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COMSAE Phase 1 Form 115 – EXAM COMPLETE QUESTIONS
AND DETAILED SOLUTIONS LATEST UPDATE THIS YEAR-JUST
RELEASED
COMSAE Phase 1 Form 115 – High-Yield ACTUAL Exam ( ALL Questions)
1. A 22-year-old woman presents with fatigue and pallor. Labs show Hb 9 g/dL, MCV 70 fL, ferritin low.
What is the most likely diagnosis?
A) Thalassemia
B) Iron deficiency anemia
C) Anemia of chronic disease
D) B12 deficiency
Answer: B
Rationale: Microcytic anemia (low MCV) with low ferritin is diagnostic of iron deficiency anemia; ferritin
reflects total body iron stores .
2. A 65-year-old smoker presents with painless gross hematuria. What is the most likely diagnosis?
A) Renal cell carcinoma
B) Bladder cancer
C) Nephrolithiasis
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D) Urinary tract infection
Answer: B
Rationale: Smoking is the strongest risk factor for urothelial (bladder) carcinoma. Painless hematuria is
the classic presentation .
3. A 45-year-old with alcohol use disorder has asterixis, confusion, and abdominal distension.
Ammonia is 190 µmol/L. Which medication directly lowers ammonia by enhancing nitrogen excretion
as hippurate?
A) Lactulose
B) Rifaximin
C) Sodium benzoate
D) Spironolactone
Answer: C
Rationale: Sodium benzoate conjugates glycine to form hippurate (renally excreted). Lactulose acidifies
the colon to trap NH4⁺ .
4. A patient presents with sudden severe headache described as the “worst of life.” What is the most
likely diagnosis?
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A) Migraine
B) Subarachnoid hemorrhage
C) Tension headache
D) Cluster headache
Answer: B
Rationale: A "thunderclap" headache (worst of life) is pathognomonic for subarachnoid hemorrhage
until proven otherwise .
5. A 72-year-old with Parkinson disease on carbidopa/levodopa develops dyskinesias. What is the
mechanism?
A) Supersensitive dopamine receptors with pulsatile stimulation
B) Direct NMDA receptor activation
C) GABA depletion
D) Serotonin toxicity
Answer: A
Rationale: Levodopa-induced dyskinesias result from pulsatile stimulation of supersensitive D2 receptors
in the striatum due to fluctuating drug levels .
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6. A 23-year-old man has fever, cough, and rusty sputum. CXR shows lobar consolidation. Most likely
organism?
A) Haemophilus influenzae
B) Mycoplasma pneumoniae
C) Streptococcus pneumoniae
D) Chlamydophila pneumoniae
Answer: C
Rationale: S. pneumoniae is the most common cause of lobar pneumonia; rusty sputum results from
extravasated blood mixed with inflammatory exudate .
7. A diabetic patient presents with fruity breath and Kussmaul respirations. What is the diagnosis?
A) Hypoglycemia
B) DKA
C) HHS
D) Lactic acidosis
Answer: B
COMSAE Phase 1 Form 115 – EXAM COMPLETE QUESTIONS
AND DETAILED SOLUTIONS LATEST UPDATE THIS YEAR-JUST
RELEASED
COMSAE Phase 1 Form 115 – High-Yield ACTUAL Exam ( ALL Questions)
1. A 22-year-old woman presents with fatigue and pallor. Labs show Hb 9 g/dL, MCV 70 fL, ferritin low.
What is the most likely diagnosis?
A) Thalassemia
B) Iron deficiency anemia
C) Anemia of chronic disease
D) B12 deficiency
Answer: B
Rationale: Microcytic anemia (low MCV) with low ferritin is diagnostic of iron deficiency anemia; ferritin
reflects total body iron stores .
2. A 65-year-old smoker presents with painless gross hematuria. What is the most likely diagnosis?
A) Renal cell carcinoma
B) Bladder cancer
C) Nephrolithiasis
, Page 2 of 139
D) Urinary tract infection
Answer: B
Rationale: Smoking is the strongest risk factor for urothelial (bladder) carcinoma. Painless hematuria is
the classic presentation .
3. A 45-year-old with alcohol use disorder has asterixis, confusion, and abdominal distension.
Ammonia is 190 µmol/L. Which medication directly lowers ammonia by enhancing nitrogen excretion
as hippurate?
A) Lactulose
B) Rifaximin
C) Sodium benzoate
D) Spironolactone
Answer: C
Rationale: Sodium benzoate conjugates glycine to form hippurate (renally excreted). Lactulose acidifies
the colon to trap NH4⁺ .
4. A patient presents with sudden severe headache described as the “worst of life.” What is the most
likely diagnosis?
, Page 3 of 139
A) Migraine
B) Subarachnoid hemorrhage
C) Tension headache
D) Cluster headache
Answer: B
Rationale: A "thunderclap" headache (worst of life) is pathognomonic for subarachnoid hemorrhage
until proven otherwise .
5. A 72-year-old with Parkinson disease on carbidopa/levodopa develops dyskinesias. What is the
mechanism?
A) Supersensitive dopamine receptors with pulsatile stimulation
B) Direct NMDA receptor activation
C) GABA depletion
D) Serotonin toxicity
Answer: A
Rationale: Levodopa-induced dyskinesias result from pulsatile stimulation of supersensitive D2 receptors
in the striatum due to fluctuating drug levels .
, Page 4 of 139
6. A 23-year-old man has fever, cough, and rusty sputum. CXR shows lobar consolidation. Most likely
organism?
A) Haemophilus influenzae
B) Mycoplasma pneumoniae
C) Streptococcus pneumoniae
D) Chlamydophila pneumoniae
Answer: C
Rationale: S. pneumoniae is the most common cause of lobar pneumonia; rusty sputum results from
extravasated blood mixed with inflammatory exudate .
7. A diabetic patient presents with fruity breath and Kussmaul respirations. What is the diagnosis?
A) Hypoglycemia
B) DKA
C) HHS
D) Lactic acidosis
Answer: B
