COMSAE 2026 COMPLETE STUDY GUIDE | 100% CORRECT
QUESTIONS & VERIFIED ANSWERS PDF
### Section 1: Cardiovascular & Pulmonology
**Question 1**
A 62-year-old man presents with progressive dyspnea, chronic cough, and
a 40-pack-year smoking history. Pulmonary function tests show FEV1/FVC
of 55%. Which of the following is the most likely diagnosis?
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Pulmonary fibrosis
**Answer: C. Emphysema**
**Rationale:** A reduced FEV1/FVC ratio indicates obstructive lung
disease. In a heavy smoker with progressive dyspnea, emphysema is most
likely due to alveolar wall destruction and loss of elastic recoil. While
chronic bronchitis also falls under COPD, the specific pathophysiology of
emphysema best explains the loss of elastic recoil .
**Question 2**
A 58-year-old male with hypertension presents with acute onset of severe
epigastric pain radiating to the back. BP is 150/95, HR 110. Exam reveals a
pulsatile abdominal mass. What is the most appropriate next step?
A. Abdominal ultrasound
B. CT angiography
C. Endoscopy
D. Serum lipase
**Answer: B. CT angiography**
**Rationale:** This presentation suggests a rupturing or expanding
abdominal aortic aneurysm (AAA). CT angiography is the definitive study
,for diagnosis and surgical planning. Ultrasound is a good screening tool
but is less detailed for rupture. Endoscopy and lipase are for GI causes .
**Question 3**
A patient presents with chest pain relieved by nitroglycerin. ECG shows ST
depression during pain episodes. What is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. STEMI
D. Pericarditis
**Answer: A. Stable angina**
**Rationale:** Stable angina is characterized by chest pain precipitated
by exertion or stress and relieved by rest or nitroglycerin. ST depression
on ECG that resolves with rest is classic. Unstable angina occurs at rest,
and STEMI shows ST elevation .
**Question 4**
A 67-year-old male with COPD presents with worsening dyspnea and
altered mental status. ABG on 2L NC: pH 7.28, PaCO2 68, PaO2 55, HCO3
26. What is the most appropriate next step?
A. Intubation and mechanical ventilation
B. Non-invasive positive pressure ventilation (NPPV)
C. Increase oxygen to 4L NC
D. Nebulized albuterol
**Answer: B. Non-invasive positive pressure ventilation (NPPV)**
**Rationale:** This is acute hypercapnic respiratory failure (pH <7.30) in
a COPD patient. NPPV (BiPAP) is first-line to support ventilation and
correct acidosis if the patient is alert and hemodynamically stable.
Intubation is for failure of NPPV. High-flow O2 can worsen hypercapnia .
**Question 5**
, A patient presents with crushing chest pain and ST elevation in leads II,
III, and aVF. Which artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Left Circumflex (LCX)
D. Left Main
**Answer: B. Right Coronary Artery (RCA)**
**Rationale:** Leads II, III, and aVF view the inferior wall of the heart.
The RCA supplies the inferior wall in most patients (right-dominant
circulation). LAD occlusions cause anterior wall MIs. Circumflex occlusions
cause lateral wall MIs .
---
### Section 2: Endocrinology & Rheumatology
**Question 6**
A 24-year-old woman presents with episodes of palpitations, tremor, and
heat intolerance. Lab tests show decreased TSH and elevated T3/T4. What
is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
**Answer: B. Graves disease**
**Rationale:** Hyperthyroidism with suppressed TSH and elevated
thyroid hormones, especially in a young woman with adrenergic symptoms
(tremor, palpitations), is most consistent with Graves disease due to
autoantibodies stimulating the TSH receptor .
**Question 7**
QUESTIONS & VERIFIED ANSWERS PDF
### Section 1: Cardiovascular & Pulmonology
**Question 1**
A 62-year-old man presents with progressive dyspnea, chronic cough, and
a 40-pack-year smoking history. Pulmonary function tests show FEV1/FVC
of 55%. Which of the following is the most likely diagnosis?
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Pulmonary fibrosis
**Answer: C. Emphysema**
**Rationale:** A reduced FEV1/FVC ratio indicates obstructive lung
disease. In a heavy smoker with progressive dyspnea, emphysema is most
likely due to alveolar wall destruction and loss of elastic recoil. While
chronic bronchitis also falls under COPD, the specific pathophysiology of
emphysema best explains the loss of elastic recoil .
**Question 2**
A 58-year-old male with hypertension presents with acute onset of severe
epigastric pain radiating to the back. BP is 150/95, HR 110. Exam reveals a
pulsatile abdominal mass. What is the most appropriate next step?
A. Abdominal ultrasound
B. CT angiography
C. Endoscopy
D. Serum lipase
**Answer: B. CT angiography**
**Rationale:** This presentation suggests a rupturing or expanding
abdominal aortic aneurysm (AAA). CT angiography is the definitive study
,for diagnosis and surgical planning. Ultrasound is a good screening tool
but is less detailed for rupture. Endoscopy and lipase are for GI causes .
**Question 3**
A patient presents with chest pain relieved by nitroglycerin. ECG shows ST
depression during pain episodes. What is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. STEMI
D. Pericarditis
**Answer: A. Stable angina**
**Rationale:** Stable angina is characterized by chest pain precipitated
by exertion or stress and relieved by rest or nitroglycerin. ST depression
on ECG that resolves with rest is classic. Unstable angina occurs at rest,
and STEMI shows ST elevation .
**Question 4**
A 67-year-old male with COPD presents with worsening dyspnea and
altered mental status. ABG on 2L NC: pH 7.28, PaCO2 68, PaO2 55, HCO3
26. What is the most appropriate next step?
A. Intubation and mechanical ventilation
B. Non-invasive positive pressure ventilation (NPPV)
C. Increase oxygen to 4L NC
D. Nebulized albuterol
**Answer: B. Non-invasive positive pressure ventilation (NPPV)**
**Rationale:** This is acute hypercapnic respiratory failure (pH <7.30) in
a COPD patient. NPPV (BiPAP) is first-line to support ventilation and
correct acidosis if the patient is alert and hemodynamically stable.
Intubation is for failure of NPPV. High-flow O2 can worsen hypercapnia .
**Question 5**
, A patient presents with crushing chest pain and ST elevation in leads II,
III, and aVF. Which artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Left Circumflex (LCX)
D. Left Main
**Answer: B. Right Coronary Artery (RCA)**
**Rationale:** Leads II, III, and aVF view the inferior wall of the heart.
The RCA supplies the inferior wall in most patients (right-dominant
circulation). LAD occlusions cause anterior wall MIs. Circumflex occlusions
cause lateral wall MIs .
---
### Section 2: Endocrinology & Rheumatology
**Question 6**
A 24-year-old woman presents with episodes of palpitations, tremor, and
heat intolerance. Lab tests show decreased TSH and elevated T3/T4. What
is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
**Answer: B. Graves disease**
**Rationale:** Hyperthyroidism with suppressed TSH and elevated
thyroid hormones, especially in a young woman with adrenergic symptoms
(tremor, palpitations), is most consistent with Graves disease due to
autoantibodies stimulating the TSH receptor .
**Question 7**
