Page 1 of 191
COMSAE LEVEL 2 (PHASE 2) — FORMS A, B & C
Practice Exam Questions With Verified
Answers & Rationales LATEST UPDATE THIS
YEAR
COMSAE LEVEL 2 (PHASE 2) — FORMS A, B & C
Practice Questions, Correct Answers & Rationales
SUMMARIZED EXAM COVERAGE
Exam Structure – 176 items divided into four sections of 44 questions each; single-best-answer,
multiple-choice format
Content Areas – Clinical decision-making, diagnosis, management, and patient care across core
rotations: Internal Medicine, Surgery, Pediatrics, OB/GYN, Psychiatry, Emergency Medicine,
Preventive Medicine, Osteopathic Principles, and Ethics
Competency Domains – Osteopathic patient care, biomedical sciences, professionalism,
systems-based practice, communication skills, and osteopathic principles and practice
High-Yield Topics – Cardiology (ECG interpretation, murmurs, arrhythmias), Pulmonology
(COPD, asthma, PE), Gastroenterology (pancreatitis, appendicitis, cholecystitis), Neurology
(Parkinson's, MS, Wernicke's), OB/GYN (placenta previa, eclampsia, PID), Pediatrics
(bronchiolitis, croup, Kawasaki), OMM (Chapman points, Still technique, somatic dysfunction),
Biostatistics, Ethics
Testing Format – Some questions include images or visual exhibits as attachments; some forms
contain videos requiring headphones
SECTION 1: FORM A — PRACTICE QUESTIONS
,Page 2 of 191
1. A 65-year-old man presents with progressive shortness of breath and orthopnea. On
examination, he has bibasilar crackles, elevated jugular venous pressure, and pitting edema.
Which of the following is the most likely diagnosis?
A) Chronic obstructive pulmonary disease
B) Heart failure
C) Pulmonary embolism
D) Pneumonia
Answer: B
The presence of orthopnea, JVP elevation, and peripheral edema indicates fluid overload
consistent with heart failure. COPD typically presents with chronic cough and wheezing,
pulmonary embolism with sudden dyspnea and pleuritic pain, and pneumonia with fever and
localized crackles.
,Page 3 of 191
2. A patient with a history of type 2 diabetes presents with sudden-onset weakness of the right
arm and leg. Imaging shows an infarct in the left middle cerebral artery territory. Which
neurological deficit is most likely?
A) Left-sided hemiplegia
B) Right-sided hemiplegia
C) Bilateral lower limb weakness
D) Facial droop on the left side
Answer: B
Infarction of the left MCA affects the contralateral (right) face, arm, and leg, producing right-
sided hemiplegia. Symptoms are typically unilateral and contralateral to the lesion.
3. Which of the following antibiotics is most appropriate for empiric treatment of community-
acquired pneumonia in an otherwise healthy adult?
A) Vancomycin
B) Ciprofloxacin
, Page 4 of 191
C) Amoxicillin
D) Cefepime
Answer: C
Amoxicillin is first-line for empiric treatment of community-acquired pneumonia in healthy
adults. Vancomycin is reserved for MRSA, ciprofloxacin for gram-negative infections, and
cefepime for hospital-acquired infections.
4. A 30-year-old woman presents with fatigue, pallor, and spoon-shaped nails. Laboratory
evaluation shows microcytic, hypochromic anemia. What is the most likely cause?
A) Vitamin B12 deficiency
B) Folate deficiency
C) Iron deficiency
D) Hemolytic anemia
Answer: C
Microcytic, hypochromic anemia with spoon-shaped nails (koilonychia) is characteristic of iron
COMSAE LEVEL 2 (PHASE 2) — FORMS A, B & C
Practice Exam Questions With Verified
Answers & Rationales LATEST UPDATE THIS
YEAR
COMSAE LEVEL 2 (PHASE 2) — FORMS A, B & C
Practice Questions, Correct Answers & Rationales
SUMMARIZED EXAM COVERAGE
Exam Structure – 176 items divided into four sections of 44 questions each; single-best-answer,
multiple-choice format
Content Areas – Clinical decision-making, diagnosis, management, and patient care across core
rotations: Internal Medicine, Surgery, Pediatrics, OB/GYN, Psychiatry, Emergency Medicine,
Preventive Medicine, Osteopathic Principles, and Ethics
Competency Domains – Osteopathic patient care, biomedical sciences, professionalism,
systems-based practice, communication skills, and osteopathic principles and practice
High-Yield Topics – Cardiology (ECG interpretation, murmurs, arrhythmias), Pulmonology
(COPD, asthma, PE), Gastroenterology (pancreatitis, appendicitis, cholecystitis), Neurology
(Parkinson's, MS, Wernicke's), OB/GYN (placenta previa, eclampsia, PID), Pediatrics
(bronchiolitis, croup, Kawasaki), OMM (Chapman points, Still technique, somatic dysfunction),
Biostatistics, Ethics
Testing Format – Some questions include images or visual exhibits as attachments; some forms
contain videos requiring headphones
SECTION 1: FORM A — PRACTICE QUESTIONS
,Page 2 of 191
1. A 65-year-old man presents with progressive shortness of breath and orthopnea. On
examination, he has bibasilar crackles, elevated jugular venous pressure, and pitting edema.
Which of the following is the most likely diagnosis?
A) Chronic obstructive pulmonary disease
B) Heart failure
C) Pulmonary embolism
D) Pneumonia
Answer: B
The presence of orthopnea, JVP elevation, and peripheral edema indicates fluid overload
consistent with heart failure. COPD typically presents with chronic cough and wheezing,
pulmonary embolism with sudden dyspnea and pleuritic pain, and pneumonia with fever and
localized crackles.
,Page 3 of 191
2. A patient with a history of type 2 diabetes presents with sudden-onset weakness of the right
arm and leg. Imaging shows an infarct in the left middle cerebral artery territory. Which
neurological deficit is most likely?
A) Left-sided hemiplegia
B) Right-sided hemiplegia
C) Bilateral lower limb weakness
D) Facial droop on the left side
Answer: B
Infarction of the left MCA affects the contralateral (right) face, arm, and leg, producing right-
sided hemiplegia. Symptoms are typically unilateral and contralateral to the lesion.
3. Which of the following antibiotics is most appropriate for empiric treatment of community-
acquired pneumonia in an otherwise healthy adult?
A) Vancomycin
B) Ciprofloxacin
, Page 4 of 191
C) Amoxicillin
D) Cefepime
Answer: C
Amoxicillin is first-line for empiric treatment of community-acquired pneumonia in healthy
adults. Vancomycin is reserved for MRSA, ciprofloxacin for gram-negative infections, and
cefepime for hospital-acquired infections.
4. A 30-year-old woman presents with fatigue, pallor, and spoon-shaped nails. Laboratory
evaluation shows microcytic, hypochromic anemia. What is the most likely cause?
A) Vitamin B12 deficiency
B) Folate deficiency
C) Iron deficiency
D) Hemolytic anemia
Answer: C
Microcytic, hypochromic anemia with spoon-shaped nails (koilonychia) is characteristic of iron
