COMSAE Phase 3 Form 112 Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales 2025/2026
Q&A | Instant Download Pdf
Q1. A 52-year-old man presents with sudden onset of severe, crushing chest
pain radiating to his left arm and jaw. He is diaphoretic and nauseous. His
ECG shows ST-segment elevation in leads II, III, and aVF. What is the next
best step in management?
• A) Administer sublingual nitroglycerin
• B) Immediate thrombolytic therapy or percutaneous coronary intervention
(PCI)
• C) Obtain cardiac enzymes and wait for results
• D) Start intravenous beta-blockers
Correct Answer: B) Immediate thrombolytic therapy or percutaneous
coronary intervention (PCI)
Rationale: This patient has an acute inferior wall ST-elevation myocardial
infarction (STEMI). The priority is immediate reperfusion therapy to restore
coronary blood flow. PCI is preferred if available within 90 minutes; otherwise,
thrombolytics are indicated. Aspirin should also be given immediately, but waiting
for enzymes or administering other medications delays critical care.
Q2. A 35-year-old man presents with sudden-onset severe chest pain radiating
to his back. He has a history of hypertension. Blood pressure is 180/110 mmHg
in the right arm and 160/100 mmHg in the left arm. What is the most likely
diagnosis?
, • A) Myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pneumothorax
Correct Answer: C) Aortic dissection
Rationale: The classic presentation of aortic dissection includes sudden, severe,
tearing chest pain radiating to the back and a significant difference in blood
pressure between arms. Hypertension is a major risk factor.
Q3. A 62-year-old male presents with progressive fatigue, pruritus, and
xanthelasmas. Lab studies show elevated alkaline phosphatase and positive
anti-mitochondrial antibodies. What is the most likely diagnosis?
• A) Primary sclerosing cholangitis
• B) Primary biliary cholangitis
• C) Alcoholic hepatitis
• D) Autoimmune hepatitis
Correct Answer: B) Primary biliary cholangitis (PBC)
Rationale: PBC typically presents with fatigue, pruritus, and a cholestatic liver
enzyme pattern (elevated ALP). The anti-mitochondrial antibody (AMA) is highly
specific for this diagnosis.
Q4. A 60-year-old man with type 2 diabetes presents with polyuria and
polydipsia. Fasting glucose is 320 mg/dL, and he has no ketones in urine.
Which is the most likely diagnosis?
• A) Type 1 diabetes mellitus
• B) Type 2 diabetes mellitus with poor control
• C) Diabetes insipidus
, • D) Hyperosmolar hyperglycemic state
Correct Answer: B) Type 2 diabetes mellitus with poor control
Rationale: The absence of ketones in the setting of significant hyperglycemia
makes diabetic ketoacidosis (DKA) less likely. This presentation is consistent with
uncontrolled type 2 diabetes or hyperosmolar hyperglycemic state (HHS), though
HHS typically presents with more severe hyperglycemia (often >600 mg/dL) and
significant dehydration. The most direct interpretation is poorly controlled type 2
diabetes.
Q5. A 45-year-old man presents with acute epigastric pain radiating to the
back after a heavy alcohol binge. Serum lipase is elevated. What is the most
likely diagnosis?
• A) Acute cholecystitis
• B) Acute pancreatitis
• C) Peptic ulcer disease
• D) Gastroesophageal reflux disease
Correct Answer: B) Acute pancreatitis
Rationale: Epigastric pain radiating to the back, elevated lipase, and history of
alcohol abuse are classic for acute pancreatitis. Lipase is more specific than
amylase for pancreatic inflammation.
Q6. A 70-year-old man presents with difficulty initiating urination, weak
stream, and nocturia. Digital rectal exam reveals an enlarged, smooth, non-
tender prostate. What is the most likely diagnosis?
• A) Prostate cancer
• B) Benign prostatic hyperplasia (BPH)
• C) Prostatitis
• D) Urinary tract infection
Questions And Correct Answers (Verified
Answers) Plus Rationales 2025/2026
Q&A | Instant Download Pdf
Q1. A 52-year-old man presents with sudden onset of severe, crushing chest
pain radiating to his left arm and jaw. He is diaphoretic and nauseous. His
ECG shows ST-segment elevation in leads II, III, and aVF. What is the next
best step in management?
• A) Administer sublingual nitroglycerin
• B) Immediate thrombolytic therapy or percutaneous coronary intervention
(PCI)
• C) Obtain cardiac enzymes and wait for results
• D) Start intravenous beta-blockers
Correct Answer: B) Immediate thrombolytic therapy or percutaneous
coronary intervention (PCI)
Rationale: This patient has an acute inferior wall ST-elevation myocardial
infarction (STEMI). The priority is immediate reperfusion therapy to restore
coronary blood flow. PCI is preferred if available within 90 minutes; otherwise,
thrombolytics are indicated. Aspirin should also be given immediately, but waiting
for enzymes or administering other medications delays critical care.
Q2. A 35-year-old man presents with sudden-onset severe chest pain radiating
to his back. He has a history of hypertension. Blood pressure is 180/110 mmHg
in the right arm and 160/100 mmHg in the left arm. What is the most likely
diagnosis?
, • A) Myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pneumothorax
Correct Answer: C) Aortic dissection
Rationale: The classic presentation of aortic dissection includes sudden, severe,
tearing chest pain radiating to the back and a significant difference in blood
pressure between arms. Hypertension is a major risk factor.
Q3. A 62-year-old male presents with progressive fatigue, pruritus, and
xanthelasmas. Lab studies show elevated alkaline phosphatase and positive
anti-mitochondrial antibodies. What is the most likely diagnosis?
• A) Primary sclerosing cholangitis
• B) Primary biliary cholangitis
• C) Alcoholic hepatitis
• D) Autoimmune hepatitis
Correct Answer: B) Primary biliary cholangitis (PBC)
Rationale: PBC typically presents with fatigue, pruritus, and a cholestatic liver
enzyme pattern (elevated ALP). The anti-mitochondrial antibody (AMA) is highly
specific for this diagnosis.
Q4. A 60-year-old man with type 2 diabetes presents with polyuria and
polydipsia. Fasting glucose is 320 mg/dL, and he has no ketones in urine.
Which is the most likely diagnosis?
• A) Type 1 diabetes mellitus
• B) Type 2 diabetes mellitus with poor control
• C) Diabetes insipidus
, • D) Hyperosmolar hyperglycemic state
Correct Answer: B) Type 2 diabetes mellitus with poor control
Rationale: The absence of ketones in the setting of significant hyperglycemia
makes diabetic ketoacidosis (DKA) less likely. This presentation is consistent with
uncontrolled type 2 diabetes or hyperosmolar hyperglycemic state (HHS), though
HHS typically presents with more severe hyperglycemia (often >600 mg/dL) and
significant dehydration. The most direct interpretation is poorly controlled type 2
diabetes.
Q5. A 45-year-old man presents with acute epigastric pain radiating to the
back after a heavy alcohol binge. Serum lipase is elevated. What is the most
likely diagnosis?
• A) Acute cholecystitis
• B) Acute pancreatitis
• C) Peptic ulcer disease
• D) Gastroesophageal reflux disease
Correct Answer: B) Acute pancreatitis
Rationale: Epigastric pain radiating to the back, elevated lipase, and history of
alcohol abuse are classic for acute pancreatitis. Lipase is more specific than
amylase for pancreatic inflammation.
Q6. A 70-year-old man presents with difficulty initiating urination, weak
stream, and nocturia. Digital rectal exam reveals an enlarged, smooth, non-
tender prostate. What is the most likely diagnosis?
• A) Prostate cancer
• B) Benign prostatic hyperplasia (BPH)
• C) Prostatitis
• D) Urinary tract infection
