COMSAE PHASE II FORM 114 PRACTICE EXAM COMPREHENSIVE
OSTEOPATHIC MEDICAL SELF-ASSESSMENT EXAMINATION
250 VERIFIED QUESTIONS WITH CORRECT
ANSWERS & DETAILED RATIONALES 2026/2027 |
INSTANT DOWNLOAD
SECTION 1: INTERNAL MEDICINE (Questions 1-60)
Q1. A 65-year-old man with a 50 pack-year smoking history presents with painless
hematuria. What is the most likely diagnosis?
A. Nephrolithiasis
B. Bladder cancer (urothelial carcinoma)
C. Urinary tract infection
D. Glomerulonephritis
Correct Answer: B
Rationale: Painless hematuria in an older smoker strongly suggests urothelial
carcinoma. Smoking is the strongest risk factor for bladder cancer, and painless
gross hematuria is the classic presentation. Nephrolithiasis typically presents
with painful hematuria and flank pain. UTI presents with dysuria and frequency.
Q2. A 55-year-old man develops substernal chest pain during exertion that is
relieved by rest. ECG is normal. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. Pericarditis
Correct Answer: B
Rationale: This describes classic stable angina—predictable exertional chest
pain relieved by rest or nitroglycerin. A normal resting ECG does not exclude
1
,stable angina. Unstable angina occurs at rest or with minimal exertion. MI would
have elevated cardiac enzymes.
Q3. A 67-year-old man with COPD has worsening dyspnea. ABG: pH 7.28, PaCO₂
68,
HCO₃⁻ 32. What is the acid-base diagnosis?
A. Metabolic acidosis
B. Respiratory acidosis with metabolic compensation
C. Mixed acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: Elevated CO₂ with compensatory HCO₃⁻ elevation indicates chronic
respiratory acidosis. The low pH confirms acidosis, elevated CO₂ indicates a
respiratory cause, and elevated HCO₃⁻ shows renal compensation (1 mEq/L HCO₃⁻
increase per 10 mmHg CO₂ increase in acute; 4 mEq/L in chronic).
Q4. A 45-year-old woman presents with episodic vertigo, fluctuating hearing loss,
tinnitus, and a sensation of aural fullness. Symptoms last several hours. What
is the most likely diagnosis?
A. Vestibular neuritis
B. Ménière disease
C. Benign paroxysmal positional vertigo (BPPV)
D. Acoustic neuroma
Correct Answer: B
Rationale: Ménière disease is characterized by the classic triad of episodic
vertigo, fluctuating sensorineural hearing loss, and tinnitus. Symptoms last
hours and are associated with aural fullness. BPPV causes brief (<1 minute)
2
,positional vertigo without hearing loss. Vestibular neuritis causes acute
prolonged vertigo without hearing loss.
Q5. A 72-year-old woman with a history of hypertension presents with dysphagia
and right-sided weakness that began 6 hours ago. She is not a candidate for
tPA. What is the most appropriate management?
A. Aspirin 325 mg
B. Heparin drip
C. Warfarin
D. Observation only
Correct Answer: A
Rationale: For acute ischemic stroke beyond the tPA window (or with
contraindications), aspirin 325 mg is the standard of care. Heparin is not
routinely recommended for acute stroke unless there is an embolic source or
progressive symptoms. Warfarin is not used acutely.
Q6. A 58-year-old man with type 2 diabetes has a 3-month history of epigastric
pain, bloating, and early satiety. What is the most likely diagnosis?
A. Peptic ulcer disease
B. Gastroparesis
C. Pancreatic cancer
D. Gallstones
Correct Answer: B
Rationale: Gastroparesis is a common complication of diabetes, presenting with
early satiety, bloating, nausea, and epigastric pain. Pancreatic cancer would be
associated with weight loss and jaundice. PUD typically causes burning pain
relieved by food or antacids.
3
, Q7. A 68-year-old man presents with 3 weeks of progressive lower back pain that
is worse at night and associated with weight loss. What is the most likely
diagnosis?
A. Osteoarthritis
B. Multiple myeloma
C. Spinal stenosis
D. Herniated disc
Correct Answer: B
Rationale: Night pain and weight loss are "red flag" symptoms suggesting
malignancy. Multiple myeloma commonly presents with back pain from osteolytic
lesions, anemia, hypercalcemia, and renal dysfunction. Osteoarthritis pain is
not typically worse at night.
Q8. A 52-year-old woman has Graves' disease. Which physical finding is most
consistent with this condition?
A. Exophthalmos
B. Pretibial myxedema
C. Thyroid bruit
D. All of the above
Correct Answer: D
Rationale: Graves' disease can present with exophthalmos (proptosis), pretibial
myxedema, and a thyroid bruit from increased vascularity. These are classic
extrathyroidal manifestations of Graves' disease.
Q9. Which anti-diabetic medication is associated with the highest risk of
4
OSTEOPATHIC MEDICAL SELF-ASSESSMENT EXAMINATION
250 VERIFIED QUESTIONS WITH CORRECT
ANSWERS & DETAILED RATIONALES 2026/2027 |
INSTANT DOWNLOAD
SECTION 1: INTERNAL MEDICINE (Questions 1-60)
Q1. A 65-year-old man with a 50 pack-year smoking history presents with painless
hematuria. What is the most likely diagnosis?
A. Nephrolithiasis
B. Bladder cancer (urothelial carcinoma)
C. Urinary tract infection
D. Glomerulonephritis
Correct Answer: B
Rationale: Painless hematuria in an older smoker strongly suggests urothelial
carcinoma. Smoking is the strongest risk factor for bladder cancer, and painless
gross hematuria is the classic presentation. Nephrolithiasis typically presents
with painful hematuria and flank pain. UTI presents with dysuria and frequency.
Q2. A 55-year-old man develops substernal chest pain during exertion that is
relieved by rest. ECG is normal. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. Pericarditis
Correct Answer: B
Rationale: This describes classic stable angina—predictable exertional chest
pain relieved by rest or nitroglycerin. A normal resting ECG does not exclude
1
,stable angina. Unstable angina occurs at rest or with minimal exertion. MI would
have elevated cardiac enzymes.
Q3. A 67-year-old man with COPD has worsening dyspnea. ABG: pH 7.28, PaCO₂
68,
HCO₃⁻ 32. What is the acid-base diagnosis?
A. Metabolic acidosis
B. Respiratory acidosis with metabolic compensation
C. Mixed acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: Elevated CO₂ with compensatory HCO₃⁻ elevation indicates chronic
respiratory acidosis. The low pH confirms acidosis, elevated CO₂ indicates a
respiratory cause, and elevated HCO₃⁻ shows renal compensation (1 mEq/L HCO₃⁻
increase per 10 mmHg CO₂ increase in acute; 4 mEq/L in chronic).
Q4. A 45-year-old woman presents with episodic vertigo, fluctuating hearing loss,
tinnitus, and a sensation of aural fullness. Symptoms last several hours. What
is the most likely diagnosis?
A. Vestibular neuritis
B. Ménière disease
C. Benign paroxysmal positional vertigo (BPPV)
D. Acoustic neuroma
Correct Answer: B
Rationale: Ménière disease is characterized by the classic triad of episodic
vertigo, fluctuating sensorineural hearing loss, and tinnitus. Symptoms last
hours and are associated with aural fullness. BPPV causes brief (<1 minute)
2
,positional vertigo without hearing loss. Vestibular neuritis causes acute
prolonged vertigo without hearing loss.
Q5. A 72-year-old woman with a history of hypertension presents with dysphagia
and right-sided weakness that began 6 hours ago. She is not a candidate for
tPA. What is the most appropriate management?
A. Aspirin 325 mg
B. Heparin drip
C. Warfarin
D. Observation only
Correct Answer: A
Rationale: For acute ischemic stroke beyond the tPA window (or with
contraindications), aspirin 325 mg is the standard of care. Heparin is not
routinely recommended for acute stroke unless there is an embolic source or
progressive symptoms. Warfarin is not used acutely.
Q6. A 58-year-old man with type 2 diabetes has a 3-month history of epigastric
pain, bloating, and early satiety. What is the most likely diagnosis?
A. Peptic ulcer disease
B. Gastroparesis
C. Pancreatic cancer
D. Gallstones
Correct Answer: B
Rationale: Gastroparesis is a common complication of diabetes, presenting with
early satiety, bloating, nausea, and epigastric pain. Pancreatic cancer would be
associated with weight loss and jaundice. PUD typically causes burning pain
relieved by food or antacids.
3
, Q7. A 68-year-old man presents with 3 weeks of progressive lower back pain that
is worse at night and associated with weight loss. What is the most likely
diagnosis?
A. Osteoarthritis
B. Multiple myeloma
C. Spinal stenosis
D. Herniated disc
Correct Answer: B
Rationale: Night pain and weight loss are "red flag" symptoms suggesting
malignancy. Multiple myeloma commonly presents with back pain from osteolytic
lesions, anemia, hypercalcemia, and renal dysfunction. Osteoarthritis pain is
not typically worse at night.
Q8. A 52-year-old woman has Graves' disease. Which physical finding is most
consistent with this condition?
A. Exophthalmos
B. Pretibial myxedema
C. Thyroid bruit
D. All of the above
Correct Answer: D
Rationale: Graves' disease can present with exophthalmos (proptosis), pretibial
myxedema, and a thyroid bruit from increased vascularity. These are classic
extrathyroidal manifestations of Graves' disease.
Q9. Which anti-diabetic medication is associated with the highest risk of
4
