COMSAE PHASE 3 FORM 302 QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM
UPDATE 2026/2027.
Core Domains:
• Internal Medicine
• Obstetrics and Gynecology
• Pediatrics
• Psychiatry and Behavioral Health
• Surgery and Surgical Subspecialties
• Emergency Medicine and Critical Care
• Preventive Medicine and Public Health
• Medical Ethics and Professionalism
• Pharmacology and Therapeutics
• Clinical Biostatistics and Epidemiology
Introduction
,This comprehensive examination is designed to assess the clinical knowledge, diagnostic acumen, and patient
management skills expected of osteopathic medical students at the Phase 3 level. The assessment emphasizes the
integration of foundational biomedical sciences with clinical application, focusing on the ability to synthesize
information from patient histories, physical examinations, and diagnostic studies to formulate appropriate
differential diagnoses and treatment plans. Questions are structured in a multiple-choice format, incorporating
both theoretical concepts and practical, scenario-based problems that reflect real-world clinical practice. This
examination challenges candidates to demonstrate critical thinking, ethical decision-making, and an
understanding of healthcare systems, preparing them for the complexities of independent medical practice.
SECTION ONE: QUESTIONS 1-100
Question 1
A 72-year-old male with a history of hypertension and type 2 diabetes presents with a 2-hour history of severe,
tearing chest pain radiating to the back. Blood pressure is 145/90 mmHg in the right arm and 100/70 mmHg in
the left arm. Heart rate is 110 bpm. Which of the following is the most appropriate next step in management?
A. Obtain a chest X-ray
B. Administer intravenous thrombolytics
C. Perform a bedside echocardiogram
D. Initiate immediate surgical consultation
,🟢D
🔴 RATIONALE: The clinical presentation of acute, tearing chest pain radiating to the back with a significant
blood pressure differential between arms is classic for acute aortic dissection. This is a surgical emergency
requiring immediate cardiothoracic surgical consultation. While chest X-ray and echocardiography may aid in
diagnosis, they should not delay definitive surgical evaluation. Thrombolytics are contraindicated and would be
catastrophic.
Question 2
A 28-year-old woman at 32 weeks gestation presents with headache, visual disturbances, and right upper
quadrant pain. Blood pressure is 165/105 mmHg. Urinalysis reveals 3+ protein. Which medication is
contraindicated in this patient's management?
A. Labetalol
B. Magnesium sulfate
C. Hydralazine
D. Lisinopril
🟢D
🔴 RATIONALE: ACE inhibitors, such as lisinopril, are contraindicated during pregnancy due to the risk of fetal
renal dysplasia, oligohydramnios, and fetal death. This patient presents with preeclampsia with severe features.
Labetalol, hydralazine, and magnesium sulfate are appropriate agents for management.
, Question 3
A 45-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia.
Which vitamin deficiency is most likely responsible for this presentation?
A. Vitamin B12
B. Vitamin B6
C. Thiamine (B1)
D. Niacin (B3)
🟢C
🔴 RATIONALE: Wernicke's encephalopathy, characterized by the triad of confusion, ataxia, and
ophthalmoplegia, is caused by thiamine (vitamin B1) deficiency. It is most commonly seen in patients with
chronic alcohol use disorder. Treatment requires prompt parenteral thiamine replacement.
Question 4
A 65-year-old female with osteoarthritis reports persistent knee pain despite taking acetaminophen 1000 mg
three times daily. She has a history of peptic ulcer disease. Which medication would be the most appropriate
next step in pain management?
A. Ibuprofen
B. Celecoxib
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM
UPDATE 2026/2027.
Core Domains:
• Internal Medicine
• Obstetrics and Gynecology
• Pediatrics
• Psychiatry and Behavioral Health
• Surgery and Surgical Subspecialties
• Emergency Medicine and Critical Care
• Preventive Medicine and Public Health
• Medical Ethics and Professionalism
• Pharmacology and Therapeutics
• Clinical Biostatistics and Epidemiology
Introduction
,This comprehensive examination is designed to assess the clinical knowledge, diagnostic acumen, and patient
management skills expected of osteopathic medical students at the Phase 3 level. The assessment emphasizes the
integration of foundational biomedical sciences with clinical application, focusing on the ability to synthesize
information from patient histories, physical examinations, and diagnostic studies to formulate appropriate
differential diagnoses and treatment plans. Questions are structured in a multiple-choice format, incorporating
both theoretical concepts and practical, scenario-based problems that reflect real-world clinical practice. This
examination challenges candidates to demonstrate critical thinking, ethical decision-making, and an
understanding of healthcare systems, preparing them for the complexities of independent medical practice.
SECTION ONE: QUESTIONS 1-100
Question 1
A 72-year-old male with a history of hypertension and type 2 diabetes presents with a 2-hour history of severe,
tearing chest pain radiating to the back. Blood pressure is 145/90 mmHg in the right arm and 100/70 mmHg in
the left arm. Heart rate is 110 bpm. Which of the following is the most appropriate next step in management?
A. Obtain a chest X-ray
B. Administer intravenous thrombolytics
C. Perform a bedside echocardiogram
D. Initiate immediate surgical consultation
,🟢D
🔴 RATIONALE: The clinical presentation of acute, tearing chest pain radiating to the back with a significant
blood pressure differential between arms is classic for acute aortic dissection. This is a surgical emergency
requiring immediate cardiothoracic surgical consultation. While chest X-ray and echocardiography may aid in
diagnosis, they should not delay definitive surgical evaluation. Thrombolytics are contraindicated and would be
catastrophic.
Question 2
A 28-year-old woman at 32 weeks gestation presents with headache, visual disturbances, and right upper
quadrant pain. Blood pressure is 165/105 mmHg. Urinalysis reveals 3+ protein. Which medication is
contraindicated in this patient's management?
A. Labetalol
B. Magnesium sulfate
C. Hydralazine
D. Lisinopril
🟢D
🔴 RATIONALE: ACE inhibitors, such as lisinopril, are contraindicated during pregnancy due to the risk of fetal
renal dysplasia, oligohydramnios, and fetal death. This patient presents with preeclampsia with severe features.
Labetalol, hydralazine, and magnesium sulfate are appropriate agents for management.
, Question 3
A 45-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia.
Which vitamin deficiency is most likely responsible for this presentation?
A. Vitamin B12
B. Vitamin B6
C. Thiamine (B1)
D. Niacin (B3)
🟢C
🔴 RATIONALE: Wernicke's encephalopathy, characterized by the triad of confusion, ataxia, and
ophthalmoplegia, is caused by thiamine (vitamin B1) deficiency. It is most commonly seen in patients with
chronic alcohol use disorder. Treatment requires prompt parenteral thiamine replacement.
Question 4
A 65-year-old female with osteoarthritis reports persistent knee pain despite taking acetaminophen 1000 mg
three times daily. She has a history of peptic ulcer disease. Which medication would be the most appropriate
next step in pain management?
A. Ibuprofen
B. Celecoxib
