COMAT-SE
EMERGENCY MEDICINE
Examination Practice Questions
2026/2027 Edition
Verified Answers Plus Rationales
Q&A; | Instant Download PDF
EXAM SPECIFICATIONS
Time Allocation: 2.5 Hours
Total Questions: 125 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: Passing per NBOME Standards
Core Focus: EM Principles, Trauma, Medical Emergencies, Procedures
COMAT-SE Emergency Medicine Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This COMAT-SE Emergency Medicine Examination Prep validates knowledge required for
osteopathic medical students on emergency medicine rotations. Content covers emergency medicine
principles, trauma, medical emergencies, toxicology, and procedures per NBOME COMAT Subject
Examination standards.
CONTENT DISTRIBUTION
• Cardiovascular Emergencies (20%) — ACS, arrhythmias, CHF, hypertensive emergencies, aortic
dissection, PE
• Trauma & Musculoskeletal (20%) — ATLS, head trauma, chest/abdominal trauma, fractures,
wound management
• Respiratory Emergencies (15%) — Airway management, asthma, COPD, pneumonia,
pneumothorax, respiratory failure
• Neurologic & Psychiatric (15%) — Stroke, seizures, AMS, headache, psychiatric emergencies,
substance abuse
• GI, Renal & Endocrine (15%) — Abdominal pain, GI bleed, DKA, renal failure, electrolyte disorders
• Toxicology, Environmental & Procedures (15%) — Overdoses, envenomations, burns,
hypothermia, EKG, imaging, procedures
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with EM principles and osteopathic considerations.
COMAT uses scaled scoring.
STUDY STRATEGY
Master ABCs and primary survey. Know emergency algorithms: ACLS, ATLS, PALS. Understand
osteopathic manipulative medicine in EM. Use rationales to develop clinical reasoning.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 standards: NBOME COMAT-SE blueprint, Tintinalli's Emergency
Medicine, Rosen's Emergency Medicine, ACLS/ATLS guidelines, and osteopathic principles.
COMAT-SE Emergency Medicine Exam Prep 2026/2027 Page 2
, SECTION I: Cardiovascular & Respiratory Emergencies
1. A 55-year-old male presents with crushing chest pain radiating to left arm. EKG shows ST
elevation in leads II, III, aVF. Most appropriate immediate management:
A. Aspirin and nitroglycerin only
✓ B. Aspirin, oxygen if hypoxic, nitroglycerin, morphine, activate cath lab for PCI
C. Beta blocker immediately
D. Discharge with follow-up
Rationale: STEMI inferior wall (II, III, aVF). MONA: Morphine, Oxygen (if <90%), Nitroglycerin, Aspirin. Most
important: immediate cath lab activation for PCI within 90 min. Beta blockers contraindicated in acute MI
with heart failure risk.
2. A patient in ventricular fibrillation should receive:
A. Atropine
✓ B. Immediate defibrillation
C. Synchronized cardioversion
D. Adenosine
Rationale: VF is pulseless shockable rhythm—immediate unsynchronized defibrillation per ACLS. Atropine
for bradycardia. Synchronized cardioversion for unstable tachycardia with pulse. Adenosine for SVT.
3. Tension pneumothorax is characterized by:
A. Bilateral breath sounds
✓ B. Tracheal deviation away, absent breath sounds, hypotension
C. Hypertension and bradycardia
D. Normal vital signs
Rationale: Tension pneumo: tracheal deviation away from side, absent breath sounds, distended neck veins,
hypotension, hypoxia. Life-threatening—needs immediate needle decompression 2nd ICS midclavicular.
4. A 25-year-old asthmatic with severe exacerbation, unable to speak in full sentences, RR 35,
HR 130. First-line treatment:
A. Oral prednisone only
✓ B. Albuterol/ipratropium nebulizer, oxygen, systemic steroids
C. Antibiotics
D. Chest X-ray first
Rationale: Severe asthma: albuterol + ipratropium nebs, O2, systemic steroids (IV/PO). Don't delay
treatment for X-ray. Antibiotics if infection suspected. Oral steroids alone insufficient for severe.
5. The most common cause of cardiac arrest in adults is:
A. Trauma
✓ B. Ventricular fibrillation from coronary artery disease
C. Pulmonary embolism
D. Drug overdose
COMAT-SE Emergency Medicine Exam Prep 2026/2027 Page 3
EMERGENCY MEDICINE
Examination Practice Questions
2026/2027 Edition
Verified Answers Plus Rationales
Q&A; | Instant Download PDF
EXAM SPECIFICATIONS
Time Allocation: 2.5 Hours
Total Questions: 125 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: Passing per NBOME Standards
Core Focus: EM Principles, Trauma, Medical Emergencies, Procedures
COMAT-SE Emergency Medicine Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This COMAT-SE Emergency Medicine Examination Prep validates knowledge required for
osteopathic medical students on emergency medicine rotations. Content covers emergency medicine
principles, trauma, medical emergencies, toxicology, and procedures per NBOME COMAT Subject
Examination standards.
CONTENT DISTRIBUTION
• Cardiovascular Emergencies (20%) — ACS, arrhythmias, CHF, hypertensive emergencies, aortic
dissection, PE
• Trauma & Musculoskeletal (20%) — ATLS, head trauma, chest/abdominal trauma, fractures,
wound management
• Respiratory Emergencies (15%) — Airway management, asthma, COPD, pneumonia,
pneumothorax, respiratory failure
• Neurologic & Psychiatric (15%) — Stroke, seizures, AMS, headache, psychiatric emergencies,
substance abuse
• GI, Renal & Endocrine (15%) — Abdominal pain, GI bleed, DKA, renal failure, electrolyte disorders
• Toxicology, Environmental & Procedures (15%) — Overdoses, envenomations, burns,
hypothermia, EKG, imaging, procedures
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with EM principles and osteopathic considerations.
COMAT uses scaled scoring.
STUDY STRATEGY
Master ABCs and primary survey. Know emergency algorithms: ACLS, ATLS, PALS. Understand
osteopathic manipulative medicine in EM. Use rationales to develop clinical reasoning.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 standards: NBOME COMAT-SE blueprint, Tintinalli's Emergency
Medicine, Rosen's Emergency Medicine, ACLS/ATLS guidelines, and osteopathic principles.
COMAT-SE Emergency Medicine Exam Prep 2026/2027 Page 2
, SECTION I: Cardiovascular & Respiratory Emergencies
1. A 55-year-old male presents with crushing chest pain radiating to left arm. EKG shows ST
elevation in leads II, III, aVF. Most appropriate immediate management:
A. Aspirin and nitroglycerin only
✓ B. Aspirin, oxygen if hypoxic, nitroglycerin, morphine, activate cath lab for PCI
C. Beta blocker immediately
D. Discharge with follow-up
Rationale: STEMI inferior wall (II, III, aVF). MONA: Morphine, Oxygen (if <90%), Nitroglycerin, Aspirin. Most
important: immediate cath lab activation for PCI within 90 min. Beta blockers contraindicated in acute MI
with heart failure risk.
2. A patient in ventricular fibrillation should receive:
A. Atropine
✓ B. Immediate defibrillation
C. Synchronized cardioversion
D. Adenosine
Rationale: VF is pulseless shockable rhythm—immediate unsynchronized defibrillation per ACLS. Atropine
for bradycardia. Synchronized cardioversion for unstable tachycardia with pulse. Adenosine for SVT.
3. Tension pneumothorax is characterized by:
A. Bilateral breath sounds
✓ B. Tracheal deviation away, absent breath sounds, hypotension
C. Hypertension and bradycardia
D. Normal vital signs
Rationale: Tension pneumo: tracheal deviation away from side, absent breath sounds, distended neck veins,
hypotension, hypoxia. Life-threatening—needs immediate needle decompression 2nd ICS midclavicular.
4. A 25-year-old asthmatic with severe exacerbation, unable to speak in full sentences, RR 35,
HR 130. First-line treatment:
A. Oral prednisone only
✓ B. Albuterol/ipratropium nebulizer, oxygen, systemic steroids
C. Antibiotics
D. Chest X-ray first
Rationale: Severe asthma: albuterol + ipratropium nebs, O2, systemic steroids (IV/PO). Don't delay
treatment for X-ray. Antibiotics if infection suspected. Oral steroids alone insufficient for severe.
5. The most common cause of cardiac arrest in adults is:
A. Trauma
✓ B. Ventricular fibrillation from coronary artery disease
C. Pulmonary embolism
D. Drug overdose
COMAT-SE Emergency Medicine Exam Prep 2026/2027 Page 3
