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FAMILY MEDICINE COMAT EXAM| FREQUENTLY MOST
TESTED QUESTIONS AND VERIFIED SOLUTIONS @ 2026
|| 2027 (ACTUAL EXAM) QUESTIONS WITH VERIFIED
ANSWERS
A 56-year-old female complains of palpitations and an unintentional 20
lb weight loss in the past six months. History reveals that her menstrual
periods stopped approximately 7 years ago. Vital signs include a blood
pressure of 135/85 and a heart rate of 110. Physical examination reveals
a non-tender enlarged thyroid gland without nodules. Structural
examination reveals tissue texture changes at T2 associated with an
upper thoracic flexion hump. Laboratory studies reveal the following
TSH: 0.05
free T3: 380
free T4: 22
A thyroid stimulating immunoglobulin test is positive. The most
appropriate initial management is
A. levothyroxine
B. methimazole
C. proylthiouracil
D. radioactive iodine ablation
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E. thyroidectomy ......ANSWER......B (although treatment with
methimazole, proylthiouracil, radioactive iodine, and surgical removal
of the thyroid gland are plausible treatments for Grave's disease,
methimazole is recommnded as a first line agent over propylthiouracil
due to potential hepatotoxicity)
A 66-year old female complains that the nail of her right great toe is
discolored and brittle. She states that she first noticed it 4 months ago
during a pedicure. Physical examination reveals the right great toenail
to be yellowed, thickened, and has white subungual debris. The most
appropriate modality to confirm the most likely diagnosis is
A. bacterial culture of nail clippings
B. culture of toenail scrapings on Sabouraud's medium
C. histopathologic examination of nail clippings under periodic acid-
Schiff stain
D. microscopic evaluation of toenail scrapings using KOH prep
E. one month terbinafine to confirm resolution ......ANSWER......D (the
most likely diagnosis is onychomycosis - microscopic evaluation is the
best first step to make the diagnosis) (A; bacterial infection is less
likely than fungal) (B; Sabouraud's agar is used to grow fungal
specimens - culture results usually return after weeks, a microscopic
evaluation would be faster - culturing would be indicated if the initial
KOH prep shows absent fungi) (C; this procedure stains fungal cell
walls and helps in visualization - however, while this test is more
sensitive, it is more expensive) (E; empiric treatment is not
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recommended due to side effects - additionally, treatment usually
lasts 3 months, not 1, due to the slow growing nature of toenails)
A 70-year-old female who is 3 days status-post urologic surgery
develops a fever overnight in the hospital. She has an indwelling Foley
catheter with good urine output. Her past medical history includes
hypertension and urinary incontinence. She has no significant family
history. Vitals reveal her temperature to be 102.2F, pulse 82,
respirations 15, and blood pressure 134/85. Physical examination is
remarkable for mild suprapubic tenderness. You note a tender nodule
on the lateral border of the umbilicus. Urinalysis reveals 60 WBC/hpf,
trace protein, positive leukocyte esterase, positive nitrites, and no casts.
A reflex culture grows motile, gram-negative rods with a dark green
appearance and fruity odor. The most appropriate pharmacologic
therapy includes
A. amoxicillin
B. cefotaxime
C. ceftriaxone
D. ciprofloxacin
E. trimethoprim-sulfamethoxazole ......ANSWER......D (indwelling
catheter can cause a UTI with Pseudomonas aeruginosa - the indicated
treatment is with a fluoroquinolone like ciprofloxacin or levofloxacin)
(none of the other answer choices have action against Pseudomonas)
A 32-year-old G1P0 female at 16 weeks' gestation presents with vaginal
bleeding. History reveals she had pelvic inflammatory disease of
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unknown etiology prior to conception. Pelvic examination reveals the
cervical os to be closed. The most likely diagnosis is
A. complete abortion
B. incomplete abortion
C. inevitable abortion
D. partial abortion
E. threatened abortion ......ANSWER......E (threatened abortion is used
to describe any vaginal bleeding that occurs within the first 20 weeks
of pregnancy) (A; a complete abortion is when the products of
conception have completely evacuated the uterus and the cervical os
is closed) (B; an incomplete abortion is when the products of
conception can be seen or palpated in the cervical canal, and the
cervical os is open) (C; an inevitable abortion is when the products of
conception can be seen or palpated within the uterus through the
dilated cervical os) (D; partial abortion is not an appropriate or
defined medical term)
A 32-year-old G1P0 female at 16 weeks' gestation presents with vaginal
bleeding. History reveals she had pelvic inflammatory disease of
unknown etiology prior to conception. Pelvic examination reveals the
cervical os to be closed. The patient ultimately has a miscarriage and
undergoes a successful dilation and curettage. You explain that she is
likely to experience another miscarriage because she has a history of
A. advanced maternal age
FAMILY MEDICINE COMAT EXAM| FREQUENTLY MOST
TESTED QUESTIONS AND VERIFIED SOLUTIONS @ 2026
|| 2027 (ACTUAL EXAM) QUESTIONS WITH VERIFIED
ANSWERS
A 56-year-old female complains of palpitations and an unintentional 20
lb weight loss in the past six months. History reveals that her menstrual
periods stopped approximately 7 years ago. Vital signs include a blood
pressure of 135/85 and a heart rate of 110. Physical examination reveals
a non-tender enlarged thyroid gland without nodules. Structural
examination reveals tissue texture changes at T2 associated with an
upper thoracic flexion hump. Laboratory studies reveal the following
TSH: 0.05
free T3: 380
free T4: 22
A thyroid stimulating immunoglobulin test is positive. The most
appropriate initial management is
A. levothyroxine
B. methimazole
C. proylthiouracil
D. radioactive iodine ablation
,2|Page
E. thyroidectomy ......ANSWER......B (although treatment with
methimazole, proylthiouracil, radioactive iodine, and surgical removal
of the thyroid gland are plausible treatments for Grave's disease,
methimazole is recommnded as a first line agent over propylthiouracil
due to potential hepatotoxicity)
A 66-year old female complains that the nail of her right great toe is
discolored and brittle. She states that she first noticed it 4 months ago
during a pedicure. Physical examination reveals the right great toenail
to be yellowed, thickened, and has white subungual debris. The most
appropriate modality to confirm the most likely diagnosis is
A. bacterial culture of nail clippings
B. culture of toenail scrapings on Sabouraud's medium
C. histopathologic examination of nail clippings under periodic acid-
Schiff stain
D. microscopic evaluation of toenail scrapings using KOH prep
E. one month terbinafine to confirm resolution ......ANSWER......D (the
most likely diagnosis is onychomycosis - microscopic evaluation is the
best first step to make the diagnosis) (A; bacterial infection is less
likely than fungal) (B; Sabouraud's agar is used to grow fungal
specimens - culture results usually return after weeks, a microscopic
evaluation would be faster - culturing would be indicated if the initial
KOH prep shows absent fungi) (C; this procedure stains fungal cell
walls and helps in visualization - however, while this test is more
sensitive, it is more expensive) (E; empiric treatment is not
,3|Page
recommended due to side effects - additionally, treatment usually
lasts 3 months, not 1, due to the slow growing nature of toenails)
A 70-year-old female who is 3 days status-post urologic surgery
develops a fever overnight in the hospital. She has an indwelling Foley
catheter with good urine output. Her past medical history includes
hypertension and urinary incontinence. She has no significant family
history. Vitals reveal her temperature to be 102.2F, pulse 82,
respirations 15, and blood pressure 134/85. Physical examination is
remarkable for mild suprapubic tenderness. You note a tender nodule
on the lateral border of the umbilicus. Urinalysis reveals 60 WBC/hpf,
trace protein, positive leukocyte esterase, positive nitrites, and no casts.
A reflex culture grows motile, gram-negative rods with a dark green
appearance and fruity odor. The most appropriate pharmacologic
therapy includes
A. amoxicillin
B. cefotaxime
C. ceftriaxone
D. ciprofloxacin
E. trimethoprim-sulfamethoxazole ......ANSWER......D (indwelling
catheter can cause a UTI with Pseudomonas aeruginosa - the indicated
treatment is with a fluoroquinolone like ciprofloxacin or levofloxacin)
(none of the other answer choices have action against Pseudomonas)
A 32-year-old G1P0 female at 16 weeks' gestation presents with vaginal
bleeding. History reveals she had pelvic inflammatory disease of
, 4|Page
unknown etiology prior to conception. Pelvic examination reveals the
cervical os to be closed. The most likely diagnosis is
A. complete abortion
B. incomplete abortion
C. inevitable abortion
D. partial abortion
E. threatened abortion ......ANSWER......E (threatened abortion is used
to describe any vaginal bleeding that occurs within the first 20 weeks
of pregnancy) (A; a complete abortion is when the products of
conception have completely evacuated the uterus and the cervical os
is closed) (B; an incomplete abortion is when the products of
conception can be seen or palpated in the cervical canal, and the
cervical os is open) (C; an inevitable abortion is when the products of
conception can be seen or palpated within the uterus through the
dilated cervical os) (D; partial abortion is not an appropriate or
defined medical term)
A 32-year-old G1P0 female at 16 weeks' gestation presents with vaginal
bleeding. History reveals she had pelvic inflammatory disease of
unknown etiology prior to conception. Pelvic examination reveals the
cervical os to be closed. The patient ultimately has a miscarriage and
undergoes a successful dilation and curettage. You explain that she is
likely to experience another miscarriage because she has a history of
A. advanced maternal age
