COMSAE PHASE 2 FORM 116 EXAM TEST
BANK – NEWEST 2026 EDITION |
COMPREHENSIVE 160-ACTUAL QUESTION
SET WITH VERIFIED ANSWERS & DETAILED
RATIONALES
Core Domains
• Osteopathic Principles and Manipulative Medicine
• Internal Medicine and Ambulatory Care
• Obstetrics and Gynecology
• Pediatrics and Adolescent Medicine
• Psychiatry and Behavioral Health
• General Surgery and Perioperative Care
• Emergency Medicine and Critical Care
• Family Medicine and Preventive Services
• Ethics, Legal, and Systems-Based Practice
Introduction
This comprehensive assessment evaluates the osteopathic medical student’s
readiness for COMLEX-USA Level 2-CE. The examination integrates clinical
knowledge, osteopathic principles, and patient-centered decision-making
across ambulatory, inpatient, and emergency settings. Questions are presented
as single-best-answer multiple-choice items that reflect the content and
difficulty of the official COMSAE Phase 2. Emphasis is placed on diagnosis,
treatment, health maintenance, osteopathic manipulative treatment, and the
interpretation of clinical findings. Success demonstrates the ability to apply
,foundational science and clinical reasoning to the care of patients across the
lifespan, consistent with the osteopathic approach to whole-person care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 62-year-old male presents to the emergency department with sudden-onset
crushing chest pain radiating to his left arm. ECG reveals ST-segment
elevations in leads V1 through V4. Which of the following is the most
appropriate immediate intervention?
A. Oral beta-blocker administration
B. Intravenous thrombolytic therapy
C. Chewable aspirin and activation of the cardiac catheterization lab
D. Subcutaneous low-molecular-weight heparin
RATIONALE: Chewable aspirin combined with emergent coronary
angiography and percutaneous coronary intervention within 90 minutes is
the standard of care for acute ST-elevation myocardial infarction to achieve
rapid reperfusion and minimize myocardial damage.
Question 2
A 45-year-old female presents with progressive shortness of breath, fatigue,
and lower extremity edema. Echocardiogram reveals an ejection fraction of
35%. Which of the following medication classes has a proven mortality
benefit in this patient's condition?
A. Loop diuretics
B. Calcium channel blockers
C. Angiotensin receptor-neprilysin inhibitors
D. Short-acting nitrates
RATIONALE: Angiotensin receptor-neprilysin inhibitors, along with beta-
blockers and mineralocorticoid receptor antagonists, are guideline-directed
,medical therapies that directly lower mortality in heart failure with reduced
ejection fraction.
Question 3
A 72-year-old man with hypertension and type 2 diabetes presents with acute
onset of severe, tearing chest pain radiating to the back. Blood pressure is
100/60 mmHg in the right arm and 140/80 mmHg in the left arm. Which
diagnostic study should be ordered first?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Electrocardiogram
D. Chest X-ray
RATIONALE: The presentation of tearing chest pain with unequal blood
pressures suggests acute aortic dissection. CT angiography is the initial test of
choice due to its high sensitivity and rapid availability.
Question 4
A 55-year-old man with a history of hypertension presents with severe
headache and vomiting. Blood pressure is 220/120 mmHg. Fundoscopy shows
papilledema. What is the most appropriate next step in management?
A. Oral clonidine
B. Intravenous antihypertensive therapy with nicardipine or labetalol
C. Captopril 25 mg orally
D. Observation with repeat blood pressure in 1 hour
RATIONALE: Hypertensive emergency with end-organ damage
manifested as papilledema requires immediate intravenous blood pressure
reduction, not oral agents that have unpredictable absorption.
Question 5
A 60-year-old man presents with progressive difficulty swallowing solids more
than liquids, regurgitation of undigested food, and weight loss. Barium
, swallow reveals a dilated esophagus with a bird-beak appearance at the
gastroesophageal junction. What is the most likely diagnosis?
A. Achalasia
B. Esophageal cancer
C. Peptic stricture
D. Diffuse esophageal spasm
RATIONALE: The classic bird-beak appearance on barium swallow with
progressive dysphagia to solids and liquids is characteristic of achalasia,
caused by failure of the lower esophageal sphincter to relax.
Question 6
A 28-year-old female presents with a malar rash, photosensitivity, oral ulcers,
and polyarthralgias. Laboratory studies reveal positive ANA and anti-double-
stranded DNA antibodies. Which of the following is the most appropriate
initial treatment for her condition?
A. High-dose corticosteroids
B. Hydroxychloroquine
C. Methotrexate
D. Cyclophosphamide
RATIONALE: Hydroxychloroquine is the cornerstone of initial therapy for
systemic lupus erythematosus without major organ involvement, reducing
flares and improving long-term outcomes.
Question 7
A 35-year-old male presents with recurrent episodes of severe right upper
quadrant pain lasting several hours, often after eating fatty meals. Ultrasound
reveals gallstones within the gallbladder. What is the most appropriate
management?
A. Laparoscopic cholecystectomy
B. Ursodeoxycholic acid therapy
BANK – NEWEST 2026 EDITION |
COMPREHENSIVE 160-ACTUAL QUESTION
SET WITH VERIFIED ANSWERS & DETAILED
RATIONALES
Core Domains
• Osteopathic Principles and Manipulative Medicine
• Internal Medicine and Ambulatory Care
• Obstetrics and Gynecology
• Pediatrics and Adolescent Medicine
• Psychiatry and Behavioral Health
• General Surgery and Perioperative Care
• Emergency Medicine and Critical Care
• Family Medicine and Preventive Services
• Ethics, Legal, and Systems-Based Practice
Introduction
This comprehensive assessment evaluates the osteopathic medical student’s
readiness for COMLEX-USA Level 2-CE. The examination integrates clinical
knowledge, osteopathic principles, and patient-centered decision-making
across ambulatory, inpatient, and emergency settings. Questions are presented
as single-best-answer multiple-choice items that reflect the content and
difficulty of the official COMSAE Phase 2. Emphasis is placed on diagnosis,
treatment, health maintenance, osteopathic manipulative treatment, and the
interpretation of clinical findings. Success demonstrates the ability to apply
,foundational science and clinical reasoning to the care of patients across the
lifespan, consistent with the osteopathic approach to whole-person care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 62-year-old male presents to the emergency department with sudden-onset
crushing chest pain radiating to his left arm. ECG reveals ST-segment
elevations in leads V1 through V4. Which of the following is the most
appropriate immediate intervention?
A. Oral beta-blocker administration
B. Intravenous thrombolytic therapy
C. Chewable aspirin and activation of the cardiac catheterization lab
D. Subcutaneous low-molecular-weight heparin
RATIONALE: Chewable aspirin combined with emergent coronary
angiography and percutaneous coronary intervention within 90 minutes is
the standard of care for acute ST-elevation myocardial infarction to achieve
rapid reperfusion and minimize myocardial damage.
Question 2
A 45-year-old female presents with progressive shortness of breath, fatigue,
and lower extremity edema. Echocardiogram reveals an ejection fraction of
35%. Which of the following medication classes has a proven mortality
benefit in this patient's condition?
A. Loop diuretics
B. Calcium channel blockers
C. Angiotensin receptor-neprilysin inhibitors
D. Short-acting nitrates
RATIONALE: Angiotensin receptor-neprilysin inhibitors, along with beta-
blockers and mineralocorticoid receptor antagonists, are guideline-directed
,medical therapies that directly lower mortality in heart failure with reduced
ejection fraction.
Question 3
A 72-year-old man with hypertension and type 2 diabetes presents with acute
onset of severe, tearing chest pain radiating to the back. Blood pressure is
100/60 mmHg in the right arm and 140/80 mmHg in the left arm. Which
diagnostic study should be ordered first?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Electrocardiogram
D. Chest X-ray
RATIONALE: The presentation of tearing chest pain with unequal blood
pressures suggests acute aortic dissection. CT angiography is the initial test of
choice due to its high sensitivity and rapid availability.
Question 4
A 55-year-old man with a history of hypertension presents with severe
headache and vomiting. Blood pressure is 220/120 mmHg. Fundoscopy shows
papilledema. What is the most appropriate next step in management?
A. Oral clonidine
B. Intravenous antihypertensive therapy with nicardipine or labetalol
C. Captopril 25 mg orally
D. Observation with repeat blood pressure in 1 hour
RATIONALE: Hypertensive emergency with end-organ damage
manifested as papilledema requires immediate intravenous blood pressure
reduction, not oral agents that have unpredictable absorption.
Question 5
A 60-year-old man presents with progressive difficulty swallowing solids more
than liquids, regurgitation of undigested food, and weight loss. Barium
, swallow reveals a dilated esophagus with a bird-beak appearance at the
gastroesophageal junction. What is the most likely diagnosis?
A. Achalasia
B. Esophageal cancer
C. Peptic stricture
D. Diffuse esophageal spasm
RATIONALE: The classic bird-beak appearance on barium swallow with
progressive dysphagia to solids and liquids is characteristic of achalasia,
caused by failure of the lower esophageal sphincter to relax.
Question 6
A 28-year-old female presents with a malar rash, photosensitivity, oral ulcers,
and polyarthralgias. Laboratory studies reveal positive ANA and anti-double-
stranded DNA antibodies. Which of the following is the most appropriate
initial treatment for her condition?
A. High-dose corticosteroids
B. Hydroxychloroquine
C. Methotrexate
D. Cyclophosphamide
RATIONALE: Hydroxychloroquine is the cornerstone of initial therapy for
systemic lupus erythematosus without major organ involvement, reducing
flares and improving long-term outcomes.
Question 7
A 35-year-old male presents with recurrent episodes of severe right upper
quadrant pain lasting several hours, often after eating fatty meals. Ultrasound
reveals gallstones within the gallbladder. What is the most appropriate
management?
A. Laparoscopic cholecystectomy
B. Ursodeoxycholic acid therapy
