1|Page
COMSAE 110 MOCK EXAM PREP 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS ALREADY A
GRADED WITH EXPERT FEEDBACK
|NEW AND REVISED
The content mirrors COMLEX-level integrated clinical vignettes across
biomedical sciences, clinical medicine, OMM, ethics, biostatistics, and systems-
based practice, aligned with the National Board of Osteopathic Medical Examiners
blueprint.
COMSAE 110–Style Mock Exam
(5 choices A–E; correct answer bolded; rationale in italics)
1. A 23-year-old male presents with 2 days of sore throat, fever, and tender
anterior cervical lymphadenopathy. Rapid strep test is negative. Which is the
next best step?
A. Start amoxicillin empirically
B. Order a monospot heterophile antibody test
C. Prescribe azithromycin for atypical coverage
D. Obtain a throat culture for group A Streptococcus
E. Reassure and discharge with symptomatic treatment
Rationale: A negative rapid antigen test with high clinical suspicion
should be confirmed with a throat culture; empiric antibiotics are not
indicated without confirmation.
2. A 58-year-old woman with longstanding rheumatoid arthritis develops
progressive dyspnea. CT chest shows honeycombing and subpleural
reticulation predominantly at the bases. What is the most likely diagnosis?
A. Usual interstitial pneumonia (idiopathic pulmonary fibrosis)
B. Nonspecific interstitial pneumonia
C. Rheumatoid-associated interstitial lung disease with usual interstitial
pneumonia pattern
,2|Page
D. Hypersensitivity pneumonitis
E. Pulmonary edema from heart failure
Rationale: RA can cause an ILD often with a UIP pattern (subpleural,
basal honeycombing); clinical context matters.
3. A 42-year-old man is found to have an elevated AST and ALT (~200 U/L
each), with a history of heavy alcohol use. AST:ALT ratio is 2:1. Which
statement is most accurate?
A. This pattern rules out alcoholic liver disease
B. ALT predominates in alcoholic liver disease
C. AST:ALT >2 suggests alcoholic liver injury but is not definitive
D. Viral hepatitis always shows AST:ALT >2
E. These enzymes are not useful in liver disease evaluation
Rationale: AST:ALT >2 is suggestive of alcoholic liver disease
(mitochondrial damage increases AST), but diagnosis requires history and
other testing.
4. A newborn has scant, malodorous stools and a negative sweat chloride. At 2
months, the infant develops persistent cough and failure to thrive. Genetic
testing reveals a CFTR mutation. Which pulmonary pathology is
characteristic?
A. Restrictive lung disease with decreased TLC
B. Diffuse alveolar hemorrhage
C. Bronchiectasis with chronic bacterial colonization
D. Pulmonary emboli frequent in infancy
E. Primary pulmonary hypertension only
Rationale: Cystic fibrosis causes thick secretions, recurrent infections, and
bronchiectasis.
5. A 66-year-old male with a 40–pack-year smoking history presents with
progressive exertional dyspnea and an FEV1/FVC ratio of 0.60 that does not
fully reverse with bronchodilator. What is the most likely diagnosis?
A. Reactive airways disease
B. Restrictive lung disease
C. COPD (chronic obstructive pulmonary disease)
D. Pulmonary embolism
E. Interstitial lung disease
Rationale: Post-bronchodilator airflow obstruction with low FEV1/FVC in
a smoker indicates COPD.
6. A 28-year-old female presents with palpitations and tremor. Labs: low TSH,
elevated free T4. She has ophthalmopathy and diffuse goiter. Best next step
for definitive therapy if she desires pregnancy within 1 year?
A. Radioactive iodine ablation now
,3|Page
B. Start methimazole (with careful planning) — but if pregnancy
imminent, PTU in first trimester is preferred
C. Refer for thyroidectomy immediately
D. Propranolol only; no antithyroid therapy needed
E. Observe without treatment
Rationale: Methimazole is effective but PTU is preferred in the first
trimester; definitive therapy timing must consider pregnancy plans.
7. A 55-year-old man with coronary artery disease is on aspirin and clopidogrel
after stent placement. He needs an urgent laparoscopic cholecystectomy for
acute cholecystitis. What is the perioperative management of antiplatelet
agents?
A. Continue both drugs without modification
B. Consult cardiology — often dual antiplatelet therapy is continued for
the mandatory period after stent; surgery may be delayed or high-risk
procedures managed with multidisciplinary plan
C. Stop both antiplatelets 24 hours before surgery without bridging
D. Replace with warfarin perioperatively
E. Give platelet transfusion before surgery
Rationale: Management of antiplatelet therapy in recent stent patients
needs cardiology input; prematurely stopping may cause stent thrombosis.
8. A 70-year-old woman with fatigue has a hemoglobin of 9.0 g/dL, MCV 70
fL, low ferritin, and positive fecal occult blood. What's the next appropriate
diagnostic step?
A. Bone marrow biopsy
B. Trial of oral iron only
C. Colonoscopy to evaluate for lower GI bleeding
D. CT abdomen without contrast
E. Upper endoscopy only
Rationale: Iron deficiency anemia in an older adult requires evaluation
for GI blood loss; colonoscopy is indicated to look for colonic sources
including malignancy.
9. A patient with type 1 diabetes has autonomic neuropathy with gastroparesis.
Which medication can be used to promote gastric emptying?
A. Omeprazole
B. Atropine
C. Metoclopramide (short-term) or erythromycin (prokinetic)
D. Loperamide
E. Domperidone (unapproved in US) without oversight
Rationale: Metoclopramide is a prokinetic often used; caution for side
effects like tardive dyskinesia; erythromycin is another option.
, 4|Page
10.A 6-year-old child presents with fever, sore throat, drooling, and muffled
voice. Lateral neck x-ray shows thumbprint sign. What is the immediate
priority?
A. Rapid strep testing
B. Start oral antibiotics and discharge
C. Secure the airway in controlled environment (suspect epiglottitis)
D. Perform throat swab culture in ED and await results
E. Send home with ibuprofen
Rationale: Thumbprint sign and obstructive symptoms suggest epiglottitis;
airway compromise risk mandates securing airway by experienced
clinicians.
11.A 45-year-old woman treated with isoniazid develops numbness and
paresthesias in her hands. Labs show low B6 level. What is the mechanism
and best treatment?
A. INH causes folate deficiency; give folic acid
B. INH causes pyridoxine (B6) deficiency by inhibiting pyridoxine
phosphokinase — give pyridoxine supplementation
C. INH causes B12 deficiency — give cyanocobalamin
D. No supplementation needed; stop INH
E. Give thiamine (B1)
Rationale: INH interferes with pyridoxine metabolism leading to
neuropathy; pyridoxine supplementation prevents/treats it.
12.A 30-year-old female presents with bilateral lower extremity swelling,
weight gain, and periorbital edema. Labs show proteinuria >3.5 g/day and
hypoalbuminemia. Which is the most likely diagnosis?
A. Acute tubular necrosis
B. Nephritic syndrome from post-streptococcal GN
C. Nephrotic syndrome (e.g., minimal change disease, FSGS,
membranous nephropathy)
D. Interstitial nephritis
E. Pre-renal azotemia
Rationale: Massive proteinuria with hypoalbuminemia and edema defines
nephrotic syndrome.
13.A 62-year-old man has sudden painless monocular vision loss. Fundoscopy
shows a pale retina with a cherry-red spot. What is the likely diagnosis and
immediate management?
A. Central retinal vein occlusion; oral steroids
B. Central retinal artery occlusion; urgent ophthalmology evaluation
and ocular massage / intraocular pressure lowering measures
C. Retinal detachment; bed rest only
COMSAE 110 MOCK EXAM PREP 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS ALREADY A
GRADED WITH EXPERT FEEDBACK
|NEW AND REVISED
The content mirrors COMLEX-level integrated clinical vignettes across
biomedical sciences, clinical medicine, OMM, ethics, biostatistics, and systems-
based practice, aligned with the National Board of Osteopathic Medical Examiners
blueprint.
COMSAE 110–Style Mock Exam
(5 choices A–E; correct answer bolded; rationale in italics)
1. A 23-year-old male presents with 2 days of sore throat, fever, and tender
anterior cervical lymphadenopathy. Rapid strep test is negative. Which is the
next best step?
A. Start amoxicillin empirically
B. Order a monospot heterophile antibody test
C. Prescribe azithromycin for atypical coverage
D. Obtain a throat culture for group A Streptococcus
E. Reassure and discharge with symptomatic treatment
Rationale: A negative rapid antigen test with high clinical suspicion
should be confirmed with a throat culture; empiric antibiotics are not
indicated without confirmation.
2. A 58-year-old woman with longstanding rheumatoid arthritis develops
progressive dyspnea. CT chest shows honeycombing and subpleural
reticulation predominantly at the bases. What is the most likely diagnosis?
A. Usual interstitial pneumonia (idiopathic pulmonary fibrosis)
B. Nonspecific interstitial pneumonia
C. Rheumatoid-associated interstitial lung disease with usual interstitial
pneumonia pattern
,2|Page
D. Hypersensitivity pneumonitis
E. Pulmonary edema from heart failure
Rationale: RA can cause an ILD often with a UIP pattern (subpleural,
basal honeycombing); clinical context matters.
3. A 42-year-old man is found to have an elevated AST and ALT (~200 U/L
each), with a history of heavy alcohol use. AST:ALT ratio is 2:1. Which
statement is most accurate?
A. This pattern rules out alcoholic liver disease
B. ALT predominates in alcoholic liver disease
C. AST:ALT >2 suggests alcoholic liver injury but is not definitive
D. Viral hepatitis always shows AST:ALT >2
E. These enzymes are not useful in liver disease evaluation
Rationale: AST:ALT >2 is suggestive of alcoholic liver disease
(mitochondrial damage increases AST), but diagnosis requires history and
other testing.
4. A newborn has scant, malodorous stools and a negative sweat chloride. At 2
months, the infant develops persistent cough and failure to thrive. Genetic
testing reveals a CFTR mutation. Which pulmonary pathology is
characteristic?
A. Restrictive lung disease with decreased TLC
B. Diffuse alveolar hemorrhage
C. Bronchiectasis with chronic bacterial colonization
D. Pulmonary emboli frequent in infancy
E. Primary pulmonary hypertension only
Rationale: Cystic fibrosis causes thick secretions, recurrent infections, and
bronchiectasis.
5. A 66-year-old male with a 40–pack-year smoking history presents with
progressive exertional dyspnea and an FEV1/FVC ratio of 0.60 that does not
fully reverse with bronchodilator. What is the most likely diagnosis?
A. Reactive airways disease
B. Restrictive lung disease
C. COPD (chronic obstructive pulmonary disease)
D. Pulmonary embolism
E. Interstitial lung disease
Rationale: Post-bronchodilator airflow obstruction with low FEV1/FVC in
a smoker indicates COPD.
6. A 28-year-old female presents with palpitations and tremor. Labs: low TSH,
elevated free T4. She has ophthalmopathy and diffuse goiter. Best next step
for definitive therapy if she desires pregnancy within 1 year?
A. Radioactive iodine ablation now
,3|Page
B. Start methimazole (with careful planning) — but if pregnancy
imminent, PTU in first trimester is preferred
C. Refer for thyroidectomy immediately
D. Propranolol only; no antithyroid therapy needed
E. Observe without treatment
Rationale: Methimazole is effective but PTU is preferred in the first
trimester; definitive therapy timing must consider pregnancy plans.
7. A 55-year-old man with coronary artery disease is on aspirin and clopidogrel
after stent placement. He needs an urgent laparoscopic cholecystectomy for
acute cholecystitis. What is the perioperative management of antiplatelet
agents?
A. Continue both drugs without modification
B. Consult cardiology — often dual antiplatelet therapy is continued for
the mandatory period after stent; surgery may be delayed or high-risk
procedures managed with multidisciplinary plan
C. Stop both antiplatelets 24 hours before surgery without bridging
D. Replace with warfarin perioperatively
E. Give platelet transfusion before surgery
Rationale: Management of antiplatelet therapy in recent stent patients
needs cardiology input; prematurely stopping may cause stent thrombosis.
8. A 70-year-old woman with fatigue has a hemoglobin of 9.0 g/dL, MCV 70
fL, low ferritin, and positive fecal occult blood. What's the next appropriate
diagnostic step?
A. Bone marrow biopsy
B. Trial of oral iron only
C. Colonoscopy to evaluate for lower GI bleeding
D. CT abdomen without contrast
E. Upper endoscopy only
Rationale: Iron deficiency anemia in an older adult requires evaluation
for GI blood loss; colonoscopy is indicated to look for colonic sources
including malignancy.
9. A patient with type 1 diabetes has autonomic neuropathy with gastroparesis.
Which medication can be used to promote gastric emptying?
A. Omeprazole
B. Atropine
C. Metoclopramide (short-term) or erythromycin (prokinetic)
D. Loperamide
E. Domperidone (unapproved in US) without oversight
Rationale: Metoclopramide is a prokinetic often used; caution for side
effects like tardive dyskinesia; erythromycin is another option.
, 4|Page
10.A 6-year-old child presents with fever, sore throat, drooling, and muffled
voice. Lateral neck x-ray shows thumbprint sign. What is the immediate
priority?
A. Rapid strep testing
B. Start oral antibiotics and discharge
C. Secure the airway in controlled environment (suspect epiglottitis)
D. Perform throat swab culture in ED and await results
E. Send home with ibuprofen
Rationale: Thumbprint sign and obstructive symptoms suggest epiglottitis;
airway compromise risk mandates securing airway by experienced
clinicians.
11.A 45-year-old woman treated with isoniazid develops numbness and
paresthesias in her hands. Labs show low B6 level. What is the mechanism
and best treatment?
A. INH causes folate deficiency; give folic acid
B. INH causes pyridoxine (B6) deficiency by inhibiting pyridoxine
phosphokinase — give pyridoxine supplementation
C. INH causes B12 deficiency — give cyanocobalamin
D. No supplementation needed; stop INH
E. Give thiamine (B1)
Rationale: INH interferes with pyridoxine metabolism leading to
neuropathy; pyridoxine supplementation prevents/treats it.
12.A 30-year-old female presents with bilateral lower extremity swelling,
weight gain, and periorbital edema. Labs show proteinuria >3.5 g/day and
hypoalbuminemia. Which is the most likely diagnosis?
A. Acute tubular necrosis
B. Nephritic syndrome from post-streptococcal GN
C. Nephrotic syndrome (e.g., minimal change disease, FSGS,
membranous nephropathy)
D. Interstitial nephritis
E. Pre-renal azotemia
Rationale: Massive proteinuria with hypoalbuminemia and edema defines
nephrotic syndrome.
13.A 62-year-old man has sudden painless monocular vision loss. Fundoscopy
shows a pale retina with a cherry-red spot. What is the likely diagnosis and
immediate management?
A. Central retinal vein occlusion; oral steroids
B. Central retinal artery occlusion; urgent ophthalmology evaluation
and ocular massage / intraocular pressure lowering measures
C. Retinal detachment; bed rest only
