COMSAE PHASE 2 FORM 112 EXAM PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Internal Medicine
Surgery and Perioperative Care
Obstetrics and Gynecology
Pediatrics
Psychiatry and Behavioral Health
Community Medicine and Public Health
Ethics and Professionalism
Healthcare Law and Regulatory Compliance
Introduction
*This comprehensive assessment is designed to prepare candidates for the COMSAE Phase 2 Form 112 exam. It
evaluates the integration of foundational medical knowledge with clinical decision-making in ambulatory and
hospital-based settings. Each question emphasizes real-world application, diagnostic reasoning, management
strategies, and ethical judgment. The format includes multiple-choice questions and clinical vignettes that
mimic board-style testing. Correct answers are verified and accompanied by concise rationales to reinforce
learning. Mastery of these questions reflects readiness for osteopathic medical licensing examinations and safe,
effective patient care.*
,SECTION ONE: QUESTIONS 1–100
Question 1
A 58-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 150/90 in the right arm and 110/70 in the left arm. Which is the
most appropriate next step?
A. Administer sublingual nitroglycerin
B. Obtain a computed tomography angiography of the chest
C. Order a stat electrocardiogram
D. Start fibrinolytic therapy
🟢B
🔴 RATIONALE: The presentation suggests aortic dissection, with blood pressure differential between arms. CT
angiography is the definitive imaging study to confirm dissection. Nitroglycerin and ECG (for MI) may delay
diagnosis. Fibrinolysis is contraindicated in dissection.
Question 2
A 72-year-old woman is brought in with progressive forgetfulness, apathy, and difficulty walking over 6 months.
She has urinary incontinence. On exam, she has a magnetic gait. What is the most likely diagnosis?
A. Alzheimer’s disease
B. Lewy body dementia
C. Frontotemporal dementia
D. Normal pressure hydrocephalus
🟢D
,🔴 RATIONALE: The triad of dementia, gait apraxia (magnetic gait), and urinary incontinence is classic for
normal pressure hydrocephalus (NPH). Alzheimer’s and other dementias lack this triad and early gait
disturbance.
Question 3
A 28-year-old G2P1 at 32 weeks gestation reports painless, bright red vaginal bleeding over the past hour. Fetal
heart rate is 150 bpm and reactive. Maternal vital signs are stable. What is the most appropriate next step?
A. Digital cervical examination
B. Transvaginal ultrasound
C. Immediate cesarean section
D. Non-stress test only
🟢B
🔴 RATIONALE: Painless third-trimester bleeding suggests placenta previa. Digital exam is contraindicated due
to risk of catastrophic hemorrhage. Transvaginal ultrasound confirms placental location. Cesarean is not yet
indicated without confirmation or instability.
Question 4
A 45-year-old with alcohol use disorder presents with jaundice, ascites, and asterixis. Labs show AST 220, ALT
110, INR 1.8, and bilirubin 6.5 mg/dL. What is the most appropriate pharmacological treatment?
A. N-acetylcysteine
B. Prednisolone
C. Rifaximin
D. Spironolactone
, 🟢B
🔴 RATIONALE: This is severe alcoholic hepatitis (Maddrey’s discriminant function likely >32). Prednisolone is
first-line to reduce inflammation and mortality. N-acetylcysteine is for acetaminophen toxicity; rifaximin for
hepatic encephalopathy; spironolactone for ascites but not primary treatment.
Question 5
A 19-year-old college student reports feeling sad, fatigue, and poor sleep for 3 weeks. Symptoms started after a
breakup. She denies suicidal ideation. PHQ-9 score is 12. What is the best initial management?
A. Escitalopram 10 mg daily
B. Cognitive behavioral therapy (CBT)
C. Supportive counseling with watchful waiting
D. Referral for electroconvulsive therapy
🟢C
🔴 RATIONALE: Mild to moderate depression with clear psychosocial trigger and no suicidal ideation may
respond to supportive counseling and observation. Antidepressants (A) are not first-line without persistent or
severe symptoms. CBT is appropriate but not initial without trial of support. ECT is for severe/refractory cases.
Question 6
A 6-year-old boy has 3 days of fever, conjunctival injection, cracked lips, and a polymorphous rash. He has one
swollen cervical lymph node. What is the most serious potential complication if untreated?
A. Coronary artery aneurysms
B. Aseptic meningitis
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Internal Medicine
Surgery and Perioperative Care
Obstetrics and Gynecology
Pediatrics
Psychiatry and Behavioral Health
Community Medicine and Public Health
Ethics and Professionalism
Healthcare Law and Regulatory Compliance
Introduction
*This comprehensive assessment is designed to prepare candidates for the COMSAE Phase 2 Form 112 exam. It
evaluates the integration of foundational medical knowledge with clinical decision-making in ambulatory and
hospital-based settings. Each question emphasizes real-world application, diagnostic reasoning, management
strategies, and ethical judgment. The format includes multiple-choice questions and clinical vignettes that
mimic board-style testing. Correct answers are verified and accompanied by concise rationales to reinforce
learning. Mastery of these questions reflects readiness for osteopathic medical licensing examinations and safe,
effective patient care.*
,SECTION ONE: QUESTIONS 1–100
Question 1
A 58-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 150/90 in the right arm and 110/70 in the left arm. Which is the
most appropriate next step?
A. Administer sublingual nitroglycerin
B. Obtain a computed tomography angiography of the chest
C. Order a stat electrocardiogram
D. Start fibrinolytic therapy
🟢B
🔴 RATIONALE: The presentation suggests aortic dissection, with blood pressure differential between arms. CT
angiography is the definitive imaging study to confirm dissection. Nitroglycerin and ECG (for MI) may delay
diagnosis. Fibrinolysis is contraindicated in dissection.
Question 2
A 72-year-old woman is brought in with progressive forgetfulness, apathy, and difficulty walking over 6 months.
She has urinary incontinence. On exam, she has a magnetic gait. What is the most likely diagnosis?
A. Alzheimer’s disease
B. Lewy body dementia
C. Frontotemporal dementia
D. Normal pressure hydrocephalus
🟢D
,🔴 RATIONALE: The triad of dementia, gait apraxia (magnetic gait), and urinary incontinence is classic for
normal pressure hydrocephalus (NPH). Alzheimer’s and other dementias lack this triad and early gait
disturbance.
Question 3
A 28-year-old G2P1 at 32 weeks gestation reports painless, bright red vaginal bleeding over the past hour. Fetal
heart rate is 150 bpm and reactive. Maternal vital signs are stable. What is the most appropriate next step?
A. Digital cervical examination
B. Transvaginal ultrasound
C. Immediate cesarean section
D. Non-stress test only
🟢B
🔴 RATIONALE: Painless third-trimester bleeding suggests placenta previa. Digital exam is contraindicated due
to risk of catastrophic hemorrhage. Transvaginal ultrasound confirms placental location. Cesarean is not yet
indicated without confirmation or instability.
Question 4
A 45-year-old with alcohol use disorder presents with jaundice, ascites, and asterixis. Labs show AST 220, ALT
110, INR 1.8, and bilirubin 6.5 mg/dL. What is the most appropriate pharmacological treatment?
A. N-acetylcysteine
B. Prednisolone
C. Rifaximin
D. Spironolactone
, 🟢B
🔴 RATIONALE: This is severe alcoholic hepatitis (Maddrey’s discriminant function likely >32). Prednisolone is
first-line to reduce inflammation and mortality. N-acetylcysteine is for acetaminophen toxicity; rifaximin for
hepatic encephalopathy; spironolactone for ascites but not primary treatment.
Question 5
A 19-year-old college student reports feeling sad, fatigue, and poor sleep for 3 weeks. Symptoms started after a
breakup. She denies suicidal ideation. PHQ-9 score is 12. What is the best initial management?
A. Escitalopram 10 mg daily
B. Cognitive behavioral therapy (CBT)
C. Supportive counseling with watchful waiting
D. Referral for electroconvulsive therapy
🟢C
🔴 RATIONALE: Mild to moderate depression with clear psychosocial trigger and no suicidal ideation may
respond to supportive counseling and observation. Antidepressants (A) are not first-line without persistent or
severe symptoms. CBT is appropriate but not initial without trial of support. ECT is for severe/refractory cases.
Question 6
A 6-year-old boy has 3 days of fever, conjunctival injection, cracked lips, and a polymorphous rash. He has one
swollen cervical lymph node. What is the most serious potential complication if untreated?
A. Coronary artery aneurysms
B. Aseptic meningitis
