COMSAE Form 113 Practice Exam Version
2 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Section 1: Cardiology (Questions 1-10)
1. A 58-year-old male with hypertension and type 2 diabetes presents with
substernal chest pressure radiating to the jaw, occurring at rest and lasting 15
minutes. ECG shows ST-segment depression in leads V3–V6. Troponin I is
elevated. Which of the following is the most appropriate next step?
• A) Aspirin and discharge with outpatient stress test
• B) Oral nitroglycerin and beta-blocker at home
• C) Immediate percutaneous coronary intervention (PCI)
• D) Intravenous thrombolytics
• E) Coronary artery bypass grafting (CABG) within 48 hours
✅ Correct Answer: C. Immediate percutaneous coronary intervention (PCI)
Rationale: This patient presents with non-ST-elevation myocardial infarction
(NSTEMI) with elevated troponin and ongoing symptoms. High-risk NSTEMI
warrants early invasive strategy with PCI within 24 hours. Thrombolytics are not
indicated for NSTEMI, and CABG is not first-line for acute management.
,2. A 72-year-old female with heart failure with preserved ejection fraction
(HFpEF) presents with worsening dyspnea, JVD, and lower extremity edema.
Which medication has been shown to reduce hospitalizations in HFpEF?
• A) Digoxin
• B) Spironolactone
• C) Hydralazine
• D) Dobutamine
• E) Metolazone
✅ Correct Answer: B. Spironolactone
Rationale: The TOPCAT trial demonstrated that spironolactone reduces
hospitalizations in HFpEF patients. Digoxin and hydralazine are not proven for this
indication. Dobutamine is used for acute decompensation, and metolazone is a
thiazide-like diuretic used for fluid overload but does not reduce hospitalizations
long-term.
3. Electrical alternans (alternating QRS amplitude) on ECG is most classically
associated with which of the following conditions?
• A) Aortic stenosis
• B) Cardiac tamponade
• C) Dilated cardiomyopathy
• D) Pericarditis
✅ Correct Answer: B. Cardiac tamponade
Rationale: Electrical alternans (beat-to-beat variation in QRS amplitude) is a
classic ECG finding in cardiac tamponade due to the heart swinging within the
pericardial effusion. Pericarditis may show diffuse ST elevations, not alternans.
,4. A 65-year-old male with a history of COPD and loud P2 on auscultation
presents with progressive dyspnea. Echocardiogram reveals right ventricular
enlargement. Which of the following is the most likely underlying etiology?
• A) Left ventricular systolic failure
• B) Mitral regurgitation
• C) Pulmonary hypertension
• D) Hypertrophic cardiomyopathy
✅ Correct Answer: C. Pulmonary hypertension
Rationale: Chronic lung disease (COPD) can lead to pulmonary hypertension,
which increases afterload on the right ventricle, causing RV enlargement (cor
pulmonale). Loud P2 indicates elevated pulmonary artery pressure. Left heart
causes and valvular disease are not the primary driver here.
5. A 28-year-old female presents with palpitations and lightheadedness. ECG
shows a regular, narrow-complex tachycardia at 180 bpm without visible P
waves. Which of the following is the most likely diagnosis?
• A) Atrial fibrillation
• B) Atrial flutter
• C) AV nodal reentrant tachycardia (AVNRT)
• D) Ventricular tachycardia
✅ Correct Answer: C. AV nodal reentrant tachycardia (AVNRT)
Rationale: AVNRT is a common cause of paroxysmal regular narrow-complex
tachycardia in young patients. P waves are often absent or buried within the QRS
, complex due to simultaneous atrial and ventricular depolarization. Atrial
fibrillation and flutter have irregular rhythms.
6. Which of the following is the drug of choice for acute rate control in a
hemodynamically stable patient with atrial fibrillation and rapid ventricular
response?
• A) Digoxin
• B) Amiodarone
• C) Metoprolol
• D) Adenosine
✅ Correct Answer: C. Metoprolol
Rationale: Beta-blockers (e.g., metoprolol) or non-dihydropyridine calcium
channel blockers (e.g., diltiazem) are first-line for acute rate control in stable atrial
fibrillation. Digoxin has a slower onset. Adenosine is for supraventricular
tachycardia, not rate control of AF.
7. A 55-year-old male with chronic kidney disease is found to have a diastolic
murmur best heard at the left sternal border. Which of the following valvular
lesions is most likely?
• A) Aortic stenosis
• B) Aortic regurgitation
• C) Mitral stenosis
• D) Mitral regurgitation
2 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Section 1: Cardiology (Questions 1-10)
1. A 58-year-old male with hypertension and type 2 diabetes presents with
substernal chest pressure radiating to the jaw, occurring at rest and lasting 15
minutes. ECG shows ST-segment depression in leads V3–V6. Troponin I is
elevated. Which of the following is the most appropriate next step?
• A) Aspirin and discharge with outpatient stress test
• B) Oral nitroglycerin and beta-blocker at home
• C) Immediate percutaneous coronary intervention (PCI)
• D) Intravenous thrombolytics
• E) Coronary artery bypass grafting (CABG) within 48 hours
✅ Correct Answer: C. Immediate percutaneous coronary intervention (PCI)
Rationale: This patient presents with non-ST-elevation myocardial infarction
(NSTEMI) with elevated troponin and ongoing symptoms. High-risk NSTEMI
warrants early invasive strategy with PCI within 24 hours. Thrombolytics are not
indicated for NSTEMI, and CABG is not first-line for acute management.
,2. A 72-year-old female with heart failure with preserved ejection fraction
(HFpEF) presents with worsening dyspnea, JVD, and lower extremity edema.
Which medication has been shown to reduce hospitalizations in HFpEF?
• A) Digoxin
• B) Spironolactone
• C) Hydralazine
• D) Dobutamine
• E) Metolazone
✅ Correct Answer: B. Spironolactone
Rationale: The TOPCAT trial demonstrated that spironolactone reduces
hospitalizations in HFpEF patients. Digoxin and hydralazine are not proven for this
indication. Dobutamine is used for acute decompensation, and metolazone is a
thiazide-like diuretic used for fluid overload but does not reduce hospitalizations
long-term.
3. Electrical alternans (alternating QRS amplitude) on ECG is most classically
associated with which of the following conditions?
• A) Aortic stenosis
• B) Cardiac tamponade
• C) Dilated cardiomyopathy
• D) Pericarditis
✅ Correct Answer: B. Cardiac tamponade
Rationale: Electrical alternans (beat-to-beat variation in QRS amplitude) is a
classic ECG finding in cardiac tamponade due to the heart swinging within the
pericardial effusion. Pericarditis may show diffuse ST elevations, not alternans.
,4. A 65-year-old male with a history of COPD and loud P2 on auscultation
presents with progressive dyspnea. Echocardiogram reveals right ventricular
enlargement. Which of the following is the most likely underlying etiology?
• A) Left ventricular systolic failure
• B) Mitral regurgitation
• C) Pulmonary hypertension
• D) Hypertrophic cardiomyopathy
✅ Correct Answer: C. Pulmonary hypertension
Rationale: Chronic lung disease (COPD) can lead to pulmonary hypertension,
which increases afterload on the right ventricle, causing RV enlargement (cor
pulmonale). Loud P2 indicates elevated pulmonary artery pressure. Left heart
causes and valvular disease are not the primary driver here.
5. A 28-year-old female presents with palpitations and lightheadedness. ECG
shows a regular, narrow-complex tachycardia at 180 bpm without visible P
waves. Which of the following is the most likely diagnosis?
• A) Atrial fibrillation
• B) Atrial flutter
• C) AV nodal reentrant tachycardia (AVNRT)
• D) Ventricular tachycardia
✅ Correct Answer: C. AV nodal reentrant tachycardia (AVNRT)
Rationale: AVNRT is a common cause of paroxysmal regular narrow-complex
tachycardia in young patients. P waves are often absent or buried within the QRS
, complex due to simultaneous atrial and ventricular depolarization. Atrial
fibrillation and flutter have irregular rhythms.
6. Which of the following is the drug of choice for acute rate control in a
hemodynamically stable patient with atrial fibrillation and rapid ventricular
response?
• A) Digoxin
• B) Amiodarone
• C) Metoprolol
• D) Adenosine
✅ Correct Answer: C. Metoprolol
Rationale: Beta-blockers (e.g., metoprolol) or non-dihydropyridine calcium
channel blockers (e.g., diltiazem) are first-line for acute rate control in stable atrial
fibrillation. Digoxin has a slower onset. Adenosine is for supraventricular
tachycardia, not rate control of AF.
7. A 55-year-old male with chronic kidney disease is found to have a diastolic
murmur best heard at the left sternal border. Which of the following valvular
lesions is most likely?
• A) Aortic stenosis
• B) Aortic regurgitation
• C) Mitral stenosis
• D) Mitral regurgitation
