COMSAE Phase 2 – Latest 2026 Edition | Complete
Study Guide with Practice Questions, Correct Answers
& Expert Rationales | Osteopathic Medical Exam Prep |
Instant PDF
250 MULTIPLE-CHOICE QUESTIONS WITH
ANSWERS AND RATIONALES
Question 1
A 65-year-old male with a history of COPD and an
abdominal aortic aneurysm measuring 6.2 cm presents for
evaluation. Given his age and pulmonary comorbidities,
which approach is most appropriate for managing this
aneurysm?
A) Open surgical repair
B) Endovascular repair
C) Conservative management with serial ultrasound
surveillance
D) Immediate emergency surgery
✓ Correct Answer: B) Endovascular repair
✓ Rationale: Endovascular aneurysm repair is preferred in
elderly patients with significant comorbidities such as
COPD because it is less invasive than open surgical repair,
, reduces perioperative morbidity, and allows for faster
recovery while still effectively excluding the aneurysm
from circulation. Open repair carries higher mortality and
complication rates in patients with severe pulmonary
disease.
Question 2
A 45-year-old HIV-positive patient presents with
progressive vision loss and reports seeing floaters.
Fundoscopic examination reveals white opaque patches
with hemorrhagic necrosis of the retina. What is the most
likely diagnosis?
A) Toxoplasmosis retinitis
B) CMV retinitis
C) Herpes zoster ophthalmicus
D) Bacterial endophthalmitis
✓ Correct Answer: B) CMV retinitis
✓ Rationale: CMV retinitis is a common opportunistic
infection in immunocompromised HIV patients,
particularly those with CD4 counts below 50,
characterized by white opaque patches with hemorrhagic
necrosis on fundoscopic examination. Prompt diagnosis
and treatment with antiviral medications such as
ganciclovir are essential to prevent irreversible vision loss,
, as this condition can progress rapidly to blindness if left
untreated.
Question 3
A 55-year-old woman with GERD presents with persistent
heartburn and epigastric pain. During osteopathic
examination, tenderness is noted at the 5th intercostal
space on the left side. This Chapman point corresponds to
which condition?
A) Peptic ulcer disease
B) GERD
C) Cholecystitis
D) Pancreatitis
✓ Correct Answer: B) GERD
✓ Rationale: The Chapman point for GERD is located at the
5th intercostal space on the left side, corresponding to
stomach acidity and reflux. Chapman points are visceral
reflex points used in osteopathic diagnosis to identify
underlying organ dysfunction and guide treatment
approaches. These neurolymphatic reflexes can help
confirm clinical suspicion and direct appropriate
management strategies for gastrointestinal conditions.
, Question 4
A 30-year-old man presents with exquisite tenderness at
the apex of the sacrum that is worsened by sitting. What is
the most likely diagnosis?
A) Piriformis syndrome
B) Sacroiliac joint dysfunction
C) Sacrococcygeal strain
D) Lumbar radiculopathy
✓ Correct Answer: C) Sacrococcygeal strain
✓ Rationale: Sacrococcygeal strain presents with localized
tenderness at the apex of the sacrum that is exacerbated
by sitting, particularly on hard surfaces. This condition
often results from direct trauma such as a fall onto the
buttocks, prolonged sitting, or childbirth, and can be
managed with osteopathic manipulative treatment
including coccygeal release techniques, activity
modification, and use of cushioned seating to reduce
direct pressure on the coccyx.
Question 5
A 7-year-old child is brought to the emergency department
after being hit in the eye with a baseball. Examination
reveals impaired upward gaze and periorbital ecchymosis.
What is the most likely diagnosis?
Study Guide with Practice Questions, Correct Answers
& Expert Rationales | Osteopathic Medical Exam Prep |
Instant PDF
250 MULTIPLE-CHOICE QUESTIONS WITH
ANSWERS AND RATIONALES
Question 1
A 65-year-old male with a history of COPD and an
abdominal aortic aneurysm measuring 6.2 cm presents for
evaluation. Given his age and pulmonary comorbidities,
which approach is most appropriate for managing this
aneurysm?
A) Open surgical repair
B) Endovascular repair
C) Conservative management with serial ultrasound
surveillance
D) Immediate emergency surgery
✓ Correct Answer: B) Endovascular repair
✓ Rationale: Endovascular aneurysm repair is preferred in
elderly patients with significant comorbidities such as
COPD because it is less invasive than open surgical repair,
, reduces perioperative morbidity, and allows for faster
recovery while still effectively excluding the aneurysm
from circulation. Open repair carries higher mortality and
complication rates in patients with severe pulmonary
disease.
Question 2
A 45-year-old HIV-positive patient presents with
progressive vision loss and reports seeing floaters.
Fundoscopic examination reveals white opaque patches
with hemorrhagic necrosis of the retina. What is the most
likely diagnosis?
A) Toxoplasmosis retinitis
B) CMV retinitis
C) Herpes zoster ophthalmicus
D) Bacterial endophthalmitis
✓ Correct Answer: B) CMV retinitis
✓ Rationale: CMV retinitis is a common opportunistic
infection in immunocompromised HIV patients,
particularly those with CD4 counts below 50,
characterized by white opaque patches with hemorrhagic
necrosis on fundoscopic examination. Prompt diagnosis
and treatment with antiviral medications such as
ganciclovir are essential to prevent irreversible vision loss,
, as this condition can progress rapidly to blindness if left
untreated.
Question 3
A 55-year-old woman with GERD presents with persistent
heartburn and epigastric pain. During osteopathic
examination, tenderness is noted at the 5th intercostal
space on the left side. This Chapman point corresponds to
which condition?
A) Peptic ulcer disease
B) GERD
C) Cholecystitis
D) Pancreatitis
✓ Correct Answer: B) GERD
✓ Rationale: The Chapman point for GERD is located at the
5th intercostal space on the left side, corresponding to
stomach acidity and reflux. Chapman points are visceral
reflex points used in osteopathic diagnosis to identify
underlying organ dysfunction and guide treatment
approaches. These neurolymphatic reflexes can help
confirm clinical suspicion and direct appropriate
management strategies for gastrointestinal conditions.
, Question 4
A 30-year-old man presents with exquisite tenderness at
the apex of the sacrum that is worsened by sitting. What is
the most likely diagnosis?
A) Piriformis syndrome
B) Sacroiliac joint dysfunction
C) Sacrococcygeal strain
D) Lumbar radiculopathy
✓ Correct Answer: C) Sacrococcygeal strain
✓ Rationale: Sacrococcygeal strain presents with localized
tenderness at the apex of the sacrum that is exacerbated
by sitting, particularly on hard surfaces. This condition
often results from direct trauma such as a fall onto the
buttocks, prolonged sitting, or childbirth, and can be
managed with osteopathic manipulative treatment
including coccygeal release techniques, activity
modification, and use of cushioned seating to reduce
direct pressure on the coccyx.
Question 5
A 7-year-old child is brought to the emergency department
after being hit in the eye with a baseball. Examination
reveals impaired upward gaze and periorbital ecchymosis.
What is the most likely diagnosis?
