COMSAE Phase 2 Form 118 Exam Questions and
Verified Answers with Rationales
COMSAE Phase 2 Form 118 Exam
EXAM COVERAGE AREAS
1. Internal Medicine (Highest Yield)
• Cardiology: ACS, heart failure, arrhythmias, valvular disease, hypertension
• Pulmonary: COPD, asthma, PE, pneumonia, interstitial lung disease
• Endocrinology: Diabetes, thyroid disorders, adrenal disorders, metabolic
syndrome
• Renal/Electrolytes: AKI, CKD, acid-base disorders, electrolyte imbalances
• Infectious Disease: Sepsis, endocarditis, osteomyelitis, meningitis, HIV
• GI/Hepatology: GI bleeding, cirrhosis, pancreatitis, inflammatory bowel
disease
• Rheumatology: RA, lupus, gout, vasculitis, seronegative
spondyloarthropathies
• Clinical reasoning and multi-step diagnosis
2. Emergency Medicine & Acute Care
• Sepsis and shock (distributive, cardiogenic, hypovolemic, obstructive)
• Stroke: ischemic vs hemorrhagic, acute management, tPA criteria
• Trauma evaluation and management, ATLS principles
• Acid-base disorders and toxicology
• ACLS-based management decisions
3. Obstetrics & Gynecology
• Prenatal care, pregnancy complications (preeclampsia, gestational diabetes,
bleeding)
• Labor management, postpartum complications
• Contraceptive counseling and family planning
• Abnormal uterine bleeding, STIs, cervical cancer screening
• Gynecologic oncology (ovarian, endometrial, cervical cancer)
4. Pediatrics
, • Growth and development, developmental milestones
• Vaccination schedules, pediatric infectious diseases
• Congenital conditions, neonatal care (hyperbilirubinemia, respiratory
distress)
• Pediatric asthma, pediatric GI disorders
• Behavioral and developmental disorders
5. Surgery & Perioperative Medicine
• Acute abdomen, surgical infections, trauma care
• Postoperative complications (fever, wound infection, ileus, DVT/PE)
• Fluid and electrolyte management in surgical patients
• Basic surgical decision-making
6. Psychiatry & Behavioral Health
• Depression, anxiety disorders, bipolar disorder
• Schizophrenia and psychotic disorders
• Substance use disorders, addiction medicine
• Delirium vs dementia, psychopharmacology
• Psychiatric emergencies (suicide risk assessment)
7. Neurology
• Stroke localization and acute stroke management
7. Neurology (continued)
• Seizures and epilepsy, headache disorders
• Neuropathies and neuromuscular disorders
• Spinal cord lesions, movement disorders (Parkinson's)
• Altered mental status evaluation
8. Family Medicine & Preventive Care
• Screening guidelines (cancer, cardiovascular, diabetes)
• Preventive health and lifestyle counseling
• Chronic disease management in the outpatient setting
• Immunizations, health maintenance
9. Osteopathic Principles & Manipulative Medicine (OPP/OMM)
, • Somatic dysfunction diagnosis and treatment
• Viscerosomatic reflexes and Chapman points
• Counterstrain, muscle energy, HVLA, myofascial techniques
• Cranial osteopathy and lymphatic techniques
• Contraindications to manipulation in clinical settings
10. Clinical Reasoning & Ethics
• Differential diagnosis formation and prioritization
• Diagnostic test interpretation (labs, imaging, EKG)
• Evidence-based medicine and clinical guidelines
• Patient communication, informed consent, and shared decision-making
• Professionalism, healthcare systems, and systems-based practice
Internal Medicine
1.A 72-year-old male with a history of hypertension and type 2 diabetes presents to
the emergency department with sudden onset of severe substernal chest pain
radiating to his left arm, associated with diaphoresis and nausea. ECG shows 2-mm
ST-segment elevations in leads V1–V4. Which of the following is the most
appropriate immediate management step?
A) Administer sublingual nitroglycerin and obtain a chest X-ray
B) Obtain cardiac enzymes and admit for medical management
C) Initiate immediate reperfusion therapy with percutaneous coronary intervention
(PCI)
D) Administer alteplase and transfer to the cardiac catheterization lab
Answer: C) Initiate immediate reperfusion therapy with percutaneous coronary
intervention (PCI)
Rationale: This patient presents with an acute ST-segment elevation myocardial
infarction (STEMI) with ST elevations in V1–V4 indicating an anterior wall MI.
Immediate reperfusion therapy is the priority, with PCI being the preferred method
if available within 90 minutes. Door-to-balloon time should be less than 90
minutes. Thrombolytics are an alternative if PCI is not available within this
timeframe.
, 2.A 45-year-old female with a history of systemic lupus erythematosus presents
with progressive shortness of breath, fatigue, and bilateral lower extremity edema.
On examination, she has jugular venous distention, a third heart sound, and
crackles in both lung bases. Which of the following findings would be most
consistent with a diagnosis of restrictive cardiomyopathy?
A) Dilated left ventricle with reduced ejection fraction
B) Increased left ventricular wall thickness with normal cavity size
C) Normal left ventricular cavity size with impaired diastolic filling
D) Asymmetric septal hypertrophy with dynamic outflow obstruction
Answer: C) Normal left ventricular cavity size with impaired diastolic filling
Rationale: Restrictive cardiomyopathy is characterized by normal or reduced
ventricular cavity size with impaired diastolic filling (impaired relaxation). The
hallmark is restrictive diastolic dysfunction with preserved systolic function
(normal ejection fraction). Causes include infiltrative diseases (amyloidosis,
sarcoidosis), connective tissue disorders (lupus), and storage diseases.
3.A 28-year-old pregnant woman at 32 weeks gestation presents with new-onset
hypertension (blood pressure 155/95 mmHg) and proteinuria (3 g/24 hours). She
complains of a severe headache and visual disturbances. Which of the following is
the most appropriate next step in management?
A) Admit for observation and repeat blood pressure monitoring
B) Start antihypertensive therapy with labetalol and plan for delivery at 37 weeks
C) Initiate magnesium sulfate for seizure prophylaxis and plan for delivery
D) Discharge home with close outpatient follow-up
Verified Answers with Rationales
COMSAE Phase 2 Form 118 Exam
EXAM COVERAGE AREAS
1. Internal Medicine (Highest Yield)
• Cardiology: ACS, heart failure, arrhythmias, valvular disease, hypertension
• Pulmonary: COPD, asthma, PE, pneumonia, interstitial lung disease
• Endocrinology: Diabetes, thyroid disorders, adrenal disorders, metabolic
syndrome
• Renal/Electrolytes: AKI, CKD, acid-base disorders, electrolyte imbalances
• Infectious Disease: Sepsis, endocarditis, osteomyelitis, meningitis, HIV
• GI/Hepatology: GI bleeding, cirrhosis, pancreatitis, inflammatory bowel
disease
• Rheumatology: RA, lupus, gout, vasculitis, seronegative
spondyloarthropathies
• Clinical reasoning and multi-step diagnosis
2. Emergency Medicine & Acute Care
• Sepsis and shock (distributive, cardiogenic, hypovolemic, obstructive)
• Stroke: ischemic vs hemorrhagic, acute management, tPA criteria
• Trauma evaluation and management, ATLS principles
• Acid-base disorders and toxicology
• ACLS-based management decisions
3. Obstetrics & Gynecology
• Prenatal care, pregnancy complications (preeclampsia, gestational diabetes,
bleeding)
• Labor management, postpartum complications
• Contraceptive counseling and family planning
• Abnormal uterine bleeding, STIs, cervical cancer screening
• Gynecologic oncology (ovarian, endometrial, cervical cancer)
4. Pediatrics
, • Growth and development, developmental milestones
• Vaccination schedules, pediatric infectious diseases
• Congenital conditions, neonatal care (hyperbilirubinemia, respiratory
distress)
• Pediatric asthma, pediatric GI disorders
• Behavioral and developmental disorders
5. Surgery & Perioperative Medicine
• Acute abdomen, surgical infections, trauma care
• Postoperative complications (fever, wound infection, ileus, DVT/PE)
• Fluid and electrolyte management in surgical patients
• Basic surgical decision-making
6. Psychiatry & Behavioral Health
• Depression, anxiety disorders, bipolar disorder
• Schizophrenia and psychotic disorders
• Substance use disorders, addiction medicine
• Delirium vs dementia, psychopharmacology
• Psychiatric emergencies (suicide risk assessment)
7. Neurology
• Stroke localization and acute stroke management
7. Neurology (continued)
• Seizures and epilepsy, headache disorders
• Neuropathies and neuromuscular disorders
• Spinal cord lesions, movement disorders (Parkinson's)
• Altered mental status evaluation
8. Family Medicine & Preventive Care
• Screening guidelines (cancer, cardiovascular, diabetes)
• Preventive health and lifestyle counseling
• Chronic disease management in the outpatient setting
• Immunizations, health maintenance
9. Osteopathic Principles & Manipulative Medicine (OPP/OMM)
, • Somatic dysfunction diagnosis and treatment
• Viscerosomatic reflexes and Chapman points
• Counterstrain, muscle energy, HVLA, myofascial techniques
• Cranial osteopathy and lymphatic techniques
• Contraindications to manipulation in clinical settings
10. Clinical Reasoning & Ethics
• Differential diagnosis formation and prioritization
• Diagnostic test interpretation (labs, imaging, EKG)
• Evidence-based medicine and clinical guidelines
• Patient communication, informed consent, and shared decision-making
• Professionalism, healthcare systems, and systems-based practice
Internal Medicine
1.A 72-year-old male with a history of hypertension and type 2 diabetes presents to
the emergency department with sudden onset of severe substernal chest pain
radiating to his left arm, associated with diaphoresis and nausea. ECG shows 2-mm
ST-segment elevations in leads V1–V4. Which of the following is the most
appropriate immediate management step?
A) Administer sublingual nitroglycerin and obtain a chest X-ray
B) Obtain cardiac enzymes and admit for medical management
C) Initiate immediate reperfusion therapy with percutaneous coronary intervention
(PCI)
D) Administer alteplase and transfer to the cardiac catheterization lab
Answer: C) Initiate immediate reperfusion therapy with percutaneous coronary
intervention (PCI)
Rationale: This patient presents with an acute ST-segment elevation myocardial
infarction (STEMI) with ST elevations in V1–V4 indicating an anterior wall MI.
Immediate reperfusion therapy is the priority, with PCI being the preferred method
if available within 90 minutes. Door-to-balloon time should be less than 90
minutes. Thrombolytics are an alternative if PCI is not available within this
timeframe.
, 2.A 45-year-old female with a history of systemic lupus erythematosus presents
with progressive shortness of breath, fatigue, and bilateral lower extremity edema.
On examination, she has jugular venous distention, a third heart sound, and
crackles in both lung bases. Which of the following findings would be most
consistent with a diagnosis of restrictive cardiomyopathy?
A) Dilated left ventricle with reduced ejection fraction
B) Increased left ventricular wall thickness with normal cavity size
C) Normal left ventricular cavity size with impaired diastolic filling
D) Asymmetric septal hypertrophy with dynamic outflow obstruction
Answer: C) Normal left ventricular cavity size with impaired diastolic filling
Rationale: Restrictive cardiomyopathy is characterized by normal or reduced
ventricular cavity size with impaired diastolic filling (impaired relaxation). The
hallmark is restrictive diastolic dysfunction with preserved systolic function
(normal ejection fraction). Causes include infiltrative diseases (amyloidosis,
sarcoidosis), connective tissue disorders (lupus), and storage diseases.
3.A 28-year-old pregnant woman at 32 weeks gestation presents with new-onset
hypertension (blood pressure 155/95 mmHg) and proteinuria (3 g/24 hours). She
complains of a severe headache and visual disturbances. Which of the following is
the most appropriate next step in management?
A) Admit for observation and repeat blood pressure monitoring
B) Start antihypertensive therapy with labetalol and plan for delivery at 37 weeks
C) Initiate magnesium sulfate for seizure prophylaxis and plan for delivery
D) Discharge home with close outpatient follow-up
