Pagei 1i ofi 89i
i
COMSAE EXAM PREP NEWEST 2026 ACTUAL i i i i i i
EXAM QUESTIONS AND CORRECT DETAILED i i i i i
ANSWERS i
✅ A 22-year-old woman presents to the office for evaluation of
i i i i i i i i i i i
malaise and easy bruising. She also reports increased menses
i i i i i i i i i
over the past 2 months. Review of records reveals a hospital
i i i i i i i i i i i
admission 6 months ago secondary to viral pneumonia. Physical i i i i i i i i i
examination findings are normal. Laboratory study results are i i i i i i i i
normal except for a platelet count of 45 × 103/mcL (reference
i i i i i i i i i i i
range: 150-450 × 103/mcL). The most likely diagnosis is
i i i i i i i i i
A. factor VII deficiency i i i
B. IgA vasculitis (Henoch-Schönlein purpura)
i i i i
C. idiopathic thrombocytopenic purpura i i i
D. thrombotic thrombocytopenic purpura i i i
E. von Willebrand disease - ✔✔✔ Correct Answer > C. IDIOPATHIC
i i i i i i i i i i
THROMBOCYTOPENIC PURPURA (ITP) i i i
An acquired form of a low platelet count secondary to antibody
i i i i i i i i i i i
formation against GpIIb/IIIa on platelets, without any perturbation i i i i i i i i
of the structure or function of WBCs, RBCs, or coagulation factors
i i i i i i i i i i i
(i.e., isolated thrombocytopenia). It is a diagnosis of exclusion
i i i i i i i i i
without specific clinical or laboratory parameters. i i i i i i
i
i
✅ A 21-year-old woman presents to the office with a 6-month
i i i i i i i i i i i
history of increasing low back pain. She reports that she competes
i i i i i i i i i i i
as a figure skater, and the pain began following a bad landing. She
i i i i i i i i i i i i i
describes the pain as achy and localized to the lumbosacral i i i i i i i i i i
junction. A radiograph of the spine taken 1 month ago reveals the
i i i i i i i i i i i i
findings shown in the exhibit. Neurologic examination findings are
i i i i i i i i i
normal, with no focal motor deficits. Structural examination
i i i i i i i i
reveals increased tone in the lumbar paravertebral muscles with
i i i i i i i i i
,Pagei 2i ofi 89i
i
midline tenderness in the lumbosacral area. Which of the following
i i i i i i i i i i
injuries did this patient most likely sustain?
i i i i i i i
A. acute L3 flexion somatic dysfunction
i i i i i i
B .acute right unilateral sacral flexion
i i i i i i
C. fracture of the L5 pars interarticularis i i i i i i
D. L5 vertebral compression fracture
i i i i
E. muscle strain of the quadratus lumborum - ✔✔✔ Correct Answer >
i i i i i i i i i i i
C. FRACTURE OF THE L5 PARS INTERARTICULARIS
i i i i i i i
i
i
✅ A male neonate is evaluated in the labor and delivery room
i i i i i i i i i i i i
immediately after delivery for tachypnea and room air hypoxia. The i i i i i i i i i i
patient was delivered via cesarean section due to fetal tachycardia
i i i i i i i i i i
and non-reassuring fetal heart tones. The mother had limited
i i i i i i i i i
prenatal care. Vital signs reveal a respiratory rate of 80-100/min.
i i i i i i i i i i
Physical examination reveals intercostal and subcostal
i i i i i i
retractions and nasal flaring. The abdomen appears scaphoid. i i i i i i i i
Chest auscultation reveals decreased lung sounds on the left and a
i i i i i i i i i i i
right shift of heart sounds. The most appropriate diagnostic test is
i i i i i i i i i i i
A. arterial blood gas analysis i i i i
B. chest radiography i i
C. echocardiography i
D. fluoroscopy i
E. oxygen challenge test - ✔✔✔ Correct Answer > B. CHESTi i i i i i i i i i
RADIOGRAPHY i
,Pagei 3i ofi 89i
i
The clinical scenario describes a neonate w/respiratory distress
i i i i i i i i
immediately after birth, w/ signs including tachypnea, nasal i i i i i i i i
flaring, intercostal and subcostal retractions, decreased lung
i i i i i i i
sounds on the left, and a rightward shift of the heart sounds. The
i i i i i i i i i i i i i
scaphoid abdomen is particularly concerning for congenital
i i i i i i i
diaphragmatic hernia (CDH), a condition where abdominal i i i i i i i
contents herniate into the chest, leading to lung hypoplasia and
i i i i i i i i i i
displacement of the heart and mediastinum. i i i i i i
i
Chest radiography is the most appropriate diagnostic test to
i i i i i i i i i
confirm the diagnosis by visualizing the herniated abdominal
i i i i i i i i
organs within the chest cavity. Other options, such as arterial blood
i i i i i i i i i i i
gas analysis or echocardiography, do not provide the immediate
i i i i i i i i i
anatomical information needed in this scenario. i i i i i i
i
A 53-year-old man is brought to the office by a staff member from
i i i i i i i i i i i i i
the group home where he has resided for the past 4 years. The staff
i i i i i i i i i i i i i i
member reports that the patient has a 1-year history of gradually
i i i i i i i i i i i
worsening mouth and tongue movements. The movements are not
i i i i i i i i i
apparent when he is sleeping. Past medical history reveals chronic
i i i i i i i i i i
schizophrenia, which has been treated with long-acting injectable i i i i i i i i
antipsychotics for approximately 25 years. He has no other known i i i i i i i i i i
neurologic history. His only current medication is fluphenazine
i i i i i i i i
decanoate. Physical examination reveals thrusting movements of i i i i i i i
the tongue to the left and frequent grimacing that can be partially
i i i i i i i i i i i i
controlled by the patient but is exacerbated when he is distracted.
i i i i i i i i i i i
The most appropriate treatment is to slowly taper fluphenazine
i i i i i i i i i
and start i i
A. carbidopa-levodopa i
B. clozapine i
C. dantrolene i
D. phenytoin i
E. tizanidine - ✔✔✔ Correct Answer > B. CLOZAPINE i i i i i i i i
, Pagei 4i ofi 89i
i
An atypical antipsychotic mainly used for treatment-resistant
i i i i i i i
schizophrenia that has a ↓ risk of extrapyramidal symptoms i i i i i i i i i
compared to typical antipsychotics. Its most dangerous adverse i i i i i i i i
effect is life-threatening agranulocytosis; as a result, frequent
i i i i i i i i
blood testing is required after initiating treatment.
i i i i i i i
i
A 28-year-old man presents to the office with a 14-day history of
i i i i i i i i i i i i
sore throat, foul taste in his mouth, and heartburn. Past medical
i i i i i i i i i i i
history reveals hemophilia and a transfusion reaction 15 years ago.
i i i i i i i i i i
The patient's temperature is 36.9°C (98.4°F). Physical examination
i i i i i i i i
reveals cervical lymphadenopathy and thick white exudate on the
i i i i i i i i i
oropharynx and tongue. Scraping of the exudate causes punctate i i i i i i i i i
mucosal bleeding. This patient's pharyngeal exudate is most likely
i i i i i i i i i
due to i i
A. bacterial pharyngitis i i
B. oral and esophageal candidiasis i i i i
C. premalignant oral leukoplakia i i i
D. squamous cell carcinoma of the pharynx i i i i i i
E. viral pharyngitis - ✔✔✔ Correct Answer > B. oral & esophageal
i i i i i i i i i i i
candidiasis i
The patient presents with a sore throat, foul taste in the mouth, and
i i i i i i i i i i i i i
heartburn, accompanied by cervical lymphadenopathy and thick i i i i i i i
white exudate on the oropharynx and tongue. The exudate causes
i i i i i i i i i i
punctate mucosal bleeding when scraped, which is highly i i i i i i i i
suggestive of oral candidiasis (thrush), particularly in an i i i i i i i i
immunocompromised individual or someone with a disrupted oral i i i i i i i i
environment, such as after antibiotic use or with chronic i i i i i i i i i
disease. i
i
Oral candidiasis is a fungal infection caused by Candida species,
i i i i i i i i i i
most commonly Candida albicans. The key features include the
i i i i i i i i i
white patches that can be scraped off, often leaving a raw, bleeding
i i i i i i i i i i i i
i
COMSAE EXAM PREP NEWEST 2026 ACTUAL i i i i i i
EXAM QUESTIONS AND CORRECT DETAILED i i i i i
ANSWERS i
✅ A 22-year-old woman presents to the office for evaluation of
i i i i i i i i i i i
malaise and easy bruising. She also reports increased menses
i i i i i i i i i
over the past 2 months. Review of records reveals a hospital
i i i i i i i i i i i
admission 6 months ago secondary to viral pneumonia. Physical i i i i i i i i i
examination findings are normal. Laboratory study results are i i i i i i i i
normal except for a platelet count of 45 × 103/mcL (reference
i i i i i i i i i i i
range: 150-450 × 103/mcL). The most likely diagnosis is
i i i i i i i i i
A. factor VII deficiency i i i
B. IgA vasculitis (Henoch-Schönlein purpura)
i i i i
C. idiopathic thrombocytopenic purpura i i i
D. thrombotic thrombocytopenic purpura i i i
E. von Willebrand disease - ✔✔✔ Correct Answer > C. IDIOPATHIC
i i i i i i i i i i
THROMBOCYTOPENIC PURPURA (ITP) i i i
An acquired form of a low platelet count secondary to antibody
i i i i i i i i i i i
formation against GpIIb/IIIa on platelets, without any perturbation i i i i i i i i
of the structure or function of WBCs, RBCs, or coagulation factors
i i i i i i i i i i i
(i.e., isolated thrombocytopenia). It is a diagnosis of exclusion
i i i i i i i i i
without specific clinical or laboratory parameters. i i i i i i
i
i
✅ A 21-year-old woman presents to the office with a 6-month
i i i i i i i i i i i
history of increasing low back pain. She reports that she competes
i i i i i i i i i i i
as a figure skater, and the pain began following a bad landing. She
i i i i i i i i i i i i i
describes the pain as achy and localized to the lumbosacral i i i i i i i i i i
junction. A radiograph of the spine taken 1 month ago reveals the
i i i i i i i i i i i i
findings shown in the exhibit. Neurologic examination findings are
i i i i i i i i i
normal, with no focal motor deficits. Structural examination
i i i i i i i i
reveals increased tone in the lumbar paravertebral muscles with
i i i i i i i i i
,Pagei 2i ofi 89i
i
midline tenderness in the lumbosacral area. Which of the following
i i i i i i i i i i
injuries did this patient most likely sustain?
i i i i i i i
A. acute L3 flexion somatic dysfunction
i i i i i i
B .acute right unilateral sacral flexion
i i i i i i
C. fracture of the L5 pars interarticularis i i i i i i
D. L5 vertebral compression fracture
i i i i
E. muscle strain of the quadratus lumborum - ✔✔✔ Correct Answer >
i i i i i i i i i i i
C. FRACTURE OF THE L5 PARS INTERARTICULARIS
i i i i i i i
i
i
✅ A male neonate is evaluated in the labor and delivery room
i i i i i i i i i i i i
immediately after delivery for tachypnea and room air hypoxia. The i i i i i i i i i i
patient was delivered via cesarean section due to fetal tachycardia
i i i i i i i i i i
and non-reassuring fetal heart tones. The mother had limited
i i i i i i i i i
prenatal care. Vital signs reveal a respiratory rate of 80-100/min.
i i i i i i i i i i
Physical examination reveals intercostal and subcostal
i i i i i i
retractions and nasal flaring. The abdomen appears scaphoid. i i i i i i i i
Chest auscultation reveals decreased lung sounds on the left and a
i i i i i i i i i i i
right shift of heart sounds. The most appropriate diagnostic test is
i i i i i i i i i i i
A. arterial blood gas analysis i i i i
B. chest radiography i i
C. echocardiography i
D. fluoroscopy i
E. oxygen challenge test - ✔✔✔ Correct Answer > B. CHESTi i i i i i i i i i
RADIOGRAPHY i
,Pagei 3i ofi 89i
i
The clinical scenario describes a neonate w/respiratory distress
i i i i i i i i
immediately after birth, w/ signs including tachypnea, nasal i i i i i i i i
flaring, intercostal and subcostal retractions, decreased lung
i i i i i i i
sounds on the left, and a rightward shift of the heart sounds. The
i i i i i i i i i i i i i
scaphoid abdomen is particularly concerning for congenital
i i i i i i i
diaphragmatic hernia (CDH), a condition where abdominal i i i i i i i
contents herniate into the chest, leading to lung hypoplasia and
i i i i i i i i i i
displacement of the heart and mediastinum. i i i i i i
i
Chest radiography is the most appropriate diagnostic test to
i i i i i i i i i
confirm the diagnosis by visualizing the herniated abdominal
i i i i i i i i
organs within the chest cavity. Other options, such as arterial blood
i i i i i i i i i i i
gas analysis or echocardiography, do not provide the immediate
i i i i i i i i i
anatomical information needed in this scenario. i i i i i i
i
A 53-year-old man is brought to the office by a staff member from
i i i i i i i i i i i i i
the group home where he has resided for the past 4 years. The staff
i i i i i i i i i i i i i i
member reports that the patient has a 1-year history of gradually
i i i i i i i i i i i
worsening mouth and tongue movements. The movements are not
i i i i i i i i i
apparent when he is sleeping. Past medical history reveals chronic
i i i i i i i i i i
schizophrenia, which has been treated with long-acting injectable i i i i i i i i
antipsychotics for approximately 25 years. He has no other known i i i i i i i i i i
neurologic history. His only current medication is fluphenazine
i i i i i i i i
decanoate. Physical examination reveals thrusting movements of i i i i i i i
the tongue to the left and frequent grimacing that can be partially
i i i i i i i i i i i i
controlled by the patient but is exacerbated when he is distracted.
i i i i i i i i i i i
The most appropriate treatment is to slowly taper fluphenazine
i i i i i i i i i
and start i i
A. carbidopa-levodopa i
B. clozapine i
C. dantrolene i
D. phenytoin i
E. tizanidine - ✔✔✔ Correct Answer > B. CLOZAPINE i i i i i i i i
, Pagei 4i ofi 89i
i
An atypical antipsychotic mainly used for treatment-resistant
i i i i i i i
schizophrenia that has a ↓ risk of extrapyramidal symptoms i i i i i i i i i
compared to typical antipsychotics. Its most dangerous adverse i i i i i i i i
effect is life-threatening agranulocytosis; as a result, frequent
i i i i i i i i
blood testing is required after initiating treatment.
i i i i i i i
i
A 28-year-old man presents to the office with a 14-day history of
i i i i i i i i i i i i
sore throat, foul taste in his mouth, and heartburn. Past medical
i i i i i i i i i i i
history reveals hemophilia and a transfusion reaction 15 years ago.
i i i i i i i i i i
The patient's temperature is 36.9°C (98.4°F). Physical examination
i i i i i i i i
reveals cervical lymphadenopathy and thick white exudate on the
i i i i i i i i i
oropharynx and tongue. Scraping of the exudate causes punctate i i i i i i i i i
mucosal bleeding. This patient's pharyngeal exudate is most likely
i i i i i i i i i
due to i i
A. bacterial pharyngitis i i
B. oral and esophageal candidiasis i i i i
C. premalignant oral leukoplakia i i i
D. squamous cell carcinoma of the pharynx i i i i i i
E. viral pharyngitis - ✔✔✔ Correct Answer > B. oral & esophageal
i i i i i i i i i i i
candidiasis i
The patient presents with a sore throat, foul taste in the mouth, and
i i i i i i i i i i i i i
heartburn, accompanied by cervical lymphadenopathy and thick i i i i i i i
white exudate on the oropharynx and tongue. The exudate causes
i i i i i i i i i i
punctate mucosal bleeding when scraped, which is highly i i i i i i i i
suggestive of oral candidiasis (thrush), particularly in an i i i i i i i i
immunocompromised individual or someone with a disrupted oral i i i i i i i i
environment, such as after antibiotic use or with chronic i i i i i i i i i
disease. i
i
Oral candidiasis is a fungal infection caused by Candida species,
i i i i i i i i i i
most commonly Candida albicans. The key features include the
i i i i i i i i i
white patches that can be scraped off, often leaving a raw, bleeding
i i i i i i i i i i i i
