1
COMSAE Phase 2 Form 111 – The Complete 176
Question Test Bank All questions with correct verified
answers & detailed rationales – graded A+ for the
newest 2026 actual exam
First, Understand the Exam
The COMSAE Phase 2 examination contains 176 items, divided into four sections of 44 questions each. All
questions are single-best-answer, multiple-choice format. Some questions include images or visual exhibits as
attachments, and some forms contain videos requiring headphones.
Content Areas – The Phase 2 content is defined by the same nine categories as the COMLEX-USA Level 2-CE, with
emphasis on clinical decision-making, diagnosis, management, and patient care across core rotations (internal
medicine, surgery, pediatrics, OB/GYN, psychiatry, emergency medicine, preventive medicine, osteopathic
principles, and ethics).
How to Use this Test Bank – Each of the 176 questions below is modeled after the actual COMSAE Phase 2 Form
111 blueprint. Read the clinical vignette, select your answer, then review the bolded answer and the
detailed rationale. Pay special attention to the why behind each answer—this is what will move you from
memorization to clinical reasoning.
❖ SECTION 1 – INTERNAL MEDICINE (Questions 1–40)
Q1. A 65-year-old male with a history of hypertension and diabetes presents with
substernal chest pressure radiating to the left arm, associated with diaphoresis
and nausea for the past 2 hours. ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the most appropriate immediate intervention?
A. Administer aspirin and sublingual nitroglycerin
B. Immediate reperfusion therapy (PCI or fibrinolysis)
C. Obtain a troponin level before treatment
D. Start intravenous beta-blocker
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Immediate reperfusion therapy (PCI or fibrinolysis)** ST-segment elevation
myocardial infarction (STEMI) requires immediate reperfusion. Aspirin is given,
but reperfusion is the priority. PCI is preferred if available within 120 minutes;
otherwise, fibrinolysis. Do not wait for troponin. </details>
pg. 1
,2
Q2. A 55-year-old male with a 40-pack-year smoking history presents with a
chronic cough, hemoptysis, and weight loss. Chest x-ray shows a right hilar mass.
Which of the following is the most appropriate next step?
A. CT scan of the chest
B. Bronchoscopy with biopsy
C. Sputum cytology
D. PET scan
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Bronchoscopy with biopsy** Suspected lung cancer requires tissue diagnosis.
Bronchoscopy is the preferred initial procedure for central lesions. CT and PET are
staging studies after diagnosis. </details>
Q3. A 72-year-old female with a history of atrial fibrillation on warfarin presents
with sudden onset of severe headache and vomiting. INR is 4.5. Non-contrast
head CT shows a left parietal intraparenchymal hemorrhage. Which of the
following is the most appropriate immediate management?
A. Administer fresh frozen plasma
B. Hold warfarin and administer vitamin K 10 mg IV
C. Give prothrombin complex concentrate (PCC)
D. Administer aspirin
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: C.
Give prothrombin complex concentrate (PCC)** For life-threatening intracranial
hemorrhage on warfarin, PCC is preferred over fresh frozen plasma for rapid
reversal. Vitamin K is given concurrently but takes hours. PCC is faster and more
effective. </details>
Q4. A 45-year-old male presents with acute onset of severe epigastric pain
radiating to the back, nausea, and vomiting. He has a history of heavy alcohol use.
Serum lipase is 1,200 U/L. Which of the following is the most appropriate initial
management?
pg. 2
,3
A. Oral intake of clear liquids
B. Intravenous fluids and pain control
C. CT scan of the abdomen
D. Antibiotics
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Intravenous fluids and pain control** Acute pancreatitis requires aggressive IV
fluid resuscitation and pain management. NPO is not necessary unless vomiting
persists; early enteral feeding is encouraged. CT is not needed for diagnosis if
criteria are met. </details>
Q5. A 68-year-old male with a history of heart failure and reduced ejection
fraction (HFrEF) is on carvedilol, lisinopril, and furosemide. He presents with
worsening dyspnea, weight gain, and 2+ pitting edema. Blood pressure is 105/65
mm Hg, heart rate 68/min. Which of the following is the most appropriate
adjustment?
A. Increase carvedilol dose
B. Increase furosemide dose
C. Add spironolactone
D. Decrease lisinopril
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Increase furosemide dose** The patient has signs of volume overload; diuretic
dose should be increased. Beta-blockers and ACE inhibitors should not be
adjusted during acute decompensation unless hypotension is severe. </details>
Q6. A 35-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is 15 mIU/L, free T4 is 0.5 ng/dL. Which of the following is the
most appropriate initial dose of levothyroxine?
A. 25 mcg daily
B. 50 mcg daily
C. 100 mcg daily
D. 150 mcg daily
pg. 3
, 4
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
50 mcg daily** Starting dose for young adults is 1.6 mcg/kg/day (~100 mcg for 70
kg). A lower starting dose (50 mcg) is often used in mild hypothyroidism to avoid
overtreatment. Recheck TSH in 6 weeks. </details>
Q7. A 58-year-old male with a history of type 2 diabetes and hypertension has a
serum creatinine of 1.8 mg/dL (baseline 1.0) and a urine albumin-to-creatinine
ratio (UACR) of 350 mg/g. Which of the following is the most appropriate therapy
to slow progression of kidney disease?
A. Metformin
B. ACE inhibitor or ARB titrated to maximum tolerated dose
C. Thiazide diuretic
D. SGLT2 inhibitor
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
ACE inhibitor or ARB titrated to maximum tolerated dose** ACE inhibitors or
ARBs reduce proteinuria and slow CKD progression in diabetic kidney disease.
SGLT2 inhibitors also slow progression but are not first-line as monotherapy for
proteinuria reduction. Metformin is safe at eGFR >30 but does not slow
progression. </details>
Q8. A 62-year-old female with a history of hypertension presents with a blood
pressure of 155/95 mm Hg on lisinopril 20 mg daily. Home readings are similar.
Which of the following is the most appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 12.5 mg daily
D. Add carvedilol
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Add amlodipine 5 mg daily** Adding a calcium channel blocker to an ACE inhibitor
is an effective step for uncontrolled hypertension. Thiazide is also an option; CCB
pg. 4
COMSAE Phase 2 Form 111 – The Complete 176
Question Test Bank All questions with correct verified
answers & detailed rationales – graded A+ for the
newest 2026 actual exam
First, Understand the Exam
The COMSAE Phase 2 examination contains 176 items, divided into four sections of 44 questions each. All
questions are single-best-answer, multiple-choice format. Some questions include images or visual exhibits as
attachments, and some forms contain videos requiring headphones.
Content Areas – The Phase 2 content is defined by the same nine categories as the COMLEX-USA Level 2-CE, with
emphasis on clinical decision-making, diagnosis, management, and patient care across core rotations (internal
medicine, surgery, pediatrics, OB/GYN, psychiatry, emergency medicine, preventive medicine, osteopathic
principles, and ethics).
How to Use this Test Bank – Each of the 176 questions below is modeled after the actual COMSAE Phase 2 Form
111 blueprint. Read the clinical vignette, select your answer, then review the bolded answer and the
detailed rationale. Pay special attention to the why behind each answer—this is what will move you from
memorization to clinical reasoning.
❖ SECTION 1 – INTERNAL MEDICINE (Questions 1–40)
Q1. A 65-year-old male with a history of hypertension and diabetes presents with
substernal chest pressure radiating to the left arm, associated with diaphoresis
and nausea for the past 2 hours. ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the most appropriate immediate intervention?
A. Administer aspirin and sublingual nitroglycerin
B. Immediate reperfusion therapy (PCI or fibrinolysis)
C. Obtain a troponin level before treatment
D. Start intravenous beta-blocker
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Immediate reperfusion therapy (PCI or fibrinolysis)** ST-segment elevation
myocardial infarction (STEMI) requires immediate reperfusion. Aspirin is given,
but reperfusion is the priority. PCI is preferred if available within 120 minutes;
otherwise, fibrinolysis. Do not wait for troponin. </details>
pg. 1
,2
Q2. A 55-year-old male with a 40-pack-year smoking history presents with a
chronic cough, hemoptysis, and weight loss. Chest x-ray shows a right hilar mass.
Which of the following is the most appropriate next step?
A. CT scan of the chest
B. Bronchoscopy with biopsy
C. Sputum cytology
D. PET scan
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Bronchoscopy with biopsy** Suspected lung cancer requires tissue diagnosis.
Bronchoscopy is the preferred initial procedure for central lesions. CT and PET are
staging studies after diagnosis. </details>
Q3. A 72-year-old female with a history of atrial fibrillation on warfarin presents
with sudden onset of severe headache and vomiting. INR is 4.5. Non-contrast
head CT shows a left parietal intraparenchymal hemorrhage. Which of the
following is the most appropriate immediate management?
A. Administer fresh frozen plasma
B. Hold warfarin and administer vitamin K 10 mg IV
C. Give prothrombin complex concentrate (PCC)
D. Administer aspirin
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: C.
Give prothrombin complex concentrate (PCC)** For life-threatening intracranial
hemorrhage on warfarin, PCC is preferred over fresh frozen plasma for rapid
reversal. Vitamin K is given concurrently but takes hours. PCC is faster and more
effective. </details>
Q4. A 45-year-old male presents with acute onset of severe epigastric pain
radiating to the back, nausea, and vomiting. He has a history of heavy alcohol use.
Serum lipase is 1,200 U/L. Which of the following is the most appropriate initial
management?
pg. 2
,3
A. Oral intake of clear liquids
B. Intravenous fluids and pain control
C. CT scan of the abdomen
D. Antibiotics
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Intravenous fluids and pain control** Acute pancreatitis requires aggressive IV
fluid resuscitation and pain management. NPO is not necessary unless vomiting
persists; early enteral feeding is encouraged. CT is not needed for diagnosis if
criteria are met. </details>
Q5. A 68-year-old male with a history of heart failure and reduced ejection
fraction (HFrEF) is on carvedilol, lisinopril, and furosemide. He presents with
worsening dyspnea, weight gain, and 2+ pitting edema. Blood pressure is 105/65
mm Hg, heart rate 68/min. Which of the following is the most appropriate
adjustment?
A. Increase carvedilol dose
B. Increase furosemide dose
C. Add spironolactone
D. Decrease lisinopril
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Increase furosemide dose** The patient has signs of volume overload; diuretic
dose should be increased. Beta-blockers and ACE inhibitors should not be
adjusted during acute decompensation unless hypotension is severe. </details>
Q6. A 35-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is 15 mIU/L, free T4 is 0.5 ng/dL. Which of the following is the
most appropriate initial dose of levothyroxine?
A. 25 mcg daily
B. 50 mcg daily
C. 100 mcg daily
D. 150 mcg daily
pg. 3
, 4
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
50 mcg daily** Starting dose for young adults is 1.6 mcg/kg/day (~100 mcg for 70
kg). A lower starting dose (50 mcg) is often used in mild hypothyroidism to avoid
overtreatment. Recheck TSH in 6 weeks. </details>
Q7. A 58-year-old male with a history of type 2 diabetes and hypertension has a
serum creatinine of 1.8 mg/dL (baseline 1.0) and a urine albumin-to-creatinine
ratio (UACR) of 350 mg/g. Which of the following is the most appropriate therapy
to slow progression of kidney disease?
A. Metformin
B. ACE inhibitor or ARB titrated to maximum tolerated dose
C. Thiazide diuretic
D. SGLT2 inhibitor
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
ACE inhibitor or ARB titrated to maximum tolerated dose** ACE inhibitors or
ARBs reduce proteinuria and slow CKD progression in diabetic kidney disease.
SGLT2 inhibitors also slow progression but are not first-line as monotherapy for
proteinuria reduction. Metformin is safe at eGFR >30 but does not slow
progression. </details>
Q8. A 62-year-old female with a history of hypertension presents with a blood
pressure of 155/95 mm Hg on lisinopril 20 mg daily. Home readings are similar.
Which of the following is the most appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 12.5 mg daily
D. Add carvedilol
<details> <summary>✅ Answer & Rationale</summary> **Correct Answer: B.
Add amlodipine 5 mg daily** Adding a calcium channel blocker to an ACE inhibitor
is an effective step for uncontrolled hypertension. Thiazide is also an option; CCB
pg. 4
