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COMSAE Phase 2 Form 116 EXAM QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 2 Form 116 exam
EXAM SUMMARIZED COMPRESSED POINT FORM CONTENT AREAS COVERED
• Internal Medicine (35-40%): cardiology, pulmonology, nephrology, gastroenterology,
endocrinology, rheumatology, hematology/oncology, infectious disease
• Surgery (10-15%): preoperative evaluation, postoperative complications, trauma, surgical
subspecialties (vascular, colorectal, bariatric)
• Obstetrics and Gynecology (10-15%): antenatal care, complications of pregnancy, labor and
delivery, gynecologic oncology, STIs, contraception
• Pediatrics (10-15%): developmental milestones, congenital disorders, pediatric infections,
childhood immunizations, failure to thrive
• Psychiatry / Neurology (10-15%): mood disorders, anxiety disorders, psychotic disorders,
substance use, stroke, seizures, headache, movement disorders
• Emergency Medicine (5-10%): acute coronary syndrome, trauma assessment, toxicology,
environmental emergencies, resuscitation
• Osteopathic Principles and OMM (5%): viscerosomatic reflexes, Chapman points, treatment of
somatic dysfunction
• Preventive Medicine / Ethics (5%): screening guidelines, vaccination schedules, informed
consent, end-of-life care, medical errors
• Exam Format: 176 single-best-answer multiple-choice questions; each question 15+ words;
answers with summarized rationales
1. A 72-year-old man with a history of hypertension presents with acute-onset severe epigastric pain
radiating to the back. Blood pressure is 110/70 mmHg in the right arm and 130/80 mmHg in the left arm.
A pulsatile abdominal mass is palpated. What is the most appropriate next step?
A) Abdominal ultrasound
B) CT angiography of the abdomen
C) Emergent surgical consultation
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D) Transthoracic echocardiogram
Answer: C
Rationale: Pain radiating to the back, BP differential, and pulsatile mass suggest ruptured or expanding
abdominal aortic aneurysm requiring urgent surgical evaluation.
2. A 68-year-old woman with a history of atrial fibrillation on warfarin presents with sudden-onset
severe headache, nausea, and left-sided weakness. INR is 4.5. CT head shows a right intracerebral
hemorrhage. What is the most appropriate immediate management?
A) Administer vitamin K alone
B) Administer fresh frozen plasma and vitamin K
C) Administer prothrombin complex concentrate
D) Hold warfarin and repeat CT in 6 hours
Answer: C
Rationale: Prothrombin complex concentrate (PCC) reverses warfarin most rapidly for intracranial
hemorrhage; FFP is slower.
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3. A 55-year-old man presents with fever, chills, and a productive cough with "currant jelly" sputum. He
has a history of heavy alcohol use. Chest x-ray shows a bulging fissure in the right upper lobe. What is
the most likely causative organism?
A) Streptococcus pneumoniae
B) Klebsiella pneumoniae
C) Haemophilus influenzae
D) Legionella pneumophila
Answer: B
Rationale: Klebsiella pneumoniae causes lobar pneumonia with bulging fissure and currant jelly sputum,
typically in alcoholics.
4. A 28-year-old G2P1 at 36 weeks gestation presents with sudden-onset severe headache, blurred
vision, and epigastric pain. Blood pressure is 165/110 mmHg. Urinalysis shows 3+ protein. Which
laboratory finding would confirm the diagnosis of HELLP syndrome?
A) Elevated AST and ALT with thrombocytopenia
B) Elevated BUN and creatinine
C) Hyperglycemia and hypokalemia
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D) Elevated bilirubin and prolonged PT
Answer: A
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe form of
preeclampsia.
5. A 45-year-old woman presents with progressive dyspnea on exertion, dry cough, and digital clubbing.
High-resolution CT of the chest shows bilateral peripheral reticular opacities with honeycombing in the
lower lobes. What is the most likely diagnosis?
A) Sarcoidosis
B) Idiopathic pulmonary fibrosis
C) Hypersensitivity pneumonitis
D) Usual interstitial pneumonia
Answer: B
Rationale: Idiopathic pulmonary fibrosis presents with progressive dyspnea, dry cough, and
honeycombing on HRCT.
COMSAE Phase 2 Form 116 EXAM QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 2 Form 116 exam
EXAM SUMMARIZED COMPRESSED POINT FORM CONTENT AREAS COVERED
• Internal Medicine (35-40%): cardiology, pulmonology, nephrology, gastroenterology,
endocrinology, rheumatology, hematology/oncology, infectious disease
• Surgery (10-15%): preoperative evaluation, postoperative complications, trauma, surgical
subspecialties (vascular, colorectal, bariatric)
• Obstetrics and Gynecology (10-15%): antenatal care, complications of pregnancy, labor and
delivery, gynecologic oncology, STIs, contraception
• Pediatrics (10-15%): developmental milestones, congenital disorders, pediatric infections,
childhood immunizations, failure to thrive
• Psychiatry / Neurology (10-15%): mood disorders, anxiety disorders, psychotic disorders,
substance use, stroke, seizures, headache, movement disorders
• Emergency Medicine (5-10%): acute coronary syndrome, trauma assessment, toxicology,
environmental emergencies, resuscitation
• Osteopathic Principles and OMM (5%): viscerosomatic reflexes, Chapman points, treatment of
somatic dysfunction
• Preventive Medicine / Ethics (5%): screening guidelines, vaccination schedules, informed
consent, end-of-life care, medical errors
• Exam Format: 176 single-best-answer multiple-choice questions; each question 15+ words;
answers with summarized rationales
1. A 72-year-old man with a history of hypertension presents with acute-onset severe epigastric pain
radiating to the back. Blood pressure is 110/70 mmHg in the right arm and 130/80 mmHg in the left arm.
A pulsatile abdominal mass is palpated. What is the most appropriate next step?
A) Abdominal ultrasound
B) CT angiography of the abdomen
C) Emergent surgical consultation
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D) Transthoracic echocardiogram
Answer: C
Rationale: Pain radiating to the back, BP differential, and pulsatile mass suggest ruptured or expanding
abdominal aortic aneurysm requiring urgent surgical evaluation.
2. A 68-year-old woman with a history of atrial fibrillation on warfarin presents with sudden-onset
severe headache, nausea, and left-sided weakness. INR is 4.5. CT head shows a right intracerebral
hemorrhage. What is the most appropriate immediate management?
A) Administer vitamin K alone
B) Administer fresh frozen plasma and vitamin K
C) Administer prothrombin complex concentrate
D) Hold warfarin and repeat CT in 6 hours
Answer: C
Rationale: Prothrombin complex concentrate (PCC) reverses warfarin most rapidly for intracranial
hemorrhage; FFP is slower.
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3. A 55-year-old man presents with fever, chills, and a productive cough with "currant jelly" sputum. He
has a history of heavy alcohol use. Chest x-ray shows a bulging fissure in the right upper lobe. What is
the most likely causative organism?
A) Streptococcus pneumoniae
B) Klebsiella pneumoniae
C) Haemophilus influenzae
D) Legionella pneumophila
Answer: B
Rationale: Klebsiella pneumoniae causes lobar pneumonia with bulging fissure and currant jelly sputum,
typically in alcoholics.
4. A 28-year-old G2P1 at 36 weeks gestation presents with sudden-onset severe headache, blurred
vision, and epigastric pain. Blood pressure is 165/110 mmHg. Urinalysis shows 3+ protein. Which
laboratory finding would confirm the diagnosis of HELLP syndrome?
A) Elevated AST and ALT with thrombocytopenia
B) Elevated BUN and creatinine
C) Hyperglycemia and hypokalemia
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D) Elevated bilirubin and prolonged PT
Answer: A
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe form of
preeclampsia.
5. A 45-year-old woman presents with progressive dyspnea on exertion, dry cough, and digital clubbing.
High-resolution CT of the chest shows bilateral peripheral reticular opacities with honeycombing in the
lower lobes. What is the most likely diagnosis?
A) Sarcoidosis
B) Idiopathic pulmonary fibrosis
C) Hypersensitivity pneumonitis
D) Usual interstitial pneumonia
Answer: B
Rationale: Idiopathic pulmonary fibrosis presents with progressive dyspnea, dry cough, and
honeycombing on HRCT.
