COMSAE Phase 2 Form 116 Exam – 200 Practice
Questions with Answers and Rationales –
COMLEX Level 2 Prep – Osteopathic Medical
Students – 2026 Updated
═══════════════════════════════════════════════
═════════════
TABLE OF CONTENTS
1. INTERNAL MEDICINE – CARDIOVASCULAR ................. 1-XX
2. INTERNAL MEDICINE – PULMONARY ..................... 1-XX
3. NEUROLOGY ........................................ 1-XX
4. OBSTETRICS & GYNECOLOGY ........................... 1-XX
5. PEDIATRICS ........................................ 1-XX
6. ENDOCRINOLOGY ..................................... 1-XX
7. GASTROENTEROLOGY .................................. 1-XX
8. OSTEOPATHIC PRINCIPLES & OMM ...................... 1-XX
9. HEMATOLOGY & ONCOLOGY ............................. 1-XX
10. RENAL & ELECTROLYTE DISORDERS .................... 1-XX
═══════════════════════════════════════════════
═════════════
Short Intro
This comprehensive resource contains 200 original practice questions for the COMSAE Phase 2 Form 116
exam and COMLEX-USA Level 2-CE preparation. Covers internal medicine (cardiovascular, pulmonary, GI,
renal, endocrine), emergency medicine (ACS, stroke, PE, anaphylaxis), obstetrics/gynecology (preeclampsia,
placenta previa, ectopic pregnancy, PID), pediatrics (croup, Kawasaki, intussusception, milestones),
,neurology (stroke, Wernicke, cranial nerves, seizures), psychiatry, surgery, and osteopathic principles
(OMM, TART, viscerosomatic reflexes, HVLA, counterstrain, Chapman points) . Answers
in bold italic with detailed italicized rationales.
Perfect for osteopathic medical students preparing for COMSAE Phase 2 Form 116
and COMLEX Level 2-CE.
INTERNAL MEDICINE – CARDIOVASCULAR (Questions 1-25)
1. 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 next step?
A) Aspirin and immediate percutaneous coronary intervention
B) Aspirin and IV tissue plasminogen activator
C) Aspirin and clopidogrel with medical management
D) Aspirin and urgent coronary artery bypass grafting
Answer: A
STEMI requires immediate reperfusion with PCI within 90 minutes if available. Fibrinolysis is
indicated only if PCI delay exceeds 90-120 minutes .
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
Answer: C
Inferior wall myocardial infarctions involve leads II, III, and aVF and are most commonly
caused by right coronary artery occlusion .
3. A patient 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
Answer: C
PCC rapidly reverses warfarin in intracranial hemorrhage. FFP is slower and less effective;
vitamin K takes hours to work. PCC provides immediate reversal of anticoagulation .
4. A patient with atrial fibrillation is at increased risk of:
A) Pneumothorax
B) Embolic stroke
C) Pulmonary fibrosis
D) Cirrhosis
Answer: B
Stasis in the atria predisposes to thrombus formation and embolization, increasing stroke
risk .
5. Which heart sound is associated with heart failure due to volume overload?
A) S1
B) S2
C) S3
D) Opening snap
Answer: C
An S3 gallop reflects rapid ventricular filling and is associated with volume overload in heart
failure .
6. A 72-year-old man with heart failure presents with dyspnea and peripheral edema.
Which medication is most appropriate for reducing preload?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B
Loop diuretics like furosemide reduce preload by promoting diuresis and decreasing venous
return. They are the mainstay for volume overload in acute heart failure exacerbations.
7. Which ECG change is most characteristic of hyperkalemia?
A) U waves
, B) Peaked T waves
C) Prolonged PR interval
D) ST depression
Answer: B
Peaked (tall, tented) T waves are the earliest ECG manifestation of hyperkalemia. As
potassium continues to rise, widened QRS and ventricular fibrillation can occur .
8. A patient with aortic stenosis would most likely present with:
A) Syncope, angina, and dyspnea on exertion
B) Palpitations and orthopnea
C) Holosystolic murmur at the apex
D) Diastolic murmur at the left sternal border
Answer: A
The classic triad of aortic stenosis includes syncope (from fixed cardiac output), angina
(from myocardial ischemia), and dyspnea on exertion (from left heart failure).
9. Which finding is most characteristic of mitral regurgitation on physical exam?
A) Mid-systolic ejection murmur at the right upper sternal border
B) Holosystolic, high-pitched murmur at the apex radiating to the axilla
C) Diastolic rumble at the apex
D) Continuous murmur at the left upper sternal border
Answer: B
Mitral regurgitation produces a holosystolic, high-pitched, blowing murmur at the apex that
radiates to the axilla.
10. What is the mechanism of action of digoxin?
A) Beta-adrenergic blockade
B) Calcium channel blockade
C) Positive inotrope by inhibiting Na+/K+-ATPase
D) Vasodilation via nitric oxide release
Answer: C
Digoxin inhibits Na+/K+-ATPase, increasing intracellular sodium and subsequently
intracellular calcium via the Na+/Ca2+ exchanger. This enhances myocardial contractility
(positive inotrope).
11. A patient with acute chest pain has a troponin of 0.04 ng/mL (normal <0.04) and a
normal ECG. Which is the most appropriate next step?
Questions with Answers and Rationales –
COMLEX Level 2 Prep – Osteopathic Medical
Students – 2026 Updated
═══════════════════════════════════════════════
═════════════
TABLE OF CONTENTS
1. INTERNAL MEDICINE – CARDIOVASCULAR ................. 1-XX
2. INTERNAL MEDICINE – PULMONARY ..................... 1-XX
3. NEUROLOGY ........................................ 1-XX
4. OBSTETRICS & GYNECOLOGY ........................... 1-XX
5. PEDIATRICS ........................................ 1-XX
6. ENDOCRINOLOGY ..................................... 1-XX
7. GASTROENTEROLOGY .................................. 1-XX
8. OSTEOPATHIC PRINCIPLES & OMM ...................... 1-XX
9. HEMATOLOGY & ONCOLOGY ............................. 1-XX
10. RENAL & ELECTROLYTE DISORDERS .................... 1-XX
═══════════════════════════════════════════════
═════════════
Short Intro
This comprehensive resource contains 200 original practice questions for the COMSAE Phase 2 Form 116
exam and COMLEX-USA Level 2-CE preparation. Covers internal medicine (cardiovascular, pulmonary, GI,
renal, endocrine), emergency medicine (ACS, stroke, PE, anaphylaxis), obstetrics/gynecology (preeclampsia,
placenta previa, ectopic pregnancy, PID), pediatrics (croup, Kawasaki, intussusception, milestones),
,neurology (stroke, Wernicke, cranial nerves, seizures), psychiatry, surgery, and osteopathic principles
(OMM, TART, viscerosomatic reflexes, HVLA, counterstrain, Chapman points) . Answers
in bold italic with detailed italicized rationales.
Perfect for osteopathic medical students preparing for COMSAE Phase 2 Form 116
and COMLEX Level 2-CE.
INTERNAL MEDICINE – CARDIOVASCULAR (Questions 1-25)
1. 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 next step?
A) Aspirin and immediate percutaneous coronary intervention
B) Aspirin and IV tissue plasminogen activator
C) Aspirin and clopidogrel with medical management
D) Aspirin and urgent coronary artery bypass grafting
Answer: A
STEMI requires immediate reperfusion with PCI within 90 minutes if available. Fibrinolysis is
indicated only if PCI delay exceeds 90-120 minutes .
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
Answer: C
Inferior wall myocardial infarctions involve leads II, III, and aVF and are most commonly
caused by right coronary artery occlusion .
3. A patient 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
Answer: C
PCC rapidly reverses warfarin in intracranial hemorrhage. FFP is slower and less effective;
vitamin K takes hours to work. PCC provides immediate reversal of anticoagulation .
4. A patient with atrial fibrillation is at increased risk of:
A) Pneumothorax
B) Embolic stroke
C) Pulmonary fibrosis
D) Cirrhosis
Answer: B
Stasis in the atria predisposes to thrombus formation and embolization, increasing stroke
risk .
5. Which heart sound is associated with heart failure due to volume overload?
A) S1
B) S2
C) S3
D) Opening snap
Answer: C
An S3 gallop reflects rapid ventricular filling and is associated with volume overload in heart
failure .
6. A 72-year-old man with heart failure presents with dyspnea and peripheral edema.
Which medication is most appropriate for reducing preload?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B
Loop diuretics like furosemide reduce preload by promoting diuresis and decreasing venous
return. They are the mainstay for volume overload in acute heart failure exacerbations.
7. Which ECG change is most characteristic of hyperkalemia?
A) U waves
, B) Peaked T waves
C) Prolonged PR interval
D) ST depression
Answer: B
Peaked (tall, tented) T waves are the earliest ECG manifestation of hyperkalemia. As
potassium continues to rise, widened QRS and ventricular fibrillation can occur .
8. A patient with aortic stenosis would most likely present with:
A) Syncope, angina, and dyspnea on exertion
B) Palpitations and orthopnea
C) Holosystolic murmur at the apex
D) Diastolic murmur at the left sternal border
Answer: A
The classic triad of aortic stenosis includes syncope (from fixed cardiac output), angina
(from myocardial ischemia), and dyspnea on exertion (from left heart failure).
9. Which finding is most characteristic of mitral regurgitation on physical exam?
A) Mid-systolic ejection murmur at the right upper sternal border
B) Holosystolic, high-pitched murmur at the apex radiating to the axilla
C) Diastolic rumble at the apex
D) Continuous murmur at the left upper sternal border
Answer: B
Mitral regurgitation produces a holosystolic, high-pitched, blowing murmur at the apex that
radiates to the axilla.
10. What is the mechanism of action of digoxin?
A) Beta-adrenergic blockade
B) Calcium channel blockade
C) Positive inotrope by inhibiting Na+/K+-ATPase
D) Vasodilation via nitric oxide release
Answer: C
Digoxin inhibits Na+/K+-ATPase, increasing intracellular sodium and subsequently
intracellular calcium via the Na+/Ca2+ exchanger. This enhances myocardial contractility
(positive inotrope).
11. A patient with acute chest pain has a troponin of 0.04 ng/mL (normal <0.04) and a
normal ECG. Which is the most appropriate next step?
