COMSAE Phase 2–Style Practice Exam (Form
106 Inspired) Test Questions and Correct
Answers (Verified Answers) Plus Rationales
1.
A 45-year-old woman presents with progressive fatigue and conjunctival pallor.
Labs show MCV 72 fL, Hb 9.8 g/dL, ferritin low, TIBC high.
What is the most likely cause?
A. Thalassemia minor
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Lead poisoning
Rationale: Microcytic anemia with low ferritin and high TIBC is classic for iron
deficiency.
2.
A 25-year-old woman develops sudden pleuritic chest pain and dyspnea after
starting oral contraceptives. HR 120, O2 sat 88%. CT angiography shows filling
defect in pulmonary arteries.
Next best step?
A. Aspirin
B. Anticoagulation with heparin
C. IVC filter
, D. Thrombolysis
Rationale: Stable PE requires anticoagulation first; thrombolysis reserved for
massive PE with hemodynamic instability.
3.
A 60-year-old man has exertional chest pain relieved by rest. Stress test shows ST
depressions.
What is the most appropriate long-term therapy to reduce mortality?
A. Nitroglycerin as needed
B. Beta blocker
C. Calcium channel blocker
D. Aspirin only
Rationale: Beta blockers improve survival in stable angina by decreasing
myocardial oxygen demand.
4.
A 7-year-old boy has recurrent infections, eczema, and thrombocytopenia.
Which condition is most likely?
A. Bruton's agammaglobulinemia
B. Wiskott–Aldrich syndrome
C. DiGeorge syndrome
D. SCID
Rationale: Triad = immunodeficiency, eczema, thrombocytopenia.
5.
,A 30-year-old man with HIV presents with headache and fever. CSF: opening
pressure high, India ink prep positive.
Most appropriate initial treatment?
A. Fluconazole oral
B. Amphotericin B + flucytosine
C. TMP-SMX
D. Acyclovir
Rationale: Cryptococcus meningitis is treated initially with amphotericin B and
flucytosine.
6.
A 55-year-old man with hypertension presents with tearing chest pain radiating to
the back. BP 180/100, asymmetric pulses.
Best initial diagnostic test?
A. Chest X-ray
B. CT angiography of chest/abdomen
C. Cardiac enzymes
D. Echocardiogram
Rationale: CTA is the best initial test for aortic dissection (if stable). TEE if
unstable.
7.
A 28-year-old woman develops symmetric morning joint stiffness >1 hour, sparing
DIP joints.
Which test is most specific?
A. ANA
B. Rheumatoid factor
, C. Anti-CCP antibody
D. ESR
Rationale: Anti-CCP is most specific for rheumatoid arthritis.
8.
A 40-year-old alcoholic has confusion, ataxia, and nystagmus.
Which vitamin deficiency is most likely?
A. Niacin
B. Thiamine
C. Vitamin B12
D. Folate
Rationale: Wernicke encephalopathy = thiamine deficiency.
9.
A 16-year-old girl presents with abdominal pain, amenorrhea, and a blue bulging
mass at the vaginal introitus.
Diagnosis?
A. Ovarian torsion
B. Imperforate hymen
C. Endometriosis
D. Ectopic pregnancy
Rationale: Imperforate hymen → hematocolpos → bulging bluish mass.
10.
106 Inspired) Test Questions and Correct
Answers (Verified Answers) Plus Rationales
1.
A 45-year-old woman presents with progressive fatigue and conjunctival pallor.
Labs show MCV 72 fL, Hb 9.8 g/dL, ferritin low, TIBC high.
What is the most likely cause?
A. Thalassemia minor
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Lead poisoning
Rationale: Microcytic anemia with low ferritin and high TIBC is classic for iron
deficiency.
2.
A 25-year-old woman develops sudden pleuritic chest pain and dyspnea after
starting oral contraceptives. HR 120, O2 sat 88%. CT angiography shows filling
defect in pulmonary arteries.
Next best step?
A. Aspirin
B. Anticoagulation with heparin
C. IVC filter
, D. Thrombolysis
Rationale: Stable PE requires anticoagulation first; thrombolysis reserved for
massive PE with hemodynamic instability.
3.
A 60-year-old man has exertional chest pain relieved by rest. Stress test shows ST
depressions.
What is the most appropriate long-term therapy to reduce mortality?
A. Nitroglycerin as needed
B. Beta blocker
C. Calcium channel blocker
D. Aspirin only
Rationale: Beta blockers improve survival in stable angina by decreasing
myocardial oxygen demand.
4.
A 7-year-old boy has recurrent infections, eczema, and thrombocytopenia.
Which condition is most likely?
A. Bruton's agammaglobulinemia
B. Wiskott–Aldrich syndrome
C. DiGeorge syndrome
D. SCID
Rationale: Triad = immunodeficiency, eczema, thrombocytopenia.
5.
,A 30-year-old man with HIV presents with headache and fever. CSF: opening
pressure high, India ink prep positive.
Most appropriate initial treatment?
A. Fluconazole oral
B. Amphotericin B + flucytosine
C. TMP-SMX
D. Acyclovir
Rationale: Cryptococcus meningitis is treated initially with amphotericin B and
flucytosine.
6.
A 55-year-old man with hypertension presents with tearing chest pain radiating to
the back. BP 180/100, asymmetric pulses.
Best initial diagnostic test?
A. Chest X-ray
B. CT angiography of chest/abdomen
C. Cardiac enzymes
D. Echocardiogram
Rationale: CTA is the best initial test for aortic dissection (if stable). TEE if
unstable.
7.
A 28-year-old woman develops symmetric morning joint stiffness >1 hour, sparing
DIP joints.
Which test is most specific?
A. ANA
B. Rheumatoid factor
, C. Anti-CCP antibody
D. ESR
Rationale: Anti-CCP is most specific for rheumatoid arthritis.
8.
A 40-year-old alcoholic has confusion, ataxia, and nystagmus.
Which vitamin deficiency is most likely?
A. Niacin
B. Thiamine
C. Vitamin B12
D. Folate
Rationale: Wernicke encephalopathy = thiamine deficiency.
9.
A 16-year-old girl presents with abdominal pain, amenorrhea, and a blue bulging
mass at the vaginal introitus.
Diagnosis?
A. Ovarian torsion
B. Imperforate hymen
C. Endometriosis
D. Ectopic pregnancy
Rationale: Imperforate hymen → hematocolpos → bulging bluish mass.
10.
