Page 1 of 66
COMSAE PHASE 2 FORM 116 EXAM 2026
COMPLETE (125) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
COMSAE
Prepare for success with this COMSAE Phase 2 Form 116 practice exam
designed to reinforce essential clinical knowledge and strengthen your
readiness for osteopathic medical assessments. The exam-style
questions help identify knowledge gaps, improve critical thinking, and
build confidence for exam day. A valuable resource for focused review
and effective preparation. Suitable for osteopathic medical students
preparing for COMSAE Phase 2 assessments.
MULTIPLE CHOICE.
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1–15)
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
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Correct answer: C. Right coronary 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 72-year-old man with a history of hypertension presents with
acute-onset severe epigastric pain radiating to the back. Blood
pressure is 110/70 mmHg in the right arm and 130/80 mmHg in
the left arm. A pulsatile abdominal mass is palpated. What is the
most appropriate next step?
A. Abdominal ultrasound
B. CT angiography of the abdomen
C. Emergent surgical consultation
D. Transthoracic echocardiogram
Correct answer: C. Emergent surgical consultation
Rationale: Pain radiating to the back, a blood pressure
differential between arms, and a pulsatile abdominal mass are
classic findings of a rupturing or symptomatic abdominal aortic
aneurysm (AAA). The most appropriate next step is emergent
surgical consultation. CT angiography is the diagnostic test of
choice, but surgical consultation should not be delayed.
3. A 55-year-old woman with a history of hypertension and
hyperlipidemia presents with progressive shortness of breath,
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orthopnea, and bilateral lower extremity edema. On
examination, she has jugular venous distension, crackles at the
lung bases, and a third heart sound (S3). What is the most likely
diagnosis?
A. Acute pericarditis
B. Aortic stenosis
C. Heart failure with reduced ejection fraction (HFrEF)
D. Pulmonary embolism
Correct answer: C. Heart failure with reduced ejection fraction
(HFrEF)
Rationale: The combination of dyspnea, orthopnea, edema, JVD,
crackles, and an S3 gallop is characteristic of heart failure. An S3
is a hallmark of reduced left ventricular compliance and is
strongly associated with HFrEF.
4. A 62-year-old man presents with sudden onset of severe,
"tearing" chest pain radiating to his back. His blood pressure is
180/100 mmHg in the right arm and 140/80 mmHg in the left arm.
What is the most likely diagnosis?
A. Acute coronary syndrome
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct answer: B. Aortic dissection
Rationale: The classic presentation of aortic dissection includes
sudden, severe "tearing" or "ripping" chest pain that radiates to
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the back, along with a pulse or blood pressure differential
between arms. Immediate CT angiography is indicated for
diagnosis.
5. A patient with chronic heart failure is taking lisinopril,
furosemide, and carvedilol. Which laboratory value should be
monitored most closely?
A. Serum sodium
B. Serum potassium
C. Serum creatinine
D. All of the above
Correct answer: D. All of the above
Rationale: ACE inhibitors (lisinopril) can cause hyperkalemia
and renal impairment. Loop diuretics (furosemide) can cause
hyponatremia, hypokalemia, and prerenal azotemia. All three
parameters should be monitored regularly.
6. A 68-year-old man with a history of myocardial infarction
presents with palpitations and lightheadedness. ECG reveals an
irregularly irregular rhythm with no discernible P waves. What is
the most appropriate next step in management?
A. Amiodarone
B. Cardioversion
C. Anticoagulation and rate control
D. Beta-blocker only
COMSAE PHASE 2 FORM 116 EXAM 2026
COMPLETE (125) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
COMSAE
Prepare for success with this COMSAE Phase 2 Form 116 practice exam
designed to reinforce essential clinical knowledge and strengthen your
readiness for osteopathic medical assessments. The exam-style
questions help identify knowledge gaps, improve critical thinking, and
build confidence for exam day. A valuable resource for focused review
and effective preparation. Suitable for osteopathic medical students
preparing for COMSAE Phase 2 assessments.
MULTIPLE CHOICE.
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1–15)
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
, Page 2 of 66
Correct answer: C. Right coronary 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 72-year-old man with a history of hypertension presents with
acute-onset severe epigastric pain radiating to the back. Blood
pressure is 110/70 mmHg in the right arm and 130/80 mmHg in
the left arm. A pulsatile abdominal mass is palpated. What is the
most appropriate next step?
A. Abdominal ultrasound
B. CT angiography of the abdomen
C. Emergent surgical consultation
D. Transthoracic echocardiogram
Correct answer: C. Emergent surgical consultation
Rationale: Pain radiating to the back, a blood pressure
differential between arms, and a pulsatile abdominal mass are
classic findings of a rupturing or symptomatic abdominal aortic
aneurysm (AAA). The most appropriate next step is emergent
surgical consultation. CT angiography is the diagnostic test of
choice, but surgical consultation should not be delayed.
3. A 55-year-old woman with a history of hypertension and
hyperlipidemia presents with progressive shortness of breath,
, Page 3 of 66
orthopnea, and bilateral lower extremity edema. On
examination, she has jugular venous distension, crackles at the
lung bases, and a third heart sound (S3). What is the most likely
diagnosis?
A. Acute pericarditis
B. Aortic stenosis
C. Heart failure with reduced ejection fraction (HFrEF)
D. Pulmonary embolism
Correct answer: C. Heart failure with reduced ejection fraction
(HFrEF)
Rationale: The combination of dyspnea, orthopnea, edema, JVD,
crackles, and an S3 gallop is characteristic of heart failure. An S3
is a hallmark of reduced left ventricular compliance and is
strongly associated with HFrEF.
4. A 62-year-old man presents with sudden onset of severe,
"tearing" chest pain radiating to his back. His blood pressure is
180/100 mmHg in the right arm and 140/80 mmHg in the left arm.
What is the most likely diagnosis?
A. Acute coronary syndrome
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct answer: B. Aortic dissection
Rationale: The classic presentation of aortic dissection includes
sudden, severe "tearing" or "ripping" chest pain that radiates to
, Page 4 of 66
the back, along with a pulse or blood pressure differential
between arms. Immediate CT angiography is indicated for
diagnosis.
5. A patient with chronic heart failure is taking lisinopril,
furosemide, and carvedilol. Which laboratory value should be
monitored most closely?
A. Serum sodium
B. Serum potassium
C. Serum creatinine
D. All of the above
Correct answer: D. All of the above
Rationale: ACE inhibitors (lisinopril) can cause hyperkalemia
and renal impairment. Loop diuretics (furosemide) can cause
hyponatremia, hypokalemia, and prerenal azotemia. All three
parameters should be monitored regularly.
6. A 68-year-old man with a history of myocardial infarction
presents with palpitations and lightheadedness. ECG reveals an
irregularly irregular rhythm with no discernible P waves. What is
the most appropriate next step in management?
A. Amiodarone
B. Cardioversion
C. Anticoagulation and rate control
D. Beta-blocker only
