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COMSAE PHASE 2 FORM 110 — PRACTICE EXAM
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025/2026 Q&A |
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A 56-year-old man presents with substernal chest pain that began 1 hour ago while he was mowing the lawn. The pain is pressure-like and radiates to the left arm. ECG shows ST elevation in leads II, III, and aVF. Next best step in management?
- A. Give sublingual nitroglycerin
- B. Administer aspirin and activate cardiac catheterization lab
- C. Start IV heparin only
- D. Order a chest X-ray
Answer: B. Administer aspirin and activate cardiac catheterization lab ST elevation in II, III, aVF = inferior STEMI. Reperfusion therapy is required (PCI if available). Aspirin reduces mortality. Chest X-ray is not appropriate initially, and nitro is supportive but not definitive.
A 25-year-old woman presents with fever, dysuria, and flank pain. Urinalysis shows WBC casts. Best treatment?
- A. Oral nitrofurantoin
- B. IV ceftriaxone
- C. Oral ciprofloxacin
- D. IV vancomycin
Answer: B. IV ceftriaxone WBC casts indicate pyelonephritis. Inpatient IV therapy (ceftriaxone) is indicated for systemic symptoms. Nitrofurantoin is for simple cystitis, not pyelo.
A 60-year-old man with chronic alcohol use presents with confusion, ataxia, and ophthalmoplegia. Which vitamin deficiency is most likely?
- A. Vitamin B1 (thiamine)
- B. Vitamin B6 (pyridoxine)
- C. Vitamin B12 (cobalamin)
- D. Vitamin C
Answer: A. Vitamin B1 (thiamine) Classic Wernicke encephalopathy triad: confusion, ataxia, ophthalmoplegia → thiamine deficiency.
A 32-year-old woman presents with fatigue, weight gain, constipation, and dry skin. TSH is elevated. Best treatment?
- A. Methimazole
- B. Levothyroxine
- C. Radioactive iodine
- D. Propranolol
Answer: B. Levothyroxine Primary hypothyroidism (high TSH). Levothyroxine is standard treatment.
Answer: A. Levodopa-carbidopa Parkinson’s first-line therapy in elderly is levodopa-carbidopa. Dopamine agonists are more often used in younger patients.
A 22-year-old woman presents with RLQ abdominal pain, fever, and leukocytosis. What is the most likely diagnosis?
- A. Ectopic pregnancy
- B. Appendicitis
- C. Ovarian torsion
- D. Pelvic inflammatory disease
Answer: B. Appendicitis Classic presentation of appendicitis in a young adult with RLQ pain and leukocytosis.
A 3-year-old girl presents with a barking cough, stridor, and hoarseness. Symptoms worsen at night. Best initial management?
- A. Racemic epinephrine
- B. IV dexamethasone
- C. Humidified air and corticosteroids
- D. Intubation
Answer: C. Humidified air and corticosteroids Croup (parainfluenza). Mild-moderate cases managed with humidified air + corticosteroids. Racemic epi for severe cases.
A 45-year-old man has RUQ pain, fever, and jaundice. Best next step in management?
- A. ERCP
- B. IV antibiotics
- C. Cholecystectomy
- D. Abdominal CT scan
Answer: A. ERCP Charcot’s triad (RUQ pain, fever, jaundice) = ascending cholangitis → urgent biliary decompression (ERCP). Antibiotics supportive but not definitive.
A 30-year-old woman presents with sudden onset pleuritic chest pain and dyspnea. She is tachycardic and hypoxic. D-dimer is elevated. Best next test?
- A. Chest X-ray
- B. CT pulmonary angiography
- C. V/Q scan
- D. ECG
Answer: B. CT pulmonary angiography In a hemodynamically stable patient with high suspicion and elevated D-dimer, CTA is the diagnostic test of choice for PE.
- D. Reassure and follow up in 6 months
Answer: B. Mammography and targeted ultrasound Imaging with mammography (age >30) plus ultrasound for characterization is appropriate; biopsy follows suspicious findings.
A 28-year-old pregnant woman at 32 weeks has severe preeclampsia with HELLP features. Best definitive management?
- A. Expectant outpatient care
- B. Magnesium sulfate and immediate delivery
- C. Oral antihypertensives only
- D. Delay delivery until 37 weeks
Answer: B. Magnesium sulfate and immediate delivery Severe preeclampsia with HELLP requires stabilization (MgSO₄ for seizure prophylaxis) and prompt delivery, balancing maternal/fetal status.
A patient presents with acute onset unilateral painless vision loss described as “curtain coming down.” Next best step?
- A. Urgent ophthalmology evaluation for retinal detachment
- B. MRI brain
- C. Slit-lamp exam for uveitis
- D. Visual acuity chart only
Answer: A. Urgent ophthalmology evaluation for retinal detachment The “curtain” description is classic for retinal detachment — ophthalmic emergency requiring prompt evaluation.
A 50-year-old man with progressive dyspnea, nonproductive cough, and basilar crackles. Chest CT shows honeycombing. Most likely diagnosis?
- A. UIP/IPF (idiopathic pulmonary fibrosis)
- B. COPD emphysema
- C. Pulmonary edema
- D. Sarcoidosis
Answer: A. UIP/IPF (idiopathic pulmonary fibrosis) Honeycombing and basilar predominant fibrosis suggest usual interstitial pneumonia / IPF.
A 40-year-old woman with bulging red eye, lid retraction, and proptosis. Thyroid function tests show low TSH and high T4. Diagnosis?
- A. Myasthenia gravis
- B. Graves ophthalmopathy (thyroid eye disease)
- C. Orbital cellulitis
- D. Cavernous sinus thrombosis
Answer: B. Graves ophthalmopathy (thyroid eye disease) Proptosis, lid retraction with hyperthyroidism is typical of Graves orbitopathy.
A 66-year-old man with painless hematuria. Best next step?
- A. Urinary culture
- B. CT urogram and cystoscopy
- C. Repeat urinalysis in one week
A 55-year-old man with chronic back pain takes high-dose NSAIDs and now has melena and low hemoglobin. Best next step?
- A. Stop NSAIDs and start PPI; consider GI consult for endoscopy
- B. Start oral iron only
- C. Switch to acetaminophen and discharge
- D. Observe
Answer: A. Stop NSAIDs and start PPI; consider GI consult for endoscopy NSAID-associated upper GI bleed requires stopping offending agent, acid suppression, and endoscopic evaluation when stable.
A 3-week-old infant has projectile vomiting and a palpable olive-shaped mass in the RUQ. Most appropriate diagnosis?
- A. Pyloric stenosis
- B. Intussusception
- C. GERD
- D. Malrotation with volvulus
Answer: A. Pyloric stenosis Infantile hypertrophic pyloric stenosis presents with projectile nonbilious vomiting and palpable olive mass.
A 35-year-old presents with unilateral facial paralysis that developed overnight; he can raise his eyebrows. Diagnosis?
- A. Bell palsy (peripheral facial nerve palsy)
- B. Stroke (central lesion)
- C. Ramsay Hunt syndrome
- D. Myasthenia gravis
Answer: B. Stroke (central lesion) If the patient CAN raise eyebrows, forehead is spared — suggests upper motor neuron (central) lesion, e.g., stroke. Peripheral (Bell) causes forehead involvement.
A patient on warfarin has an INR of 10 but no bleeding. Best management?
- A. Give vitamin K orally and hold warfarin
- B. Give IV vitamin K and prothrombin complex concentrate (PCC) immediately
- C. Continue warfarin and recheck INR in 24 hours
- D. Start low-molecular-weight heparin
Answer: A. Give vitamin K orally and hold warfarin For very high INR without bleeding, oral vitamin K and temporary hold of warfarin is recommended. PCC reserved for serious bleeding.
A 45-year-old woman with erythema migrans following a tick bite. Best next step?
- A. Doxycycline for 10–21 days
- B. Amoxicillin for 3 days
- C. No treatment required
- D. Single dose azithromycin
A 19-year-old male has knee pain after a twisting injury; positive anterior drawer test. Most likely injured structure?
- A. Medial meniscus
- B. Lateral collateral ligament
- C. Anterior cruciate ligament (ACL)
- D. Patellar tendon
Answer: C. Anterior cruciate ligament (ACL) Twisting injury with positive anterior drawer indicates ACL tear.
A 62-year-old man with chronic hepatitis B develops ascites and jaundice; US shows nodular liver. Best screening test for hepatocellular carcinoma?
- A. AFP (alpha-fetoprotein) and abdominal ultrasound every 6 months
- B. CT abdomen yearly
- C. MRI yearly
- D. No screening indicated
Answer: A. AFP and abdominal ultrasound every 6 months Patients with cirrhosis from hepatitis B are screened for HCC with ultrasound ± AFP every 6 months.
A patient presents with severe hyperkalemia (K+ 6.8 mEq/L) and peaked T waves on ECG. Immediate step?
- A. IV calcium gluconate, then insulin with dextrose
- B. IV furosemide only
- C. Oral kayexalate only
- D. Start oral potassium supplements
Answer: A. IV calcium gluconate, then insulin with dextrose Calcium stabilizes the myocardium; insulin (with glucose) shifts K+ intracellularly — immediate measures in severe hyperkalemia.
A 50-year-old man presents with sudden painless loss of vision in one eye; fundoscopic exam reveals a pale retina with a cherry-red spot. Diagnosis?
- A. Central retinal artery occlusion
- B. Retinal detachment
- C. Central retinal vein occlusion
- D. Optic neuritis
Answer: A. Central retinal artery occlusion CRA occlusion shows pale retina and cherry-red spot; sudden painless monocular vision loss is classic.
A patient with COPD presents with acute worsening dyspnea, increased sputum purulence, and volume. Best treatment?
- A. Inhaled bronchodilators, systemic steroids, and antibiotics as indicated
- B. Start long-term oxygen only
- C. Immediate lung transplant referral
- D. Antiviral therapy
Answer: A. Inhaled bronchodilators, systemic steroids, and antibiotics as indicated COPD exacerbation management includes bronchodilators, systemic corticosteroids, and antibiotics if bacterial infection suspected.
- A. PCOS (polycystic ovary syndrome)
- B. Cushing syndrome
- C. Hypothyroidism
- D. Premature ovarian failure
Answer: A. PCOS (polycystic ovary syndrome) Clinical features and LH:FSH pattern are typical for PCOS.
A 70-year-old man has difficulty initiating urination, weak stream, and nocturia. First-line medical therapy?
- A. Tamsulosin (alpha-1 blocker)
- B. Finasteride immediately
- C. Urgent prostatectomy
- D. Sildenafil
Answer: A. Tamsulosin (alpha-1 blocker) Alpha-1 blockers relieve urinary obstruction symptoms quickly; 5-alpha-reductase inhibitors like finasteride are used for long-term reduction in prostate size.
A patient presents with fever, severe headache, photophobia, and neck stiffness. CSF shows neutrophilic pleocytosis, low glucose, and high protein. Most likely cause?
- A. Bacterial meningitis
- B. Viral meningitis
- C. Fungal meningitis
- D. Subarachnoid hemorrhage
Answer: A. Bacterial meningitis Neutrophilic CSF with low glucose is consistent with bacterial meningitis — treat promptly with empiric IV antibiotics and consider dexamethasone.
A 4-year-old with recurrent otitis media refractory to medical therapy. Next recommended intervention?
- A. Tympanostomy tube placement (myringotomy with tubes)
- B. Adenoidectomy only
- C. Tonsillectomy only
- D. Observation
Answer: A. Tympanostomy tube placement (myringotomy with tubes) Recurrent otitis media with effusion despite medical therapy — ear tubes reduce recurrences and complications.
A 58-year-old woman with severe, sudden abdominal pain out of proportion to exam. Risk factors include AFib. Best initial test?
- A. CT angiography of the abdomen
- B. Abdominal X-ray
- C. Serum amylase only
- D. Colonoscopy
Answer: A. CT angiography of the abdomen Acute mesenteric ischemia often presents with severe pain out of proportion — CTA is diagnostic to detect arterial occlusion.
- C. Inclusion body myositis
- D. Myasthenia gravis
Answer: A. Polymyositis Polymyositis has endomysial inflammation and CD8+ T cells; dermatomyositis shows perifascicular atrophy and skin findings.
A 29-year-old woman presents with fever, dysphagia, and a muffled “hot potato” voice; uvula deviated away from the lesion. Diagnosis?
- A. Peritonsillar abscess
- B. Retropharyngeal abscess
- C. Ludwig angina
- D. Epiglottitis
Answer: A. Peritonsillar abscess Muffled voice, uvular deviation and tonsillar bulging suggest peritonsillar abscess — needs drainage and antibiotics.
A 70-year-old man complains of progressive memory loss and frequent urinary incontinence with gait difficulty. MRI shows enlarged ventricles out of proportion to atrophy. Diagnosis?
- A. Normal pressure hydrocephalus
- B. Alzheimer dementia
- C. Vascular dementia
- D. Parkinson disease dementia
Answer: A. Normal pressure hydrocephalus Triad: gait disturbance, dementia, urinary incontinence with enlarged ventricles — consider CSF removal trial and shunting.
A 34-year-old presents with severe epigastric pain radiating to the back after heavy alcohol use. Lipase is elevated. Best initial management?
- A. Aggressive IV fluids, pain control, and NPO status
- B. Immediate ERCP in all cases
- C. Start oral feeding right away
- D. Immediate surgery
Answer: A. Aggressive IV fluids, pain control, and NPO status Acute pancreatitis initial care is supportive — fluids, analgesia, and bowel rest; ERCP indicated for biliary obstruction.
A 48-year-old man with red, swollen, painful great toe that started overnight and is extremely tender. Most likely diagnosis?
- A. Acute gouty arthritis
- B. Septic arthritis
- C. Cellulitis
- D. Osteoarthritis
Answer: A. Acute gouty arthritis Acute, extremely painful monoarthritis of the first MTP (podagra) is typical of gout; aspiration may be needed to rule out septic arthritis.
