Page 1 of 184
Family Medicine COMAT EXAM 2026-2027
COMPLETE 300 QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR
QUESTION: A new mother presents with fever, chills and unilateral right breast pain. She has
been breastfeeding without complications since delivery two weeks ago. Physical examination
reveals right breast tenderness, erythema, swelling, and purulent nipple discharge. The most
appropriate recommendation and treatment is to
A. continue breast feeding and take dicloxacillin
B. continue breast feeding and take fluconazole
C. discontinue breast feeding and take cephalexin
D. pump milk and discard while taking amoxicillin/clavulanate
E. pump milk and discard while taking clindamycin - ANSWER-A (the diagnosis is mastitis - the
treatment for mastitis is to continue breastfeeding, or to pump milk if the baby is no longer
breastfeeding, to encourage emptying, as well as taking an appropriate antibiotic)
,Page 2 of 184
QUESTION: A 69-year-old male complains of erectile dysfunction. History is pertinent for well
controlled hypertension on propranolol and stable angina with sublingual nitroglycerin as
needed. Physical examination reveals an overweight male with a smooth non-tender prostate,
symmetrical testicular exam without tenderness or mass, intact sensation throughout the
perineal area and normal pulses in the bilateral legs without cyanosis or edema. Structural
examination reveals tissue T3-T7 to be neutral, sidebent right, rotated left. Which of the
following is the most appropriate initial management?
A. modify antihypertensive medication
B. recommend vacuum assist device
C. sleep study
D. trial of sildenafil
E. urology referral - ANSWER-A (erectile dysfunction is a side effect of medication in up to 25%
of cases, including SSRIs, antihypertensives such as beta blockers, calcium channel blockers,
alpha blockers, antidepressants, digoxin, and antihistamines - changes to medication should be
made before trying a PDE-5 inhibitor)
QUESTION: A 40-year-old female is evaluated for bilateral nipple discharge History is limited
due to patient's baseline mental status as she resides in a nursing home due to mental
,Page 3 of 184
retardation. According to her nursing home records, the patient has no family history of breast
cancer and has never been pregnant. Vital signs are all within normal limits. A clinical breast
examination confirms the presence of non-bloody, milky bilateral nipple discharge. No palpable
mass or discoloration is appreciated. Which of the following diagnostic studies will confirm the
most likely diagnosis?
A. hCG
B. contrast-enhanced CT of the head
C. mammography
D. TSH and T4
E. prolactin - ANSWER-E (prolactin level is the best initial test to confirm suspicion of a
prolactinoma in patients with galactorrhea) (A; hCG should be checked in all female patients
with galactorrhea to rule out pregancy, but since the question asks for a confirmatory test on
the most likely diagnosis, so prolactin is more correct) (B; MRI is appropriate to identify the
prolactinoma, but the prolactin test would still be the first choice) (C; a mammogram or breast
ultrasound is appropriate for a diagnostic workup on galactorrhea, but it is not a confirmatory
test for a prolactinoma) (D; hypothyroidism is an uncommon cause of galactorrhea - it is not the
most likely diagnosis)
, Page 4 of 184
QUESTION: A 40-year-old female is evaluated for bilateral nipple discharge History is limited
due to patient's baseline mental status as she resides in a nursing home due to mental
retardation. Further history reveals that the patient does not have the capacity to make her
own health care decisions. The nursing home reports that she has a sister who lives very close
to the facility and visits her frequently. The patient's father lives several hours away and only
visits her once a year. Who should provide consent for further work up of the patient's
galactorrhea in this situation?
A. attending physician
B. ethics committee
C. father
D. judge
E. sister - ANSWER-C (the hierarchy for personal health care decisions for those who are
incompetent is; spouse, parent, next of kin, default surrogate)
QUESTION: A 55-year old male ingested sildenafil and now has a sustained priapism. The cause
of this phenomenon involves
Family Medicine COMAT EXAM 2026-2027
COMPLETE 300 QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR
QUESTION: A new mother presents with fever, chills and unilateral right breast pain. She has
been breastfeeding without complications since delivery two weeks ago. Physical examination
reveals right breast tenderness, erythema, swelling, and purulent nipple discharge. The most
appropriate recommendation and treatment is to
A. continue breast feeding and take dicloxacillin
B. continue breast feeding and take fluconazole
C. discontinue breast feeding and take cephalexin
D. pump milk and discard while taking amoxicillin/clavulanate
E. pump milk and discard while taking clindamycin - ANSWER-A (the diagnosis is mastitis - the
treatment for mastitis is to continue breastfeeding, or to pump milk if the baby is no longer
breastfeeding, to encourage emptying, as well as taking an appropriate antibiotic)
,Page 2 of 184
QUESTION: A 69-year-old male complains of erectile dysfunction. History is pertinent for well
controlled hypertension on propranolol and stable angina with sublingual nitroglycerin as
needed. Physical examination reveals an overweight male with a smooth non-tender prostate,
symmetrical testicular exam without tenderness or mass, intact sensation throughout the
perineal area and normal pulses in the bilateral legs without cyanosis or edema. Structural
examination reveals tissue T3-T7 to be neutral, sidebent right, rotated left. Which of the
following is the most appropriate initial management?
A. modify antihypertensive medication
B. recommend vacuum assist device
C. sleep study
D. trial of sildenafil
E. urology referral - ANSWER-A (erectile dysfunction is a side effect of medication in up to 25%
of cases, including SSRIs, antihypertensives such as beta blockers, calcium channel blockers,
alpha blockers, antidepressants, digoxin, and antihistamines - changes to medication should be
made before trying a PDE-5 inhibitor)
QUESTION: A 40-year-old female is evaluated for bilateral nipple discharge History is limited
due to patient's baseline mental status as she resides in a nursing home due to mental
,Page 3 of 184
retardation. According to her nursing home records, the patient has no family history of breast
cancer and has never been pregnant. Vital signs are all within normal limits. A clinical breast
examination confirms the presence of non-bloody, milky bilateral nipple discharge. No palpable
mass or discoloration is appreciated. Which of the following diagnostic studies will confirm the
most likely diagnosis?
A. hCG
B. contrast-enhanced CT of the head
C. mammography
D. TSH and T4
E. prolactin - ANSWER-E (prolactin level is the best initial test to confirm suspicion of a
prolactinoma in patients with galactorrhea) (A; hCG should be checked in all female patients
with galactorrhea to rule out pregancy, but since the question asks for a confirmatory test on
the most likely diagnosis, so prolactin is more correct) (B; MRI is appropriate to identify the
prolactinoma, but the prolactin test would still be the first choice) (C; a mammogram or breast
ultrasound is appropriate for a diagnostic workup on galactorrhea, but it is not a confirmatory
test for a prolactinoma) (D; hypothyroidism is an uncommon cause of galactorrhea - it is not the
most likely diagnosis)
, Page 4 of 184
QUESTION: A 40-year-old female is evaluated for bilateral nipple discharge History is limited
due to patient's baseline mental status as she resides in a nursing home due to mental
retardation. Further history reveals that the patient does not have the capacity to make her
own health care decisions. The nursing home reports that she has a sister who lives very close
to the facility and visits her frequently. The patient's father lives several hours away and only
visits her once a year. Who should provide consent for further work up of the patient's
galactorrhea in this situation?
A. attending physician
B. ethics committee
C. father
D. judge
E. sister - ANSWER-C (the hierarchy for personal health care decisions for those who are
incompetent is; spouse, parent, next of kin, default surrogate)
QUESTION: A 55-year old male ingested sildenafil and now has a sustained priapism. The cause
of this phenomenon involves
