COMSAE Phase II & phase 111 Form 114
Practice Exam Questions And Correct
Answers (Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf,,
Section 1: Internal Medicine (Questions 1–25)
Q1. A 24-year-old woman presents with acute lower abdominal pain and fever.
Pelvic exam shows cervical motion tenderness. What is the most likely diagnosis?
✅ Correct Answer: C. Pelvic inflammatory disease (PID)
Rationale: Lower abdominal pain, fever, and cervical motion tenderness constitute
the "chandelier sign," which is classic for PID. This condition is typically caused
by Neisseria gonorrhoeae or Chlamydia trachomatis ascending from the cervix to
the upper genital tract.
Q2. A 65-year-old man with a 50 pack-year smoking history presents with painless
hematuria. What is the most likely diagnosis?
✅ Correct Answer: B. Bladder cancer (urothelial carcinoma)
Rationale: Smoking is the strongest risk factor for bladder cancer, and painless
hematuria is its classic presenting symptom.
Q3. A 55-year-old man develops substernal chest pain during exertion that is
relieved by rest. ECG is normal. What is the most likely diagnosis?
✅ Correct Answer: C. Stable angina
,Rationale: Stable angina is characterized by predictable chest pain triggered by
exertion or stress and relieved by rest. The normal ECG at rest does not exclude
stable angina; provocative testing is often needed for diagnosis.
Q4. A 45-year-old female presents with several days of sharp right upper quadrant
pain radiating to the right shoulder, especially after fatty meals. Which physical
exam finding would be most suggestive of acute cholecystitis?
✅ Correct Answer: A. Positive Murphy sign
Rationale: A positive Murphy sign (abrupt arrest of inspiration upon palpation of
the RUQ) has high sensitivity and specificity for acute cholecystitis. While a
palpable gallbladder (Courvoisier sign) suggests malignancy, it is not typical for
acute cholecystitis.
Q5. A 35-year-old male with no medical history presents with palpitations and
lightheadedness. ECG shows a regular, narrow-complex tachycardia at 180 bpm
with no visible P waves. What is the most likely diagnosis?
✅ Correct Answer: B. AV nodal reentrant tachycardia (AVNRT)
Rationale: AVNRT is the most common cause of regular narrow-complex
tachycardia in young adults without structural heart disease. P waves are often
buried within the QRS complex due to nearly simultaneous atrial and ventricular
activation.
Q6. A 68-year-old male with hypertension presents with a crescendo-decrescendo
systolic murmur best heard at the right 2nd intercostal space, radiating to the
carotids. The murmur increases in intensity during Valsalva. What is the most
likely diagnosis?
✅ Correct Answer: C. Hypertrophic cardiomyopathy (HCM)
,Rationale: A systolic murmur that increases with Valsalva is characteristic of
HCM (decreased preload worsens outflow obstruction). Aortic stenosis murmurs
typically decrease with Valsalva. The murmur of aortic stenosis also radiates to the
carotids but does not intensify with Valsalva.
Q7. A 50-year-old female presents with fatigue, proximal muscle weakness, and a
rash over her knuckles. Which autoantibody is most specific for this condition?
✅ Correct Answer: A. Anti-Jo-1
Rationale: The clinical presentation (proximal muscle weakness, Gottron
papules/papules over knuckles) is consistent with dermatomyositis. Anti-Jo-1 is
associated with antisynthetase syndrome (mechanic's hands, interstitial lung
disease). Anti-Mi-2 is more specific for dermatomyositis without ILD.
Anti-dsDNA and ANA are non-specific.
Q8. A 72-year-old man with known COPD and heart failure presents with
worsening dyspnea. Physical exam reveals JVD, lower extremity edema, and a
tender, palpable liver. Which clinical sign best explains these findings?
✅ Correct Answer: B. Hepatojugular reflux
Rationale: Hepatojugular reflux (sustained JVD elevation with RUQ pressure)
indicates right ventricular failure and is sensitive for elevated central venous
pressure. Kussmaul sign (JVD elevation with inspiration) occurs in constrictive
pericarditis.
Q9. A 28-year-old G1P0 at 32 weeks gestation presents with new-onset
hypertension (BP 150/95) and 2+ proteinuria on dipstick. Her baseline BP was
110/70. What is the most likely diagnosis?
✅ Correct Answer: D. Preeclampsia without severe features
, Rationale: New-onset hypertension (≥140/90) after 20 weeks with proteinuria in a
previously normotensive patient defines preeclampsia. Gestational hypertension is
hypertension without proteinuria. Chronic hypertension would have been present
before 20 weeks.
Q10. A 60-year-old female with a history of breast cancer (ER+, PR+, HER2/neu-)
presents with new-onset back pain and hypercalcemia. Which of the following is
the most likely underlying mechanism for the hypercalcemia?
✅ Correct Answer: C. Paraneoplastic production of PTHrP
Rationale: Breast cancer commonly metastasizes to bone and can produce
parathyroid hormone-related protein (PTHrP), leading to humoral hypercalcemia
of malignancy. This is a common paraneoplastic syndrome in solid tumors.
Q11. A 48-year-old male with type 2 diabetes and hypertension presents with a
serum creatinine of 1.9 mg/dL (baseline 1.0 mg/dL) found on routine labs. He is
asymptomatic, and urinalysis is bland. What is the most appropriate next step?
✅ Correct Answer: B. Renal ultrasound
Rationale: The acute rise in creatinine without symptoms or sediment requires
ruling out obstruction. Renal ultrasound is non-invasive and can identify
hydronephrosis from obstructive causes. Hyperkalemia is not mentioned. NSAID
cessation is reasonable but not the first step without evidence of prerenal etiology.
Q12. A 26-year-old female with systemic lupus erythematosus presents with acute
onset of shortness of breath and pleuritic chest pain. Which of the following is the
most likely cause?
✅ Correct Answer: C. Pleural effusion from lupus pleuritis
Rationale: Serositis (pleuritis, pericarditis) is a common manifestation of SLE.
Pleuritic chest pain in a lupus patient is most often due to pleural inflammation
Practice Exam Questions And Correct
Answers (Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf,,
Section 1: Internal Medicine (Questions 1–25)
Q1. A 24-year-old woman presents with acute lower abdominal pain and fever.
Pelvic exam shows cervical motion tenderness. What is the most likely diagnosis?
✅ Correct Answer: C. Pelvic inflammatory disease (PID)
Rationale: Lower abdominal pain, fever, and cervical motion tenderness constitute
the "chandelier sign," which is classic for PID. This condition is typically caused
by Neisseria gonorrhoeae or Chlamydia trachomatis ascending from the cervix to
the upper genital tract.
Q2. A 65-year-old man with a 50 pack-year smoking history presents with painless
hematuria. What is the most likely diagnosis?
✅ Correct Answer: B. Bladder cancer (urothelial carcinoma)
Rationale: Smoking is the strongest risk factor for bladder cancer, and painless
hematuria is its classic presenting symptom.
Q3. A 55-year-old man develops substernal chest pain during exertion that is
relieved by rest. ECG is normal. What is the most likely diagnosis?
✅ Correct Answer: C. Stable angina
,Rationale: Stable angina is characterized by predictable chest pain triggered by
exertion or stress and relieved by rest. The normal ECG at rest does not exclude
stable angina; provocative testing is often needed for diagnosis.
Q4. A 45-year-old female presents with several days of sharp right upper quadrant
pain radiating to the right shoulder, especially after fatty meals. Which physical
exam finding would be most suggestive of acute cholecystitis?
✅ Correct Answer: A. Positive Murphy sign
Rationale: A positive Murphy sign (abrupt arrest of inspiration upon palpation of
the RUQ) has high sensitivity and specificity for acute cholecystitis. While a
palpable gallbladder (Courvoisier sign) suggests malignancy, it is not typical for
acute cholecystitis.
Q5. A 35-year-old male with no medical history presents with palpitations and
lightheadedness. ECG shows a regular, narrow-complex tachycardia at 180 bpm
with no visible P waves. What is the most likely diagnosis?
✅ Correct Answer: B. AV nodal reentrant tachycardia (AVNRT)
Rationale: AVNRT is the most common cause of regular narrow-complex
tachycardia in young adults without structural heart disease. P waves are often
buried within the QRS complex due to nearly simultaneous atrial and ventricular
activation.
Q6. A 68-year-old male with hypertension presents with a crescendo-decrescendo
systolic murmur best heard at the right 2nd intercostal space, radiating to the
carotids. The murmur increases in intensity during Valsalva. What is the most
likely diagnosis?
✅ Correct Answer: C. Hypertrophic cardiomyopathy (HCM)
,Rationale: A systolic murmur that increases with Valsalva is characteristic of
HCM (decreased preload worsens outflow obstruction). Aortic stenosis murmurs
typically decrease with Valsalva. The murmur of aortic stenosis also radiates to the
carotids but does not intensify with Valsalva.
Q7. A 50-year-old female presents with fatigue, proximal muscle weakness, and a
rash over her knuckles. Which autoantibody is most specific for this condition?
✅ Correct Answer: A. Anti-Jo-1
Rationale: The clinical presentation (proximal muscle weakness, Gottron
papules/papules over knuckles) is consistent with dermatomyositis. Anti-Jo-1 is
associated with antisynthetase syndrome (mechanic's hands, interstitial lung
disease). Anti-Mi-2 is more specific for dermatomyositis without ILD.
Anti-dsDNA and ANA are non-specific.
Q8. A 72-year-old man with known COPD and heart failure presents with
worsening dyspnea. Physical exam reveals JVD, lower extremity edema, and a
tender, palpable liver. Which clinical sign best explains these findings?
✅ Correct Answer: B. Hepatojugular reflux
Rationale: Hepatojugular reflux (sustained JVD elevation with RUQ pressure)
indicates right ventricular failure and is sensitive for elevated central venous
pressure. Kussmaul sign (JVD elevation with inspiration) occurs in constrictive
pericarditis.
Q9. A 28-year-old G1P0 at 32 weeks gestation presents with new-onset
hypertension (BP 150/95) and 2+ proteinuria on dipstick. Her baseline BP was
110/70. What is the most likely diagnosis?
✅ Correct Answer: D. Preeclampsia without severe features
, Rationale: New-onset hypertension (≥140/90) after 20 weeks with proteinuria in a
previously normotensive patient defines preeclampsia. Gestational hypertension is
hypertension without proteinuria. Chronic hypertension would have been present
before 20 weeks.
Q10. A 60-year-old female with a history of breast cancer (ER+, PR+, HER2/neu-)
presents with new-onset back pain and hypercalcemia. Which of the following is
the most likely underlying mechanism for the hypercalcemia?
✅ Correct Answer: C. Paraneoplastic production of PTHrP
Rationale: Breast cancer commonly metastasizes to bone and can produce
parathyroid hormone-related protein (PTHrP), leading to humoral hypercalcemia
of malignancy. This is a common paraneoplastic syndrome in solid tumors.
Q11. A 48-year-old male with type 2 diabetes and hypertension presents with a
serum creatinine of 1.9 mg/dL (baseline 1.0 mg/dL) found on routine labs. He is
asymptomatic, and urinalysis is bland. What is the most appropriate next step?
✅ Correct Answer: B. Renal ultrasound
Rationale: The acute rise in creatinine without symptoms or sediment requires
ruling out obstruction. Renal ultrasound is non-invasive and can identify
hydronephrosis from obstructive causes. Hyperkalemia is not mentioned. NSAID
cessation is reasonable but not the first step without evidence of prerenal etiology.
Q12. A 26-year-old female with systemic lupus erythematosus presents with acute
onset of shortness of breath and pleuritic chest pain. Which of the following is the
most likely cause?
✅ Correct Answer: C. Pleural effusion from lupus pleuritis
Rationale: Serositis (pleuritis, pericarditis) is a common manifestation of SLE.
Pleuritic chest pain in a lupus patient is most often due to pleural inflammation
