2026 COMSAE 114 LATEST EXAM
VERSION | QUESTIONS AND CORRECT
ANSWERS AND STUDY GUIDE FOR
GUARANTEED PASS
1. A 65-year-old man with hypertension and diabetes awakens with
vertigo, dysarthria, and left-sided facial numbness. Exam shows left
Horner syndrome, left facial pain/temp loss, right body pain/temp loss,
and dysphagia. Most likely vessel?
• A) Anterior cerebral artery
• B) Middle cerebral artery
• C) Posterior inferior cerebellar artery
• D) Anterior spinal artery
,,,answer,,,: C – Lateral medullary (Wallenberg) syndrome from PICA
occlusion.
2. A 28-year-old woman presents with episodic severe unilateral
periorbital headache, ipsilateral tearing, rhinorrhea, and ptosis. Episodes
last 20 minutes and recur daily for 2 weeks. Best acute treatment?
• A) Sumatriptan subcutaneous
• B) Oxygen 15 L/min via non-rebreather
• C) Verapamil
• D) Indomethacin
,,,,answer,,,: B – Cluster headache: first-line acute treatment is high-flow
oxygen.
3. A 45-year-old with major depressive disorder started sertraline 2 weeks
ago. Now presents with agitation, confusion, myoclonus, fever, and
diaphoresis. Medications include tramadol for back pain. Most likely
diagnosis?
• A) Neuroleptic malignant syndrome
• B) Serotonin syndrome
• C) Malignant hyperthermia
• D) Tyramine reaction
,,,answer,,,: B – Serotonin syndrome from SSRI + tramadol (serotonergic).
Treat with cyproheptadine, benzodiazepines.
4. A 72-year-old with sudden-onset aphasia and right-sided weakness. CT
head without contrast is normal. Onset was 2 hours ago. Next best step?
• A) Aspirin 325 mg
• B) IV tPA
• C) CTA head/neck
• D) MRI brain
,,,answer,,,: B – Ischemic stroke within 3-4.5 hour window, no
contraindications → IV tPA.
5. A 25-year-old with new-onset seizure lasting 4 minutes, now post-ictal.
No prior seizures. Head CT normal. Next step?
• A) Levetiracetam daily
• B) EEG
• C) MRI brain with contrast
• D) Observe without treatment
,,,,answer,,,: B – First unprovoked seizure: EEG to assess recurrence risk.
6. A 35-year-old with progressive ascending weakness over 5 days,
areflexia, no fever, recent diarrheal illness. Next best step?
• A) Lumbar puncture
• B) MRI spine
• C) IV immunoglobulin
• D) Pulmonary function tests
,,,answer,,,: D – Guillain-Barré syndrome: monitor vital capacity first, then
LP (albuminocytologic dissociation).
7. A 60-year-old with Parkinson disease on carbidopa/levodopa develops
sudden immobility, rigidity, fever, and elevated CK. Most likely?
• A) Parkinson disease progression
• B) Neuroleptic malignant syndrome
• C) Serotonin syndrome
• D) Levodopa toxicity
,,,answer,,,: B – NMS: rigidity, fever, autonomic instability, elevated CK.
8. A 30-year-old with "worst headache of life" onset during sexual
intercourse. Noncontrast head CT is normal. Next step?
• A) Discharge with analgesics
• B) Lumbar puncture
• C) CTA head
• D) MRI brain
,,,answer,,,: B – Suspect subarachnoid hemorrhage; LP for xanthochromia
if CT negative.
, 9. A 20-year-old with episodic palpitations, diaphoresis, headache, and
anxiety. BP 180/110 during episode, normal between. Most likely?
• A) Panic disorder
• B) Pheochromocytoma
• C) Hyperthyroidism
• D) Caffeine toxicity
,,,answer,,,: B – Pheochromocytoma: episodic hypertension, headache,
diaphoresis, palpitations.
10. A 55-year-old with acute onset of inability to recognize faces,
including his wife. Lesion location?
• A) Fusiform gyrus (temporal lobe)
• B) Occipital lobe
• C) Parietal lobe
• D) Prefrontal cortex
,,,answer,,,: A – Prosopagnosia: fusiform gyrus lesion (usually bilateral).
11. A 42-year-old with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. Next best treatment?
• A) Thiamine IV
• B) Glucose IV
• C) Folate
• D) Magnesium
,,,answer,,,: A – Wernicke encephalopathy: thiamine before glucose.
12. A 68-year-old with Alzheimer disease develops sudden agitation,
hallucinations, and fluctuating consciousness over 2 days. Urinalysis
positive for leukocytes. Most likely?
VERSION | QUESTIONS AND CORRECT
ANSWERS AND STUDY GUIDE FOR
GUARANTEED PASS
1. A 65-year-old man with hypertension and diabetes awakens with
vertigo, dysarthria, and left-sided facial numbness. Exam shows left
Horner syndrome, left facial pain/temp loss, right body pain/temp loss,
and dysphagia. Most likely vessel?
• A) Anterior cerebral artery
• B) Middle cerebral artery
• C) Posterior inferior cerebellar artery
• D) Anterior spinal artery
,,,answer,,,: C – Lateral medullary (Wallenberg) syndrome from PICA
occlusion.
2. A 28-year-old woman presents with episodic severe unilateral
periorbital headache, ipsilateral tearing, rhinorrhea, and ptosis. Episodes
last 20 minutes and recur daily for 2 weeks. Best acute treatment?
• A) Sumatriptan subcutaneous
• B) Oxygen 15 L/min via non-rebreather
• C) Verapamil
• D) Indomethacin
,,,,answer,,,: B – Cluster headache: first-line acute treatment is high-flow
oxygen.
3. A 45-year-old with major depressive disorder started sertraline 2 weeks
ago. Now presents with agitation, confusion, myoclonus, fever, and
diaphoresis. Medications include tramadol for back pain. Most likely
diagnosis?
• A) Neuroleptic malignant syndrome
• B) Serotonin syndrome
• C) Malignant hyperthermia
• D) Tyramine reaction
,,,answer,,,: B – Serotonin syndrome from SSRI + tramadol (serotonergic).
Treat with cyproheptadine, benzodiazepines.
4. A 72-year-old with sudden-onset aphasia and right-sided weakness. CT
head without contrast is normal. Onset was 2 hours ago. Next best step?
• A) Aspirin 325 mg
• B) IV tPA
• C) CTA head/neck
• D) MRI brain
,,,answer,,,: B – Ischemic stroke within 3-4.5 hour window, no
contraindications → IV tPA.
5. A 25-year-old with new-onset seizure lasting 4 minutes, now post-ictal.
No prior seizures. Head CT normal. Next step?
• A) Levetiracetam daily
• B) EEG
• C) MRI brain with contrast
• D) Observe without treatment
,,,,answer,,,: B – First unprovoked seizure: EEG to assess recurrence risk.
6. A 35-year-old with progressive ascending weakness over 5 days,
areflexia, no fever, recent diarrheal illness. Next best step?
• A) Lumbar puncture
• B) MRI spine
• C) IV immunoglobulin
• D) Pulmonary function tests
,,,answer,,,: D – Guillain-Barré syndrome: monitor vital capacity first, then
LP (albuminocytologic dissociation).
7. A 60-year-old with Parkinson disease on carbidopa/levodopa develops
sudden immobility, rigidity, fever, and elevated CK. Most likely?
• A) Parkinson disease progression
• B) Neuroleptic malignant syndrome
• C) Serotonin syndrome
• D) Levodopa toxicity
,,,answer,,,: B – NMS: rigidity, fever, autonomic instability, elevated CK.
8. A 30-year-old with "worst headache of life" onset during sexual
intercourse. Noncontrast head CT is normal. Next step?
• A) Discharge with analgesics
• B) Lumbar puncture
• C) CTA head
• D) MRI brain
,,,answer,,,: B – Suspect subarachnoid hemorrhage; LP for xanthochromia
if CT negative.
, 9. A 20-year-old with episodic palpitations, diaphoresis, headache, and
anxiety. BP 180/110 during episode, normal between. Most likely?
• A) Panic disorder
• B) Pheochromocytoma
• C) Hyperthyroidism
• D) Caffeine toxicity
,,,answer,,,: B – Pheochromocytoma: episodic hypertension, headache,
diaphoresis, palpitations.
10. A 55-year-old with acute onset of inability to recognize faces,
including his wife. Lesion location?
• A) Fusiform gyrus (temporal lobe)
• B) Occipital lobe
• C) Parietal lobe
• D) Prefrontal cortex
,,,answer,,,: A – Prosopagnosia: fusiform gyrus lesion (usually bilateral).
11. A 42-year-old with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. Next best treatment?
• A) Thiamine IV
• B) Glucose IV
• C) Folate
• D) Magnesium
,,,answer,,,: A – Wernicke encephalopathy: thiamine before glucose.
12. A 68-year-old with Alzheimer disease develops sudden agitation,
hallucinations, and fluctuating consciousness over 2 days. Urinalysis
positive for leukocytes. Most likely?
