COMSAE PHASE 3 FORM 301 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 Sciences
Surgery and Surgical Subspecialties
Emergency Medicine and Critical Care
Preventive Medicine and Public Health
Medical Ethics and Jurisprudence
Introduction
This comprehensive assessment is designed to evaluate the readiness of fourth-year osteopathic medical students
for the COMSAE Phase 3 examination. It rigorously tests the candidate's ability to synthesize foundational medical
knowledge with advanced clinical reasoning, patient management, and ethical decision-making across the core
disciplines of medicine. The following 100 multiple-choice questions are structured to mirror the complexity and
integrative nature of the actual exam, employing both direct knowledge-based queries and intricate, multi-step
clinical scenarios. Emphasis is placed on the real-world application of medical principles, requiring the examinee to
prioritize diagnoses, interpret diagnostic data, and formulate effective, evidence-based treatment plans. Success on
this examination demonstrates a high level of preparedness for the transition into graduate medical education and
independent clinical practice.
,Section One: Questions 1–100
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents to the clinic with a chief
complaint of progressive dyspnea on exertion and a non-productive cough for the past three weeks. He reports
a 15-pack-year smoking history. On physical examination, his blood pressure is 145/88 mmHg, heart rate is 92
bpm, and respiratory rate is 22/min. Auscultation reveals fine, bibasilar crackles that do not clear with coughing.
A chest X-ray shows an enlarged cardiac silhouette and interstitial pulmonary edema. Which of the following is
the most appropriate next step in the management of this patient?
A. Initiate a beta-blocker for rate control.
B. Prescribe a course of oral corticosteroids for suspected interstitial lung disease.
C. Administer a loop diuretic to manage volume overload.
D. Schedule a high-resolution CT scan of the chest for further evaluation.
🟢C
🔴 RATIONALE: The patient presents with classic signs of acute decompensated heart failure (dyspnea, crackles,
cardiomegaly, interstitial edema) likely exacerbated by his hypertension and diabetes. The most immediate and
appropriate next step is to manage the fluid overload with a loop diuretic, such as furosemide. While a beta-
blocker is a cornerstone of chronic HF management, it is not indicated for acute decompensation.
Corticosteroids would be for a pulmonary inflammatory process, which is not the primary diagnosis here. A
high-res CT scan is a secondary step after initial stabilization and is not the most urgent management
intervention.
,Question 2
A 32-year-old woman, gravida 1, para 0, at 28 weeks gestation, presents with a one-day history of a severe,
persistent headache, visual disturbances (blurred vision), and right upper quadrant abdominal pain. Her blood
pressure is 168/105 mmHg, and urinalysis reveals 3+ protein. Her platelet count is 85,000/mcL, and AST is 120
U/L. Which of the following is the most appropriate next step in management for this patient?
A. Prescribe oral labetalol for outpatient management of hypertension.
B. Administer magnesium sulfate and proceed with delivery.
C. Order a non-stress test and biophysical profile for fetal surveillance.
D. Discharge home with strict bed rest and a low-sodium diet.
🟢B
🔴 RATIONALE: This patient meets the criteria for severe preeclampsia with features of HELLP syndrome
(hemolysis, elevated liver enzymes, low platelets) at 28 weeks gestation. The presence of severe hypertension,
thrombocytopenia, and hepatic dysfunction indicates a high-risk, life-threatening condition for both mother
and fetus. The definitive treatment for preeclampsia with severe features is delivery, and magnesium sulfate is
administered for seizure prophylaxis. Outpatient management is contraindicated due to the severity of the
condition, and simply monitoring the fetus without intervening does not address the maternal pathophysiology.
Question 3
A previously healthy 4-year-old child is brought to the emergency room by his parents after a sudden onset of
a barking cough, stridor, and respiratory distress. He has been afebrile and otherwise well. On examination, he is
anxious and tachypneic with subcostal and suprasternal retractions. Which of the following is the most likely
diagnosis?
, A. Bacterial tracheitis
B. Acute epiglottitis
C. Laryngotracheobronchitis (Croup)
D. Foreign body aspiration
🟢C
🔴 RATIONALE: The classic presentation of a barking cough, inspiratory stridor, and respiratory distress in a
young child, especially without fever, is highly suggestive of viral laryngotracheobronchitis (croup). Croup is a
common viral illness that causes subglottic edema. Bacterial tracheitis and epiglottitis typically present with a
high fever and a more toxic appearance. Foreign body aspiration usually presents with a sudden onset of
choking, followed by wheezing or asymmetric breath sounds, rather than the classic croupy cough.
Question 4
A 24-year-old medical student presents with a four-month history of pervasive worry about a wide variety of
events, including his academic performance, his health, and the safety of his family members. He reports
difficulty concentrating, muscle tension, and insomnia. He finds it very difficult to control his worry and it is
causing significant distress and interfering with his ability to study for his board exams. Which of the following is
the most appropriate initial pharmacological treatment?
A. Sertraline
B. Alprazolam
C. Diphenhydramine
D. Aripiprazole
🟢A
2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains:
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Psychiatry and Behavioral Sciences
Surgery and Surgical Subspecialties
Emergency Medicine and Critical Care
Preventive Medicine and Public Health
Medical Ethics and Jurisprudence
Introduction
This comprehensive assessment is designed to evaluate the readiness of fourth-year osteopathic medical students
for the COMSAE Phase 3 examination. It rigorously tests the candidate's ability to synthesize foundational medical
knowledge with advanced clinical reasoning, patient management, and ethical decision-making across the core
disciplines of medicine. The following 100 multiple-choice questions are structured to mirror the complexity and
integrative nature of the actual exam, employing both direct knowledge-based queries and intricate, multi-step
clinical scenarios. Emphasis is placed on the real-world application of medical principles, requiring the examinee to
prioritize diagnoses, interpret diagnostic data, and formulate effective, evidence-based treatment plans. Success on
this examination demonstrates a high level of preparedness for the transition into graduate medical education and
independent clinical practice.
,Section One: Questions 1–100
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents to the clinic with a chief
complaint of progressive dyspnea on exertion and a non-productive cough for the past three weeks. He reports
a 15-pack-year smoking history. On physical examination, his blood pressure is 145/88 mmHg, heart rate is 92
bpm, and respiratory rate is 22/min. Auscultation reveals fine, bibasilar crackles that do not clear with coughing.
A chest X-ray shows an enlarged cardiac silhouette and interstitial pulmonary edema. Which of the following is
the most appropriate next step in the management of this patient?
A. Initiate a beta-blocker for rate control.
B. Prescribe a course of oral corticosteroids for suspected interstitial lung disease.
C. Administer a loop diuretic to manage volume overload.
D. Schedule a high-resolution CT scan of the chest for further evaluation.
🟢C
🔴 RATIONALE: The patient presents with classic signs of acute decompensated heart failure (dyspnea, crackles,
cardiomegaly, interstitial edema) likely exacerbated by his hypertension and diabetes. The most immediate and
appropriate next step is to manage the fluid overload with a loop diuretic, such as furosemide. While a beta-
blocker is a cornerstone of chronic HF management, it is not indicated for acute decompensation.
Corticosteroids would be for a pulmonary inflammatory process, which is not the primary diagnosis here. A
high-res CT scan is a secondary step after initial stabilization and is not the most urgent management
intervention.
,Question 2
A 32-year-old woman, gravida 1, para 0, at 28 weeks gestation, presents with a one-day history of a severe,
persistent headache, visual disturbances (blurred vision), and right upper quadrant abdominal pain. Her blood
pressure is 168/105 mmHg, and urinalysis reveals 3+ protein. Her platelet count is 85,000/mcL, and AST is 120
U/L. Which of the following is the most appropriate next step in management for this patient?
A. Prescribe oral labetalol for outpatient management of hypertension.
B. Administer magnesium sulfate and proceed with delivery.
C. Order a non-stress test and biophysical profile for fetal surveillance.
D. Discharge home with strict bed rest and a low-sodium diet.
🟢B
🔴 RATIONALE: This patient meets the criteria for severe preeclampsia with features of HELLP syndrome
(hemolysis, elevated liver enzymes, low platelets) at 28 weeks gestation. The presence of severe hypertension,
thrombocytopenia, and hepatic dysfunction indicates a high-risk, life-threatening condition for both mother
and fetus. The definitive treatment for preeclampsia with severe features is delivery, and magnesium sulfate is
administered for seizure prophylaxis. Outpatient management is contraindicated due to the severity of the
condition, and simply monitoring the fetus without intervening does not address the maternal pathophysiology.
Question 3
A previously healthy 4-year-old child is brought to the emergency room by his parents after a sudden onset of
a barking cough, stridor, and respiratory distress. He has been afebrile and otherwise well. On examination, he is
anxious and tachypneic with subcostal and suprasternal retractions. Which of the following is the most likely
diagnosis?
, A. Bacterial tracheitis
B. Acute epiglottitis
C. Laryngotracheobronchitis (Croup)
D. Foreign body aspiration
🟢C
🔴 RATIONALE: The classic presentation of a barking cough, inspiratory stridor, and respiratory distress in a
young child, especially without fever, is highly suggestive of viral laryngotracheobronchitis (croup). Croup is a
common viral illness that causes subglottic edema. Bacterial tracheitis and epiglottitis typically present with a
high fever and a more toxic appearance. Foreign body aspiration usually presents with a sudden onset of
choking, followed by wheezing or asymmetric breath sounds, rather than the classic croupy cough.
Question 4
A 24-year-old medical student presents with a four-month history of pervasive worry about a wide variety of
events, including his academic performance, his health, and the safety of his family members. He reports
difficulty concentrating, muscle tension, and insomnia. He finds it very difficult to control his worry and it is
causing significant distress and interfering with his ability to study for his board exams. Which of the following is
the most appropriate initial pharmacological treatment?
A. Sertraline
B. Alprazolam
C. Diphenhydramine
D. Aripiprazole
🟢A
