Page 1 of 143
COMSAE PHASE 1-FORM 113 PRACTICE EXAM WITH
COMPLETE 250 QUESTIONS AND CORRECT DETAILED
RATIONALISED SOLUTIONS LATEST UPDATED VERSION
THIS YEAR 2026-2027
A randomized, high-yield question bank for the COMSAE Phase 1 Form 113 Practice Exam,
developed in the same style as the previous Form 115 set. Each question is a clinical
vignette with a single best answer and a summarized italic rationale. No domains or sections
are quoted. Questions are randomized and exam-relevant to the NBOME blueprint.
Question 1
A 28-year-old female presents with fatigue, joint pain, and a “butterfly” rash on her face. ANA is
positive. Which antibody is most specific for SLE?
A) Anti-dsDNA
B) Anti-Sm
C) Anti-Ro
D) Rheumatoid factor
Answer: B
Rationale: Anti-Sm is highly specific for SLE (though less sensitive than anti-dsDNA).
, Page 2 of 143
Question 2
A 55-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight loss,
and a persistent cough. Chest X-ray shows a right hilar mass. What is the next best step?
A) PET scan
B) CT chest
C) Bronchoscopy with biopsy
D) Sputum cytology
Answer: B
Rationale: CT chest is the next step to characterize the mass, assess mediastinal involvement,
and guide biopsy.
Question 3
A 30-year-old male presents with acute-onset severe testicular pain. On exam, the testis is
tender, elevated, and there is no cremasteric reflex. What is the most likely diagnosis?
A) Testicular torsion
B) Epididymitis
C) Orchitis
D) Hydrocele
, Page 3 of 143
Answer: A
Rationale: Sudden severe testicular pain with absent cremasteric reflex is testicular torsion until
proven otherwise.
Question 4
A 45-year-old male with alcohol use disorder presents with painful swelling of the first
metatarsophalangeal joint. What is the most likely diagnosis?
A) Gout
B) Pseudogout
C) Septic arthritis
D) Rheumatoid arthritis
Answer: A
Rationale: Acute gouty arthritis classically presents with podagra (first MTP joint) in association
with alcohol use and hyperuricemia.
Question 5
A 65-year-old female with osteoporosis is prescribed a bisphosphonate. What is the mechanism
of this drug?
A) Increases osteoblast activity
, Page 4 of 143
B) Inhibits osteoclast-mediated bone resorption
C) Increases PTH release
D) Increases intestinal calcium absorption
Answer: B
Rationale: Bisphosphonates inhibit osteoclasts by inducing apoptosis, reducing bone resorption.
Question 6
A 25-year-old male presents with acute dyspnea and sharp chest pain after a long flight. He is
tachycardic and hypoxic. What is the most appropriate next step?
A) Chest X-ray
B) CT pulmonary angiography
C) D-dimer
D) V/Q scan
Answer: B
Rationale: In a high-risk patient with suspected pulmonary embolism, CT pulmonary
angiography is definitive.
Question 7
A patient with asthma develops wheezing and flushing minutes after taking ibuprofen. What is
COMSAE PHASE 1-FORM 113 PRACTICE EXAM WITH
COMPLETE 250 QUESTIONS AND CORRECT DETAILED
RATIONALISED SOLUTIONS LATEST UPDATED VERSION
THIS YEAR 2026-2027
A randomized, high-yield question bank for the COMSAE Phase 1 Form 113 Practice Exam,
developed in the same style as the previous Form 115 set. Each question is a clinical
vignette with a single best answer and a summarized italic rationale. No domains or sections
are quoted. Questions are randomized and exam-relevant to the NBOME blueprint.
Question 1
A 28-year-old female presents with fatigue, joint pain, and a “butterfly” rash on her face. ANA is
positive. Which antibody is most specific for SLE?
A) Anti-dsDNA
B) Anti-Sm
C) Anti-Ro
D) Rheumatoid factor
Answer: B
Rationale: Anti-Sm is highly specific for SLE (though less sensitive than anti-dsDNA).
, Page 2 of 143
Question 2
A 55-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight loss,
and a persistent cough. Chest X-ray shows a right hilar mass. What is the next best step?
A) PET scan
B) CT chest
C) Bronchoscopy with biopsy
D) Sputum cytology
Answer: B
Rationale: CT chest is the next step to characterize the mass, assess mediastinal involvement,
and guide biopsy.
Question 3
A 30-year-old male presents with acute-onset severe testicular pain. On exam, the testis is
tender, elevated, and there is no cremasteric reflex. What is the most likely diagnosis?
A) Testicular torsion
B) Epididymitis
C) Orchitis
D) Hydrocele
, Page 3 of 143
Answer: A
Rationale: Sudden severe testicular pain with absent cremasteric reflex is testicular torsion until
proven otherwise.
Question 4
A 45-year-old male with alcohol use disorder presents with painful swelling of the first
metatarsophalangeal joint. What is the most likely diagnosis?
A) Gout
B) Pseudogout
C) Septic arthritis
D) Rheumatoid arthritis
Answer: A
Rationale: Acute gouty arthritis classically presents with podagra (first MTP joint) in association
with alcohol use and hyperuricemia.
Question 5
A 65-year-old female with osteoporosis is prescribed a bisphosphonate. What is the mechanism
of this drug?
A) Increases osteoblast activity
, Page 4 of 143
B) Inhibits osteoclast-mediated bone resorption
C) Increases PTH release
D) Increases intestinal calcium absorption
Answer: B
Rationale: Bisphosphonates inhibit osteoclasts by inducing apoptosis, reducing bone resorption.
Question 6
A 25-year-old male presents with acute dyspnea and sharp chest pain after a long flight. He is
tachycardic and hypoxic. What is the most appropriate next step?
A) Chest X-ray
B) CT pulmonary angiography
C) D-dimer
D) V/Q scan
Answer: B
Rationale: In a high-risk patient with suspected pulmonary embolism, CT pulmonary
angiography is definitive.
Question 7
A patient with asthma develops wheezing and flushing minutes after taking ibuprofen. What is
