COMSAE Phase 2 Form 109 Practice Exam – Questions
with Answers & Explanations | Latest 2026 COMLEX
Level 2-CE Prep
COMSAE Phase 2 Form 109 Practice Exam – Latest 2026 prep with 250 multiple-choice
questions, verified answers, and detailed explanations. Covers Internal Medicine, OB/GYN,
Pediatrics, Surgery, Psychiatry, Emergency Medicine, and Osteopathic Principles. Perfect
for COMLEX Level 2-CE readiness and guaranteed pass. Instant PDF download.
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1–35)
1. A 62-year-old man presents with exertional chest pain relieved by rest. ECG during
pain episodes shows transient ST-segment depression. Which is the most likely
diagnosis?
A. Prinzmetal angina
B. Stable angina
C. Unstable angina
D. Acute pericarditis
Answer: B. Predictable exertional chest pain relieved by rest with transient ST depression is
most consistent with stable angina due to fixed atherosclerotic coronary artery disease .
2. A 45-year-old man presents with sudden-onset chest pain radiating to his left arm.
He is diaphoretic and nauseated. ECG shows ST-segment elevation 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
Answer: C. ST elevations in leads II, III, and aVF indicate an inferior wall myocardial
infarction, most commonly due to occlusion of the right coronary artery .
3. A 72-year-old man with hypertension presents with sudden severe tearing chest
pain radiating to the back. Blood pressure is 180/95 mmHg in the right arm and
140/80 mmHg in the left arm. Which diagnostic study should be ordered first?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Electrocardiogram
D. Chest X-ray
Answer: B. Tearing chest pain with unequal blood pressures suggests acute aortic
dissection. CT angiography is the initial test of choice due to high sensitivity and rapid
availability .
4. A 68-year-old female on warfarin for atrial fibrillation presents with acute-onset
severe headache and right-sided weakness. INR is 4.2. Non-contrast head CT shows
a left parietal lobe hemorrhage. Which intervention is most urgent?
A. Administer vitamin K 10 mg IV and prothrombin complex concentrate (PCC)
B. Give fresh frozen plasma only
C. Start a heparin drip
D. Administer tissue plasminogen activator
,Answer: A. Warfarin-related intracranial hemorrhage requires rapid reversal with PCC (or
FFP) plus IV vitamin K. PCC is faster than FFP; tPA is contraindicated .
5. A 65-year-old man presents with progressive dyspnea on exertion, orthopnea, and
peripheral edema. Echocardiogram shows a reduced ejection fraction of 30%. What is
the diagnosis?
A. Heart failure with preserved ejection fraction
B. Heart failure with reduced ejection fraction
C. Pulmonary hypertension
D. Constrictive pericarditis
Answer: B. Dyspnea, orthopnea, and peripheral edema with a reduced ejection fraction
indicate heart failure with reduced ejection fraction (systolic heart failure) .
6. A patient with atrial fibrillation has an ECG revealing an irregularly irregular rhythm
with no discernible P waves. In a hemodynamically stable patient, what is the most
appropriate management?
A. Amiodarone
B. Cardioversion
C. Anticoagulation and rate control
D. Beta-blocker only
Answer: C. In hemodynamically stable atrial fibrillation, the priority is rate control (beta-
blockers or calcium channel blockers) and anticoagulation to prevent thromboembolic
events based on CHA₂DS₂-VASc score .
7. A 70-year-old man presents with progressive resting tremor, bradykinesia, and
rigidity. Which neurotransmitter deficiency is responsible?
A. Acetylcholine
, B. Dopamine
C. Serotonin
D. GABA
Answer: B. Parkinson disease results from degeneration of dopaminergic neurons in the
substantia nigra pars compacta .
8. A 55-year-old man with hypertension presents with severe headache and vomiting.
BP is 220/120 mmHg. Fundoscopy shows papilledema. What is the most appropriate
next step?
A. Oral clonidine
B. IV antihypertensive therapy (e.g., nicardipine, labetalol)
C. Captopril 25 mg PO
D. Observation with repeat BP in 1 hour
Answer: B. Hypertensive emergency with end-organ damage (papilledema) requires
immediate IV blood pressure reduction, not oral agents .
9. A 60-year-old man with COPD presents with worsening dyspnea and somnolence.
ABG shows pH 7.25, PaCO₂ 72 mm Hg, and HCO₃⁻ 31 mEq/L. He is awake enough to
follow commands. Which intervention is most appropriate?
A. Immediate endotracheal intubation
B. Noninvasive positive-pressure ventilation (NIPPV)
C. High-flow oxygen targeting 100% saturation
D. IV sodium bicarbonate
Answer: B. Acute-on-chronic hypercapnic respiratory failure with acidemia in COPD is a
major indication for NIPPV (BiPAP) when the patient can protect the airway and cooperate .
with Answers & Explanations | Latest 2026 COMLEX
Level 2-CE Prep
COMSAE Phase 2 Form 109 Practice Exam – Latest 2026 prep with 250 multiple-choice
questions, verified answers, and detailed explanations. Covers Internal Medicine, OB/GYN,
Pediatrics, Surgery, Psychiatry, Emergency Medicine, and Osteopathic Principles. Perfect
for COMLEX Level 2-CE readiness and guaranteed pass. Instant PDF download.
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1–35)
1. A 62-year-old man presents with exertional chest pain relieved by rest. ECG during
pain episodes shows transient ST-segment depression. Which is the most likely
diagnosis?
A. Prinzmetal angina
B. Stable angina
C. Unstable angina
D. Acute pericarditis
Answer: B. Predictable exertional chest pain relieved by rest with transient ST depression is
most consistent with stable angina due to fixed atherosclerotic coronary artery disease .
2. A 45-year-old man presents with sudden-onset chest pain radiating to his left arm.
He is diaphoretic and nauseated. ECG shows ST-segment elevation 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
Answer: C. ST elevations in leads II, III, and aVF indicate an inferior wall myocardial
infarction, most commonly due to occlusion of the right coronary artery .
3. A 72-year-old man with hypertension presents with sudden severe tearing chest
pain radiating to the back. Blood pressure is 180/95 mmHg in the right arm and
140/80 mmHg in the left arm. Which diagnostic study should be ordered first?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Electrocardiogram
D. Chest X-ray
Answer: B. Tearing chest pain with unequal blood pressures suggests acute aortic
dissection. CT angiography is the initial test of choice due to high sensitivity and rapid
availability .
4. A 68-year-old female on warfarin for atrial fibrillation presents with acute-onset
severe headache and right-sided weakness. INR is 4.2. Non-contrast head CT shows
a left parietal lobe hemorrhage. Which intervention is most urgent?
A. Administer vitamin K 10 mg IV and prothrombin complex concentrate (PCC)
B. Give fresh frozen plasma only
C. Start a heparin drip
D. Administer tissue plasminogen activator
,Answer: A. Warfarin-related intracranial hemorrhage requires rapid reversal with PCC (or
FFP) plus IV vitamin K. PCC is faster than FFP; tPA is contraindicated .
5. A 65-year-old man presents with progressive dyspnea on exertion, orthopnea, and
peripheral edema. Echocardiogram shows a reduced ejection fraction of 30%. What is
the diagnosis?
A. Heart failure with preserved ejection fraction
B. Heart failure with reduced ejection fraction
C. Pulmonary hypertension
D. Constrictive pericarditis
Answer: B. Dyspnea, orthopnea, and peripheral edema with a reduced ejection fraction
indicate heart failure with reduced ejection fraction (systolic heart failure) .
6. A patient with atrial fibrillation has an ECG revealing an irregularly irregular rhythm
with no discernible P waves. In a hemodynamically stable patient, what is the most
appropriate management?
A. Amiodarone
B. Cardioversion
C. Anticoagulation and rate control
D. Beta-blocker only
Answer: C. In hemodynamically stable atrial fibrillation, the priority is rate control (beta-
blockers or calcium channel blockers) and anticoagulation to prevent thromboembolic
events based on CHA₂DS₂-VASc score .
7. A 70-year-old man presents with progressive resting tremor, bradykinesia, and
rigidity. Which neurotransmitter deficiency is responsible?
A. Acetylcholine
, B. Dopamine
C. Serotonin
D. GABA
Answer: B. Parkinson disease results from degeneration of dopaminergic neurons in the
substantia nigra pars compacta .
8. A 55-year-old man with hypertension presents with severe headache and vomiting.
BP is 220/120 mmHg. Fundoscopy shows papilledema. What is the most appropriate
next step?
A. Oral clonidine
B. IV antihypertensive therapy (e.g., nicardipine, labetalol)
C. Captopril 25 mg PO
D. Observation with repeat BP in 1 hour
Answer: B. Hypertensive emergency with end-organ damage (papilledema) requires
immediate IV blood pressure reduction, not oral agents .
9. A 60-year-old man with COPD presents with worsening dyspnea and somnolence.
ABG shows pH 7.25, PaCO₂ 72 mm Hg, and HCO₃⁻ 31 mEq/L. He is awake enough to
follow commands. Which intervention is most appropriate?
A. Immediate endotracheal intubation
B. Noninvasive positive-pressure ventilation (NIPPV)
C. High-flow oxygen targeting 100% saturation
D. IV sodium bicarbonate
Answer: B. Acute-on-chronic hypercapnic respiratory failure with acidemia in COPD is a
major indication for NIPPV (BiPAP) when the patient can protect the airway and cooperate .
