COMSAE Phase 2 Form 116 Exam |Best Practice Questions
with Answers & Rationales | COMLEX Level 2 Prep 2026
JUST RELEASED.pdf
Key COMSAE Phase 2 Topics
Topic Key Points
Cardiology STEMI localization, heart sounds (S3), atrial fibrillation, anticoagulation reversal
(PCC), troponin specificity
Pulmonary Croup vs. epiglottitis, COPD exacerbation, community-acquired pneumonia (S.
pneumoniae), crazy-paving pattern (PAP), stroke management
Endocrine Wernicke encephalopathy (thiamine), DKA, Graves disease (TSH suppression),
Hashimoto (most common hypothyroidism), Cushing syndrome
GI H. pylori (PUD), lipase (pancreatitis), gallstones (acute pancreatitis), celiac disease
(villous atrophy), N-acetylcysteine (acetaminophen)
Neurology CN VI (lateral rectus), Bell palsy, Parkinson (substantia nigra), SIADH, meningitis,
subarachnoid hemorrhage
OB/GYN Preeclampsia (MgSO4), placenta previa, PCOS, ectopic pregnancy, gestational
diabetes (macrosomia), postpartum hemorrhage (uterine atony)
Infectious Lyme (Borrelia burgdorferi), CA-MRSA, C. difficile, PJP (CD4 <200), nitrofurantoin
Disease (UTI)
Rheumatology RA (symmetric polyarthritis), SLE (anti-dsDNA), Ankylosing spondylitis (HLA-B27),
gout (urate crystals), giant cell arteritis (corticosteroids)
Pediatrics Croup, RSV bronchiolitis, Kawasaki (coronary aneurysms), epiglottitis, PDA
murmur, newborn screening
OMM Chapman points (visceral diagnosis), Muscle energy, HVLA, viscerosomatic
reflexes, sacral rocking
Updated for 2026/2027. This comprehensive review covers the COMSAE Phase 2 Form
116 examination, which contains multiple-choice questions divided into four sections of
40 questions each . The exam mirrors the content blueprint of COMLEX-USA Level 2-
CE and evaluates seven competency domains, including osteopathic patient care,
biomedical sciences, professionalism, systems-based practice, communication skills, and
osteopathic principles and practice .
,SECTION 1: Cardiology (Questions 1-20)
1. A 67-year-old man develops crushing substernal chest pain radiating to his left
arm. ECG shows ST-segment elevations in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Posterior descending artery
Rationale: ST elevations in leads II, III, and aVF indicate an inferior wall myocardial
infarction. The right coronary artery supplies the inferior wall in most individuals. Prompt
recognition guides reperfusion therapy and risk assessment for complications such as AV
block .
2. A 62-year-old man presents with crushing substernal chest pain for 2 hours. ECG
shows ST elevations in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left anterior descending artery
B) Circumflex artery
C) Right coronary artery
D) Left main coronary artery
Rationale: Inferior wall myocardial infarctions involve leads II, III, and aVF and are most
commonly caused by right coronary artery occlusion .
3. A 55-year-old man with hypertension presents with acute substernal chest pain
radiating to the jaw. ECG shows ST elevations in leads V2-V4. Troponin is elevated.
Which is the most appropriate immediate management?
A) Aspirin and sublingual nitroglycerin
B) Aspirin, nitroglycerin, and immediate PCI
C) Heparin and warfarin
D) Thrombolytic therapy alone
,Rationale: Anterior wall STEMI (leads V2-V4) requires immediate reperfusion with PCI if
available. The LAD artery supplies the anterior wall and septum, and prompt
revascularization is essential .
4. Which heart sound is associated with heart failure due to volume overload?
A) S1
B) S2
C) S3
D) Opening snap
Rationale: An S3 gallop reflects rapid ventricular filling and volume overload .
5. Which heart sound is associated with closure of the aortic and pulmonic valves?
A) S1
B) S2
C) S3
D) S4
Rationale: S2 corresponds to the closure of the aortic and pulmonic valves at the
beginning of diastole .
6. A patient with atrial fibrillation is at increased risk of:
A) Pneumothorax
B) Embolic stroke
C) Pulmonary fibrosis
D) Cirrhosis
Rationale: Stasis in the atria predisposes to thrombus formation and embolization .
7. A 72-year-old man with atrial fibrillation on warfarin presents with sudden severe
headache. INR is 4.8. CT head shows a right frontal intraparenchymal hemorrhage.
Which is the most appropriate immediate treatment?
, A) Vitamin K 10 mg IV
B) Fresh frozen plasma
C) Prothrombin complex concentrate
D) Hold warfarin and observe
Rationale: PCC rapidly reverses warfarin in intracranial hemorrhage; FFP is slower and
less effective, and vitamin K takes hours to work. PCC provides immediate reversal of
anticoagulation, which is critical in intracranial hemorrhage to prevent expansion of
bleeding .
8. Which cardiac biomarker is most specific for myocardial infarction?
A) CK
B) Myoglobin
C) LDH
D) Troponin I
Rationale: Troponin I is highly sensitive and specific for myocardial injury .
9. A newborn with continuous machinery murmur most likely has:
A) ASD
B) VSD
C) Tetralogy of Fallot
D) Patent ductus arteriosus
Rationale: PDA produces a characteristic continuous machinery-like murmur .
10. Which ECG finding is most characteristic of hyperkalemia?
A) Prolonged QT interval
B) Peaked T waves
C) U waves
D) ST-segment depression
with Answers & Rationales | COMLEX Level 2 Prep 2026
JUST RELEASED.pdf
Key COMSAE Phase 2 Topics
Topic Key Points
Cardiology STEMI localization, heart sounds (S3), atrial fibrillation, anticoagulation reversal
(PCC), troponin specificity
Pulmonary Croup vs. epiglottitis, COPD exacerbation, community-acquired pneumonia (S.
pneumoniae), crazy-paving pattern (PAP), stroke management
Endocrine Wernicke encephalopathy (thiamine), DKA, Graves disease (TSH suppression),
Hashimoto (most common hypothyroidism), Cushing syndrome
GI H. pylori (PUD), lipase (pancreatitis), gallstones (acute pancreatitis), celiac disease
(villous atrophy), N-acetylcysteine (acetaminophen)
Neurology CN VI (lateral rectus), Bell palsy, Parkinson (substantia nigra), SIADH, meningitis,
subarachnoid hemorrhage
OB/GYN Preeclampsia (MgSO4), placenta previa, PCOS, ectopic pregnancy, gestational
diabetes (macrosomia), postpartum hemorrhage (uterine atony)
Infectious Lyme (Borrelia burgdorferi), CA-MRSA, C. difficile, PJP (CD4 <200), nitrofurantoin
Disease (UTI)
Rheumatology RA (symmetric polyarthritis), SLE (anti-dsDNA), Ankylosing spondylitis (HLA-B27),
gout (urate crystals), giant cell arteritis (corticosteroids)
Pediatrics Croup, RSV bronchiolitis, Kawasaki (coronary aneurysms), epiglottitis, PDA
murmur, newborn screening
OMM Chapman points (visceral diagnosis), Muscle energy, HVLA, viscerosomatic
reflexes, sacral rocking
Updated for 2026/2027. This comprehensive review covers the COMSAE Phase 2 Form
116 examination, which contains multiple-choice questions divided into four sections of
40 questions each . The exam mirrors the content blueprint of COMLEX-USA Level 2-
CE and evaluates seven competency domains, including osteopathic patient care,
biomedical sciences, professionalism, systems-based practice, communication skills, and
osteopathic principles and practice .
,SECTION 1: Cardiology (Questions 1-20)
1. A 67-year-old man develops crushing substernal chest pain radiating to his left
arm. ECG shows ST-segment elevations in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Posterior descending artery
Rationale: ST elevations in leads II, III, and aVF indicate an inferior wall myocardial
infarction. The right coronary artery supplies the inferior wall in most individuals. Prompt
recognition guides reperfusion therapy and risk assessment for complications such as AV
block .
2. A 62-year-old man presents with crushing substernal chest pain for 2 hours. ECG
shows ST elevations in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left anterior descending artery
B) Circumflex artery
C) Right coronary artery
D) Left main coronary artery
Rationale: Inferior wall myocardial infarctions involve leads II, III, and aVF and are most
commonly caused by right coronary artery occlusion .
3. A 55-year-old man with hypertension presents with acute substernal chest pain
radiating to the jaw. ECG shows ST elevations in leads V2-V4. Troponin is elevated.
Which is the most appropriate immediate management?
A) Aspirin and sublingual nitroglycerin
B) Aspirin, nitroglycerin, and immediate PCI
C) Heparin and warfarin
D) Thrombolytic therapy alone
,Rationale: Anterior wall STEMI (leads V2-V4) requires immediate reperfusion with PCI if
available. The LAD artery supplies the anterior wall and septum, and prompt
revascularization is essential .
4. Which heart sound is associated with heart failure due to volume overload?
A) S1
B) S2
C) S3
D) Opening snap
Rationale: An S3 gallop reflects rapid ventricular filling and volume overload .
5. Which heart sound is associated with closure of the aortic and pulmonic valves?
A) S1
B) S2
C) S3
D) S4
Rationale: S2 corresponds to the closure of the aortic and pulmonic valves at the
beginning of diastole .
6. A patient with atrial fibrillation is at increased risk of:
A) Pneumothorax
B) Embolic stroke
C) Pulmonary fibrosis
D) Cirrhosis
Rationale: Stasis in the atria predisposes to thrombus formation and embolization .
7. A 72-year-old man with atrial fibrillation on warfarin presents with sudden severe
headache. INR is 4.8. CT head shows a right frontal intraparenchymal hemorrhage.
Which is the most appropriate immediate treatment?
, A) Vitamin K 10 mg IV
B) Fresh frozen plasma
C) Prothrombin complex concentrate
D) Hold warfarin and observe
Rationale: PCC rapidly reverses warfarin in intracranial hemorrhage; FFP is slower and
less effective, and vitamin K takes hours to work. PCC provides immediate reversal of
anticoagulation, which is critical in intracranial hemorrhage to prevent expansion of
bleeding .
8. Which cardiac biomarker is most specific for myocardial infarction?
A) CK
B) Myoglobin
C) LDH
D) Troponin I
Rationale: Troponin I is highly sensitive and specific for myocardial injury .
9. A newborn with continuous machinery murmur most likely has:
A) ASD
B) VSD
C) Tetralogy of Fallot
D) Patent ductus arteriosus
Rationale: PDA produces a characteristic continuous machinery-like murmur .
10. Which ECG finding is most characteristic of hyperkalemia?
A) Prolonged QT interval
B) Peaked T waves
C) U waves
D) ST-segment depression
