COMSAE Phase 2 Level 2 BSA 117 Full Practice Exam
| Best Questions Covering All Core Disciplines with
Detailed Rationales | Osteopathic Medical Licensing
Exam Prep 2026
Question 1
A 68-year-old man with a history of hypertension, type 2 diabetes mellitus, and
hyperlipidemia presents to the emergency department 45 minutes after developing
crushing substernal chest pain that radiates to his left shoulder and jaw.
Electrocardiography demonstrates ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Explanation: ST-segment elevation in leads II, III, and aVF indicates an inferior-wall
ST-elevation myocardial infarction. In most patients, the inferior wall is supplied by the right
coronary artery, making it the most likely culprit vessel.
Question 2
A 27-year-old woman at 34 weeks' gestation presents with severe headache, blurred
vision, and blood pressure of 170/112 mmHg. Urinalysis demonstrates significant
proteinuria. Which diagnosis is most likely?
A. Gestational hypertension
B. Chronic hypertension
C. Severe preeclampsia
D. Eclampsia
Answer: C. Severe preeclampsia
,Explanation: New-onset hypertension after 20 weeks of gestation accompanied by
proteinuria and severe features such as headache and visual disturbances is diagnostic of
severe preeclampsia.
Question 3
A 72-year-old man suddenly develops right-sided weakness, facial droop, and
expressive aphasia. Noncontrast computed tomography of the head shows no
evidence of intracranial hemorrhage. Which diagnosis is most likely?
A. Hemorrhagic stroke
B. Bell palsy
C. Hypoglycemia
D. Acute ischemic stroke
Answer: D. Acute ischemic stroke
Explanation: Persistent focal neurologic deficits with no hemorrhage on noncontrast
head CT strongly suggest an acute ischemic stroke and prompt evaluation for reperfusion
therapy if appropriate.
Question 4
A 63-year-old woman develops sudden shortness of breath, pleuritic chest pain,
tachycardia, and hypoxemia four days after total hip arthroplasty. Which diagnosis is
most likely?
A. Acute heart failure
B. Community-acquired pneumonia
C. Acute asthma exacerbation
D. Pulmonary embolism
Answer: D. Pulmonary embolism
Explanation: Recent major orthopedic surgery is a significant risk factor for venous
thromboembolism. Acute dyspnea, pleuritic chest pain, and hypoxemia are classic findings
of pulmonary embolism.
,Question 5
A 58-year-old man presents with severe epigastric pain radiating to his back after
consuming a large meal. Laboratory testing reveals a markedly elevated serum lipase
concentration. Which diagnosis is most likely?
A. Acute cholecystitis
B. Perforated peptic ulcer
C. Gastritis
D. Acute pancreatitis
Answer: D. Acute pancreatitis
Explanation: Severe epigastric pain radiating to the back together with elevated serum
lipase is highly characteristic of acute pancreatitis.
6. A 54-year-old woman presents with progressive fatigue, weight gain, constipation,
cold intolerance, and dry skin. Laboratory studies reveal an elevated thyroid-
stimulating hormone level and a decreased free thyroxine concentration. Which
diagnosis is most likely?
A. Graves disease
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Primary hypothyroidism
Answer: D. Primary hypothyroidism
Explanation: Elevated TSH with low free T4 indicates failure of the thyroid gland,
consistent with primary hypothyroidism.
7. A 66-year-old man with atrial fibrillation develops sudden severe abdominal pain
that is far greater than expected based on physical examination findings. Which
diagnosis is most likely?
A. Acute appendicitis
B. Acute cholecystitis
C. Diverticulitis
D. Acute mesenteric ischemia
Answer: D. Acute mesenteric ischemia
, Explanation: Severe abdominal pain out of proportion to the physical examination in a
patient with atrial fibrillation strongly suggests acute mesenteric ischemia due to arterial
embolism.
8. A 23-year-old man presents with fever, neck stiffness, photophobia, and altered
mental status. Cerebrospinal fluid analysis demonstrates elevated protein, low
glucose, and neutrophilic predominance. Which diagnosis is most likely?
A. Viral meningitis
B. Fungal meningitis
C. Tuberculous meningitis
D. Acute bacterial meningitis
Answer: D. Acute bacterial meningitis
Explanation: Bacterial meningitis typically produces neutrophilic cerebrospinal fluid,
elevated protein, and decreased glucose.
9. A 71-year-old woman falls at home and is unable to bear weight. Examination
demonstrates a shortened, externally rotated right lower extremity. Which injury is
most likely?
A. Pelvic fracture
B. Tibial fracture
C. Femoral shaft fracture
D. Femoral neck fracture
Answer: D. Femoral neck fracture
Explanation: A shortened, externally rotated leg following a fall is a classic presentation
of a femoral neck fracture in an older adult.
10. A 59-year-old man presents with painless gross hematuria and has smoked one
pack of cigarettes daily for 40 years. Which diagnosis should be strongly suspected?
A. Nephrolithiasis
B. Acute cystitis
| Best Questions Covering All Core Disciplines with
Detailed Rationales | Osteopathic Medical Licensing
Exam Prep 2026
Question 1
A 68-year-old man with a history of hypertension, type 2 diabetes mellitus, and
hyperlipidemia presents to the emergency department 45 minutes after developing
crushing substernal chest pain that radiates to his left shoulder and jaw.
Electrocardiography demonstrates ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Explanation: ST-segment elevation in leads II, III, and aVF indicates an inferior-wall
ST-elevation myocardial infarction. In most patients, the inferior wall is supplied by the right
coronary artery, making it the most likely culprit vessel.
Question 2
A 27-year-old woman at 34 weeks' gestation presents with severe headache, blurred
vision, and blood pressure of 170/112 mmHg. Urinalysis demonstrates significant
proteinuria. Which diagnosis is most likely?
A. Gestational hypertension
B. Chronic hypertension
C. Severe preeclampsia
D. Eclampsia
Answer: C. Severe preeclampsia
,Explanation: New-onset hypertension after 20 weeks of gestation accompanied by
proteinuria and severe features such as headache and visual disturbances is diagnostic of
severe preeclampsia.
Question 3
A 72-year-old man suddenly develops right-sided weakness, facial droop, and
expressive aphasia. Noncontrast computed tomography of the head shows no
evidence of intracranial hemorrhage. Which diagnosis is most likely?
A. Hemorrhagic stroke
B. Bell palsy
C. Hypoglycemia
D. Acute ischemic stroke
Answer: D. Acute ischemic stroke
Explanation: Persistent focal neurologic deficits with no hemorrhage on noncontrast
head CT strongly suggest an acute ischemic stroke and prompt evaluation for reperfusion
therapy if appropriate.
Question 4
A 63-year-old woman develops sudden shortness of breath, pleuritic chest pain,
tachycardia, and hypoxemia four days after total hip arthroplasty. Which diagnosis is
most likely?
A. Acute heart failure
B. Community-acquired pneumonia
C. Acute asthma exacerbation
D. Pulmonary embolism
Answer: D. Pulmonary embolism
Explanation: Recent major orthopedic surgery is a significant risk factor for venous
thromboembolism. Acute dyspnea, pleuritic chest pain, and hypoxemia are classic findings
of pulmonary embolism.
,Question 5
A 58-year-old man presents with severe epigastric pain radiating to his back after
consuming a large meal. Laboratory testing reveals a markedly elevated serum lipase
concentration. Which diagnosis is most likely?
A. Acute cholecystitis
B. Perforated peptic ulcer
C. Gastritis
D. Acute pancreatitis
Answer: D. Acute pancreatitis
Explanation: Severe epigastric pain radiating to the back together with elevated serum
lipase is highly characteristic of acute pancreatitis.
6. A 54-year-old woman presents with progressive fatigue, weight gain, constipation,
cold intolerance, and dry skin. Laboratory studies reveal an elevated thyroid-
stimulating hormone level and a decreased free thyroxine concentration. Which
diagnosis is most likely?
A. Graves disease
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Primary hypothyroidism
Answer: D. Primary hypothyroidism
Explanation: Elevated TSH with low free T4 indicates failure of the thyroid gland,
consistent with primary hypothyroidism.
7. A 66-year-old man with atrial fibrillation develops sudden severe abdominal pain
that is far greater than expected based on physical examination findings. Which
diagnosis is most likely?
A. Acute appendicitis
B. Acute cholecystitis
C. Diverticulitis
D. Acute mesenteric ischemia
Answer: D. Acute mesenteric ischemia
, Explanation: Severe abdominal pain out of proportion to the physical examination in a
patient with atrial fibrillation strongly suggests acute mesenteric ischemia due to arterial
embolism.
8. A 23-year-old man presents with fever, neck stiffness, photophobia, and altered
mental status. Cerebrospinal fluid analysis demonstrates elevated protein, low
glucose, and neutrophilic predominance. Which diagnosis is most likely?
A. Viral meningitis
B. Fungal meningitis
C. Tuberculous meningitis
D. Acute bacterial meningitis
Answer: D. Acute bacterial meningitis
Explanation: Bacterial meningitis typically produces neutrophilic cerebrospinal fluid,
elevated protein, and decreased glucose.
9. A 71-year-old woman falls at home and is unable to bear weight. Examination
demonstrates a shortened, externally rotated right lower extremity. Which injury is
most likely?
A. Pelvic fracture
B. Tibial fracture
C. Femoral shaft fracture
D. Femoral neck fracture
Answer: D. Femoral neck fracture
Explanation: A shortened, externally rotated leg following a fall is a classic presentation
of a femoral neck fracture in an older adult.
10. A 59-year-old man presents with painless gross hematuria and has smoked one
pack of cigarettes daily for 40 years. Which diagnosis should be strongly suspected?
A. Nephrolithiasis
B. Acute cystitis
