COMSAE PHASE 2 FORM 118 PRACTICE EXAMINATION – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Cardiovascular and Pulmonary Medicine
Gastroenterology and Renal Medicine
Endocrinology and Metabolism
Neurology and Psychiatry
Infectious Disease and Immunology
Obstetrics and Gynecology
Musculoskeletal Medicine and Rheumatology
Hematology and Oncology
Medical Ethics and Legal Issues in Osteopathic Medicine
Introduction
This comprehensive practice examination is meticulously designed to assess the advanced clinical knowledge
and diagnostic reasoning required for success on the COMSAE Phase 2 Form 118 examination. The assessment
rigorously evaluates the candidate's mastery over core clinical disciplines, integrating pathophysiology,
diagnostic workup, and evidence-based management strategies. Structured with 200 multiple-choice questions
divided into two sections, this exam emphasizes the application of osteopathic principles and real-world clinical
decision-making across medical specialties. Each question is followed by a clear, detailed rationale to reinforce
learning and ensure a thorough understanding of key concepts. This document serves as a definitive tool for
final preparation, mirroring the complexity and depth of the official COMSAE Phase 2 examination .
,SECTION ONE: QUESTIONS 1 – 100
1. A 62-year-old man presents with crushing substernal chest pain radiating to his left arm for 45 minutes.
ECG shows ST elevation in leads II, III, and aVF. Which artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
🟢B
🔴 Explanation: ST elevation in leads II, III, and aVF indicates an inferior myocardial infarction, most
commonly caused by occlusion of the right coronary artery, which supplies the inferior wall of the heart .
2. A 45-year-old woman presents with heat intolerance, weight loss, and palpitations. Labs show low TSH
and elevated free T4. Which condition is the most likely cause?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Iodine deficiency
🟢B
🔴 Explanation: Low TSH with elevated T4 indicates primary hyperthyroidism. Graves disease is the most
common cause and is autoimmune, involving TSH receptor stimulation .
3. A 67-year-old man presents with resting tremor, rigidity, and bradykinesia. Which neurotransmitter is
deficient?
A. Serotonin
,B. Acetylcholine
C. Dopamine
D. GABA
🟢C
🔴 Explanation: Parkinson disease results from degeneration of dopaminergic neurons in the substantia
nigra .
4. A patient with chest pain has ST-segment 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. Left main coronary artery
🟢C
🔴 Explanation: Inferior wall myocardial infarctions typically involve the right coronary artery .
5. Which organism is the most common cause of community-acquired pneumonia in adults?
A. Klebsiella pneumoniae
B. Pseudomonas aeruginosa
C. Streptococcus pneumoniae
D. Mycoplasma pneumoniae
🟢C
🔴 Explanation: Streptococcus pneumoniae remains the leading cause of community-acquired bacterial
pneumonia .
, 6. A 28-year-old woman presents with fatigue and cold intolerance. TSH is 9.0 µU/mL, free T4 is low. What
is the most likely diagnosis?
A. Subacute thyroiditis
B. Hashimoto thyroiditis
C. Central hypothyroidism
D. Graves disease
🟢B
🔴 Explanation: Hashimoto thyroiditis is the most common cause of hypothyroidism in iodine-sufficient
areas, with elevated TSH and low T4 .
7. A 65-year-old man with COPD presents with dyspnea. ABG shows pH 7.35, pCO₂ 55, HCO₃⁻ 30. What is
the diagnosis?
A. Compensated respiratory acidosis
B. Acute respiratory acidosis
C. Metabolic alkalosis
D. Mixed acid-base disorder
🟢A
🔴 Explanation: Chronic CO₂ retention with compensatory bicarbonate elevation indicates compensated
respiratory acidosis .
8. A 28-year-old woman develops severe headache, visual disturbances, and hypertension at 34 weeks
gestation. Urinalysis demonstrates proteinuria. Which of the following is the most definitive treatment?
A. Labetalol therapy
B. Magnesium sulfate alone
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Cardiovascular and Pulmonary Medicine
Gastroenterology and Renal Medicine
Endocrinology and Metabolism
Neurology and Psychiatry
Infectious Disease and Immunology
Obstetrics and Gynecology
Musculoskeletal Medicine and Rheumatology
Hematology and Oncology
Medical Ethics and Legal Issues in Osteopathic Medicine
Introduction
This comprehensive practice examination is meticulously designed to assess the advanced clinical knowledge
and diagnostic reasoning required for success on the COMSAE Phase 2 Form 118 examination. The assessment
rigorously evaluates the candidate's mastery over core clinical disciplines, integrating pathophysiology,
diagnostic workup, and evidence-based management strategies. Structured with 200 multiple-choice questions
divided into two sections, this exam emphasizes the application of osteopathic principles and real-world clinical
decision-making across medical specialties. Each question is followed by a clear, detailed rationale to reinforce
learning and ensure a thorough understanding of key concepts. This document serves as a definitive tool for
final preparation, mirroring the complexity and depth of the official COMSAE Phase 2 examination .
,SECTION ONE: QUESTIONS 1 – 100
1. A 62-year-old man presents with crushing substernal chest pain radiating to his left arm for 45 minutes.
ECG shows ST elevation in leads II, III, and aVF. Which artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
🟢B
🔴 Explanation: ST elevation in leads II, III, and aVF indicates an inferior myocardial infarction, most
commonly caused by occlusion of the right coronary artery, which supplies the inferior wall of the heart .
2. A 45-year-old woman presents with heat intolerance, weight loss, and palpitations. Labs show low TSH
and elevated free T4. Which condition is the most likely cause?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Iodine deficiency
🟢B
🔴 Explanation: Low TSH with elevated T4 indicates primary hyperthyroidism. Graves disease is the most
common cause and is autoimmune, involving TSH receptor stimulation .
3. A 67-year-old man presents with resting tremor, rigidity, and bradykinesia. Which neurotransmitter is
deficient?
A. Serotonin
,B. Acetylcholine
C. Dopamine
D. GABA
🟢C
🔴 Explanation: Parkinson disease results from degeneration of dopaminergic neurons in the substantia
nigra .
4. A patient with chest pain has ST-segment 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. Left main coronary artery
🟢C
🔴 Explanation: Inferior wall myocardial infarctions typically involve the right coronary artery .
5. Which organism is the most common cause of community-acquired pneumonia in adults?
A. Klebsiella pneumoniae
B. Pseudomonas aeruginosa
C. Streptococcus pneumoniae
D. Mycoplasma pneumoniae
🟢C
🔴 Explanation: Streptococcus pneumoniae remains the leading cause of community-acquired bacterial
pneumonia .
, 6. A 28-year-old woman presents with fatigue and cold intolerance. TSH is 9.0 µU/mL, free T4 is low. What
is the most likely diagnosis?
A. Subacute thyroiditis
B. Hashimoto thyroiditis
C. Central hypothyroidism
D. Graves disease
🟢B
🔴 Explanation: Hashimoto thyroiditis is the most common cause of hypothyroidism in iodine-sufficient
areas, with elevated TSH and low T4 .
7. A 65-year-old man with COPD presents with dyspnea. ABG shows pH 7.35, pCO₂ 55, HCO₃⁻ 30. What is
the diagnosis?
A. Compensated respiratory acidosis
B. Acute respiratory acidosis
C. Metabolic alkalosis
D. Mixed acid-base disorder
🟢A
🔴 Explanation: Chronic CO₂ retention with compensatory bicarbonate elevation indicates compensated
respiratory acidosis .
8. A 28-year-old woman develops severe headache, visual disturbances, and hypertension at 34 weeks
gestation. Urinalysis demonstrates proteinuria. Which of the following is the most definitive treatment?
A. Labetalol therapy
B. Magnesium sulfate alone
