COMSAE Phase 1 Form C115 Practice Exam
Questions And Correct Verified Detailed Answers
(GUARANTEED PASS)
Section 1: Cardiovascular System
A 58-year-old male with a history of hypertension presents with
sudden onset of severe, tearing chest pain radiating to the back.
Blood pressure is 150/90 in the right arm and 110/70 in the left
arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest
pain radiating to the back, often with blood pressure differential between
arms. Risk factors include hypertension and connective tissue disorders.
A 72-year-old male with chronic heart failure presents with
worsening dyspnea, jugular venous distention, and peripheral
edema. His ejection fraction is 35%. Which medication class has
been shown to reduce mortality in this condition?
,A) Calcium channel blockers
B) Beta-blockers
C) Direct vasodilators
D) Loop diuretics
Correct Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol)
reduce mortality in heart failure with reduced ejection fraction (HFrEF) by
decreasing sympathetic activation and reducing remodeling.
A 45-year-old female presents with palpitations, heat intolerance,
and weight loss. ECG shows atrial fibrillation with a ventricular rate
of 140. Thyroid-stimulating hormone (TSH) is undetectable. What is
the most appropriate next step in management?
A) Digoxin
B) Radioactive iodine ablation
C) Beta-blocker and antithyroid medication
D) Direct current cardioversion
Correct Answer: C
Rationale: In thyrotoxicosis-induced atrial fibrillation, beta-blockers
control the ventricular rate while antithyroid medications (methimazole,
propylthiouracil) address the underlying hyperthyroidism. Cardioversion
is less effective until the patient is euthyroid.
,A 68-year-old male with a history of coronary artery disease
presents with stable angina. He is already on aspirin and a statin.
Which medication should be added for antianginal and mortality
benefit?
A) Nitroglycerin sublingual
B) Ranolazine
C) Metoprolol
D) Verapamil
Correct Answer: C
Rationale: Beta-blockers (metoprolol, atenolol) reduce myocardial oxygen
demand, improve symptoms, and reduce mortality in patients with stable
angina and prior myocardial infarction.
A 55-year-old male with hypertension presents for a routine
physical. His blood pressure is 145/92. He has no comorbidities.
According to JNC 8 guidelines, what is the appropriate blood
pressure target for this patient?
A) <130/80
B) <140/90
C) <150/90
D) <160/100
Correct Answer: B
Rationale: For patients <60 years without diabetes or chronic kidney
, disease, the JNC 8 target is <140/90. The ACC/AHA 2017 guideline
recommends <130/80, but JNC 8 remains tested.
A 62-year-old female presents with dyspnea on exertion and fatigue.
On auscultation, there is a late-peaking crescendo-decrescendo
systolic murmur at the right upper sternal border radiating to the
carotids. What is the most likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: Aortic stenosis causes a late-peaking systolic murmur at the
right upper sternal border radiating to the carotids. Symptoms include
angina, syncope, and dyspnea (classic triad).
A 70-year-old male with a history of aortic stenosis presents with
syncope during exercise. Echocardiogram shows aortic valve area
of 0.8 cm² and mean gradient of 50 mmHg. What is the most
appropriate management?
A) Medical management with diuretics
B) Beta-blocker therapy
Questions And Correct Verified Detailed Answers
(GUARANTEED PASS)
Section 1: Cardiovascular System
A 58-year-old male with a history of hypertension presents with
sudden onset of severe, tearing chest pain radiating to the back.
Blood pressure is 150/90 in the right arm and 110/70 in the left
arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest
pain radiating to the back, often with blood pressure differential between
arms. Risk factors include hypertension and connective tissue disorders.
A 72-year-old male with chronic heart failure presents with
worsening dyspnea, jugular venous distention, and peripheral
edema. His ejection fraction is 35%. Which medication class has
been shown to reduce mortality in this condition?
,A) Calcium channel blockers
B) Beta-blockers
C) Direct vasodilators
D) Loop diuretics
Correct Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol)
reduce mortality in heart failure with reduced ejection fraction (HFrEF) by
decreasing sympathetic activation and reducing remodeling.
A 45-year-old female presents with palpitations, heat intolerance,
and weight loss. ECG shows atrial fibrillation with a ventricular rate
of 140. Thyroid-stimulating hormone (TSH) is undetectable. What is
the most appropriate next step in management?
A) Digoxin
B) Radioactive iodine ablation
C) Beta-blocker and antithyroid medication
D) Direct current cardioversion
Correct Answer: C
Rationale: In thyrotoxicosis-induced atrial fibrillation, beta-blockers
control the ventricular rate while antithyroid medications (methimazole,
propylthiouracil) address the underlying hyperthyroidism. Cardioversion
is less effective until the patient is euthyroid.
,A 68-year-old male with a history of coronary artery disease
presents with stable angina. He is already on aspirin and a statin.
Which medication should be added for antianginal and mortality
benefit?
A) Nitroglycerin sublingual
B) Ranolazine
C) Metoprolol
D) Verapamil
Correct Answer: C
Rationale: Beta-blockers (metoprolol, atenolol) reduce myocardial oxygen
demand, improve symptoms, and reduce mortality in patients with stable
angina and prior myocardial infarction.
A 55-year-old male with hypertension presents for a routine
physical. His blood pressure is 145/92. He has no comorbidities.
According to JNC 8 guidelines, what is the appropriate blood
pressure target for this patient?
A) <130/80
B) <140/90
C) <150/90
D) <160/100
Correct Answer: B
Rationale: For patients <60 years without diabetes or chronic kidney
, disease, the JNC 8 target is <140/90. The ACC/AHA 2017 guideline
recommends <130/80, but JNC 8 remains tested.
A 62-year-old female presents with dyspnea on exertion and fatigue.
On auscultation, there is a late-peaking crescendo-decrescendo
systolic murmur at the right upper sternal border radiating to the
carotids. What is the most likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: Aortic stenosis causes a late-peaking systolic murmur at the
right upper sternal border radiating to the carotids. Symptoms include
angina, syncope, and dyspnea (classic triad).
A 70-year-old male with a history of aortic stenosis presents with
syncope during exercise. Echocardiogram shows aortic valve area
of 0.8 cm² and mean gradient of 50 mmHg. What is the most
appropriate management?
A) Medical management with diuretics
B) Beta-blocker therapy
