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COMSAE 115 - 2026 COMPREHENSIVE
OSTEOPATHIC MEDICAL SELF-ASSESSMENT
EXAMINATION — PHASE 1 FORM 115
COMPLETE (135) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
COMSAE
Prepare for the COMSAE 115 Exam with this comprehensive study
resource designed to reinforce essential osteopathic medical concepts
and support effective exam preparation. This document helps you review
high-yield topics, assess your understanding, and identify areas that may
require additional study. Use it to strengthen your knowledge, improve
exam readiness, and build confidence before your assessment. An
excellent companion for organized and efficient COMSAE exam
preparation.
MULTIPLE CHOICE.
Section 1: Cardiovascular System (Questions 1–15)
1. A 65-year-old man with a history of hypertension presents with
sudden onset of severe chest pain that radiates to his back. His
blood pressure is 180/100 mmHg in the right arm and 100/60
mmHg in the left arm. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
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C. Aortic dissection
D. Pericarditis
Correct answer: C. Aortic dissection
Rationale: Aortic dissection typically presents with sudden, severe
chest pain radiating to the back, along with a pulse or blood
pressure differential between arms. Hypertension is a major risk
factor.
2. A 55-year-old man with a 30-pack-year smoking history
presents with chest pain that worsens with inspiration and
improves when leaning forward. An ECG shows diffuse ST-
segment elevation. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pericarditis
C. Aortic dissection
D. Pulmonary embolism
Correct answer: B. Pericarditis
Rationale: Pericarditis presents with pleuritic chest pain that
improves with leaning forward. Diffuse ST-segment elevation on
ECG is a classic finding. Pericarditis is the most common pericardial
disease and can be caused by viral infections, uremia, or post-MI.
3. A 60-year-old woman with a history of type 2 diabetes
presents with exertional chest pain that resolves with rest. An
exercise stress test reveals ST-segment depression. Which of
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the following is the most appropriate next step?
A. Aspirin and discharge
B. Cardiac catheterization
C. Stress echocardiogram
D. Beta-blocker therapy
Correct answer: B. Cardiac catheterization
Rationale: The patient has stable angina with a positive stress test.
Cardiac catheterization is the gold standard for evaluating coronary
artery disease and determining the need for revascularization.
4. A patient with heart failure is prescribed an ACE inhibitor.
Which of the following side effects is most commonly
associated with ACE inhibitors?
A. Hyperkalemia
B. Hypokalemia
C. Cough
D. Tachycardia
Correct answer: C. Cough
Rationale: A dry, persistent cough is a common side effect of ACE
inhibitors, occurring in approximately 10-20% of patients due to
bradykinin accumulation.
5. A 70-year-old man with a history of atrial fibrillation is started
on warfarin. Which of the following laboratory values should be
monitored to assess the therapeutic effect of warfarin?
A. Partial thromboplastin time (PTT)
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B. International normalized ratio (INR)
C. Platelet count
D. Bleeding time
Correct answer: B. International normalized ratio (INR)
Rationale: INR is the standard laboratory value used to monitor
warfarin therapy. The target INR for atrial fibrillation is typically 2.0-
3.0.
6. A patient presents with jugular venous distension,
hepatomegaly, and peripheral edema. Which of the following
conditions is most likely?
A. Left-sided heart failure
B. Right-sided heart failure
C. Pulmonary embolism
D. Aortic stenosis
Correct answer: B. Right-sided heart failure
Rationale: Right-sided heart failure presents with signs of systemic
venous congestion, including jugular venous distension,
hepatomegaly, ascites, and peripheral edema.
7. A 45-year-old man presents with a holosystolic murmur at the
apex that radiates to the axilla. Which of the following is the
most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
COMSAE 115 - 2026 COMPREHENSIVE
OSTEOPATHIC MEDICAL SELF-ASSESSMENT
EXAMINATION — PHASE 1 FORM 115
COMPLETE (135) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
COMSAE
Prepare for the COMSAE 115 Exam with this comprehensive study
resource designed to reinforce essential osteopathic medical concepts
and support effective exam preparation. This document helps you review
high-yield topics, assess your understanding, and identify areas that may
require additional study. Use it to strengthen your knowledge, improve
exam readiness, and build confidence before your assessment. An
excellent companion for organized and efficient COMSAE exam
preparation.
MULTIPLE CHOICE.
Section 1: Cardiovascular System (Questions 1–15)
1. A 65-year-old man with a history of hypertension presents with
sudden onset of severe chest pain that radiates to his back. His
blood pressure is 180/100 mmHg in the right arm and 100/60
mmHg in the left arm. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
, Page 2 of 64
C. Aortic dissection
D. Pericarditis
Correct answer: C. Aortic dissection
Rationale: Aortic dissection typically presents with sudden, severe
chest pain radiating to the back, along with a pulse or blood
pressure differential between arms. Hypertension is a major risk
factor.
2. A 55-year-old man with a 30-pack-year smoking history
presents with chest pain that worsens with inspiration and
improves when leaning forward. An ECG shows diffuse ST-
segment elevation. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pericarditis
C. Aortic dissection
D. Pulmonary embolism
Correct answer: B. Pericarditis
Rationale: Pericarditis presents with pleuritic chest pain that
improves with leaning forward. Diffuse ST-segment elevation on
ECG is a classic finding. Pericarditis is the most common pericardial
disease and can be caused by viral infections, uremia, or post-MI.
3. A 60-year-old woman with a history of type 2 diabetes
presents with exertional chest pain that resolves with rest. An
exercise stress test reveals ST-segment depression. Which of
, Page 3 of 64
the following is the most appropriate next step?
A. Aspirin and discharge
B. Cardiac catheterization
C. Stress echocardiogram
D. Beta-blocker therapy
Correct answer: B. Cardiac catheterization
Rationale: The patient has stable angina with a positive stress test.
Cardiac catheterization is the gold standard for evaluating coronary
artery disease and determining the need for revascularization.
4. A patient with heart failure is prescribed an ACE inhibitor.
Which of the following side effects is most commonly
associated with ACE inhibitors?
A. Hyperkalemia
B. Hypokalemia
C. Cough
D. Tachycardia
Correct answer: C. Cough
Rationale: A dry, persistent cough is a common side effect of ACE
inhibitors, occurring in approximately 10-20% of patients due to
bradykinin accumulation.
5. A 70-year-old man with a history of atrial fibrillation is started
on warfarin. Which of the following laboratory values should be
monitored to assess the therapeutic effect of warfarin?
A. Partial thromboplastin time (PTT)
, Page 4 of 64
B. International normalized ratio (INR)
C. Platelet count
D. Bleeding time
Correct answer: B. International normalized ratio (INR)
Rationale: INR is the standard laboratory value used to monitor
warfarin therapy. The target INR for atrial fibrillation is typically 2.0-
3.0.
6. A patient presents with jugular venous distension,
hepatomegaly, and peripheral edema. Which of the following
conditions is most likely?
A. Left-sided heart failure
B. Right-sided heart failure
C. Pulmonary embolism
D. Aortic stenosis
Correct answer: B. Right-sided heart failure
Rationale: Right-sided heart failure presents with signs of systemic
venous congestion, including jugular venous distension,
hepatomegaly, ascites, and peripheral edema.
7. A 45-year-old man presents with a holosystolic murmur at the
apex that radiates to the axilla. Which of the following is the
most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
