COMSAE PHASE 2 – FORM 109 PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Preventive Medicine and Population Health
Psychiatry and Behavioral Science
Surgical Principles and Perioperative Care
Medical Ethics and Professionalism
Healthcare Law and Regulatory Compliance
Clinical Reasoning and Diagnostic Testing
Introduction
*This examination is designed to assess readiness for the COMSAE Phase 2 – Form 109 by evaluating core
clinical knowledge, diagnostic reasoning, and patient management skills across major disciplines. Questions are
presented in multiple-choice and clinical scenario formats that mirror real-world decision-making in supervised
and independent practice. Emphasis is placed on applying evidence-based guidelines, recognizing high-risk
conditions, integrating ethical and legal standards, and prioritizing patient safety. Each item requires synthesis
of foundational theory with practical judgment. Correct answers are verified and accompanied by rationales to
reinforce learning and identify knowledge gaps for focused remediation.*
,SECTION ONE: QUESTIONS 1–100
Question 1
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
🟢B
🔴 RATIONALE: The presentation of tearing chest pain with unequal blood pressures suggests aortic dissection.
CT angiography is the initial test of choice due to high sensitivity and rapid availability. ECG may be normal or
show nonspecific changes and does not rule out dissection. Chest X-ray may show widened mediastinum but
lacks sensitivity. Echocardiography is operator-dependent and may miss arch involvement.
Question 2
A 28-year-old woman at 34 weeks gestation reports a sudden gush of fluid from the vagina. Contractions have
not started. Fetal heart rate tracing is reassuring. What is the most appropriate next step?
A. Immediate delivery by cesarean section
B. Expectant management with hospitalization
,C. Administration of tocolytics
D. Outpatient follow-up with cervical length measurement
🟢B
🔴 RATIONALE: Preterm premature rupture of membranes (PPROM) at 34 weeks without signs of infection or
fetal distress is managed with expectant hospitalization to allow for fetal lung maturation and reduce neonatal
complications. Tocolytics are not indicated without contractions. Outpatient management is unsafe. Immediate
cesarean is unnecessary without distress.
Question 3
A 6-year-old boy presents with a 3-day history of fever, cough, and conjunctivitis followed by an erythematous
maculopapular rash beginning on the face and spreading downward. What is the most likely diagnosis?
A. Rubella
B. Measles (rubeola)
C. Scarlet fever
D. Erythema infectiosum
🟢B
🔴 RATIONALE: Measles classically presents with prodromal fever, cough, coryza, conjunctivitis (the “three Cs”),
followed by rash that spreads cephalocaudally. Rubella has milder symptoms and postauricular
lymphadenopathy. Scarlet fever has sandpaper rash and strawberry tongue. Erythema infectiosum (fifth disease)
has slapped-cheek rash.
Question 4
A 55-year-old man with a 30-pack-year smoking history presents with hemoptysis and weight loss. A chest CT
, shows a 3 cm spiculated nodule in the right upper lobe. Which next step is most appropriate?
A. Positron emission tomography (PET) scan
B. Bronchoscopy with biopsy
C. Observation with repeat CT in 3 months
D. Empiric antibiotics
🟢B
🔴 RATIONALE: Suspicious nodule in a high-risk patient requires tissue diagnosis. Bronchoscopy is appropriate
for central or accessible lesions. PET scan is staging, not diagnostic. Observation or antibiotics delays diagnosis
of possible lung cancer.
Question 5
A 32-year-old woman reports depressed mood, anhedonia, and fatigue for 3 months. She also has
hypersomnia, increased appetite, and carbohydrate craving. Symptoms are worse in winter and improve in
summer. Which is the most appropriate initial treatment?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Bright light therapy
🟢D
🔴 RATIONALE: This pattern is consistent with seasonal affective disorder (major depressive disorder with
seasonal pattern). Bright light therapy is first-line. Antidepressants are effective but not initial unless light
therapy fails. Bupropion is sometimes used for prevention.
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Preventive Medicine and Population Health
Psychiatry and Behavioral Science
Surgical Principles and Perioperative Care
Medical Ethics and Professionalism
Healthcare Law and Regulatory Compliance
Clinical Reasoning and Diagnostic Testing
Introduction
*This examination is designed to assess readiness for the COMSAE Phase 2 – Form 109 by evaluating core
clinical knowledge, diagnostic reasoning, and patient management skills across major disciplines. Questions are
presented in multiple-choice and clinical scenario formats that mirror real-world decision-making in supervised
and independent practice. Emphasis is placed on applying evidence-based guidelines, recognizing high-risk
conditions, integrating ethical and legal standards, and prioritizing patient safety. Each item requires synthesis
of foundational theory with practical judgment. Correct answers are verified and accompanied by rationales to
reinforce learning and identify knowledge gaps for focused remediation.*
,SECTION ONE: QUESTIONS 1–100
Question 1
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
🟢B
🔴 RATIONALE: The presentation of tearing chest pain with unequal blood pressures suggests aortic dissection.
CT angiography is the initial test of choice due to high sensitivity and rapid availability. ECG may be normal or
show nonspecific changes and does not rule out dissection. Chest X-ray may show widened mediastinum but
lacks sensitivity. Echocardiography is operator-dependent and may miss arch involvement.
Question 2
A 28-year-old woman at 34 weeks gestation reports a sudden gush of fluid from the vagina. Contractions have
not started. Fetal heart rate tracing is reassuring. What is the most appropriate next step?
A. Immediate delivery by cesarean section
B. Expectant management with hospitalization
,C. Administration of tocolytics
D. Outpatient follow-up with cervical length measurement
🟢B
🔴 RATIONALE: Preterm premature rupture of membranes (PPROM) at 34 weeks without signs of infection or
fetal distress is managed with expectant hospitalization to allow for fetal lung maturation and reduce neonatal
complications. Tocolytics are not indicated without contractions. Outpatient management is unsafe. Immediate
cesarean is unnecessary without distress.
Question 3
A 6-year-old boy presents with a 3-day history of fever, cough, and conjunctivitis followed by an erythematous
maculopapular rash beginning on the face and spreading downward. What is the most likely diagnosis?
A. Rubella
B. Measles (rubeola)
C. Scarlet fever
D. Erythema infectiosum
🟢B
🔴 RATIONALE: Measles classically presents with prodromal fever, cough, coryza, conjunctivitis (the “three Cs”),
followed by rash that spreads cephalocaudally. Rubella has milder symptoms and postauricular
lymphadenopathy. Scarlet fever has sandpaper rash and strawberry tongue. Erythema infectiosum (fifth disease)
has slapped-cheek rash.
Question 4
A 55-year-old man with a 30-pack-year smoking history presents with hemoptysis and weight loss. A chest CT
, shows a 3 cm spiculated nodule in the right upper lobe. Which next step is most appropriate?
A. Positron emission tomography (PET) scan
B. Bronchoscopy with biopsy
C. Observation with repeat CT in 3 months
D. Empiric antibiotics
🟢B
🔴 RATIONALE: Suspicious nodule in a high-risk patient requires tissue diagnosis. Bronchoscopy is appropriate
for central or accessible lesions. PET scan is staging, not diagnostic. Observation or antibiotics delays diagnosis
of possible lung cancer.
Question 5
A 32-year-old woman reports depressed mood, anhedonia, and fatigue for 3 months. She also has
hypersomnia, increased appetite, and carbohydrate craving. Symptoms are worse in winter and improve in
summer. Which is the most appropriate initial treatment?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Bright light therapy
🟢D
🔴 RATIONALE: This pattern is consistent with seasonal affective disorder (major depressive disorder with
seasonal pattern). Bright light therapy is first-line. Antidepressants are effective but not initial unless light
therapy fails. Bupropion is sometimes used for prevention.
