COMSAE Phase 2 Form 112 Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales 2025/2026
Q&A | Instant Download Pdf
Clinical Presentations & Diagnosis
Q1. A 23-year-old man presents with acute right testicular pain and swelling
for 6 hours. Physical exam shows a tender, high-riding right testis with absent
cremasteric reflex. What is the most likely diagnosis?
• A. Epididymitis
• B. Testicular torsion
• C. Orchitis
• D. Varicocele
Answer: B. Testicular torsion
Rationale: Acute severe pain with a high-riding testis and absent cremasteric
reflex is classic for testicular torsion, a surgical emergency. Unlike epididymitis
(which is gradual and often relieved by scrotal elevation), torsion requires
immediate surgical exploration.
,Q2. A 35-year-old woman has fatigue, cold intolerance, constipation, and
weight gain. Labs: TSH = 12 μIU/mL (high), Free T4 = low. Which is the best
initial treatment?
• A. Methimazole
• B. Levothyroxine
• C. Radioactive iodine
• D. Propranolol
Answer: B. Levothyroxine
Rationale: Elevated TSH with low free T4 indicates primary hypothyroidism
(most commonly Hashimoto's thyroiditis). Levothyroxine is the standard thyroid
hormone replacement therapy. Methimazole and radioactive iodine are used for
hyperthyroidism.
Q3. A 68-year-old man with a history of smoking presents with painless gross
hematuria. UA confirms numerous RBCs. Which diagnostic test is most
appropriate?
• A. Cystoscopy
• B. Renal ultrasound
• C. CT abdomen without contrast
• D. PSA level
Answer: A. Cystoscopy
Rationale: Painless hematuria in a smoker is suspicious for bladder cancer.
Cystoscopy is the gold standard for visualizing bladder mucosa and obtaining
biopsies when needed.
,Q4. A 4-year-old boy is brought in for a limp. His hip X-ray shows femoral
head flattening and fragmentation. Which condition best explains this?
• A. Slipped capital femoral epiphysis
• B. Legg-Calvé-Perthes disease
• C. Developmental dysplasia of the hip
• D. Transient synovitis
Answer: B. Legg-Calvé-Perthes disease
Rationale: Legg-Calvé-Perthes disease is idiopathic avascular necrosis of the
femoral head occurring in children aged 4-10 years. X-ray findings include
flattening, sclerosis, and fragmentation of the femoral head.
Q5. A 24-year-old woman presents with dysuria, frequency, and urgency.
Urinalysis shows positive leukocyte esterase and nitrites. What is the most
appropriate initial treatment?
• A. Ciprofloxacin
• B. Nitrofurantoin
• C. Trimethoprim-sulfamethoxazole
• D. Ceftriaxone
Answer: B. Nitrofurantoin
Rationale: First-line treatment for uncomplicated cystitis in young women is
nitrofurantoin (5-day course) due to low resistance rates. Fluoroquinolones like
ciprofloxacin are reserved for complicated cases due to resistance and side effect
concerns.
, Q6. A 68-year-old man with hypertension develops ankle swelling after
starting a new antihypertensive medication. Which medication is the most
likely cause?
• A. Hydrochlorothiazide
• B. Amlodipine
• C. Lisinopril
• D. Metoprolol
Answer: B. Amlodipine
Rationale: Calcium channel blockers, particularly dihydropyridines like
amlodipine, commonly cause peripheral edema due to arteriolar dilation leading to
increased capillary hydrostatic pressure.
Q7. A 45-year-old man with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. What is the most appropriate initial treatment?
• A. IV glucose
• B. IV thiamine
• C. IV naloxone
• D. IV folate
Answer: B. IV thiamine
Rationale: The classic triad of Wernicke encephalopathy (confusion,
ophthalmoplegia, ataxia) is caused by thiamine deficiency. Immediate IV thiamine
administration is critical—and should be given before glucose to prevent
worsening of encephalopathy.
Questions And Correct Answers (Verified
Answers) Plus Rationales 2025/2026
Q&A | Instant Download Pdf
Clinical Presentations & Diagnosis
Q1. A 23-year-old man presents with acute right testicular pain and swelling
for 6 hours. Physical exam shows a tender, high-riding right testis with absent
cremasteric reflex. What is the most likely diagnosis?
• A. Epididymitis
• B. Testicular torsion
• C. Orchitis
• D. Varicocele
Answer: B. Testicular torsion
Rationale: Acute severe pain with a high-riding testis and absent cremasteric
reflex is classic for testicular torsion, a surgical emergency. Unlike epididymitis
(which is gradual and often relieved by scrotal elevation), torsion requires
immediate surgical exploration.
,Q2. A 35-year-old woman has fatigue, cold intolerance, constipation, and
weight gain. Labs: TSH = 12 μIU/mL (high), Free T4 = low. Which is the best
initial treatment?
• A. Methimazole
• B. Levothyroxine
• C. Radioactive iodine
• D. Propranolol
Answer: B. Levothyroxine
Rationale: Elevated TSH with low free T4 indicates primary hypothyroidism
(most commonly Hashimoto's thyroiditis). Levothyroxine is the standard thyroid
hormone replacement therapy. Methimazole and radioactive iodine are used for
hyperthyroidism.
Q3. A 68-year-old man with a history of smoking presents with painless gross
hematuria. UA confirms numerous RBCs. Which diagnostic test is most
appropriate?
• A. Cystoscopy
• B. Renal ultrasound
• C. CT abdomen without contrast
• D. PSA level
Answer: A. Cystoscopy
Rationale: Painless hematuria in a smoker is suspicious for bladder cancer.
Cystoscopy is the gold standard for visualizing bladder mucosa and obtaining
biopsies when needed.
,Q4. A 4-year-old boy is brought in for a limp. His hip X-ray shows femoral
head flattening and fragmentation. Which condition best explains this?
• A. Slipped capital femoral epiphysis
• B. Legg-Calvé-Perthes disease
• C. Developmental dysplasia of the hip
• D. Transient synovitis
Answer: B. Legg-Calvé-Perthes disease
Rationale: Legg-Calvé-Perthes disease is idiopathic avascular necrosis of the
femoral head occurring in children aged 4-10 years. X-ray findings include
flattening, sclerosis, and fragmentation of the femoral head.
Q5. A 24-year-old woman presents with dysuria, frequency, and urgency.
Urinalysis shows positive leukocyte esterase and nitrites. What is the most
appropriate initial treatment?
• A. Ciprofloxacin
• B. Nitrofurantoin
• C. Trimethoprim-sulfamethoxazole
• D. Ceftriaxone
Answer: B. Nitrofurantoin
Rationale: First-line treatment for uncomplicated cystitis in young women is
nitrofurantoin (5-day course) due to low resistance rates. Fluoroquinolones like
ciprofloxacin are reserved for complicated cases due to resistance and side effect
concerns.
, Q6. A 68-year-old man with hypertension develops ankle swelling after
starting a new antihypertensive medication. Which medication is the most
likely cause?
• A. Hydrochlorothiazide
• B. Amlodipine
• C. Lisinopril
• D. Metoprolol
Answer: B. Amlodipine
Rationale: Calcium channel blockers, particularly dihydropyridines like
amlodipine, commonly cause peripheral edema due to arteriolar dilation leading to
increased capillary hydrostatic pressure.
Q7. A 45-year-old man with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. What is the most appropriate initial treatment?
• A. IV glucose
• B. IV thiamine
• C. IV naloxone
• D. IV folate
Answer: B. IV thiamine
Rationale: The classic triad of Wernicke encephalopathy (confusion,
ophthalmoplegia, ataxia) is caused by thiamine deficiency. Immediate IV thiamine
administration is critical—and should be given before glucose to prevent
worsening of encephalopathy.
