COMSAE Phase 2 Level 2 BSA 117 Practice Exam
|Real Questions with Answers & Rationales |
COMLEX Level 2 Prep 2026 | PDF
This comprehensive practice exam mirrors the style and content of the COMSAE Phase 2
Form BSA 117, which evaluates clinical reasoning across core disciplines including internal
medicine, surgery, pediatrics, OB/GYN, psychiatry, emergency medicine, and preventive
medicine . The actual exam contains 160 items divided into four sections of 40 questions
each .
SECTION 1: Cardiology & Pulmonology (Questions 1-20)
Question 1
A 62-year-old man with a 40-pack-year smoking history presents with chronic productive
cough for 3 months each year for the past 2 years. Which diagnosis best fits his condition?
A. Bronchial asthma
B. Chronic bronchitis
C. Bronchiectasis
D. Emphysema
Answer: B. Chronic bronchitis
Rationale: Chronic bronchitis is defined clinically as a productive cough lasting at least 3
months in 2 consecutive years. Smoking is the primary risk factor due to airway
inflammation and mucus gland enlargement .
Question 2
A 67-year-old man presents with crushing substernal chest pain radiating to his left shoulder
for 45 minutes. He is diaphoretic and nauseated. ECG demonstrates ST-segment elevation
in leads II, III, and aVF. Blood pressure is 92/58 mmHg. Which is the most appropriate next
step?
,A. Exercise stress test
B. Immediate percutaneous coronary intervention
C. Intravenous beta-blocker
D. Repeat ECG in 6 hours
Answer: B. Immediate percutaneous coronary intervention
Rationale: Inferior STEMI with hypotension requires emergent reperfusion therapy. PCI is
the preferred definitive treatment when available promptly. Time to reperfusion is the major
determinant of myocardial salvage .
Question 3
A 62-year-old man with a 40-pack-year smoking history presents with worsening dyspnea
and a chronic cough productive of mucoid sputum. Spirometry shows FEV1/FVC of 0.55
and FEV1 45% of predicted. Which medication has been shown to reduce mortality in this
condition when hypoxemia is present?
A. Inhaled corticosteroid
B. Long-acting beta agonist
C. Long-term oxygen therapy
D. Tiotropium
Answer: C. Long-term oxygen therapy
Rationale: Long-term oxygen therapy reduces mortality in COPD patients with resting
PaO2 ≤55 mmHg or evidence of cor pulmonale .
Question 4
A patient has a holosystolic murmur at the left lower sternal border that increases with
inspiration. What is the diagnosis?
A. Mitral regurgitation
B. Tricuspid regurgitation
C. Aortic stenosis
D. Pulmonic stenosis
Answer: B. Tricuspid regurgitation
,Rationale: Right-sided murmurs increase with inspiration due to increased venous return
(Carvallo sign) .
Question 5
A 58-year-old man presents with chest pain radiating to the left arm. ECG shows ST
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Answer: B. Right coronary artery
Rationale: Inferior wall myocardial infarction involving leads II, III, and aVF is most
commonly due to occlusion of the right coronary artery in most individuals .
Question 6
A patient develops severe chest pain 48 hours after an acute myocardial infarction. A
scratchy sound is heard on auscultation. Which complication has occurred?
A. Ventricular free-wall rupture
B. Papillary muscle rupture
C. Dressler syndrome
D. Acute fibrinous pericarditis
Answer: D. Acute fibrinous pericarditis
Rationale: Acute fibrinous pericarditis typically occurs 1–3 days after transmural MI due to
inflammation overlying necrotic myocardium. Dressler syndrome occurs weeks later and is
autoimmune-mediated .
Question 7
A 68-year-old man develops crushing substernal chest pain for 2 hours. ECG shows ST
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
, A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Diagonal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions typically involve the right coronary artery,
producing ST elevations in leads II, III, and aVF .
Question 8
A patient with COPD and chronic difficulty breathing would most likely develop which acid-
base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: A. Respiratory acidosis
Rationale: COPD causes chronic CO₂ retention (hypoventilation), leading to respiratory
acidosis .
Question 9
The most common cause of community-acquired pneumonia is:
A. Staphylococcus aureus
B. Klebsiella pneumoniae
C. Streptococcus pneumoniae
D. Pseudomonas aeruginosa
Answer: C. Streptococcus pneumoniae
Rationale: S. pneumoniae remains the most common cause of community-acquired
pneumonia .
Question 10
|Real Questions with Answers & Rationales |
COMLEX Level 2 Prep 2026 | PDF
This comprehensive practice exam mirrors the style and content of the COMSAE Phase 2
Form BSA 117, which evaluates clinical reasoning across core disciplines including internal
medicine, surgery, pediatrics, OB/GYN, psychiatry, emergency medicine, and preventive
medicine . The actual exam contains 160 items divided into four sections of 40 questions
each .
SECTION 1: Cardiology & Pulmonology (Questions 1-20)
Question 1
A 62-year-old man with a 40-pack-year smoking history presents with chronic productive
cough for 3 months each year for the past 2 years. Which diagnosis best fits his condition?
A. Bronchial asthma
B. Chronic bronchitis
C. Bronchiectasis
D. Emphysema
Answer: B. Chronic bronchitis
Rationale: Chronic bronchitis is defined clinically as a productive cough lasting at least 3
months in 2 consecutive years. Smoking is the primary risk factor due to airway
inflammation and mucus gland enlargement .
Question 2
A 67-year-old man presents with crushing substernal chest pain radiating to his left shoulder
for 45 minutes. He is diaphoretic and nauseated. ECG demonstrates ST-segment elevation
in leads II, III, and aVF. Blood pressure is 92/58 mmHg. Which is the most appropriate next
step?
,A. Exercise stress test
B. Immediate percutaneous coronary intervention
C. Intravenous beta-blocker
D. Repeat ECG in 6 hours
Answer: B. Immediate percutaneous coronary intervention
Rationale: Inferior STEMI with hypotension requires emergent reperfusion therapy. PCI is
the preferred definitive treatment when available promptly. Time to reperfusion is the major
determinant of myocardial salvage .
Question 3
A 62-year-old man with a 40-pack-year smoking history presents with worsening dyspnea
and a chronic cough productive of mucoid sputum. Spirometry shows FEV1/FVC of 0.55
and FEV1 45% of predicted. Which medication has been shown to reduce mortality in this
condition when hypoxemia is present?
A. Inhaled corticosteroid
B. Long-acting beta agonist
C. Long-term oxygen therapy
D. Tiotropium
Answer: C. Long-term oxygen therapy
Rationale: Long-term oxygen therapy reduces mortality in COPD patients with resting
PaO2 ≤55 mmHg or evidence of cor pulmonale .
Question 4
A patient has a holosystolic murmur at the left lower sternal border that increases with
inspiration. What is the diagnosis?
A. Mitral regurgitation
B. Tricuspid regurgitation
C. Aortic stenosis
D. Pulmonic stenosis
Answer: B. Tricuspid regurgitation
,Rationale: Right-sided murmurs increase with inspiration due to increased venous return
(Carvallo sign) .
Question 5
A 58-year-old man presents with chest pain radiating to the left arm. ECG shows ST
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Answer: B. Right coronary artery
Rationale: Inferior wall myocardial infarction involving leads II, III, and aVF is most
commonly due to occlusion of the right coronary artery in most individuals .
Question 6
A patient develops severe chest pain 48 hours after an acute myocardial infarction. A
scratchy sound is heard on auscultation. Which complication has occurred?
A. Ventricular free-wall rupture
B. Papillary muscle rupture
C. Dressler syndrome
D. Acute fibrinous pericarditis
Answer: D. Acute fibrinous pericarditis
Rationale: Acute fibrinous pericarditis typically occurs 1–3 days after transmural MI due to
inflammation overlying necrotic myocardium. Dressler syndrome occurs weeks later and is
autoimmune-mediated .
Question 7
A 68-year-old man develops crushing substernal chest pain for 2 hours. ECG shows ST
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
, A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Diagonal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions typically involve the right coronary artery,
producing ST elevations in leads II, III, and aVF .
Question 8
A patient with COPD and chronic difficulty breathing would most likely develop which acid-
base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: A. Respiratory acidosis
Rationale: COPD causes chronic CO₂ retention (hypoventilation), leading to respiratory
acidosis .
Question 9
The most common cause of community-acquired pneumonia is:
A. Staphylococcus aureus
B. Klebsiella pneumoniae
C. Streptococcus pneumoniae
D. Pseudomonas aeruginosa
Answer: C. Streptococcus pneumoniae
Rationale: S. pneumoniae remains the most common cause of community-acquired
pneumonia .
Question 10
