COMSAE PHASE 3 SCHOOL-ADMINISTERED ASSESSMENT QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027..
Core Domains
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Surgery and Surgical Subspecialties
Psychiatry and Behavioral Health
Emergency Medicine and Critical Care
Preventive Medicine and Public Health
Medical Ethics and Professionalism
Healthcare Systems and Patient Safety
Introduction
This comprehensive examination is designed to assess the readiness of senior medical students for clinical practice.
It evaluates foundational medical knowledge, clinical reasoning, and the application of evidence-based medicine in
complex patient scenarios. The assessment emphasizes diagnostic acumen, treatment planning, and the critical
decision-making skills necessary for safe and effective patient care. It integrates principles of ethics,
professionalism, and healthcare systems to prepare students for the responsibilities of residency and beyond. The
structure includes multiple-choice questions that test a broad range of core clinical subjects.
,SECTION ONE: QUESTIONS 1-100
1. A 45-year-old male with a history of hypertension presents with acute, severe, tearing chest pain radiating
to his back. His blood pressure is 180/100 mmHg in his right arm and 110/70 mmHg in his left arm. What is
the most appropriate initial imaging study to confirm the suspected diagnosis?
A. Computed tomography (CT) angiogram of the chest
B. Transthoracic echocardiogram
C. Chest X-ray
D. Magnetic resonance imaging (MRI) of the chest
🟢A
🔴 RATIONALE: The patient's presentation of severe, tearing chest pain with a blood pressure differential
between arms is classic for an acute aortic dissection. A CT angiogram of the chest is the gold standard imaging
modality for rapid and accurate diagnosis of aortic dissection. It is widely available, fast, and provides detailed
visualization of the aorta and its branches.
2. A 32-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. Her thyroid-
stimulating hormone (TSH) is 12.5 mIU/L (normal 0.5-5.0). What is the most appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine ablation
D. Propranolol
,🟢B
🔴 RATIONALE: This patient has overt hypothyroidism, as evidenced by elevated TSH and classic symptoms. The
standard initial treatment is levothyroxine replacement therapy. Methimazole and radioactive iodine are used to
treat hyperthyroidism. Propranolol is used to manage symptoms of hyperthyroidism, not hypothyroidism.
3. A 67-year-old female with a history of osteoporosis is started on a new medication. She develops severe
heartburn and esophageal pain. Which medication is most likely responsible for her symptoms?
A. Risedronate
B. Teriparatide
C. Raloxifene
D. Denosumab
🟢A
🔴 RATIONALE: Bisphosphonates, such as risedronate and alendronate, are known to cause significant
gastrointestinal side effects, particularly esophagitis and heartburn. Teriparatide, raloxifene, and denosumab do
not commonly cause these symptoms.
4. A 28-year-old primigravida at 38 weeks gestation presents with sudden onset of severe, constant
abdominal pain and vaginal bleeding. Her uterus is firm and tender. What is the most likely diagnosis?
, A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
🟢B
🔴 RATIONALE: Abruptio placentae is characterized by the premature separation of the placenta from the
uterine wall, presenting with painful vaginal bleeding and a tense, tender uterus. Placenta previa typically
presents with painless vaginal bleeding. Uterine rupture is rare and usually associated with uterine scars. Vasa
previa involves fetal vessels over the cervical os.
5. A 7-year-old boy is brought to the clinic with a fever of 102°F, sore throat, and difficulty swallowing. On
examination, his tonsils are erythematous and covered with a grayish-white exudate. What is the most
appropriate initial test to confirm the likely diagnosis?
A. Throat culture for Group A Streptococcus
B. Rapid antigen detection test for Group A Streptococcus
C. Complete blood count (CBC)
D. Monospot test
🟢B
🔴 RATIONALE: While a throat culture is the gold standard, a rapid antigen detection test is the most
appropriate initial test due to its rapid results and high specificity. It allows for immediate treatment decisions
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027..
Core Domains
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Surgery and Surgical Subspecialties
Psychiatry and Behavioral Health
Emergency Medicine and Critical Care
Preventive Medicine and Public Health
Medical Ethics and Professionalism
Healthcare Systems and Patient Safety
Introduction
This comprehensive examination is designed to assess the readiness of senior medical students for clinical practice.
It evaluates foundational medical knowledge, clinical reasoning, and the application of evidence-based medicine in
complex patient scenarios. The assessment emphasizes diagnostic acumen, treatment planning, and the critical
decision-making skills necessary for safe and effective patient care. It integrates principles of ethics,
professionalism, and healthcare systems to prepare students for the responsibilities of residency and beyond. The
structure includes multiple-choice questions that test a broad range of core clinical subjects.
,SECTION ONE: QUESTIONS 1-100
1. A 45-year-old male with a history of hypertension presents with acute, severe, tearing chest pain radiating
to his back. His blood pressure is 180/100 mmHg in his right arm and 110/70 mmHg in his left arm. What is
the most appropriate initial imaging study to confirm the suspected diagnosis?
A. Computed tomography (CT) angiogram of the chest
B. Transthoracic echocardiogram
C. Chest X-ray
D. Magnetic resonance imaging (MRI) of the chest
🟢A
🔴 RATIONALE: The patient's presentation of severe, tearing chest pain with a blood pressure differential
between arms is classic for an acute aortic dissection. A CT angiogram of the chest is the gold standard imaging
modality for rapid and accurate diagnosis of aortic dissection. It is widely available, fast, and provides detailed
visualization of the aorta and its branches.
2. A 32-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. Her thyroid-
stimulating hormone (TSH) is 12.5 mIU/L (normal 0.5-5.0). What is the most appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine ablation
D. Propranolol
,🟢B
🔴 RATIONALE: This patient has overt hypothyroidism, as evidenced by elevated TSH and classic symptoms. The
standard initial treatment is levothyroxine replacement therapy. Methimazole and radioactive iodine are used to
treat hyperthyroidism. Propranolol is used to manage symptoms of hyperthyroidism, not hypothyroidism.
3. A 67-year-old female with a history of osteoporosis is started on a new medication. She develops severe
heartburn and esophageal pain. Which medication is most likely responsible for her symptoms?
A. Risedronate
B. Teriparatide
C. Raloxifene
D. Denosumab
🟢A
🔴 RATIONALE: Bisphosphonates, such as risedronate and alendronate, are known to cause significant
gastrointestinal side effects, particularly esophagitis and heartburn. Teriparatide, raloxifene, and denosumab do
not commonly cause these symptoms.
4. A 28-year-old primigravida at 38 weeks gestation presents with sudden onset of severe, constant
abdominal pain and vaginal bleeding. Her uterus is firm and tender. What is the most likely diagnosis?
, A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
🟢B
🔴 RATIONALE: Abruptio placentae is characterized by the premature separation of the placenta from the
uterine wall, presenting with painful vaginal bleeding and a tense, tender uterus. Placenta previa typically
presents with painless vaginal bleeding. Uterine rupture is rare and usually associated with uterine scars. Vasa
previa involves fetal vessels over the cervical os.
5. A 7-year-old boy is brought to the clinic with a fever of 102°F, sore throat, and difficulty swallowing. On
examination, his tonsils are erythematous and covered with a grayish-white exudate. What is the most
appropriate initial test to confirm the likely diagnosis?
A. Throat culture for Group A Streptococcus
B. Rapid antigen detection test for Group A Streptococcus
C. Complete blood count (CBC)
D. Monospot test
🟢B
🔴 RATIONALE: While a throat culture is the gold standard, a rapid antigen detection test is the most
appropriate initial test due to its rapid results and high specificity. It allows for immediate treatment decisions
