COMSAE 108b TEST FULLY SOLVED &
UPDATED(VERIFIED).
Q1. A 23-year-old woman presents with dysuria, frequency, and urgency for 2
days. She has no fever, flank pain, or vaginal discharge. Urinalysis shows
leukocyte esterase and nitrites. What is the best next step in management?
• A. Renal ultrasound
• B. Blood cultures
• C. Oral trimethoprim-sulfamethoxazole
• D. IV ceftriaxone
• E. Cystoscopy
Correct Answer: C. Oral trimethoprim-sulfamethoxazole
Rationale: This is uncomplicated cystitis in a young woman. Oral TMP-SMX is
first-line unless contraindicated. No need for imaging or IV therapy .
Q2. A 66-year-old man with hypertension presents with sudden severe tearing
chest pain radiating to his back. BP is 200/110 mmHg in the right arm and
180/100 mmHg in the left arm. What is the most appropriate next step?
• A. Start IV heparin
• B. Order CT angiography of the chest
• C. Perform immediate cardiac catheterization
• D. Administer nitroglycerin
, • E. Order transthoracic echocardiogram
Correct Answer: B. Order CT angiography of the chest
Rationale: Classic presentation of aortic dissection (tearing chest pain, pulse
differential, widened mediastinum). CTA chest is diagnostic. Heparin and
nitroglycerin are inappropriate here .
Q3. A 17-year-old boy presents with knee pain after soccer. Exam shows a
positive Lachman test. What structure is most likely injured?
• A. Posterior cruciate ligament
• B. Medial meniscus
• C. Anterior cruciate ligament
• D. Medial collateral ligament
• E. Lateral collateral ligament
Correct Answer: C. Anterior cruciate ligament
Rationale: Positive Lachman test is the most sensitive physical exam maneuver
for ACL tear .
Q4. A 2-year-old girl has fever, drooling, and difficulty breathing. She is
sitting leaning forward with her neck extended. Stridor is present. What is the
next best step?
• A. Throat culture
• B. Secure airway in the operating room
, • C. Give oral amoxicillin
• D. Order neck x-ray
• E. Administer racemic epinephrine
Correct Answer: B. Secure airway in the operating room
Rationale: This is acute epiglottitis (typically H. influenzae type B). Airway
management is the priority before any diagnostics. Never examine the throat of a
suspected epiglottitis patient .
Q5. A 54-year-old woman with a history of COPD presents with shortness of
breath and productive cough. She is afebrile, wheezing, and SpO₂ is 87% on
room air. What is the most appropriate initial treatment?
• A. Oral antibiotics only
• B. Supplemental oxygen and nebulized albuterol/ipratropium
• C. IV corticosteroids only
• D. Chest physiotherapy only
• E. IV antibiotics
Correct Answer: B. Supplemental oxygen and nebulized
albuterol/ipratropium
Rationale: Acute exacerbation of COPD requires oxygen to correct hypoxemia
and bronchodilators (albuterol + ipratropium). Systemic corticosteroids are also
indicated but not as the sole initial treatment .
, Q6. A 45-year-old man presents with substernal chest pain relieved by leaning
forward. EKG shows diffuse ST-segment elevations. What is the next best step
in management?
• A. IV alteplase
• B. High-dose NSAIDs
• C. Coronary angiography
• D. Beta-blockers
• E. IV heparin
Correct Answer: B. High-dose NSAIDs
Rationale: This is acute pericarditis (positional chest pain relieved by leaning
forward, diffuse ST elevations). NSAIDs are first-line therapy .
Q7. A 30-year-old woman presents with new-onset thyrotoxicosis. Exam
shows an enlarged thyroid with a bruit. Labs: suppressed TSH, elevated
T3/T4, positive TSI antibodies. What is the most appropriate first-line
treatment?
• A. Thyroidectomy
• B. Beta-blocker
• C. Radioiodine ablation
• D. Levothyroxine
• E. Methimazole
Correct Answer: B. Beta-blocker
Rationale: This is Graves' disease (positive TSI antibodies, bruit). Initial
management is symptom control with a beta-blocker; definitive treatment
(methimazole, RAI, or surgery) follows later .
UPDATED(VERIFIED).
Q1. A 23-year-old woman presents with dysuria, frequency, and urgency for 2
days. She has no fever, flank pain, or vaginal discharge. Urinalysis shows
leukocyte esterase and nitrites. What is the best next step in management?
• A. Renal ultrasound
• B. Blood cultures
• C. Oral trimethoprim-sulfamethoxazole
• D. IV ceftriaxone
• E. Cystoscopy
Correct Answer: C. Oral trimethoprim-sulfamethoxazole
Rationale: This is uncomplicated cystitis in a young woman. Oral TMP-SMX is
first-line unless contraindicated. No need for imaging or IV therapy .
Q2. A 66-year-old man with hypertension presents with sudden severe tearing
chest pain radiating to his back. BP is 200/110 mmHg in the right arm and
180/100 mmHg in the left arm. What is the most appropriate next step?
• A. Start IV heparin
• B. Order CT angiography of the chest
• C. Perform immediate cardiac catheterization
• D. Administer nitroglycerin
, • E. Order transthoracic echocardiogram
Correct Answer: B. Order CT angiography of the chest
Rationale: Classic presentation of aortic dissection (tearing chest pain, pulse
differential, widened mediastinum). CTA chest is diagnostic. Heparin and
nitroglycerin are inappropriate here .
Q3. A 17-year-old boy presents with knee pain after soccer. Exam shows a
positive Lachman test. What structure is most likely injured?
• A. Posterior cruciate ligament
• B. Medial meniscus
• C. Anterior cruciate ligament
• D. Medial collateral ligament
• E. Lateral collateral ligament
Correct Answer: C. Anterior cruciate ligament
Rationale: Positive Lachman test is the most sensitive physical exam maneuver
for ACL tear .
Q4. A 2-year-old girl has fever, drooling, and difficulty breathing. She is
sitting leaning forward with her neck extended. Stridor is present. What is the
next best step?
• A. Throat culture
• B. Secure airway in the operating room
, • C. Give oral amoxicillin
• D. Order neck x-ray
• E. Administer racemic epinephrine
Correct Answer: B. Secure airway in the operating room
Rationale: This is acute epiglottitis (typically H. influenzae type B). Airway
management is the priority before any diagnostics. Never examine the throat of a
suspected epiglottitis patient .
Q5. A 54-year-old woman with a history of COPD presents with shortness of
breath and productive cough. She is afebrile, wheezing, and SpO₂ is 87% on
room air. What is the most appropriate initial treatment?
• A. Oral antibiotics only
• B. Supplemental oxygen and nebulized albuterol/ipratropium
• C. IV corticosteroids only
• D. Chest physiotherapy only
• E. IV antibiotics
Correct Answer: B. Supplemental oxygen and nebulized
albuterol/ipratropium
Rationale: Acute exacerbation of COPD requires oxygen to correct hypoxemia
and bronchodilators (albuterol + ipratropium). Systemic corticosteroids are also
indicated but not as the sole initial treatment .
, Q6. A 45-year-old man presents with substernal chest pain relieved by leaning
forward. EKG shows diffuse ST-segment elevations. What is the next best step
in management?
• A. IV alteplase
• B. High-dose NSAIDs
• C. Coronary angiography
• D. Beta-blockers
• E. IV heparin
Correct Answer: B. High-dose NSAIDs
Rationale: This is acute pericarditis (positional chest pain relieved by leaning
forward, diffuse ST elevations). NSAIDs are first-line therapy .
Q7. A 30-year-old woman presents with new-onset thyrotoxicosis. Exam
shows an enlarged thyroid with a bruit. Labs: suppressed TSH, elevated
T3/T4, positive TSI antibodies. What is the most appropriate first-line
treatment?
• A. Thyroidectomy
• B. Beta-blocker
• C. Radioiodine ablation
• D. Levothyroxine
• E. Methimazole
Correct Answer: B. Beta-blocker
Rationale: This is Graves' disease (positive TSI antibodies, bruit). Initial
management is symptom control with a beta-blocker; definitive treatment
(methimazole, RAI, or surgery) follows later .
