COMSAE Phase 3 Form 114 Practice Exam 200 Questions
And Correct Answers (Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf,,
The COMSAE Phase 3 is designed to assess readiness for the COMLEX-USA Level 3
examination. Form 114 (BSA 114i) is a student version with an answer key.
Exam Structure:
• Total items: 200 questions
• Sections: 4 sections of 50 questions each
• Format: Single-best-answer, multiple-choice
• Content: Clinical decision-making in supervised practice settings, including
Internal Medicine, Surgery, Pediatrics, OB/GYN, Psychiatry, Emergency Medicine,
and Osteopathic Principles
SECTION 1: INTERNAL MEDICINE – CARDIOVASCULAR (Questions
1–10)
Q1. A 68-year-old male with a history of hypertension and diabetes presents with
substernal chest pressure that began 2 hours ago. ECG shows ST-segment elevation in
leads V1–V4. Which of the following is the most appropriate immediate intervention?
• A) Aspirin 325 mg orally
• B) Nitroglycerin sublingual
• C) Emergent percutaneous coronary intervention (PCI)
• D) Intravenous heparin
,Correct Answer: C
Rationale: ST elevation in V1–V4 indicates an anterior wall myocardial infarction.
Emergent PCI is the treatment of choice if available within 90–120 minutes. Aspirin and
nitroglycerin are adjunctive but not the definitive intervention.
Q2. A 55-year-old man presents with chest pain radiating to the left arm. ECG shows ST
elevation in leads II, III, and aVF. Which artery is most likely occluded?
• A) Left anterior descending artery
• B) Right coronary artery
• C) Left circumflex artery
• D) Posterior descending artery
Correct Answer: B
Rationale: Inferior wall MI (leads II, III, aVF) is most commonly due to occlusion of the
right coronary artery (RCA).
Q3. A 72-year-old female presents with progressive dyspnea on exertion, orthopnea,
and bilateral lower extremity edema. She has a history of hypertension. On auscultation,
an S3 gallop is heard. Which of the following is the most likely diagnosis?
• A) Acute coronary syndrome
• B) Heart failure with reduced ejection fraction
• C) Pulmonary embolism
• D) Chronic obstructive pulmonary disease
,Correct Answer: B
Rationale: The triad of progressive dyspnea, orthopnea, peripheral edema, and an S3
gallop is classic for heart failure with reduced ejection fraction.
Q4. 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 myocardial infarction
Correct Answer: C
Rationale: Stable angina is characterized by predictable chest pain triggered by exertion
or stress and relieved by rest. A normal resting ECG does not exclude stable angina.
Q5. A 68-year-old male with hypertension presents with a crescendo-decrescendo
systolic murmur best heard at the right 2nd intercostal space, radiating to the carotids.
What is the most likely diagnosis?
• A) Aortic stenosis
• B) Mitral regurgitation
• C) Aortic regurgitation
• D) Mitral stenosis
Correct Answer: A
, Rationale: A crescendo-decrescendo systolic murmur at the right upper sternal border
radiating to the carotids is classic for aortic stenosis.
Q6. A 68-year-old man with heart failure presents with acute dyspnea and pink frothy
sputum. Lung auscultation reveals diffuse crackles. BP 150/90, HR 110. What is the most
appropriate immediate intervention?
• A) IV furosemide
• B) IV nitroglycerin
• C) IV morphine
• D) Noninvasive positive pressure ventilation (NIPPV)
Correct Answer: D
Rationale: NIPPV provides immediate improvement in oxygenation and reduces
preload and afterload in acute cardiogenic pulmonary edema.
Q7. A 45-year-old female presents with palpitations, weight loss, heat intolerance, and
fine tremor. Thyroid examination reveals a diffusely enlarged gland. What is the most
likely diagnosis?
• A) Hashimoto's thyroiditis
• B) Graves' disease
• C) Subacute thyroiditis
• D) Toxic multinodular goiter
Correct Answer: B
And Correct Answers (Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf,,
The COMSAE Phase 3 is designed to assess readiness for the COMLEX-USA Level 3
examination. Form 114 (BSA 114i) is a student version with an answer key.
Exam Structure:
• Total items: 200 questions
• Sections: 4 sections of 50 questions each
• Format: Single-best-answer, multiple-choice
• Content: Clinical decision-making in supervised practice settings, including
Internal Medicine, Surgery, Pediatrics, OB/GYN, Psychiatry, Emergency Medicine,
and Osteopathic Principles
SECTION 1: INTERNAL MEDICINE – CARDIOVASCULAR (Questions
1–10)
Q1. A 68-year-old male with a history of hypertension and diabetes presents with
substernal chest pressure that began 2 hours ago. ECG shows ST-segment elevation in
leads V1–V4. Which of the following is the most appropriate immediate intervention?
• A) Aspirin 325 mg orally
• B) Nitroglycerin sublingual
• C) Emergent percutaneous coronary intervention (PCI)
• D) Intravenous heparin
,Correct Answer: C
Rationale: ST elevation in V1–V4 indicates an anterior wall myocardial infarction.
Emergent PCI is the treatment of choice if available within 90–120 minutes. Aspirin and
nitroglycerin are adjunctive but not the definitive intervention.
Q2. A 55-year-old man presents with chest pain radiating to the left arm. ECG shows ST
elevation in leads II, III, and aVF. Which artery is most likely occluded?
• A) Left anterior descending artery
• B) Right coronary artery
• C) Left circumflex artery
• D) Posterior descending artery
Correct Answer: B
Rationale: Inferior wall MI (leads II, III, aVF) is most commonly due to occlusion of the
right coronary artery (RCA).
Q3. A 72-year-old female presents with progressive dyspnea on exertion, orthopnea,
and bilateral lower extremity edema. She has a history of hypertension. On auscultation,
an S3 gallop is heard. Which of the following is the most likely diagnosis?
• A) Acute coronary syndrome
• B) Heart failure with reduced ejection fraction
• C) Pulmonary embolism
• D) Chronic obstructive pulmonary disease
,Correct Answer: B
Rationale: The triad of progressive dyspnea, orthopnea, peripheral edema, and an S3
gallop is classic for heart failure with reduced ejection fraction.
Q4. 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 myocardial infarction
Correct Answer: C
Rationale: Stable angina is characterized by predictable chest pain triggered by exertion
or stress and relieved by rest. A normal resting ECG does not exclude stable angina.
Q5. A 68-year-old male with hypertension presents with a crescendo-decrescendo
systolic murmur best heard at the right 2nd intercostal space, radiating to the carotids.
What is the most likely diagnosis?
• A) Aortic stenosis
• B) Mitral regurgitation
• C) Aortic regurgitation
• D) Mitral stenosis
Correct Answer: A
, Rationale: A crescendo-decrescendo systolic murmur at the right upper sternal border
radiating to the carotids is classic for aortic stenosis.
Q6. A 68-year-old man with heart failure presents with acute dyspnea and pink frothy
sputum. Lung auscultation reveals diffuse crackles. BP 150/90, HR 110. What is the most
appropriate immediate intervention?
• A) IV furosemide
• B) IV nitroglycerin
• C) IV morphine
• D) Noninvasive positive pressure ventilation (NIPPV)
Correct Answer: D
Rationale: NIPPV provides immediate improvement in oxygenation and reduces
preload and afterload in acute cardiogenic pulmonary edema.
Q7. A 45-year-old female presents with palpitations, weight loss, heat intolerance, and
fine tremor. Thyroid examination reveals a diffusely enlarged gland. What is the most
likely diagnosis?
• A) Hashimoto's thyroiditis
• B) Graves' disease
• C) Subacute thyroiditis
• D) Toxic multinodular goiter
Correct Answer: B
