefore, an ACA stroke classically presents with contralateral weakness and sensory loss that is greater in the leg than the arm or face. Associated frontal lobe signs, such as abulia and urinary incontinence, are also common.
Question 3: A patient presents with symptoms of anxiety, including palpitations, mydriasis (dilated pupils), and diaphoresis. From an osteopathic perspective, hyperactivity of the sympathetic nervous system is a contributing factor. Somatic dysfunction in which of the following spinal regions would be the most direct target for OMT to modulate sympathetic tone to the head and neck?
- OA-AA
- T1-T4 (Correct answer)
- T10-L2
- Sacrum and Pelvis
Correct answer: T1-T4
The preganglionic sympathetic nerve cell bodies that provide innervation to the entire head and neck are located in the intermediolateral cell column of the spinal cord from approximately T1 to T4. These fibers ascend the sympathetic chain to synapse in the cervical ganglia. Therefore, treating somatic dysfunction in the T1-T4 region is a primary osteopathic approach to normalizing sympathetic tone to the head and neck.
Question 4: A 45-year-old male with a history of bipolar disorder states during an office visit, 'I've decided I can't take it anymore. I'm going to drive my car off the Millersville bridge on my way home today.' The patient appears calm but resolute. What is the physician's most appropriate and immediate action?
- Prescribe a new mood stabilizer and schedule a follow-up for the next day.
- Contact the patient's family to ask them to remove his car keys.
- Perform osteopathic cranial manipulative medicine to calm the patient's nervous system.
- Arrange for an immediate psychiatric evaluation, initiating involuntary commitment if necessary. (Correct answer)
Correct answer: Arrange for an immediate psychiatric evaluation, initiating involuntary commitment if necessary.
When a patient expresses clear suicidal ideation with a specific plan, intent, and means, they are at high, imminent risk of self-harm. The physician has a duty to protect the patient. The most appropriate and legally required action is to ensure the patient's immediate safety by arranging for an emergency psychiatric evaluation, which may require an involuntary commitment or 'hold'. While other options might be part of a broader treatment plan, they do not address the acute, life-threatening danger.
Question 5: A 29-year-old patient is started on fluoxetine for major depressive disorder. The physician counsels the patient that the most common initial side effects, such as headache and gastrointestinal upset, are related to the medication's primary mechanism of action. Which of the following best describes this mechanism?
- Selective inhibition of serotonin reuptake (Correct answer)
- Blocking the reuptake of both norepinephrine and dopamine
- Antagonism of postsynaptic dopamine D2 receptors
- Inhibition of monoamine oxidase A and B
Correct answer: Selective inhibition of serotonin reuptake
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Its therapeutic effect and many of its side effects are due to its primary mechanism of action: blocking the serotonin transporter (SERT), which leads to increased concentrations of serotonin in the synaptic cleft.
Question 6: An osteopathic physician is evaluating a 40-year-old patient with chronic fatigue syndrome and depression. During the cranial examination, the physician notes a markedly decreased rate and amplitude of the cranial rhythmic impulse (CRI). This finding is most often associated with which of the following states?
- Acute febrile illness
- Following a session of vigorous exercise
- Increased systemic vitality and wellness
- States of stress, depression, or chronic illness (Correct answer)
Correct answer: States of stress, depression, or chronic illness
The cranial rhythmic impulse (CRI) is considered in osteopathic medicine to be a palpable reflection of the body's inherent vitality and health. A decrease in its rate and amplitude is classically associated with states that deplete vitality, such as chronic stress, depression, fatigue, and chronic infections. Conversely, factors like fever and exercise tend to temporarily increase the rate.
COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Nervous System and Mental Health Questions and Answers
A 24-year-old graduate student presents with a long history of unstable interpersonal relationships, frantic efforts to avoid real or imagined abandonment, and recurrent suicidal gestures.
She describes a chronic feeling of 'emptiness' and has episodes of intense, inappropriate anger.
Which of the following personality disorders best fits this clinical presentation?