COMSAE PHASE 3 FORM 301 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Internal Medicine and Primary Care
2. Surgical Principles and Perioperative Care
3. Pediatrics and Adolescent Medicine
4. Obstetrics and Gynecology
5. Psychiatry and Behavioral Health
6. Emergency Medicine and Acute Care
7. Preventive Medicine and Public Health
8. Legal, Ethical, and Professional Standards
Introduction
This comprehensive examination is designed to assess a candidate's readiness for clinical practice at the entry-to-
practice level. It evaluates the application of foundational medical knowledge, clinical reasoning, and decision-
making skills in a variety of patient care scenarios. The assessment employs a multiple-choice format, including
both single-best-answer questions and clinical vignettes, to gauge the candidate's ability to synthesize information
and manage patient care effectively. Emphasis is placed on real-world application, integrating core medical
knowledge with professional standards, ethical principles, and regulatory compliance. This tool serves as a critical
measure of a physician's preparedness to deliver safe, effective, and patient-centered care.
,Section One: Questions 1–100
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a two-day history of
severe, tearing chest pain that radiates to his back. His blood pressure is 190/110 mmHg in the right arm and
100/60 mmHg in the left arm. Which of the following is the most appropriate next step in management?
A. Administer intravenous (IV) metoprolol
B. Obtain a stat electrocardiogram (ECG)
C. Order a high-resolution computed tomography (CT) angiogram
D. Perform a bedside transthoracic echocardiogram (TTE)
🟢C
🔴 RATIONALE: The patient's presentation is classic for an acute aortic dissection, characterized by severe,
tearing pain and a pulse or blood pressure differential. The most definitive and rapidly available diagnostic test
to confirm this is a CT angiogram of the chest and abdomen. While all other options are part of the
management or diagnostic workup, a CT angiogram is the diagnostic study of choice to confirm the presence
and extent of the dissection prior to surgical or medical intervention.
2. A 28-year-old female presents with a chief complaint of progressive weakness in her lower extremities and
difficulty walking over the past two weeks. She reports a history of an upper respiratory infection three
weeks ago. On examination, she has bilateral lower extremity weakness, hyperreflexia, and a sensory level at
T10. Which of the following is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Multiple sclerosis
,C. Spinal cord compression
D. Transverse myelitis
🟢D
🔴 RATIONALE: Transverse myelitis is an acute inflammatory process of the spinal cord that often follows a viral
infection. Key features include the acute to subacute onset of bilateral lower extremity weakness, sensory
changes with a distinct sensory level, and hyperreflexia due to an upper motor neuron lesion. Guillain-Barré
syndrome is a peripheral neuropathy, usually presenting with ascending weakness and hyporeflexia. Multiple
sclerosis can cause this, but the acute onset after an infection and a clear sensory level strongly suggest
transverse myelitis as the most likely primary diagnosis in this acute setting.
3. A 45-year-old male with a history of heavy alcohol use presents with confusion, jaundice, and abdominal
distension. His laboratory results show an elevated international normalized ratio (INR) and a low serum
albumin. Which of the following is the most critical initial step in the management of this patient?
A. Administer IV vitamin K
B. Order a paracentesis
C. Prescribe oral lactulose
D. Start a continuous IV infusion of octreotide
🟢C
🔴 RATIONALE: The patient is presenting with signs of alcoholic hepatitis and likely hepatic encephalopathy,
indicated by confusion. The most critical initial step is to initiate treatment for hepatic encephalopathy to lower
serum ammonia levels. Lactulose is the first-line therapy for this condition. While vitamin K may be given for the
, elevated INR and paracentesis may be needed for ascites, the immediate life-threatening concern is the altered
mental status from encephalopathy, making lactulose the priority.
4. A 68-year-old female with a history of osteoarthritis presents with a painful, swollen left knee. She has had
no trauma. On examination, the knee is warm, erythematous, and tender. Joint aspiration reveals cloudy
fluid with a white blood cell (WBC) count of 75,000/mm³ and 85% polymorphonuclear neutrophils (PMNs).
Which of the following is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Pseudogout
D. Septic arthritis
🟢D
🔴 RATIONALE: A significantly elevated WBC count in joint fluid (>50,000/mm³) with a predominance of PMNs
is highly indicative of a septic joint (infectious arthritis). While gout and pseudogout can also present with an
acutely inflamed joint, they typically have lower WBC counts unless there is a superimposed infection.
Osteoarthritis is a non-inflammatory condition and would not present with these findings. The presence of a
high WBC count, especially with >90% PMNs, is a hallmark of septic arthritis and mandates immediate
treatment.
5. A 6-month-old infant is brought to the clinic for a routine well-child visit. The mother is concerned
because the infant cannot sit without support. Which of the following is the most appropriate response?
A. Refer the infant to a pediatric neurologist immediately
B. Reassure the mother that this is a normal finding for this age
2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Internal Medicine and Primary Care
2. Surgical Principles and Perioperative Care
3. Pediatrics and Adolescent Medicine
4. Obstetrics and Gynecology
5. Psychiatry and Behavioral Health
6. Emergency Medicine and Acute Care
7. Preventive Medicine and Public Health
8. Legal, Ethical, and Professional Standards
Introduction
This comprehensive examination is designed to assess a candidate's readiness for clinical practice at the entry-to-
practice level. It evaluates the application of foundational medical knowledge, clinical reasoning, and decision-
making skills in a variety of patient care scenarios. The assessment employs a multiple-choice format, including
both single-best-answer questions and clinical vignettes, to gauge the candidate's ability to synthesize information
and manage patient care effectively. Emphasis is placed on real-world application, integrating core medical
knowledge with professional standards, ethical principles, and regulatory compliance. This tool serves as a critical
measure of a physician's preparedness to deliver safe, effective, and patient-centered care.
,Section One: Questions 1–100
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a two-day history of
severe, tearing chest pain that radiates to his back. His blood pressure is 190/110 mmHg in the right arm and
100/60 mmHg in the left arm. Which of the following is the most appropriate next step in management?
A. Administer intravenous (IV) metoprolol
B. Obtain a stat electrocardiogram (ECG)
C. Order a high-resolution computed tomography (CT) angiogram
D. Perform a bedside transthoracic echocardiogram (TTE)
🟢C
🔴 RATIONALE: The patient's presentation is classic for an acute aortic dissection, characterized by severe,
tearing pain and a pulse or blood pressure differential. The most definitive and rapidly available diagnostic test
to confirm this is a CT angiogram of the chest and abdomen. While all other options are part of the
management or diagnostic workup, a CT angiogram is the diagnostic study of choice to confirm the presence
and extent of the dissection prior to surgical or medical intervention.
2. A 28-year-old female presents with a chief complaint of progressive weakness in her lower extremities and
difficulty walking over the past two weeks. She reports a history of an upper respiratory infection three
weeks ago. On examination, she has bilateral lower extremity weakness, hyperreflexia, and a sensory level at
T10. Which of the following is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Multiple sclerosis
,C. Spinal cord compression
D. Transverse myelitis
🟢D
🔴 RATIONALE: Transverse myelitis is an acute inflammatory process of the spinal cord that often follows a viral
infection. Key features include the acute to subacute onset of bilateral lower extremity weakness, sensory
changes with a distinct sensory level, and hyperreflexia due to an upper motor neuron lesion. Guillain-Barré
syndrome is a peripheral neuropathy, usually presenting with ascending weakness and hyporeflexia. Multiple
sclerosis can cause this, but the acute onset after an infection and a clear sensory level strongly suggest
transverse myelitis as the most likely primary diagnosis in this acute setting.
3. A 45-year-old male with a history of heavy alcohol use presents with confusion, jaundice, and abdominal
distension. His laboratory results show an elevated international normalized ratio (INR) and a low serum
albumin. Which of the following is the most critical initial step in the management of this patient?
A. Administer IV vitamin K
B. Order a paracentesis
C. Prescribe oral lactulose
D. Start a continuous IV infusion of octreotide
🟢C
🔴 RATIONALE: The patient is presenting with signs of alcoholic hepatitis and likely hepatic encephalopathy,
indicated by confusion. The most critical initial step is to initiate treatment for hepatic encephalopathy to lower
serum ammonia levels. Lactulose is the first-line therapy for this condition. While vitamin K may be given for the
, elevated INR and paracentesis may be needed for ascites, the immediate life-threatening concern is the altered
mental status from encephalopathy, making lactulose the priority.
4. A 68-year-old female with a history of osteoarthritis presents with a painful, swollen left knee. She has had
no trauma. On examination, the knee is warm, erythematous, and tender. Joint aspiration reveals cloudy
fluid with a white blood cell (WBC) count of 75,000/mm³ and 85% polymorphonuclear neutrophils (PMNs).
Which of the following is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Pseudogout
D. Septic arthritis
🟢D
🔴 RATIONALE: A significantly elevated WBC count in joint fluid (>50,000/mm³) with a predominance of PMNs
is highly indicative of a septic joint (infectious arthritis). While gout and pseudogout can also present with an
acutely inflamed joint, they typically have lower WBC counts unless there is a superimposed infection.
Osteoarthritis is a non-inflammatory condition and would not present with these findings. The presence of a
high WBC count, especially with >90% PMNs, is a hallmark of septic arthritis and mandates immediate
treatment.
5. A 6-month-old infant is brought to the clinic for a routine well-child visit. The mother is concerned
because the infant cannot sit without support. Which of the following is the most appropriate response?
A. Refer the infant to a pediatric neurologist immediately
B. Reassure the mother that this is a normal finding for this age
