COMSAE COMPREHENSIVE OSTEOPATHIC
MEDICAL SELF-ASSESSMENT EXAMINATION –
PHASE 2 EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Internal Medicine and Emergency Care
2. Surgery and Procedural Competence
3. Obstetrics, Gynecology, and Women's Health
4. Pediatrics and Human Development
5. Psychiatry and Behavioral Health
6. Osteopathic Principles, Practice, and Manipulative Treatment (OMT)
7. Family Medicine and Preventive Health
8. Systems-Based Practice, Ethics, and Professionalism
1. A 45-year-old man comes to the emergency department with a 3-hour history of acute, crushing
substernal chest pain radiating to his left jaw and diaphoresis. An ECG reveals ST-segment
elevation in leads II, III, and aVF. His blood pressure is 85/50 mm Hg, pulse is 110/min, and
jugular veins are distended. Lung fields are clear to auscultation. Which of the following is the
most appropriate next step in management?
A. Administer sublingual nitroglycerin and observe
B. Perform emergent primary percutaneous coronary intervention (PCI)
C. Administer intravenous beta-blockers immediately
D. Obtain a high-resolution CT angiogram of the chest
, CORRECT ANSWER : B
Rationale: The patient is presenting with an acute inferior ST-elevation myocardial infarction
(STEMI) complicated by right ventricular infarction (indicated by hypotension, clear lung fields,
and jugular venous distension). Primary percutaneous coronary intervention (PCI) is the
preferred reperfusion strategy and should be performed emergently. Nitroglycerin and beta-
blockers are contraindicated or hazardous here because they can precipitate profound
cardiogenic shock in the setting of right ventricular preload dependence.
2. A 34-year-old G2P1001 woman at 32 weeks gestation presents with painless, bright red vaginal
bleeding over the last two hours. She reports no uterine contractions or fetal movement changes.
Her vital signs are stable, and the fetal heart rate is 145/min with moderate variability.
Transabdominal ultrasound reveals the placenta covering the internal cervical os entirely. Which
of the following management steps is contraindicated?
A. Administration of antenatal corticosteroids for fetal lung maturity
B. Performing a digital cervical examination in the emergency department
C. Maintaining strict pelvic rest and inpatient monitoring
D. Scheduling a scheduled cesarean delivery at 36 to 37 weeks gestation if stable
CORRECT ANSWER : B
Rationale: This patient has complete placenta previa, which classically presents with painless
third-trimester vaginal bleeding. Performing a digital cervical or speculum examination is
strictly contraindicated because it can disrupt the placental attachment site, precipitating
catastrophic, life-threatening maternal and fetal hemorrhage.
3. A 62-year-old man with a 40-pack-year smoking history is evaluated for progressive dyspnea
and a chronic cough productive of thick, white sputum for the past three months each year over
the last two consecutive years. Spirometry confirms an FEV1/FVC ratio of 0.62 and an FEV1 of
52% of predicted that improves minimally following bronchodilator administration. Which of the
following is the primary pathologic mechanism responsible for this patient's fixed airflow
obstruction?
A. IgE-mediated acute bronchospasm and mucosal edema
B. Chronic inflammation, airway remodeling, mucous gland hypertrophy, and small
airway fibrosis
C. Destruction of alveolar walls leading to loss of elastic recoil
D. Granulomatous inflammation and interstitial fibrosis of the lung parenchyma
MEDICAL SELF-ASSESSMENT EXAMINATION –
PHASE 2 EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Internal Medicine and Emergency Care
2. Surgery and Procedural Competence
3. Obstetrics, Gynecology, and Women's Health
4. Pediatrics and Human Development
5. Psychiatry and Behavioral Health
6. Osteopathic Principles, Practice, and Manipulative Treatment (OMT)
7. Family Medicine and Preventive Health
8. Systems-Based Practice, Ethics, and Professionalism
1. A 45-year-old man comes to the emergency department with a 3-hour history of acute, crushing
substernal chest pain radiating to his left jaw and diaphoresis. An ECG reveals ST-segment
elevation in leads II, III, and aVF. His blood pressure is 85/50 mm Hg, pulse is 110/min, and
jugular veins are distended. Lung fields are clear to auscultation. Which of the following is the
most appropriate next step in management?
A. Administer sublingual nitroglycerin and observe
B. Perform emergent primary percutaneous coronary intervention (PCI)
C. Administer intravenous beta-blockers immediately
D. Obtain a high-resolution CT angiogram of the chest
, CORRECT ANSWER : B
Rationale: The patient is presenting with an acute inferior ST-elevation myocardial infarction
(STEMI) complicated by right ventricular infarction (indicated by hypotension, clear lung fields,
and jugular venous distension). Primary percutaneous coronary intervention (PCI) is the
preferred reperfusion strategy and should be performed emergently. Nitroglycerin and beta-
blockers are contraindicated or hazardous here because they can precipitate profound
cardiogenic shock in the setting of right ventricular preload dependence.
2. A 34-year-old G2P1001 woman at 32 weeks gestation presents with painless, bright red vaginal
bleeding over the last two hours. She reports no uterine contractions or fetal movement changes.
Her vital signs are stable, and the fetal heart rate is 145/min with moderate variability.
Transabdominal ultrasound reveals the placenta covering the internal cervical os entirely. Which
of the following management steps is contraindicated?
A. Administration of antenatal corticosteroids for fetal lung maturity
B. Performing a digital cervical examination in the emergency department
C. Maintaining strict pelvic rest and inpatient monitoring
D. Scheduling a scheduled cesarean delivery at 36 to 37 weeks gestation if stable
CORRECT ANSWER : B
Rationale: This patient has complete placenta previa, which classically presents with painless
third-trimester vaginal bleeding. Performing a digital cervical or speculum examination is
strictly contraindicated because it can disrupt the placental attachment site, precipitating
catastrophic, life-threatening maternal and fetal hemorrhage.
3. A 62-year-old man with a 40-pack-year smoking history is evaluated for progressive dyspnea
and a chronic cough productive of thick, white sputum for the past three months each year over
the last two consecutive years. Spirometry confirms an FEV1/FVC ratio of 0.62 and an FEV1 of
52% of predicted that improves minimally following bronchodilator administration. Which of the
following is the primary pathologic mechanism responsible for this patient's fixed airflow
obstruction?
A. IgE-mediated acute bronchospasm and mucosal edema
B. Chronic inflammation, airway remodeling, mucous gland hypertrophy, and small
airway fibrosis
C. Destruction of alveolar walls leading to loss of elastic recoil
D. Granulomatous inflammation and interstitial fibrosis of the lung parenchyma
