COMSAE Phase 1 Form 113 Practice Exam 2026: 100 High-
Yield Questions with Answers & Rationales — Complete
NBOME Osteopathic Board Review for COMLEX-USA Level
1 Success | pdf
SECTION 1: Cardiology
Question 1
A 58-year-old male with hypertension and type 2 diabetes presents with substernal chest
pressure radiating to the jaw, occurring at rest and lasting 15 minutes. ECG shows ST-
segment depression in leads V3–V6. Troponin I is elevated. Which of the following is the
most appropriate next step?
A) Aspirin and discharge with outpatient stress test
B) Oral nitroglycerin and beta-blocker at home
C) Immediate percutaneous coronary intervention (PCI)
D) Intravenous thrombolytics
E) Coronary artery bypass grafting (CABG) within 48 hours
Answer: C) Immediate percutaneous coronary intervention (PCI)
Rationale: The patient presents with non-ST-elevation myocardial infarction (NSTEMI)
with elevated troponin and ongoing symptoms. High-risk NSTEMI warrants early
, invasive strategy with PCI within 24 hours. Thrombolytics are not indicated for
NSTEMI. CABG is not first-line for acute management.
Question 2
A 72-year-old female with heart failure with preserved ejection fraction (HFpEF) presents
with worsening dyspnea, JVD, and lower extremity edema. Which medication has been
shown to reduce hospitalizations in HFpEF?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Dobutamine
E) Metolazone
Answer: B) Spironolactone
Rationale: TOPCAT trial showed that spironolactone reduces hospitalizations in
HFpEF patients with elevated BNP. Digoxin does not reduce mortality or
hospitalizations in HFpEF. Hydralazine is not indicated for HFpEF.
Question 3
A 45-year-old male presents with palpitations. ECG shows a narrow complex tachycardia at
180 bpm with no visible P waves. Carotid sinus massage terminates the rhythm. What is the
most likely diagnosis?
A) Atrial fibrillation
B) Atrial flutter
C) AV nodal reentrant tachycardia (AVNRT)
D) Ventricular tachycardia
E) Sinus tachycardia
Answer: C) AV nodal reentrant tachycardia (AVNRT)
Yield Questions with Answers & Rationales — Complete
NBOME Osteopathic Board Review for COMLEX-USA Level
1 Success | pdf
SECTION 1: Cardiology
Question 1
A 58-year-old male with hypertension and type 2 diabetes presents with substernal chest
pressure radiating to the jaw, occurring at rest and lasting 15 minutes. ECG shows ST-
segment depression in leads V3–V6. Troponin I is elevated. Which of the following is the
most appropriate next step?
A) Aspirin and discharge with outpatient stress test
B) Oral nitroglycerin and beta-blocker at home
C) Immediate percutaneous coronary intervention (PCI)
D) Intravenous thrombolytics
E) Coronary artery bypass grafting (CABG) within 48 hours
Answer: C) Immediate percutaneous coronary intervention (PCI)
Rationale: The patient presents with non-ST-elevation myocardial infarction (NSTEMI)
with elevated troponin and ongoing symptoms. High-risk NSTEMI warrants early
, invasive strategy with PCI within 24 hours. Thrombolytics are not indicated for
NSTEMI. CABG is not first-line for acute management.
Question 2
A 72-year-old female with heart failure with preserved ejection fraction (HFpEF) presents
with worsening dyspnea, JVD, and lower extremity edema. Which medication has been
shown to reduce hospitalizations in HFpEF?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Dobutamine
E) Metolazone
Answer: B) Spironolactone
Rationale: TOPCAT trial showed that spironolactone reduces hospitalizations in
HFpEF patients with elevated BNP. Digoxin does not reduce mortality or
hospitalizations in HFpEF. Hydralazine is not indicated for HFpEF.
Question 3
A 45-year-old male presents with palpitations. ECG shows a narrow complex tachycardia at
180 bpm with no visible P waves. Carotid sinus massage terminates the rhythm. What is the
most likely diagnosis?
A) Atrial fibrillation
B) Atrial flutter
C) AV nodal reentrant tachycardia (AVNRT)
D) Ventricular tachycardia
E) Sinus tachycardia
Answer: C) AV nodal reentrant tachycardia (AVNRT)
