COMSAE Phase 2-Style Comprehensive
Osteopathic Medical Examination: Practice
Questions with Answers and Rationales
CARDIOLOGY (Questions 1-12)
1. A 65-year-old man with COPD presents with dyspnea. ABG shows pH 7.35, pCO₂ 55, HCO₃⁻
30. What is the diagnosis?
,- A) Acute respiratory acidosis
- B) Compensated respiratory acidosis
- C) Metabolic alkalosis
- D) Mixed acid-base disorder
Answer: B) Compensated respiratory acidosis
Rationale: Chronic CO₂ retention with compensatory bicarbonate elevation indicates compensated
respiratory acidosis. The pH is near normal due to renal compensation, but pCO₂ remains
elevated .
2. A 70-year-old with atrial fibrillation and hypertension should be started on which medication for
stroke prevention?
- A) Aspirin
- B) Clopidogrel
,- C) Apixaban
- D) Warfarin + aspirin
Answer: C) Apixaban
Rationale: Direct oral anticoagulants like apixaban are preferred for nonvalvular atrial fibrillation
due to favorable risk-benefit profile and fewer drug interactions compared to warfarin .
3. A patient with chest pain has ST elevation in leads II, III, aVF. Which artery is likely occluded?
- A) Left anterior descending
- B) Right coronary artery
- C) Circumflex artery
- D) Left main coronary artery
, Answer: B) Right coronary artery
Rationale: Inferior MI involves the right coronary artery (RCA), which supplies the inferior wall of
the left ventricle. Leads II, III, and aVF represent the inferior territory .
4. A 6-month-old with "blue spells" relieved by squatting. What is the most likely diagnosis?
- A) Ventricular septal defect
- B) Tetralogy of Fallot
- C) Transposition of great arteries
- D) Atrial septal defect
Answer: B) Tetralogy of Fallot
Rationale: TOF causes cyanotic spells improved by squatting, which increases systemic vascular
resistance, decreases right-to-left shunting, and improves oxygenation .
Osteopathic Medical Examination: Practice
Questions with Answers and Rationales
CARDIOLOGY (Questions 1-12)
1. A 65-year-old man with COPD presents with dyspnea. ABG shows pH 7.35, pCO₂ 55, HCO₃⁻
30. What is the diagnosis?
,- A) Acute respiratory acidosis
- B) Compensated respiratory acidosis
- C) Metabolic alkalosis
- D) Mixed acid-base disorder
Answer: B) Compensated respiratory acidosis
Rationale: Chronic CO₂ retention with compensatory bicarbonate elevation indicates compensated
respiratory acidosis. The pH is near normal due to renal compensation, but pCO₂ remains
elevated .
2. A 70-year-old with atrial fibrillation and hypertension should be started on which medication for
stroke prevention?
- A) Aspirin
- B) Clopidogrel
,- C) Apixaban
- D) Warfarin + aspirin
Answer: C) Apixaban
Rationale: Direct oral anticoagulants like apixaban are preferred for nonvalvular atrial fibrillation
due to favorable risk-benefit profile and fewer drug interactions compared to warfarin .
3. A patient with chest pain has ST elevation in leads II, III, aVF. Which artery is likely occluded?
- A) Left anterior descending
- B) Right coronary artery
- C) Circumflex artery
- D) Left main coronary artery
, Answer: B) Right coronary artery
Rationale: Inferior MI involves the right coronary artery (RCA), which supplies the inferior wall of
the left ventricle. Leads II, III, and aVF represent the inferior territory .
4. A 6-month-old with "blue spells" relieved by squatting. What is the most likely diagnosis?
- A) Ventricular septal defect
- B) Tetralogy of Fallot
- C) Transposition of great arteries
- D) Atrial septal defect
Answer: B) Tetralogy of Fallot
Rationale: TOF causes cyanotic spells improved by squatting, which increases systemic vascular
resistance, decreases right-to-left shunting, and improves oxygenation .
