Page 1 of 114
Internal Medicine COMAT ACTUAL QUESTIONS
AND DETAILED SOLUTIONS LATEST UPDATE
THIS YEAR
Internal Medicine COMAT — Summarized Coverage
The Internal Medicine COMAT is administered by the National Board of Osteopathic Medical
Examiners and evaluates osteopathic medical students on diagnosis, management, pathophysiology,
pharmacology, and clinical reasoning across adult internal medicine conditions. Questions are
vignette-based and emphasize next-best-step management, interpretation of labs/imaging, and
integrated clinical decision-making.
1. Hypertension diagnosis, staging, complications, and antihypertensive management
2. Coronary artery disease, stable angina, ACS, STEMI/NSTEMI management
3. Heart failure (HFrEF vs HFpEF), volume status, and medication therapy
4. Cardiac arrhythmias: atrial fibrillation, SVT, VT, AV blocks, ECG interpretation
5. Valvular heart disease and murmur recognition
6. Shock states: septic, cardiogenic, hypovolemic, obstructive
7. COPD and asthma diagnosis, exacerbation treatment, and inhaler therapy
8. Pneumonia types, causative organisms, and antibiotic selection
9. Pulmonary embolism and DVT diagnosis and anticoagulation
10. Pleural effusion, pneumothorax, and ARDS recognition and management
11. Chronic kidney disease, AKI, electrolyte disorders, and dialysis indications
12. Acid-base disorders and compensation interpretation
13. Diabetes mellitus management, insulin therapy, DKA vs HHS
14. Thyroid disorders: hypothyroidism, hyperthyroidism, thyroid storm, myxedema coma
15. Adrenal disorders: Addison disease, Cushing syndrome, pheochromocytoma
16. Liver disease: hepatitis, cirrhosis, portal hypertension, hepatic encephalopathy
17. GI bleeding evaluation and management (upper vs lower GI bleed)
18. Pancreatitis, gallbladder disease, and biliary obstruction
19. Inflammatory bowel disease vs irritable bowel syndrome differentiation
20. Anemia workup: microcytic, macrocytic, normocytic patterns
21. Leukemia, lymphoma, coagulation disorders, DIC, TTP, HUS
22. Infectious diseases: HIV, sepsis, endocarditis, cellulitis, osteomyelitis
23. Rheumatologic disorders: RA, SLE, vasculitis, gout, polymyalgia rheumatica
24. Neurologic conditions: stroke, seizure disorders, delirium, dementia
25. Psychiatry in medicine: depression, anxiety, substance withdrawal, delirium
26. Preventive medicine and screening guidelines (vaccines, cancer screening)
27. Interpretation of CBC, CMP, troponins, ABGs, urinalysis, cultures, imaging
28. Antibiotic selection, adverse effects, and resistance principles
29. Osteopathic principles and OMM integration in internal medicine conditions
30. Integrated board-style management scenarios involving diagnosis, stabilization,
pharmacologic treatment, complications, and next-best-step clinical reasoning
, Page 2 of 114
Internal Medicine COMAT — Practice Questions (Batch 1: Questions 1–50)
Q1. A 55-year-old patient has repeated blood pressure readings of 148/92 mmHg on two separate visits.
Which diagnosis is most appropriate?
A. Normal blood pressure
B. Stage 2 hypertension
C. Stage 1 hypertension
D. Hypertensive emergency
Answer: C
Rationale: 140–159/90–99 mmHg defines Stage 1 hypertension based on current classification systems.
Q2. A patient with chest pain shows ST elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
, Page 3 of 114
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
Answer: B
Rationale: Inferior wall MI (II, III, aVF) is most commonly due to right coronary artery occlusion.
Q3. A patient presents with sudden shortness of breath, pleuritic chest pain, and tachycardia. What is
the most appropriate next step if PE is suspected and patient is stable?
A. Immediate thrombolysis
B. CT pulmonary angiography
C. Chest X-ray only
D. Bronchoscopy
Answer: B
Rationale: Stable patients with suspected PE should undergo CT pulmonary angiography for
confirmation.
, Page 4 of 114
Q4. A patient has an ejection fraction of 30% and symptoms of dyspnea and fatigue. Which medication
improves mortality in HFrEF?
A. Furosemide
B. ACE inhibitor
C. Acetaminophen
D. Albuterol
Answer: B
Rationale: ACE inhibitors reduce mortality and remodeling in heart failure with reduced ejection
fraction.
Q5. A patient presents with wheezing, chest tightness, and reversible airway obstruction. Which first-
line rescue medication is indicated?
A. Inhaled corticosteroid
B. Short-acting beta-agonist
Internal Medicine COMAT ACTUAL QUESTIONS
AND DETAILED SOLUTIONS LATEST UPDATE
THIS YEAR
Internal Medicine COMAT — Summarized Coverage
The Internal Medicine COMAT is administered by the National Board of Osteopathic Medical
Examiners and evaluates osteopathic medical students on diagnosis, management, pathophysiology,
pharmacology, and clinical reasoning across adult internal medicine conditions. Questions are
vignette-based and emphasize next-best-step management, interpretation of labs/imaging, and
integrated clinical decision-making.
1. Hypertension diagnosis, staging, complications, and antihypertensive management
2. Coronary artery disease, stable angina, ACS, STEMI/NSTEMI management
3. Heart failure (HFrEF vs HFpEF), volume status, and medication therapy
4. Cardiac arrhythmias: atrial fibrillation, SVT, VT, AV blocks, ECG interpretation
5. Valvular heart disease and murmur recognition
6. Shock states: septic, cardiogenic, hypovolemic, obstructive
7. COPD and asthma diagnosis, exacerbation treatment, and inhaler therapy
8. Pneumonia types, causative organisms, and antibiotic selection
9. Pulmonary embolism and DVT diagnosis and anticoagulation
10. Pleural effusion, pneumothorax, and ARDS recognition and management
11. Chronic kidney disease, AKI, electrolyte disorders, and dialysis indications
12. Acid-base disorders and compensation interpretation
13. Diabetes mellitus management, insulin therapy, DKA vs HHS
14. Thyroid disorders: hypothyroidism, hyperthyroidism, thyroid storm, myxedema coma
15. Adrenal disorders: Addison disease, Cushing syndrome, pheochromocytoma
16. Liver disease: hepatitis, cirrhosis, portal hypertension, hepatic encephalopathy
17. GI bleeding evaluation and management (upper vs lower GI bleed)
18. Pancreatitis, gallbladder disease, and biliary obstruction
19. Inflammatory bowel disease vs irritable bowel syndrome differentiation
20. Anemia workup: microcytic, macrocytic, normocytic patterns
21. Leukemia, lymphoma, coagulation disorders, DIC, TTP, HUS
22. Infectious diseases: HIV, sepsis, endocarditis, cellulitis, osteomyelitis
23. Rheumatologic disorders: RA, SLE, vasculitis, gout, polymyalgia rheumatica
24. Neurologic conditions: stroke, seizure disorders, delirium, dementia
25. Psychiatry in medicine: depression, anxiety, substance withdrawal, delirium
26. Preventive medicine and screening guidelines (vaccines, cancer screening)
27. Interpretation of CBC, CMP, troponins, ABGs, urinalysis, cultures, imaging
28. Antibiotic selection, adverse effects, and resistance principles
29. Osteopathic principles and OMM integration in internal medicine conditions
30. Integrated board-style management scenarios involving diagnosis, stabilization,
pharmacologic treatment, complications, and next-best-step clinical reasoning
, Page 2 of 114
Internal Medicine COMAT — Practice Questions (Batch 1: Questions 1–50)
Q1. A 55-year-old patient has repeated blood pressure readings of 148/92 mmHg on two separate visits.
Which diagnosis is most appropriate?
A. Normal blood pressure
B. Stage 2 hypertension
C. Stage 1 hypertension
D. Hypertensive emergency
Answer: C
Rationale: 140–159/90–99 mmHg defines Stage 1 hypertension based on current classification systems.
Q2. A patient with chest pain shows ST elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
, Page 3 of 114
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
Answer: B
Rationale: Inferior wall MI (II, III, aVF) is most commonly due to right coronary artery occlusion.
Q3. A patient presents with sudden shortness of breath, pleuritic chest pain, and tachycardia. What is
the most appropriate next step if PE is suspected and patient is stable?
A. Immediate thrombolysis
B. CT pulmonary angiography
C. Chest X-ray only
D. Bronchoscopy
Answer: B
Rationale: Stable patients with suspected PE should undergo CT pulmonary angiography for
confirmation.
, Page 4 of 114
Q4. A patient has an ejection fraction of 30% and symptoms of dyspnea and fatigue. Which medication
improves mortality in HFrEF?
A. Furosemide
B. ACE inhibitor
C. Acetaminophen
D. Albuterol
Answer: B
Rationale: ACE inhibitors reduce mortality and remodeling in heart failure with reduced ejection
fraction.
Q5. A patient presents with wheezing, chest tightness, and reversible airway obstruction. Which first-
line rescue medication is indicated?
A. Inhaled corticosteroid
B. Short-acting beta-agonist
