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COMSAE Phase 2 Form 114 Exam QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 2 Form 114 Exam
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment Examination) Phase 2 is designed to
assess concepts and principles necessary for making appropriate medical diagnoses, serving as
preparation for the COMLEX-USA Level 2-CE examination.
Exam Overview
Feature Details
Total Questions 160 items
Format 4 sections of 40 questions each
Time Limit 4 hours (timed version)
Question Type Single-best-answer, multiple-choice
Features Some forms include videos/images; headphones required for video forms
Form 114 BSA 114i (student form with answer key, includes videos)
Cost $60 per form (student purchase)
Content Domains: Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics and
Gynecology, Pediatrics, Psychiatry, Surgery, Osteopathic Principles.
Internal Medicine (Questions 1-50)
Question 1
A 24-year-old woman presents with acute lower abdominal pain and fever. Pelvic exam shows cervical
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motion tenderness. What is the most likely diagnosis?
A) Ovarian cyst rupture
B) Appendicitis
C) Pelvic inflammatory disease (PID)
D) Ectopic pregnancy
Answer: C) Pelvic inflammatory disease (PID)
Rationale: Lower abdominal pain, fever, and cervical motion tenderness (chandelier sign) are classic for
PID, typically caused by Neisseria gonorrhoeae or Chlamydia trachomatis ascending from the cervix.
Question 2
A 65-year-old man with a 50 pack-year smoking history presents with painless hematuria. What is the
most likely diagnosis?
A) Nephrolithiasis
B) Bladder cancer (urothelial carcinoma)
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C) Urinary tract infection
D) Benign prostatic hyperplasia
Answer: B) Bladder cancer (urothelial carcinoma)
Rationale: Smoking is the strongest risk factor for bladder cancer, and painless hematuria is its classic
presenting symptom.
Question 3
A 55-year-old man develops substernal chest pain during exertion that is relieved by rest. ECG is normal.
What is the most likely diagnosis?
A) Unstable angina
B) Prinzmetal angina
C) Stable angina
D) Non-ST elevation MI
Answer: C) Stable angina
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Rationale: Stable angina is characterized by predictable chest pain triggered by exertion or stress and
relieved by rest. The normal ECG at rest does not exclude stable angina; provocative testing is often
needed for diagnosis.
Question 4
A 4-year-old boy presents with hemarthrosis after minor trauma. Labs show increased PTT, normal PT.
Which factor is most likely deficient?
A) Factor VII
B) Factor VIII
C) Factor IX
D) von Willebrand factor
Answer: B) Factor VIII
Rationale: An intrinsic pathway defect (elevated PTT with normal PT) points to Hemophilia A (Factor VIII
deficiency) or Hemophilia B (Factor IX deficiency). Hemophilia A is more common.
COMSAE Phase 2 Form 114 Exam QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 2 Form 114 Exam
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment Examination) Phase 2 is designed to
assess concepts and principles necessary for making appropriate medical diagnoses, serving as
preparation for the COMLEX-USA Level 2-CE examination.
Exam Overview
Feature Details
Total Questions 160 items
Format 4 sections of 40 questions each
Time Limit 4 hours (timed version)
Question Type Single-best-answer, multiple-choice
Features Some forms include videos/images; headphones required for video forms
Form 114 BSA 114i (student form with answer key, includes videos)
Cost $60 per form (student purchase)
Content Domains: Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics and
Gynecology, Pediatrics, Psychiatry, Surgery, Osteopathic Principles.
Internal Medicine (Questions 1-50)
Question 1
A 24-year-old woman presents with acute lower abdominal pain and fever. Pelvic exam shows cervical
, Page 2 of 173
motion tenderness. What is the most likely diagnosis?
A) Ovarian cyst rupture
B) Appendicitis
C) Pelvic inflammatory disease (PID)
D) Ectopic pregnancy
Answer: C) Pelvic inflammatory disease (PID)
Rationale: Lower abdominal pain, fever, and cervical motion tenderness (chandelier sign) are classic for
PID, typically caused by Neisseria gonorrhoeae or Chlamydia trachomatis ascending from the cervix.
Question 2
A 65-year-old man with a 50 pack-year smoking history presents with painless hematuria. What is the
most likely diagnosis?
A) Nephrolithiasis
B) Bladder cancer (urothelial carcinoma)
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C) Urinary tract infection
D) Benign prostatic hyperplasia
Answer: B) Bladder cancer (urothelial carcinoma)
Rationale: Smoking is the strongest risk factor for bladder cancer, and painless hematuria is its classic
presenting symptom.
Question 3
A 55-year-old man develops substernal chest pain during exertion that is relieved by rest. ECG is normal.
What is the most likely diagnosis?
A) Unstable angina
B) Prinzmetal angina
C) Stable angina
D) Non-ST elevation MI
Answer: C) Stable angina
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Rationale: Stable angina is characterized by predictable chest pain triggered by exertion or stress and
relieved by rest. The normal ECG at rest does not exclude stable angina; provocative testing is often
needed for diagnosis.
Question 4
A 4-year-old boy presents with hemarthrosis after minor trauma. Labs show increased PTT, normal PT.
Which factor is most likely deficient?
A) Factor VII
B) Factor VIII
C) Factor IX
D) von Willebrand factor
Answer: B) Factor VIII
Rationale: An intrinsic pathway defect (elevated PTT with normal PT) points to Hemophilia A (Factor VIII
deficiency) or Hemophilia B (Factor IX deficiency). Hemophilia A is more common.
