COMSAE PHASE 3 FORM 303 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
Internal Medicine
Surgery
Pediatrics
Obstetrics and Gynecology
Psychiatry and Behavioral Science
Emergency Medicine and Critical Care
Preventive Medicine and Public Health
Ethics, Jurisprudence, and Healthcare Administration
Introduction
This comprehensive assessment is designed to rigorously evaluate the candidate's readiness for the COMSAE Phase
3 examination. It measures the integration of foundational medical knowledge with clinical reasoning, focusing on
the application of evidence-based medicine in complex, real-world scenarios. The examination emphasizes the
synthesis of information across core disciplines, requiring test-takers to demonstrate proficiency in diagnosis,
management, and patient safety. Each multiple-choice question mirrors the format and challenge of the actual
exam, demanding critical thinking and sound clinical decision-making. This tool is intended for self-assessment
and to identify areas requiring further study, preparing the candidate for the final steps toward osteopathic
medical licensure.
,SECTION ONE: QUESTIONS 1-100
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with sudden, painless vision
loss in his left eye. Fundoscopic examination reveals a pale, swollen retina with a cherry-red spot at the fovea.
What is the most likely underlying etiology?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Vitreous hemorrhage
D. Retinal detachment
🟢 B. Central retinal artery occlusion
🔴 RATIONALE: The classic presentation of a sudden, painless, monocular visual loss with a cherry-red spot and
pale retina is pathognomonic for a central retinal artery occlusion (CRAO). The cherry-red spot is the normal
choroidal perfusion seen through the thin fovea, contrasting with the pale, ischemic retina. A central retinal vein
occlusion would present with retinal hemorrhages and "blood and thunder" appearance. Vitreous hemorrhage
may be painful and associated with floaters, and retinal detachment is often preceded by flashes and floaters.
2. A 28-year-old female with a history of systemic lupus erythematosus (SLE) presents with a 3-day history of
severe headache, confusion, and a generalized tonic-clonic seizure. Her blood pressure is 145/90 mmHg.
Urinalysis shows proteinuria and hematuria. Which of the following is the most appropriate initial diagnostic
test to evaluate the etiology of her symptoms?
A. Non-contrast CT of the head
B. Lumbar puncture
,C. Magnetic resonance angiography (MRA) of the brain
D. Antinuclear antibody (ANA) titer
🟢 A. Non-contrast CT of the head
🔴 RATIONALE: For a patient with SLE presenting with new-onset seizures and altered mental status, a non-
contrast CT scan of the head is the most appropriate initial diagnostic test. It is crucial to rule out an acute
intracranial hemorrhage or a large territorial infarct, which can change management. SLE patients are at
increased risk for both ischemia and hemorrhage. An LP is a potential next step to rule out CNS infection, but
must be preceded by imaging to ensure safety. MRA is useful but not first-line. ANA titers are already known to
be elevated.
3. A 45-year-old male undergoes a routine health screening. His labs show a fasting blood glucose of 125
mg/dL, and he reports a 3-year history of well-controlled hypertension on lisinopril. Which of the following is
the most appropriate next step in managing his glycemic status?
A. Start metformin therapy
B. Obtain a hemoglobin A1c level
C. Repeat the fasting blood glucose on a different day
D. Perform an oral glucose tolerance test (OGTT)
🟢 C. Repeat the fasting blood glucose on a different day
🔴 RATIONALE: A single fasting blood glucose (FBG) of 125 mg/dL is in the diagnostic range for diabetes (≥126
mg/dL), but diagnosis requires confirmation with a repeat test on a subsequent day, either a second FBG, a 2-
hour OGTT, or a HbA1c. Starting metformin would be premature without a confirmed diagnosis. While an
, HbA1c and OGTT are valid diagnostic methods, confirming with another FBG is the most direct and cost-
effective next step.
4. A 6-year-old boy is brought to the clinic by his mother for a 2-day history of fever, cough, and rhinorrhea. On
exam, his temperature is 38.5°C, and he has a barking cough and inspiratory stridor. His immunization records
show he is up-to-date for his age. What is the most appropriate initial management?
A. Administer nebulized epinephrine
B. Administer oral dexamethasone
C. Obtain a neck radiograph
D. Administer ampicillin
🟢 B. Administer oral dexamethasone
🔴 RATIONALE: This patient presents with classic symptoms of viral croup (laryngotracheobronchitis): barking
cough, stridor, and fever in a child. The most important initial management for croup, particularly in a non-
distressed patient, is corticosteroids. Dexamethasone is the preferred agent. Nebulized epinephrine is indicated
for moderate to severe respiratory distress, not as first-line treatment for a child without stridor at rest or
retractions. Neck radiographs are not needed for this classic presentation. Ampicillin is for bacterial infections,
which is not the primary etiology.
5. A 68-year-old female with a history of osteoporosis presents with a 1-week history of severe, progressive low
back pain that radiates to her left buttock. She reports no trauma. On exam, she has decreased range of motion
in her lumbar spine and pain with axial loading. A plain radiograph shows loss of vertebral body height. Which
of the following findings on physical examination would be most specific for a vertebral compression fracture?
RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
Internal Medicine
Surgery
Pediatrics
Obstetrics and Gynecology
Psychiatry and Behavioral Science
Emergency Medicine and Critical Care
Preventive Medicine and Public Health
Ethics, Jurisprudence, and Healthcare Administration
Introduction
This comprehensive assessment is designed to rigorously evaluate the candidate's readiness for the COMSAE Phase
3 examination. It measures the integration of foundational medical knowledge with clinical reasoning, focusing on
the application of evidence-based medicine in complex, real-world scenarios. The examination emphasizes the
synthesis of information across core disciplines, requiring test-takers to demonstrate proficiency in diagnosis,
management, and patient safety. Each multiple-choice question mirrors the format and challenge of the actual
exam, demanding critical thinking and sound clinical decision-making. This tool is intended for self-assessment
and to identify areas requiring further study, preparing the candidate for the final steps toward osteopathic
medical licensure.
,SECTION ONE: QUESTIONS 1-100
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with sudden, painless vision
loss in his left eye. Fundoscopic examination reveals a pale, swollen retina with a cherry-red spot at the fovea.
What is the most likely underlying etiology?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Vitreous hemorrhage
D. Retinal detachment
🟢 B. Central retinal artery occlusion
🔴 RATIONALE: The classic presentation of a sudden, painless, monocular visual loss with a cherry-red spot and
pale retina is pathognomonic for a central retinal artery occlusion (CRAO). The cherry-red spot is the normal
choroidal perfusion seen through the thin fovea, contrasting with the pale, ischemic retina. A central retinal vein
occlusion would present with retinal hemorrhages and "blood and thunder" appearance. Vitreous hemorrhage
may be painful and associated with floaters, and retinal detachment is often preceded by flashes and floaters.
2. A 28-year-old female with a history of systemic lupus erythematosus (SLE) presents with a 3-day history of
severe headache, confusion, and a generalized tonic-clonic seizure. Her blood pressure is 145/90 mmHg.
Urinalysis shows proteinuria and hematuria. Which of the following is the most appropriate initial diagnostic
test to evaluate the etiology of her symptoms?
A. Non-contrast CT of the head
B. Lumbar puncture
,C. Magnetic resonance angiography (MRA) of the brain
D. Antinuclear antibody (ANA) titer
🟢 A. Non-contrast CT of the head
🔴 RATIONALE: For a patient with SLE presenting with new-onset seizures and altered mental status, a non-
contrast CT scan of the head is the most appropriate initial diagnostic test. It is crucial to rule out an acute
intracranial hemorrhage or a large territorial infarct, which can change management. SLE patients are at
increased risk for both ischemia and hemorrhage. An LP is a potential next step to rule out CNS infection, but
must be preceded by imaging to ensure safety. MRA is useful but not first-line. ANA titers are already known to
be elevated.
3. A 45-year-old male undergoes a routine health screening. His labs show a fasting blood glucose of 125
mg/dL, and he reports a 3-year history of well-controlled hypertension on lisinopril. Which of the following is
the most appropriate next step in managing his glycemic status?
A. Start metformin therapy
B. Obtain a hemoglobin A1c level
C. Repeat the fasting blood glucose on a different day
D. Perform an oral glucose tolerance test (OGTT)
🟢 C. Repeat the fasting blood glucose on a different day
🔴 RATIONALE: A single fasting blood glucose (FBG) of 125 mg/dL is in the diagnostic range for diabetes (≥126
mg/dL), but diagnosis requires confirmation with a repeat test on a subsequent day, either a second FBG, a 2-
hour OGTT, or a HbA1c. Starting metformin would be premature without a confirmed diagnosis. While an
, HbA1c and OGTT are valid diagnostic methods, confirming with another FBG is the most direct and cost-
effective next step.
4. A 6-year-old boy is brought to the clinic by his mother for a 2-day history of fever, cough, and rhinorrhea. On
exam, his temperature is 38.5°C, and he has a barking cough and inspiratory stridor. His immunization records
show he is up-to-date for his age. What is the most appropriate initial management?
A. Administer nebulized epinephrine
B. Administer oral dexamethasone
C. Obtain a neck radiograph
D. Administer ampicillin
🟢 B. Administer oral dexamethasone
🔴 RATIONALE: This patient presents with classic symptoms of viral croup (laryngotracheobronchitis): barking
cough, stridor, and fever in a child. The most important initial management for croup, particularly in a non-
distressed patient, is corticosteroids. Dexamethasone is the preferred agent. Nebulized epinephrine is indicated
for moderate to severe respiratory distress, not as first-line treatment for a child without stridor at rest or
retractions. Neck radiographs are not needed for this classic presentation. Ampicillin is for bacterial infections,
which is not the primary etiology.
5. A 68-year-old female with a history of osteoporosis presents with a 1-week history of severe, progressive low
back pain that radiates to her left buttock. She reports no trauma. On exam, she has decreased range of motion
in her lumbar spine and pain with axial loading. A plain radiograph shows loss of vertebral body height. Which
of the following findings on physical examination would be most specific for a vertebral compression fracture?
