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COMSAE Phase 2 Form 110 –EXAM ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
COMSAE Phase 2 Form 110 –
Based on the official NBOME COMSAE Phase 2 specifications and expert-curated question banks aligned
with COMLEX-USA Level 2-CE, this guide includes a comprehensive point-form summary of exam
coverage and questions with detailed rationales .
Point-Form Summary of Exam Coverage
Exam Overview
• Developer: National Board of Osteopathic Medical Examiners (NBOME)
• Purpose: Self-assessment for COMLEX-USA Level 2-CE readiness; gauges knowledge base and
problem-solving skills
• Format: Aligns with COMLEX-USA Level 2-CE blueprint; computer-based
• Cost: $60 per form for students; $55 for COM bulk purchases
Core Competencies (COMLEX-USA Level 2-CE Blueprint)
Domain Approx. Weight
Osteopathic Principles & OMM 8-12%
Internal Medicine 20-25%
Surgery 10-15%
Pediatrics 8-12%
Obstetrics & Gynecology 8-12%
Psychiatry 8-12%
Emergency Medicine 8-12%
Preventive Medicine & Public Health 8-12%
Other (Radiology, Dermatology, etc.) Remainder
Cardiology
• Inferior STEMI – ST elevation in leads II, III, aVF → right coronary artery occlusion
• Aortic dissection – tearing chest pain radiating to back, pulse differential, widened mediastinum
• Atrial fibrillation – cardioembolic stroke risk, anticoagulation (warfarin, DOACs)
• Heart failure – BNP, HFrEF vs. HFpEF management
Pulmonology
• COPD exacerbation – BiPAP for hypercapnic respiratory failure
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• Pulmonary embolism – Wells criteria, D-dimer, CT angiography
• Community-acquired pneumonia – Streptococcus pneumoniae most common
• Spontaneous pneumothorax – tall, thin young males
Gastroenterology
• Ascending cholangitis – Charcot's triad (RUQ pain, fever, jaundice) → ERCP
• Barrett esophagus with peptic stricture – long-standing GERD, dysphagia
• Appendicitis – RLQ pain, fever, leukocytosis, McBurney's point
• NSAID-induced upper GI bleed – melena, stop NSAIDs, PPI, endoscopy
Infectious Disease
• Pyelonephritis – WBC casts, IV ceftriaxone
• Scarlet fever – Group A Strep, sandpaper rash, strawberry tongue
• Epiglottitis – high fever, drooling, tripod position, airway emergency
• Croup – barking cough, stridor, parainfluenza virus
• Lyme disease – erythema migrans (bull's-eye), doxycycline
Neurology
• Wernicke encephalopathy – confusion, ataxia, ophthalmoplegia → thiamine deficiency
• Parkinson disease – resting tremor, bradykinesia, cogwheel rigidity → levodopa-carbidopa
• Central vs. peripheral facial palsy – forehead sparing = central (stroke)
• Ischemic stroke – tPA within window if no hemorrhage
OB/GYN
• Severe preeclampsia with HELLP – magnesium sulfate + immediate delivery
• Pyloric stenosis – projectile vomiting, palpable olive mass
• Ectopic pregnancy – β-hCG, transvaginal ultrasound
Pediatrics
• Croup – mild-moderate: humidified air + corticosteroids
• Epiglottitis – airway emergency, do not examine oropharynx
Ophthalmology
• Retinal detachment – painless vision loss, "curtain coming down"
• Central retinal artery occlusion – cherry red spot, RAPD
• Acute angle-closure glaucoma – sudden painful vision loss, halos, fixed mid-dilated pupil
Osteopathic Principles & OMM
• Chapman's reflexes – anterior/posterior points for organ dysfunction
• Fryette's laws – Type I (neutral, opposite rotation/sidebending) vs. Type II
• Sacral diagnoses – seated flexion test, ILA position, spring test
Pharmacology
• Warfarin – INR management; INR 10 without bleeding → oral vitamin K
• Levodopa-carbidopa – first-line for Parkinson's in elderly
• Nitrofurantoin – uncomplicated cystitis; NOT pyelonephritis
• Thiamine – Wernicke encephalopathy
Section 1: Cardiology (Questions 1-25)
1. A 56-year-old man presents with substernal chest pain that began 1 hour ago while mowing the
lawn. The pain is pressure-like and radiates to the left arm. ECG shows ST elevation in leads II, III, and
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aVF. What is the next best step in management?
A) Give sublingual nitroglycerin
B) Administer aspirin and activate the cardiac catheterization lab
C) Start IV heparin only
D) Order a chest X-ray
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior STEMI, typically due to right coronary
artery occlusion. Reperfusion therapy via primary PCI is required. Aspirin (325 mg chewed) reduces
mortality and should be given immediately. Nitroglycerin is supportive but not definitive, and a chest X-
ray is not the priority in the acute setting .
2. A 70-year-old man with atrial fibrillation presents with acute left-sided weakness that began 2
hours ago. Non-contrast CT brain shows no hemorrhage. What is the best immediate next step?
A) Start IV tPA if within the treatment window and no contraindications
B) Start aspirin 325 mg daily
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C) Give a heparin bolus
D) Order an MRI brain for further evaluation
Answer: A
Rationale: This patient has an acute ischemic stroke (left-sided weakness) without hemorrhage on non-
contrast CT. If symptoms began within the thrombolytic window (typically 3-4.5 hours) and there are no
contraindications, IV tPA is indicated to improve outcomes. Aspirin alone is insufficient, and heparin is
not first-line for acute ischemic stroke .
3. A patient presents with acute onset of severe, tearing chest pain radiating to the back. Blood
pressure is 150/90 mmHg in the right arm and 90/60 mmHg in the left arm. Chest X-ray shows a
widened mediastinum. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B
COMSAE Phase 2 Form 110 –EXAM ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
COMSAE Phase 2 Form 110 –
Based on the official NBOME COMSAE Phase 2 specifications and expert-curated question banks aligned
with COMLEX-USA Level 2-CE, this guide includes a comprehensive point-form summary of exam
coverage and questions with detailed rationales .
Point-Form Summary of Exam Coverage
Exam Overview
• Developer: National Board of Osteopathic Medical Examiners (NBOME)
• Purpose: Self-assessment for COMLEX-USA Level 2-CE readiness; gauges knowledge base and
problem-solving skills
• Format: Aligns with COMLEX-USA Level 2-CE blueprint; computer-based
• Cost: $60 per form for students; $55 for COM bulk purchases
Core Competencies (COMLEX-USA Level 2-CE Blueprint)
Domain Approx. Weight
Osteopathic Principles & OMM 8-12%
Internal Medicine 20-25%
Surgery 10-15%
Pediatrics 8-12%
Obstetrics & Gynecology 8-12%
Psychiatry 8-12%
Emergency Medicine 8-12%
Preventive Medicine & Public Health 8-12%
Other (Radiology, Dermatology, etc.) Remainder
Cardiology
• Inferior STEMI – ST elevation in leads II, III, aVF → right coronary artery occlusion
• Aortic dissection – tearing chest pain radiating to back, pulse differential, widened mediastinum
• Atrial fibrillation – cardioembolic stroke risk, anticoagulation (warfarin, DOACs)
• Heart failure – BNP, HFrEF vs. HFpEF management
Pulmonology
• COPD exacerbation – BiPAP for hypercapnic respiratory failure
, Page 2 of 176
• Pulmonary embolism – Wells criteria, D-dimer, CT angiography
• Community-acquired pneumonia – Streptococcus pneumoniae most common
• Spontaneous pneumothorax – tall, thin young males
Gastroenterology
• Ascending cholangitis – Charcot's triad (RUQ pain, fever, jaundice) → ERCP
• Barrett esophagus with peptic stricture – long-standing GERD, dysphagia
• Appendicitis – RLQ pain, fever, leukocytosis, McBurney's point
• NSAID-induced upper GI bleed – melena, stop NSAIDs, PPI, endoscopy
Infectious Disease
• Pyelonephritis – WBC casts, IV ceftriaxone
• Scarlet fever – Group A Strep, sandpaper rash, strawberry tongue
• Epiglottitis – high fever, drooling, tripod position, airway emergency
• Croup – barking cough, stridor, parainfluenza virus
• Lyme disease – erythema migrans (bull's-eye), doxycycline
Neurology
• Wernicke encephalopathy – confusion, ataxia, ophthalmoplegia → thiamine deficiency
• Parkinson disease – resting tremor, bradykinesia, cogwheel rigidity → levodopa-carbidopa
• Central vs. peripheral facial palsy – forehead sparing = central (stroke)
• Ischemic stroke – tPA within window if no hemorrhage
OB/GYN
• Severe preeclampsia with HELLP – magnesium sulfate + immediate delivery
• Pyloric stenosis – projectile vomiting, palpable olive mass
• Ectopic pregnancy – β-hCG, transvaginal ultrasound
Pediatrics
• Croup – mild-moderate: humidified air + corticosteroids
• Epiglottitis – airway emergency, do not examine oropharynx
Ophthalmology
• Retinal detachment – painless vision loss, "curtain coming down"
• Central retinal artery occlusion – cherry red spot, RAPD
• Acute angle-closure glaucoma – sudden painful vision loss, halos, fixed mid-dilated pupil
Osteopathic Principles & OMM
• Chapman's reflexes – anterior/posterior points for organ dysfunction
• Fryette's laws – Type I (neutral, opposite rotation/sidebending) vs. Type II
• Sacral diagnoses – seated flexion test, ILA position, spring test
Pharmacology
• Warfarin – INR management; INR 10 without bleeding → oral vitamin K
• Levodopa-carbidopa – first-line for Parkinson's in elderly
• Nitrofurantoin – uncomplicated cystitis; NOT pyelonephritis
• Thiamine – Wernicke encephalopathy
Section 1: Cardiology (Questions 1-25)
1. A 56-year-old man presents with substernal chest pain that began 1 hour ago while mowing the
lawn. The pain is pressure-like and radiates to the left arm. ECG shows ST elevation in leads II, III, and
, Page 3 of 176
aVF. What is the next best step in management?
A) Give sublingual nitroglycerin
B) Administer aspirin and activate the cardiac catheterization lab
C) Start IV heparin only
D) Order a chest X-ray
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior STEMI, typically due to right coronary
artery occlusion. Reperfusion therapy via primary PCI is required. Aspirin (325 mg chewed) reduces
mortality and should be given immediately. Nitroglycerin is supportive but not definitive, and a chest X-
ray is not the priority in the acute setting .
2. A 70-year-old man with atrial fibrillation presents with acute left-sided weakness that began 2
hours ago. Non-contrast CT brain shows no hemorrhage. What is the best immediate next step?
A) Start IV tPA if within the treatment window and no contraindications
B) Start aspirin 325 mg daily
, Page 4 of 176
C) Give a heparin bolus
D) Order an MRI brain for further evaluation
Answer: A
Rationale: This patient has an acute ischemic stroke (left-sided weakness) without hemorrhage on non-
contrast CT. If symptoms began within the thrombolytic window (typically 3-4.5 hours) and there are no
contraindications, IV tPA is indicated to improve outcomes. Aspirin alone is insufficient, and heparin is
not first-line for acute ischemic stroke .
3. A patient presents with acute onset of severe, tearing chest pain radiating to the back. Blood
pressure is 150/90 mmHg in the right arm and 90/60 mmHg in the left arm. Chest X-ray shows a
widened mediastinum. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B
