COMSAE Level 110 (2026) UPDATED STUDY
BLUEPRINT & VERIFIED CONCEPT REVIEW ||
PROFESSIONAL PREP EDITION
Behavioral Health / Psychiatry
1. A 22-year-old college student presents with a 6-month history of pervasive sadness,
anhedonia, poor concentration, and insomnia. She reports passive suicidal ideation but
no plan. The most appropriate initial pharmacotherapy is:
A) Sertraline ✓
B) Clozapine
C) Lithium
D) Lorazepam
2. A patient is brought to the ER by police after being found yelling at traffic. On exam, he is
disheveled, has pressured speech, and reports that the TV is sending him secret
messages. The most likely diagnosis is:
A) Major Depressive Disorder with Psychotic Features
B) Schizophreniaform Disorder
C) Schizophrenia ✓
D) Delusional Disorder
3. What is the most common comorbid condition with Borderline Personality Disorder?
A) Obsessive-Compulsive Disorder
B) Bipolar I Disorder
C) Major Depressive Disorder ✓
D) Schizophrenia
4. A physician prescribing a medication for a patient with a history of substance use
disorder should:
A) Avoid all controlled substances regardless of clinical need.
B) Use a written contract and frequent, small prescriptions. ✓
C) Prescribe a large supply to minimize clinic visits.
D) Rely solely on patient self-report for monitoring.
Cardiology
, 5. A 65-year-old male with a history of hypertension presents with sudden, "tearing" chest
pain radiating to his back. His BP is 180/100 in the right arm and 140/80 in the left arm.
The most likely diagnosis is:
A) Acute Myocardial Infarction
B) Aortic Dissection ✓
C) Pulmonary Embolism
D) Pericarditis
6. The first-line treatment for stable, symptomatic atrial fibrillation in a patient with no
structural heart disease is:
A) Amiodarone
B) Metoprolol ✓
C) Digoxin
D) Diltiazem
7. A patient with an acute STEMI is managed with percutaneous coronary intervention
(PCI). Which medication is crucial to administer prior to the procedure to reduce infarct
size?
A) Lisinopril
B) Atorvastatin
C) Clopidogrel ✓
D) Furosemide
8. The most common cause of right-sided heart failure is:
A) Hypertension
B) Mitral Valve Prolapse
C) Left-sided heart failure ✓
D) Pulmonary hypertension
Pulmonology
9. A 25-year-old with a history of asthma presents with acute shortness of breath,
wheezing, and difficulty speaking in full sentences. Initial management should include:
A) Theophylline
B) Inhaled Ipratropium
C) Systemic Corticosteroids ✓
D) Supplemental Oxygen and Inhaled Short-Acting Beta-Agonist (SABA) ✓
10. A 70-year-old smoker presents with a 30-pound weight loss, hemoptysis, and a 4-cm
spiculated mass on CXR. The next best step in diagnosis is:
, A) Sputum Cytology
B) Bronchoscopy with biopsy ✓
C) Empiric antibiotics
D) PET-CT scan
11. The hallmark finding in COPD on pulmonary function testing (PFT) is:
A) Decreased FEV1/FVC ratio that is reversible with bronchodilators
B) Decreased FEV1/FVC ratio that is not fully reversible ✓
C) Restrictive pattern with reduced Total Lung Capacity (TLC)
D) Increased Diffusing Capacity for Carbon Monoxide (DLCO)
12. A patient develops sudden pleuritic chest pain and dyspnea 1 week after total hip
replacement. The most appropriate initial diagnostic test is:
A) Ventilation-Perfusion (V/Q) Scan
B) D-dimer assay
C) CT Pulmonary Angiography (CTPA) ✓
D) Chest X-ray
Gastroenterology
13. A 45-year-old obese woman presents with RUQ pain after fatty meals. Ultrasound shows
gallstones and a positive sonographic Murphy's sign. The diagnosis is:
A) Asymptomatic Cholelithiasis
B) Acute Cholecystitis ✓
C) Choledocholithiasis
D) Biliary Colic
14. The first-line treatment for confirmed H. pylori infection is:
A) Proton Pump Inhibitor (PPI) alone
B) Triple Therapy (PPI + Amoxicillin + Clarithromycin) ✓
C) Bismuth subsalicylate
D) H2 Blocker
15. A patient with chronic alcohol use presents with hematemesis. Endoscopy reveals
dilated, tortuous veins in the distal esophagus. The initial management of active
bleeding is:
A) Intravenous Proton Pump Inhibitor (PPI)
B) Band Ligation ✓
C) Sengstaken-Blakemore tube
D) Octreotide infusion
, 16. The most common cause of community-acquired infectious diarrhea in the US is:
A) Clostridium difficile
B) Salmonella spp.
C) Campylobacter spp.
D) Norovirus ✓
Nephrology / Urology
17. A patient with a history of recurrent calcium oxalate kidney stones should be advised to:
A) Restrict calcium intake
B) Increase fluid intake ✓
C) Increase sodium intake
D) Take high-dose Vitamin C
18. Acute Tubular Necrosis (ATN) is characterized by:
A) Hypereosinophilia
B) Muddy brown granular casts in urine ✓
C) A positive anti-GBM antibody
D) A rapid response to corticosteroids
19. The most common cause of nephrotic syndrome in adults is:
A) Minimal Change Disease
B) Focal Segmental Glomerulosclerosis (FSGS)
C) Membranous Nephropathy ✓
D) Diabetic Nephropathy
20. A 65-year-old man with BPH presents with acute urinary retention. The most
appropriate immediate intervention is:
A) Tamsulosin
C) Transurethral resection of the prostate (TURP)
B) Urinary catheterization ✓
D) Finasteride
Neurology
21. A 70-year-old hypertensive man presents with acute onset of dizziness, vertigo, ataxia,
and crossed sensory loss (ipsilateral face, contralateral body). The most likely affected
vessel is:
A) Middle Cerebral Artery (MCA)
B) Anterior Cerebral Artery (ACA)
BLUEPRINT & VERIFIED CONCEPT REVIEW ||
PROFESSIONAL PREP EDITION
Behavioral Health / Psychiatry
1. A 22-year-old college student presents with a 6-month history of pervasive sadness,
anhedonia, poor concentration, and insomnia. She reports passive suicidal ideation but
no plan. The most appropriate initial pharmacotherapy is:
A) Sertraline ✓
B) Clozapine
C) Lithium
D) Lorazepam
2. A patient is brought to the ER by police after being found yelling at traffic. On exam, he is
disheveled, has pressured speech, and reports that the TV is sending him secret
messages. The most likely diagnosis is:
A) Major Depressive Disorder with Psychotic Features
B) Schizophreniaform Disorder
C) Schizophrenia ✓
D) Delusional Disorder
3. What is the most common comorbid condition with Borderline Personality Disorder?
A) Obsessive-Compulsive Disorder
B) Bipolar I Disorder
C) Major Depressive Disorder ✓
D) Schizophrenia
4. A physician prescribing a medication for a patient with a history of substance use
disorder should:
A) Avoid all controlled substances regardless of clinical need.
B) Use a written contract and frequent, small prescriptions. ✓
C) Prescribe a large supply to minimize clinic visits.
D) Rely solely on patient self-report for monitoring.
Cardiology
, 5. A 65-year-old male with a history of hypertension presents with sudden, "tearing" chest
pain radiating to his back. His BP is 180/100 in the right arm and 140/80 in the left arm.
The most likely diagnosis is:
A) Acute Myocardial Infarction
B) Aortic Dissection ✓
C) Pulmonary Embolism
D) Pericarditis
6. The first-line treatment for stable, symptomatic atrial fibrillation in a patient with no
structural heart disease is:
A) Amiodarone
B) Metoprolol ✓
C) Digoxin
D) Diltiazem
7. A patient with an acute STEMI is managed with percutaneous coronary intervention
(PCI). Which medication is crucial to administer prior to the procedure to reduce infarct
size?
A) Lisinopril
B) Atorvastatin
C) Clopidogrel ✓
D) Furosemide
8. The most common cause of right-sided heart failure is:
A) Hypertension
B) Mitral Valve Prolapse
C) Left-sided heart failure ✓
D) Pulmonary hypertension
Pulmonology
9. A 25-year-old with a history of asthma presents with acute shortness of breath,
wheezing, and difficulty speaking in full sentences. Initial management should include:
A) Theophylline
B) Inhaled Ipratropium
C) Systemic Corticosteroids ✓
D) Supplemental Oxygen and Inhaled Short-Acting Beta-Agonist (SABA) ✓
10. A 70-year-old smoker presents with a 30-pound weight loss, hemoptysis, and a 4-cm
spiculated mass on CXR. The next best step in diagnosis is:
, A) Sputum Cytology
B) Bronchoscopy with biopsy ✓
C) Empiric antibiotics
D) PET-CT scan
11. The hallmark finding in COPD on pulmonary function testing (PFT) is:
A) Decreased FEV1/FVC ratio that is reversible with bronchodilators
B) Decreased FEV1/FVC ratio that is not fully reversible ✓
C) Restrictive pattern with reduced Total Lung Capacity (TLC)
D) Increased Diffusing Capacity for Carbon Monoxide (DLCO)
12. A patient develops sudden pleuritic chest pain and dyspnea 1 week after total hip
replacement. The most appropriate initial diagnostic test is:
A) Ventilation-Perfusion (V/Q) Scan
B) D-dimer assay
C) CT Pulmonary Angiography (CTPA) ✓
D) Chest X-ray
Gastroenterology
13. A 45-year-old obese woman presents with RUQ pain after fatty meals. Ultrasound shows
gallstones and a positive sonographic Murphy's sign. The diagnosis is:
A) Asymptomatic Cholelithiasis
B) Acute Cholecystitis ✓
C) Choledocholithiasis
D) Biliary Colic
14. The first-line treatment for confirmed H. pylori infection is:
A) Proton Pump Inhibitor (PPI) alone
B) Triple Therapy (PPI + Amoxicillin + Clarithromycin) ✓
C) Bismuth subsalicylate
D) H2 Blocker
15. A patient with chronic alcohol use presents with hematemesis. Endoscopy reveals
dilated, tortuous veins in the distal esophagus. The initial management of active
bleeding is:
A) Intravenous Proton Pump Inhibitor (PPI)
B) Band Ligation ✓
C) Sengstaken-Blakemore tube
D) Octreotide infusion
, 16. The most common cause of community-acquired infectious diarrhea in the US is:
A) Clostridium difficile
B) Salmonella spp.
C) Campylobacter spp.
D) Norovirus ✓
Nephrology / Urology
17. A patient with a history of recurrent calcium oxalate kidney stones should be advised to:
A) Restrict calcium intake
B) Increase fluid intake ✓
C) Increase sodium intake
D) Take high-dose Vitamin C
18. Acute Tubular Necrosis (ATN) is characterized by:
A) Hypereosinophilia
B) Muddy brown granular casts in urine ✓
C) A positive anti-GBM antibody
D) A rapid response to corticosteroids
19. The most common cause of nephrotic syndrome in adults is:
A) Minimal Change Disease
B) Focal Segmental Glomerulosclerosis (FSGS)
C) Membranous Nephropathy ✓
D) Diabetic Nephropathy
20. A 65-year-old man with BPH presents with acute urinary retention. The most
appropriate immediate intervention is:
A) Tamsulosin
C) Transurethral resection of the prostate (TURP)
B) Urinary catheterization ✓
D) Finasteride
Neurology
21. A 70-year-old hypertensive man presents with acute onset of dizziness, vertigo, ataxia,
and crossed sensory loss (ipsilateral face, contralateral body). The most likely affected
vessel is:
A) Middle Cerebral Artery (MCA)
B) Anterior Cerebral Artery (ACA)
