COMSAE PHASE 2 – FORM 109
PRACTICE EXAM QUESTIONS
AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS
RATIONALES 2025/2026 Q&A |
INSTANT DOWNLOAD PDF,
Question 1
A 72-year-old man with hypertension and type 2 diabetes presents with
acute onset of severe, tearing chest pain radiating to the back. Blood
pressure is 100/60 mmHg in the right arm and 140/80 mmHg in the left
arm. Which diagnostic study should be ordered first?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Electrocardiogram
D. Chest X-ray
Correct ,,,answer,,,,: B. CT angiography of the chest
Rationale: The presentation of tearing chest pain with unequal blood
pressures suggests aortic dissection. CT angiography is the initial test of
,choice due to high sensitivity and rapid availability. ECG may be normal or
show nonspecific changes and does not rule out dissection. Chest X-ray
may show widened mediastinum but lacks sensitivity. Echocardiography
is operator-dependent and may miss arch involvement .
Question 2
A 28-year-old woman at 34 weeks gestation reports a sudden gush of fluid
from the vagina. Contractions have not started. Fetal heart rate tracing is
reassuring. What is the most appropriate next step?
A. Immediate delivery by cesarean section
B. Expectant management with hospitalization
C. Outpatient follow-up in 1 week
D. Induction of labor with oxytocin
Correct ,,,answer,,,,: B. Expectant management with hospitalization
Rationale: This presentation describes premature rupture of membranes
(PROM) at 34 weeks. With reassuring fetal status and no signs of
infection, expectant management with hospitalization is appropriate to
allow for fetal lung maturation while monitoring for chorioamnionitis.
Delivery is indicated if infection develops or fetal status deteriorates .
Question 3
A 68-year-old man with a 40-pack-year smoking history presents with a
cough and unintentional weight loss. Chest CT shows a 3 cm spiculated
nodule in the right upper lobe. Which next step is most appropriate?
,A. Positron emission tomography (PET) scan
B. Bronchoscopy with biopsy
C. Observation with repeat CT in 3 months
D. Empiric antibiotics
Correct ,,,answer,,,,: B. Bronchoscopy with biopsy
Rationale: A suspicious nodule in a high-risk patient requires tissue
diagnosis. Bronchoscopy is appropriate for central or accessible lesions.
PET scan is for staging, not diagnosis. Observation or antibiotics delays
diagnosis of possible lung cancer .
Question 4
A 32-year-old woman reports depressed mood, anhedonia, and fatigue for
3 months. She also has hypersomnia, increased appetite, and
carbohydrate craving. Symptoms are worse in winter and improve in
summer. Which is the most appropriate initial treatment?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Bright light therapy
Correct ,,,answer,,,,: D. Bright light therapy
Rationale: This pattern is consistent with seasonal affective disorder
(major depressive disorder with seasonal pattern). Bright light therapy is
first-line. Antidepressants are effective but not initial unless light therapy
fails. Bupropion is sometimes used for prevention .
, Question 5
A 45-year-old woman with systemic lupus erythematosus develops
fatigue, generalized weakness, and serum potassium of 5.8 mEq/L.
Medications include prednisone and hydroxychloroquine. Which
additional finding would most likely be present?
A. Metabolic acidosis with normal anion gap
B. Metabolic alkalosis
C. Elevated serum creatinine
D. Hypercalcemia
Correct ,,,answer,,,,: C. Elevated serum creatinine
Rationale: Hyperkalemia in SLE suggests possible lupus nephritis or type
IV renal tubular acidosis due to interstitial nephritis. Elevated creatinine
indicates renal impairment. Metabolic acidosis (normal anion gap) may
be seen in type IV RTA but is not the "most likely" additional finding
without creatinine elevation .
Question 6
A 19-year-old college student is brought to the emergency department
after ingesting 25 tablets of acetaminophen 3 hours ago. Serum
acetaminophen level is 180 mcg/mL at 4 hours post-ingestion. Which
treatment is indicated?
A. Activated charcoal only
B. N-acetylcysteine (NAC)
PRACTICE EXAM QUESTIONS
AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS
RATIONALES 2025/2026 Q&A |
INSTANT DOWNLOAD PDF,
Question 1
A 72-year-old man with hypertension and type 2 diabetes presents with
acute onset of severe, tearing chest pain radiating to the back. Blood
pressure is 100/60 mmHg in the right arm and 140/80 mmHg in the left
arm. Which diagnostic study should be ordered first?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Electrocardiogram
D. Chest X-ray
Correct ,,,answer,,,,: B. CT angiography of the chest
Rationale: The presentation of tearing chest pain with unequal blood
pressures suggests aortic dissection. CT angiography is the initial test of
,choice due to high sensitivity and rapid availability. ECG may be normal or
show nonspecific changes and does not rule out dissection. Chest X-ray
may show widened mediastinum but lacks sensitivity. Echocardiography
is operator-dependent and may miss arch involvement .
Question 2
A 28-year-old woman at 34 weeks gestation reports a sudden gush of fluid
from the vagina. Contractions have not started. Fetal heart rate tracing is
reassuring. What is the most appropriate next step?
A. Immediate delivery by cesarean section
B. Expectant management with hospitalization
C. Outpatient follow-up in 1 week
D. Induction of labor with oxytocin
Correct ,,,answer,,,,: B. Expectant management with hospitalization
Rationale: This presentation describes premature rupture of membranes
(PROM) at 34 weeks. With reassuring fetal status and no signs of
infection, expectant management with hospitalization is appropriate to
allow for fetal lung maturation while monitoring for chorioamnionitis.
Delivery is indicated if infection develops or fetal status deteriorates .
Question 3
A 68-year-old man with a 40-pack-year smoking history presents with a
cough and unintentional weight loss. Chest CT shows a 3 cm spiculated
nodule in the right upper lobe. Which next step is most appropriate?
,A. Positron emission tomography (PET) scan
B. Bronchoscopy with biopsy
C. Observation with repeat CT in 3 months
D. Empiric antibiotics
Correct ,,,answer,,,,: B. Bronchoscopy with biopsy
Rationale: A suspicious nodule in a high-risk patient requires tissue
diagnosis. Bronchoscopy is appropriate for central or accessible lesions.
PET scan is for staging, not diagnosis. Observation or antibiotics delays
diagnosis of possible lung cancer .
Question 4
A 32-year-old woman reports depressed mood, anhedonia, and fatigue for
3 months. She also has hypersomnia, increased appetite, and
carbohydrate craving. Symptoms are worse in winter and improve in
summer. Which is the most appropriate initial treatment?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Bright light therapy
Correct ,,,answer,,,,: D. Bright light therapy
Rationale: This pattern is consistent with seasonal affective disorder
(major depressive disorder with seasonal pattern). Bright light therapy is
first-line. Antidepressants are effective but not initial unless light therapy
fails. Bupropion is sometimes used for prevention .
, Question 5
A 45-year-old woman with systemic lupus erythematosus develops
fatigue, generalized weakness, and serum potassium of 5.8 mEq/L.
Medications include prednisone and hydroxychloroquine. Which
additional finding would most likely be present?
A. Metabolic acidosis with normal anion gap
B. Metabolic alkalosis
C. Elevated serum creatinine
D. Hypercalcemia
Correct ,,,answer,,,,: C. Elevated serum creatinine
Rationale: Hyperkalemia in SLE suggests possible lupus nephritis or type
IV renal tubular acidosis due to interstitial nephritis. Elevated creatinine
indicates renal impairment. Metabolic acidosis (normal anion gap) may
be seen in type IV RTA but is not the "most likely" additional finding
without creatinine elevation .
Question 6
A 19-year-old college student is brought to the emergency department
after ingesting 25 tablets of acetaminophen 3 hours ago. Serum
acetaminophen level is 180 mcg/mL at 4 hours post-ingestion. Which
treatment is indicated?
A. Activated charcoal only
B. N-acetylcysteine (NAC)
