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COMSAE PHASE 2 FORM 112 — COMPREHENSIVE CLINICAL
MEDICINE BOARD PREPARATION QUESTIONS WITH DETAILED-
VERIFIED ANSWERS- ALREADY GRADED A+ || NEWEST EXAM
Clinical Medicine / Osteopathic Medical Education
COMSAE Phase 2 Form 112-style practice exam covers core clinical
disciplines: Internal Medicine (cardiology, pulmonology,
gastroenterology, endocrinology, nephrology, rheumatology), Surgery,
Pediatrics, OB/GYN, Psychiatry, Neurology, Emergency Medicine, and
Osteopathic Principles. Emphasis is on diagnosis, management,
pathophysiology, and clinical reasoning across major organ systems.
QUESTION 1
A 58-year-old male with a history of hypertension presents with acute
onset of severe epigastric pain radiating to the back. Blood pressure is
150/95 mmHg, heart rate is 110 bpm. Examination reveals a pulsatile
abdominal mass. What is the most appropriate next step?
A. Abdominal ultrasound
B. CT angiography
C. Endoscopy
D. Serum lipase
Correct Answer: B. CT angiography
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Rationale: This presentation is highly suggestive of a rupturing or
symptomatic abdominal aortic aneurysm (AAA). CT angiography is the
definitive imaging modality for diagnosis and surgical planning. While
ultrasound is an excellent screening tool for AAA, it provides insufficient
detail for surgical planning in an acute setting. Endoscopy and serum
lipase are not appropriate as the presentation is vascular, not
gastrointestinal or pancreatic.
QUESTION 2
A 32-year-old G2P1 woman at 38 weeks gestation presents with
spontaneous rupture of membranes 6 hours ago. Contractions are
occurring every 3 minutes. Cervical examination reveals 5 cm dilation,
80% effacement, and vertex at -1 station. Fetal heart rate is 140 bpm with
moderate variability. What is the most appropriate management?
A. Immediate cesarean section
B. Oxytocin augmentation
C. Continue expectant management
D. Administer corticosteroids
Correct Answer: B. Oxytocin augmentation
Rationale: This patient is in active labor with ruptured membranes for
more than 4 hours. Contractions, while present, may be inadequate for
progression. Oxytocin augmentation is indicated to optimize uterine
activity and promote vaginal delivery. Cesarean section is not indicated
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without fetal distress or failure to progress. Expectant management risks
chorioamnionitis, and corticosteroids are not needed at term.
QUESTION 3
A 67-year-old man presents with exertional chest pain that is relieved by
rest. Electrocardiogram shows ST-segment depression during exercise
stress testing. Which of the following is the most likely underlying
mechanism?
A. Coronary artery spasm
B. Atherosclerotic plaque causing fixed stenosis
C. Pulmonary embolism
D. Aortic dissection
Correct Answer: B. Atherosclerotic plaque causing fixed stenosis
Rationale: Stable angina is caused by fixed atherosclerotic narrowing of
the coronary arteries. During exertion, myocardial oxygen demand
increases but cannot be met due to limited coronary flow reserve,
resulting in subendocardial ischemia and characteristic ST-segment
depression on stress testing. Coronary artery spasm causes variant
(Prinzmetal) angina, typically occurring at rest.
QUESTION 4
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A 23-year-old woman presents with fatigue, weight gain, and cold
intolerance. Laboratory studies show elevated thyroid-stimulating
hormone (TSH) and low free T4. Which is the most likely diagnosis?
A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Thyroid adenoma
Correct Answer: B. Hashimoto thyroiditis
Rationale: Primary hypothyroidism with elevated TSH and low free T4 is
most commonly caused by Hashimoto thyroiditis, an autoimmune
destruction of the thyroid gland. Graves disease causes hyperthyroidism
(low TSH, high T4). Subacute thyroiditis typically presents with thyroid
pain and a transient hyperthyroid phase followed by hypothyroidism.
QUESTION 5
A patient with chronic obstructive pulmonary disease (COPD) is given
high-flow oxygen and subsequently develops worsening hypercapnia.
What is the primary mechanism?
A. Reduced respiratory drive due to oxygen correction of hypoxia
B. Increased metabolic CO2 production
COMSAE PHASE 2 FORM 112 — COMPREHENSIVE CLINICAL
MEDICINE BOARD PREPARATION QUESTIONS WITH DETAILED-
VERIFIED ANSWERS- ALREADY GRADED A+ || NEWEST EXAM
Clinical Medicine / Osteopathic Medical Education
COMSAE Phase 2 Form 112-style practice exam covers core clinical
disciplines: Internal Medicine (cardiology, pulmonology,
gastroenterology, endocrinology, nephrology, rheumatology), Surgery,
Pediatrics, OB/GYN, Psychiatry, Neurology, Emergency Medicine, and
Osteopathic Principles. Emphasis is on diagnosis, management,
pathophysiology, and clinical reasoning across major organ systems.
QUESTION 1
A 58-year-old male with a history of hypertension presents with acute
onset of severe epigastric pain radiating to the back. Blood pressure is
150/95 mmHg, heart rate is 110 bpm. Examination reveals a pulsatile
abdominal mass. What is the most appropriate next step?
A. Abdominal ultrasound
B. CT angiography
C. Endoscopy
D. Serum lipase
Correct Answer: B. CT angiography
, Page 2 of 112
Rationale: This presentation is highly suggestive of a rupturing or
symptomatic abdominal aortic aneurysm (AAA). CT angiography is the
definitive imaging modality for diagnosis and surgical planning. While
ultrasound is an excellent screening tool for AAA, it provides insufficient
detail for surgical planning in an acute setting. Endoscopy and serum
lipase are not appropriate as the presentation is vascular, not
gastrointestinal or pancreatic.
QUESTION 2
A 32-year-old G2P1 woman at 38 weeks gestation presents with
spontaneous rupture of membranes 6 hours ago. Contractions are
occurring every 3 minutes. Cervical examination reveals 5 cm dilation,
80% effacement, and vertex at -1 station. Fetal heart rate is 140 bpm with
moderate variability. What is the most appropriate management?
A. Immediate cesarean section
B. Oxytocin augmentation
C. Continue expectant management
D. Administer corticosteroids
Correct Answer: B. Oxytocin augmentation
Rationale: This patient is in active labor with ruptured membranes for
more than 4 hours. Contractions, while present, may be inadequate for
progression. Oxytocin augmentation is indicated to optimize uterine
activity and promote vaginal delivery. Cesarean section is not indicated
, Page 3 of 112
without fetal distress or failure to progress. Expectant management risks
chorioamnionitis, and corticosteroids are not needed at term.
QUESTION 3
A 67-year-old man presents with exertional chest pain that is relieved by
rest. Electrocardiogram shows ST-segment depression during exercise
stress testing. Which of the following is the most likely underlying
mechanism?
A. Coronary artery spasm
B. Atherosclerotic plaque causing fixed stenosis
C. Pulmonary embolism
D. Aortic dissection
Correct Answer: B. Atherosclerotic plaque causing fixed stenosis
Rationale: Stable angina is caused by fixed atherosclerotic narrowing of
the coronary arteries. During exertion, myocardial oxygen demand
increases but cannot be met due to limited coronary flow reserve,
resulting in subendocardial ischemia and characteristic ST-segment
depression on stress testing. Coronary artery spasm causes variant
(Prinzmetal) angina, typically occurring at rest.
QUESTION 4
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A 23-year-old woman presents with fatigue, weight gain, and cold
intolerance. Laboratory studies show elevated thyroid-stimulating
hormone (TSH) and low free T4. Which is the most likely diagnosis?
A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Thyroid adenoma
Correct Answer: B. Hashimoto thyroiditis
Rationale: Primary hypothyroidism with elevated TSH and low free T4 is
most commonly caused by Hashimoto thyroiditis, an autoimmune
destruction of the thyroid gland. Graves disease causes hyperthyroidism
(low TSH, high T4). Subacute thyroiditis typically presents with thyroid
pain and a transient hyperthyroid phase followed by hypothyroidism.
QUESTION 5
A patient with chronic obstructive pulmonary disease (COPD) is given
high-flow oxygen and subsequently develops worsening hypercapnia.
What is the primary mechanism?
A. Reduced respiratory drive due to oxygen correction of hypoxia
B. Increased metabolic CO2 production
