NBME COMSAE Exam Study Guide Latest Update
2026 | Pass Exam Prep
1. The placenta either completely or partially covers the cervical opening,
preventing the mother from delivering the baby vaginally. As a result, the
baby must be delivered by Caesarean section. This condition occurs in 1 in
250 live births. Risk factors include prior Caesarean delivery, multiple
pregnancies, intrauterine surgery, smoking, multiple gestations, and advanced
maternal age. Previas often present as painless bright red vaginal bleeding
and may or may not be associated with contractions. They account for 20
percent of bleeding in the third trimester.
A complication of pregnancy in which the placenta covers the cervical
opening, preventing the mother from delivering the baby vaginally.
placenta previa
2. Post-coital Contraception: Which of the following correctly describes the
mechanism of action of the contragestation products, Mifepristone and
Ulipristol?
Progesterone agonists
Estrogen agonists
Estrogen antagonists
Progesterone antagonists
3. What type of visual field defect is caused by damage to the right optic
nerve?
Left anopia
Quadrantanopia
Right anopia
, Bitemporal hemianopia
4. Which of the following is a sign of an ulnar nerve injury?
Sudden locking of the elbow joint
Paresthesia to the fourth and fifth fingers
Hemorrhage, swelling, and muscle spasm in the forearm
Sharp pain in the elbow joint
5. If a patient presents with a flat deltoid and loss of sensation over the lateral
arm, what condition might they be experiencing, and what would be the next
step in management?
Brachial plexus injury; start pain management.
Rotator cuff tear; recommend physical therapy.
Shoulder dislocation; refer for immediate surgery.
Axillary nerve injury; perform a physical examination and consider
imaging.
6. Describe the biochemical process that is impaired in Gilbert Syndrome and
its effect on bilirubin levels.
Gilbert Syndrome is characterized by normal UDP
glucuronosyltransferase activity with elevated conjugated bilirubin.
Gilbert Syndrome is caused by a complete lack of UDP
glucuronosyltransferase, resulting in high conjugated bilirubin levels.
Gilbert Syndrome involves a mild decrease in UDP
glucuronosyltransferase activity, leading to impaired bilirubin
conjugation and elevated unconjugated bilirubin levels.
, Gilbert Syndrome results from an increase in UDP
glucuronosyltransferase, causing decreased bilirubin levels.
7. Describe the mechanism of action of Bupropion in relation to
neurotransmitter levels.
Bupropion blocks the receptors for norepinephrine and dopamine,
reducing their effects.
Bupropion enhances the release of serotonin and GABA, decreasing
their levels in the synaptic cleft.
Bupropion inhibits the reuptake of norepinephrine and dopamine,
increasing their levels in the synaptic cleft.
Bupropion promotes the synthesis of acetylcholine, enhancing its
action in the brain.
8. Describe the physiological mechanism that leads to decompression disease
in divers.
Decompression disease is a result of muscle fatigue after prolonged
diving.
Decompression disease is caused by a lack of oxygen during deep
dives.
Decompression disease results from excessive carbon dioxide
buildup in the bloodstream.
Decompression disease occurs when nitrogen bubbles form in the
body due to rapid ascent after deep diving.
9. Describe the clinical implications of placenta increta compared to placenta
accreta.
Placenta increta is less severe and requires no special management,
while placenta accreta requires immediate surgical intervention.
, Placenta increta poses a higher risk of hemorrhage and
complications during delivery due to deeper invasion into the
myometrium compared to placenta accreta.
Placenta increta and placenta accreta have the same clinical
implications and management strategies.
Placenta increta is associated with lower risk of complications than
placenta accreta.
10. If a patient is diagnosed with placenta accreta, what management strategies
should be considered to prevent complications during delivery?
No specific management is needed as placenta accreta resolves on
its own.
Immediate vaginal delivery without intervention should be planned.
Careful monitoring and planning for potential surgical intervention,
such as a cesarean hysterectomy, should be considered.
Only medication management is required without surgical options.
11. Both carotid massage and valsalva maneuvers both reduce heart rate and
blood pressure by:
decreasing venous return
choking the patient
decreasing preload
stimulating baroreceptors
stimulating chemoreceptors
12. Describe the potential complications associated with placenta previa during
pregnancy.
2026 | Pass Exam Prep
1. The placenta either completely or partially covers the cervical opening,
preventing the mother from delivering the baby vaginally. As a result, the
baby must be delivered by Caesarean section. This condition occurs in 1 in
250 live births. Risk factors include prior Caesarean delivery, multiple
pregnancies, intrauterine surgery, smoking, multiple gestations, and advanced
maternal age. Previas often present as painless bright red vaginal bleeding
and may or may not be associated with contractions. They account for 20
percent of bleeding in the third trimester.
A complication of pregnancy in which the placenta covers the cervical
opening, preventing the mother from delivering the baby vaginally.
placenta previa
2. Post-coital Contraception: Which of the following correctly describes the
mechanism of action of the contragestation products, Mifepristone and
Ulipristol?
Progesterone agonists
Estrogen agonists
Estrogen antagonists
Progesterone antagonists
3. What type of visual field defect is caused by damage to the right optic
nerve?
Left anopia
Quadrantanopia
Right anopia
, Bitemporal hemianopia
4. Which of the following is a sign of an ulnar nerve injury?
Sudden locking of the elbow joint
Paresthesia to the fourth and fifth fingers
Hemorrhage, swelling, and muscle spasm in the forearm
Sharp pain in the elbow joint
5. If a patient presents with a flat deltoid and loss of sensation over the lateral
arm, what condition might they be experiencing, and what would be the next
step in management?
Brachial plexus injury; start pain management.
Rotator cuff tear; recommend physical therapy.
Shoulder dislocation; refer for immediate surgery.
Axillary nerve injury; perform a physical examination and consider
imaging.
6. Describe the biochemical process that is impaired in Gilbert Syndrome and
its effect on bilirubin levels.
Gilbert Syndrome is characterized by normal UDP
glucuronosyltransferase activity with elevated conjugated bilirubin.
Gilbert Syndrome is caused by a complete lack of UDP
glucuronosyltransferase, resulting in high conjugated bilirubin levels.
Gilbert Syndrome involves a mild decrease in UDP
glucuronosyltransferase activity, leading to impaired bilirubin
conjugation and elevated unconjugated bilirubin levels.
, Gilbert Syndrome results from an increase in UDP
glucuronosyltransferase, causing decreased bilirubin levels.
7. Describe the mechanism of action of Bupropion in relation to
neurotransmitter levels.
Bupropion blocks the receptors for norepinephrine and dopamine,
reducing their effects.
Bupropion enhances the release of serotonin and GABA, decreasing
their levels in the synaptic cleft.
Bupropion inhibits the reuptake of norepinephrine and dopamine,
increasing their levels in the synaptic cleft.
Bupropion promotes the synthesis of acetylcholine, enhancing its
action in the brain.
8. Describe the physiological mechanism that leads to decompression disease
in divers.
Decompression disease is a result of muscle fatigue after prolonged
diving.
Decompression disease is caused by a lack of oxygen during deep
dives.
Decompression disease results from excessive carbon dioxide
buildup in the bloodstream.
Decompression disease occurs when nitrogen bubbles form in the
body due to rapid ascent after deep diving.
9. Describe the clinical implications of placenta increta compared to placenta
accreta.
Placenta increta is less severe and requires no special management,
while placenta accreta requires immediate surgical intervention.
, Placenta increta poses a higher risk of hemorrhage and
complications during delivery due to deeper invasion into the
myometrium compared to placenta accreta.
Placenta increta and placenta accreta have the same clinical
implications and management strategies.
Placenta increta is associated with lower risk of complications than
placenta accreta.
10. If a patient is diagnosed with placenta accreta, what management strategies
should be considered to prevent complications during delivery?
No specific management is needed as placenta accreta resolves on
its own.
Immediate vaginal delivery without intervention should be planned.
Careful monitoring and planning for potential surgical intervention,
such as a cesarean hysterectomy, should be considered.
Only medication management is required without surgical options.
11. Both carotid massage and valsalva maneuvers both reduce heart rate and
blood pressure by:
decreasing venous return
choking the patient
decreasing preload
stimulating baroreceptors
stimulating chemoreceptors
12. Describe the potential complications associated with placenta previa during
pregnancy.
