COMSAE PHASE 2 FORM 116 EXAMINATION
COMPLETE QUESTIONS AND DETAILED
SOLUTIONS LATEST UPDATE THIS YEAR JUST
RELEASED
EXAM COVERAGE
Patient management: Prioritizing stabilization, diagnosis, and definitive
treatment.
Clinical reasoning: Choosing initial versus confirmatory testing
appropriately.
Osteopathic practice: Identifying indications and contraindications for
OMT.
Preventive care: Applying screening, counseling, and vaccination guidance.
Emergency care: Recognizing unstable presentations and immediate
interventions.
Medical ethics: Consent, autonomy, surrogate decisions, confidentiality.
Interpretation skills: ECGs, spirometry, imaging, labs, acid-base analysis.
Procedural awareness: Understanding indications, complications, and
follow-up.
Population health: Prevention and systems-based thinking.
1. A 67-year-old man develops crushing substernal pain,
diaphoresis, and hypotension while awaiting laboratory
,testing in the emergency department. What is the most
appropriate immediate next action?
A. Obtain echocardiogram
B. Administer aspirin and initiate urgent reperfusion
strategy
C. Repeat ECG in two hours
D. Order stress testing
Answer: B
Rationale: Unstable suspected acute coronary syndrome
requires immediate treatment and reperfusion planning
before confirmatory delays.
2. A postpartum patient reports sadness beginning ten
days after delivery but remains functional and bonded
with the infant. Most likely diagnosis?
A. Major depressive disorder
B. Postpartum psychosis
C. Postpartum blues
D. Cyclothymia
Answer: C
Rationale: Early mild mood symptoms with preserved
functioning suggest postpartum blues.
3. During counseling, a patient requests discharge despite
limited understanding of treatment risks. First physician
,action?
A. Obtain security assistance
B. Assess decision-making capacity
C. Contact family immediately
D. Discharge patient
Answer: B
Rationale: Capacity evaluation precedes accepting or
rejecting patient refusal.
4. A patient presents with unilateral calf swelling after
surgery and elevated D-dimer. Best next diagnostic step?
A. CT chest
B. Compression ultrasonography
C. MRI leg
D. Repeat D-dimer
Answer: B
Rationale: Ultrasound is preferred for suspected lower
extremity DVT.
5. A teenager has episodic wheezing and nighttime cough
occurring twice monthly. Most appropriate initial long-
term treatment?
A. Daily systemic steroids
B. Short-acting bronchodilator as needed
C. Triple inhaler therapy
, D. Antibiotics
Answer: B
Rationale: Intermittent asthma generally begins with
rescue therapy.
6. A patient with diabetes presents with confusion,
dehydration, and glucose exceeding 700 mg/dL without
ketones. Initial management?
A. Insulin only
B. IV fluids first
C. Bicarbonate infusion
D. Oral agents
Answer: B
Rationale: Fluid replacement precedes insulin in
hyperosmolar states.
7. A physician recommends treatment primarily to satisfy
institutional metrics despite little patient benefit. Ethical
principle violated?
A. Beneficence
B. Justice
C. Fidelity
D. Nonmaleficence
Answer: A
Rationale: Actions should prioritize patient welfare.
COMPLETE QUESTIONS AND DETAILED
SOLUTIONS LATEST UPDATE THIS YEAR JUST
RELEASED
EXAM COVERAGE
Patient management: Prioritizing stabilization, diagnosis, and definitive
treatment.
Clinical reasoning: Choosing initial versus confirmatory testing
appropriately.
Osteopathic practice: Identifying indications and contraindications for
OMT.
Preventive care: Applying screening, counseling, and vaccination guidance.
Emergency care: Recognizing unstable presentations and immediate
interventions.
Medical ethics: Consent, autonomy, surrogate decisions, confidentiality.
Interpretation skills: ECGs, spirometry, imaging, labs, acid-base analysis.
Procedural awareness: Understanding indications, complications, and
follow-up.
Population health: Prevention and systems-based thinking.
1. A 67-year-old man develops crushing substernal pain,
diaphoresis, and hypotension while awaiting laboratory
,testing in the emergency department. What is the most
appropriate immediate next action?
A. Obtain echocardiogram
B. Administer aspirin and initiate urgent reperfusion
strategy
C. Repeat ECG in two hours
D. Order stress testing
Answer: B
Rationale: Unstable suspected acute coronary syndrome
requires immediate treatment and reperfusion planning
before confirmatory delays.
2. A postpartum patient reports sadness beginning ten
days after delivery but remains functional and bonded
with the infant. Most likely diagnosis?
A. Major depressive disorder
B. Postpartum psychosis
C. Postpartum blues
D. Cyclothymia
Answer: C
Rationale: Early mild mood symptoms with preserved
functioning suggest postpartum blues.
3. During counseling, a patient requests discharge despite
limited understanding of treatment risks. First physician
,action?
A. Obtain security assistance
B. Assess decision-making capacity
C. Contact family immediately
D. Discharge patient
Answer: B
Rationale: Capacity evaluation precedes accepting or
rejecting patient refusal.
4. A patient presents with unilateral calf swelling after
surgery and elevated D-dimer. Best next diagnostic step?
A. CT chest
B. Compression ultrasonography
C. MRI leg
D. Repeat D-dimer
Answer: B
Rationale: Ultrasound is preferred for suspected lower
extremity DVT.
5. A teenager has episodic wheezing and nighttime cough
occurring twice monthly. Most appropriate initial long-
term treatment?
A. Daily systemic steroids
B. Short-acting bronchodilator as needed
C. Triple inhaler therapy
, D. Antibiotics
Answer: B
Rationale: Intermittent asthma generally begins with
rescue therapy.
6. A patient with diabetes presents with confusion,
dehydration, and glucose exceeding 700 mg/dL without
ketones. Initial management?
A. Insulin only
B. IV fluids first
C. Bicarbonate infusion
D. Oral agents
Answer: B
Rationale: Fluid replacement precedes insulin in
hyperosmolar states.
7. A physician recommends treatment primarily to satisfy
institutional metrics despite little patient benefit. Ethical
principle violated?
A. Beneficence
B. Justice
C. Fidelity
D. Nonmaleficence
Answer: A
Rationale: Actions should prioritize patient welfare.
