COMSAE PHASE 2 FORM 120+
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026/2027 Q&A | INSTANT DOWNLOAD
PDF
Core Domains
Internal Medicine
Cardiology and Cardiovascular Disorders
Pulmonology and Respiratory Disorders
Gastroenterology and Hepatology
Nephrology and Electrolyte Disorders
Endocrinology and Metabolic Disorders
Neurology and Neuromuscular Disorders
Infectious Disease
Rheumatology and Musculoskeletal Disorders
Osteopathic Principles and Manipulative Medicine
Introduction
The COMSAE Phase 2 Comprehensive Self-Assessment Examination
evaluates osteopathic medical students' clinical knowledge and
decision-making skills essential for success on the COMLEX-USA
,Level 2-CE. This comprehensive assessment covers major clinical
disciplines integrated with osteopathic principles, emphasizing
patient presentations, diagnostic reasoning, and evidence-based
management strategies. The examination employs multiple-choice
questions incorporating real-world clinical scenarios that require
synthesis of patient history, physical examination findings, and
diagnostic studies. Candidates must demonstrate competency in
differential diagnosis, treatment planning, and application of
osteopathic manipulative medicine within clinical contexts
consistent with entry-level osteopathic medical practice.
SECTION ONE: QUESTIONS 1–100
Question 1
A 68-year-old male with a history of hypertension and type 2
diabetes mellitus presents to the emergency department with
sudden onset of severe, tearing chest pain that radiates to his
back. His blood pressure is 180/110 mmHg in the right arm and
150/90 mmHg in the left arm. Which of the following is the most
appropriate initial imaging study to confirm the suspected
diagnosis?
A. Transthoracic echocardiogram
B. Computed tomography angiography of the chest
C. Magnetic resonance imaging of the chest
D. Standard chest radiograph
,🟢 B. Computed tomography angiography of the chest
🔴 RATIONALE: The presentation of sudden, severe tearing chest
pain radiating to the back with a blood pressure differential
between arms is classic for acute aortic dissection. CT
angiography is the initial imaging modality of choice due to its
high sensitivity and specificity, rapid acquisition, and widespread
availability. It accurately delineates the extent of the dissection
and involvement of branch vessels, which is crucial for surgical
planning .
Question 2
A 45-year-old female with a history of systemic lupus
erythematosus presents with progressive shortness of breath and
a non-productive cough over the past two months. Chest
radiograph shows bilateral interstitial infiltrates. Pulmonary
function tests reveal a restrictive pattern with reduced DLCO.
Which of the following is the most likely underlying pulmonary
pathology?
A. Pulmonary embolism
B. Diffuse alveolar hemorrhage
C. Interstitial lung disease
D. Pulmonary hypertension
🟢 C. Interstitial lung disease
🔴 RATIONALE: The combination of progressive dyspnea, non-
productive cough, bilateral interstitial infiltrates, and a restrictive
pattern with reduced DLCO is most consistent with interstitial lung
, disease. ILD is a known pulmonary manifestation of SLE,
characterized by inflammation and fibrosis of the lung interstitium
.
Question 3
A 32-year-old male is brought to the emergency department after
being found unresponsive at home. His friends report he was
using heroin earlier in the evening. On examination, he has a
respiratory rate of 4 breaths per minute and pinpoint pupils.
Which of the following is the most appropriate immediate
pharmacological intervention?
A. Naloxone
B. Flumazenil
C. Activated charcoal
D. N-acetylcysteine
🟢 A. Naloxone
🔴 RATIONALE: The presentation of unresponsiveness, severe
respiratory depression, and pinpoint pupils following heroin use is
indicative of an opioid overdose. Naloxone is a specific opioid
antagonist that rapidly reverses these effects and is the first-line
treatment to restore adequate ventilation .
Question 4
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026/2027 Q&A | INSTANT DOWNLOAD
Core Domains
Internal Medicine
Cardiology and Cardiovascular Disorders
Pulmonology and Respiratory Disorders
Gastroenterology and Hepatology
Nephrology and Electrolyte Disorders
Endocrinology and Metabolic Disorders
Neurology and Neuromuscular Disorders
Infectious Disease
Rheumatology and Musculoskeletal Disorders
Osteopathic Principles and Manipulative Medicine
Introduction
The COMSAE Phase 2 Comprehensive Self-Assessment Examination
evaluates osteopathic medical students' clinical knowledge and
decision-making skills essential for success on the COMLEX-USA
,Level 2-CE. This comprehensive assessment covers major clinical
disciplines integrated with osteopathic principles, emphasizing
patient presentations, diagnostic reasoning, and evidence-based
management strategies. The examination employs multiple-choice
questions incorporating real-world clinical scenarios that require
synthesis of patient history, physical examination findings, and
diagnostic studies. Candidates must demonstrate competency in
differential diagnosis, treatment planning, and application of
osteopathic manipulative medicine within clinical contexts
consistent with entry-level osteopathic medical practice.
SECTION ONE: QUESTIONS 1–100
Question 1
A 68-year-old male with a history of hypertension and type 2
diabetes mellitus presents to the emergency department with
sudden onset of severe, tearing chest pain that radiates to his
back. His blood pressure is 180/110 mmHg in the right arm and
150/90 mmHg in the left arm. Which of the following is the most
appropriate initial imaging study to confirm the suspected
diagnosis?
A. Transthoracic echocardiogram
B. Computed tomography angiography of the chest
C. Magnetic resonance imaging of the chest
D. Standard chest radiograph
,🟢 B. Computed tomography angiography of the chest
🔴 RATIONALE: The presentation of sudden, severe tearing chest
pain radiating to the back with a blood pressure differential
between arms is classic for acute aortic dissection. CT
angiography is the initial imaging modality of choice due to its
high sensitivity and specificity, rapid acquisition, and widespread
availability. It accurately delineates the extent of the dissection
and involvement of branch vessels, which is crucial for surgical
planning .
Question 2
A 45-year-old female with a history of systemic lupus
erythematosus presents with progressive shortness of breath and
a non-productive cough over the past two months. Chest
radiograph shows bilateral interstitial infiltrates. Pulmonary
function tests reveal a restrictive pattern with reduced DLCO.
Which of the following is the most likely underlying pulmonary
pathology?
A. Pulmonary embolism
B. Diffuse alveolar hemorrhage
C. Interstitial lung disease
D. Pulmonary hypertension
🟢 C. Interstitial lung disease
🔴 RATIONALE: The combination of progressive dyspnea, non-
productive cough, bilateral interstitial infiltrates, and a restrictive
pattern with reduced DLCO is most consistent with interstitial lung
, disease. ILD is a known pulmonary manifestation of SLE,
characterized by inflammation and fibrosis of the lung interstitium
.
Question 3
A 32-year-old male is brought to the emergency department after
being found unresponsive at home. His friends report he was
using heroin earlier in the evening. On examination, he has a
respiratory rate of 4 breaths per minute and pinpoint pupils.
Which of the following is the most appropriate immediate
pharmacological intervention?
A. Naloxone
B. Flumazenil
C. Activated charcoal
D. N-acetylcysteine
🟢 A. Naloxone
🔴 RATIONALE: The presentation of unresponsiveness, severe
respiratory depression, and pinpoint pupils following heroin use is
indicative of an opioid overdose. Naloxone is a specific opioid
antagonist that rapidly reverses these effects and is the first-line
treatment to restore adequate ventilation .
Question 4
