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

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?

Accepted Answer

Anterior Cerebral Artery (ACA)

Answer

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?

Accepted Answer

T1-T4

Answer

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?

Accepted Answer

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

Answer

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?

Accepted Answer

Selective inhibition of serotonin reuptake

Answer

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.

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

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