COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Nervous System and Mental Health 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?

Accepted Answer

Borderline Personality Disorder

Answer

Avoidant Personality Disorder

Answer

Narcissistic Personality Disorder

Answer

Obsessive-Compulsive 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?

Accepted Answer

Anterior Cerebral Artery (ACA)

Answer

Middle Cerebral Artery (MCA)

Answer

Posterior Cerebral Artery (PCA)

Answer

Basilar Artery

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?

Accepted Answer

T1-T4

Answer

OA-AA

Answer

T10-L2

Answer

Sacrum and Pelvis

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?

Accepted Answer

Arrange for an immediate psychiatric evaluation, initiating involuntary commitment if necessary.

Answer

Prescribe a new mood stabilizer and schedule a follow-up for the next day.

Answer

Contact the patient's family to ask them to remove his car keys.

Answer

Perform osteopathic cranial manipulative medicine to calm the patient's nervous system.

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?

Accepted Answer

Selective inhibition of serotonin reuptake

Answer

Blocking the reuptake of both norepinephrine and dopamine

Answer

Antagonism of postsynaptic dopamine D2 receptors

Answer

Inhibition of monoamine oxidase A and B

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?

Accepted Answer

States of stress, depression, or chronic illness

Answer

Acute febrile illness

Answer

Following a session of vigorous exercise

Answer

Increased systemic vitality and wellness