COMSSAE PHASE 3 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains:
- Osteopathic Manipulative Medicine (OMM)
- Internal Medicine
*- Surgery*
*- Obstetrics and Gynecology*
*- Pediatrics*
*- Family Medicine*
*- Psychiatry and Behavioral Sciences*
*- Emergency Medicine*
*- Orthopedics and Sports Medicine*
*- Ethics and Osteopathic Principles*
This comprehensive practice assessment is designed to prepare osteopathic medical graduates for the
competency-based evaluation required in residency training. The exam evaluates critical clinical decision-
making skills, diagnostic reasoning, and therapeutic management across multiple medical specialties.
Questions employ a multiple-choice format with scenario-based clinical vignettes that mirror real-world
patient encounters. Emphasis is placed on applying osteopathic principles to modern clinical practice,
integrating manipulative treatment considerations with conventional medical management. Candidates will
demonstrate proficiency in patient assessment, treatment planning, and ethical decision-making essential for
safe and effective patient care in residency programs. The test bank reflects the breadth and depth of
knowledge expected of entry-level residents.
SECTION ONE: QUESTIONS 1–100
,Question 1
A 45-year-old male presents with chronic low back pain lasting 6 months. Physical examination reveals somatic
dysfunction with restricted extension and left rotation at L4-L5. Which osteopathic manipulative technique is
most appropriate for this dysfunction?
A. Muscle energy technique
B. High-velocity low-amplitude thrust
C. Counterstrain
D. Myofascial release
🟢 A. Muscle energy technique
🔴 RATIONALE: Muscle energy technique is particularly effective for treating rotational somatic dysfunctions
and is well-suited for lumbar vertebrae with restricted rotation. The patient demonstrates L4-L5 restricted
extension and left rotation, making muscle energy the first-line osteopathic approach for this specific
dysfunction pattern.
Question 2
A 67-year-old female with a history of type 2 diabetes presents with polyuria, polydipsia, and a blood glucose of
380 mg/dL. Her arterial blood gas shows pH 7.22, HCO3 14 mEq/L, and an elevated anion gap. What is the
most likely diagnosis?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Lactic acidosis
D. Metabolic alkalosis
,🟢 B. Diabetic ketoacidosis
🔴 RATIONALE: Diabetic ketoacidosis (DKA) is characterized by hyperglycemia (>250 mg/dL), metabolic
acidosis (pH <7.3, HCO3 <18 mEq/L), and an elevated anion gap. This patient's presentation of severe
hyperglycemia, acidosis, and elevated anion gap is classic for DKA, which is more common in type 1 diabetes
but can occur in type 2 under stress.
Question 3
A 28-year-old female at 32 weeks gestation presents with severe headache, visual disturbances, and blood
pressure of 165/110 mmHg. Urinalysis shows 3+ protein. What is the most appropriate immediate
management?
A. Oral labetalol and outpatient follow-up
B. Intravenous magnesium sulfate and blood pressure control
C. Immediate cesarean delivery
D. Reassurance and rest
🟢 B. Intravenous magnesium sulfate and blood pressure control
🔴 RATIONALE: This patient has severe preeclampsia with features of severe disease (BP >160/110, headache,
visual changes, proteinuria). Magnesium sulfate is indicated for seizure prophylaxis, and blood pressure must
be controlled to prevent stroke. Delivery is definitive but at 32 weeks, stabilization occurs first unless
maternal/fetal status deteriorates.
, Question 4
A 72-year-old male presents with sudden onset of right-sided weakness and aphasia. Symptoms began 90
minutes ago. CT head shows no hemorrhage. What is the most appropriate next step?
A. Aspirin 325 mg
B. Intravenous tissue plasminogen activator (tPA)
C. Heparin infusion
D. Mechanical thrombectomy only
🟢 B. Intravenous tissue plasminogen activator (tPA)
🔴 RATIONALE: This patient is within the 4.5-hour window for IV tPA administration for acute ischemic
stroke. CT has ruled out hemorrhage, and there are no contraindications mentioned. tPA is the standard of care
for eligible patients presenting within the therapeutic window to improve neurological outcomes.
Question 5
A 35-year-old female presents with fatigue, weight gain, cold intolerance, and elevated TSH with low free T4.
Which antibody is most likely to be positive?
A. Anti-thyroid peroxidase (anti-TPO)
B. Anti-thyrotropin receptor antibody
C. Anti-thyroglobulin antibody
D. Anti-nuclear antibody
🟢 A. Anti-thyroid peroxidase (anti-TPO)
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains:
- Osteopathic Manipulative Medicine (OMM)
- Internal Medicine
*- Surgery*
*- Obstetrics and Gynecology*
*- Pediatrics*
*- Family Medicine*
*- Psychiatry and Behavioral Sciences*
*- Emergency Medicine*
*- Orthopedics and Sports Medicine*
*- Ethics and Osteopathic Principles*
This comprehensive practice assessment is designed to prepare osteopathic medical graduates for the
competency-based evaluation required in residency training. The exam evaluates critical clinical decision-
making skills, diagnostic reasoning, and therapeutic management across multiple medical specialties.
Questions employ a multiple-choice format with scenario-based clinical vignettes that mirror real-world
patient encounters. Emphasis is placed on applying osteopathic principles to modern clinical practice,
integrating manipulative treatment considerations with conventional medical management. Candidates will
demonstrate proficiency in patient assessment, treatment planning, and ethical decision-making essential for
safe and effective patient care in residency programs. The test bank reflects the breadth and depth of
knowledge expected of entry-level residents.
SECTION ONE: QUESTIONS 1–100
,Question 1
A 45-year-old male presents with chronic low back pain lasting 6 months. Physical examination reveals somatic
dysfunction with restricted extension and left rotation at L4-L5. Which osteopathic manipulative technique is
most appropriate for this dysfunction?
A. Muscle energy technique
B. High-velocity low-amplitude thrust
C. Counterstrain
D. Myofascial release
🟢 A. Muscle energy technique
🔴 RATIONALE: Muscle energy technique is particularly effective for treating rotational somatic dysfunctions
and is well-suited for lumbar vertebrae with restricted rotation. The patient demonstrates L4-L5 restricted
extension and left rotation, making muscle energy the first-line osteopathic approach for this specific
dysfunction pattern.
Question 2
A 67-year-old female with a history of type 2 diabetes presents with polyuria, polydipsia, and a blood glucose of
380 mg/dL. Her arterial blood gas shows pH 7.22, HCO3 14 mEq/L, and an elevated anion gap. What is the
most likely diagnosis?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Lactic acidosis
D. Metabolic alkalosis
,🟢 B. Diabetic ketoacidosis
🔴 RATIONALE: Diabetic ketoacidosis (DKA) is characterized by hyperglycemia (>250 mg/dL), metabolic
acidosis (pH <7.3, HCO3 <18 mEq/L), and an elevated anion gap. This patient's presentation of severe
hyperglycemia, acidosis, and elevated anion gap is classic for DKA, which is more common in type 1 diabetes
but can occur in type 2 under stress.
Question 3
A 28-year-old female at 32 weeks gestation presents with severe headache, visual disturbances, and blood
pressure of 165/110 mmHg. Urinalysis shows 3+ protein. What is the most appropriate immediate
management?
A. Oral labetalol and outpatient follow-up
B. Intravenous magnesium sulfate and blood pressure control
C. Immediate cesarean delivery
D. Reassurance and rest
🟢 B. Intravenous magnesium sulfate and blood pressure control
🔴 RATIONALE: This patient has severe preeclampsia with features of severe disease (BP >160/110, headache,
visual changes, proteinuria). Magnesium sulfate is indicated for seizure prophylaxis, and blood pressure must
be controlled to prevent stroke. Delivery is definitive but at 32 weeks, stabilization occurs first unless
maternal/fetal status deteriorates.
, Question 4
A 72-year-old male presents with sudden onset of right-sided weakness and aphasia. Symptoms began 90
minutes ago. CT head shows no hemorrhage. What is the most appropriate next step?
A. Aspirin 325 mg
B. Intravenous tissue plasminogen activator (tPA)
C. Heparin infusion
D. Mechanical thrombectomy only
🟢 B. Intravenous tissue plasminogen activator (tPA)
🔴 RATIONALE: This patient is within the 4.5-hour window for IV tPA administration for acute ischemic
stroke. CT has ruled out hemorrhage, and there are no contraindications mentioned. tPA is the standard of care
for eligible patients presenting within the therapeutic window to improve neurological outcomes.
Question 5
A 35-year-old female presents with fatigue, weight gain, cold intolerance, and elevated TSH with low free T4.
Which antibody is most likely to be positive?
A. Anti-thyroid peroxidase (anti-TPO)
B. Anti-thyrotropin receptor antibody
C. Anti-thyroglobulin antibody
D. Anti-nuclear antibody
🟢 A. Anti-thyroid peroxidase (anti-TPO)
