1|Page
COMSAE 114 (COMLEX-USA STYLE)
ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
ALREADY A GRADED |NEW AND
REVISED
1. A 65-year-old patient presents with crushing substernal chest pain
radiating to the left arm. Which biomarker rises first in myocardial
infarction?
A. Troponin I
B. Myoglobin
C. CK-MB
D. LDH
Rationale: Myoglobin rises earliest after myocardial injury due to
rapid release from damaged muscle.
2. A patient with COPD retains CO₂. What acid-base disorder is
expected?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Respiratory alkalosis
Rationale: CO₂ retention leads to respiratory acidosis.
3. A child presents with barking cough and stridor. Most likely
diagnosis?
A. Asthma
B. Croup (laryngotracheobronchitis)
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C. Epiglottitis
D. Bronchitis
Rationale: Croup causes inspiratory stridor and barking cough.
4. Which organism most commonly causes urinary tract infection?
A. Staphylococcus aureus
B. Escherichia coli
C. Pseudomonas aeruginosa
D. Streptococcus pneumoniae
Rationale: E. coli is the most common UTI pathogen.
5. A patient with diabetes has fruity breath odor. What is the cause?
A. Lactic acidosis
B. Hypoglycemia
C. Ketone production
D. Renal failure
Rationale: Ketoacidosis produces acetone breath.
6. Which valve is most commonly affected in rheumatic fever?
A. Tricuspid
B. Mitral
C. Pulmonic
D. Aortic only
Rationale: Mitral valve is most frequently affected.
7. A patient has right lower quadrant pain and rebound tenderness.
Diagnosis?
A. Cholecystitis
B. Appendicitis
C. Pancreatitis
D. Diverticulitis
Rationale: RLQ pain is classic for appendicitis.
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8. Which condition causes decreased cortisol and hyperpigmentation?
A. Cushing syndrome
B. Addison disease
C. Hyperthyroidism
D. SIADH
Rationale: ACTH excess causes pigmentation in Addison disease.
9. A patient with asthma has wheezing due to:
A. Fluid in alveoli
B. Bronchoconstriction
C. Pleural effusion
D. Pulmonary fibrosis
Rationale: Airway narrowing causes wheezing.
10. Which electrolyte abnormality causes peaked T waves?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Rationale: Hyperkalemia alters cardiac conduction.
11. A patient with pancreatitis has elevated:
A. Troponin
B. Lipase
C. Amylase only never lipase
D. BNP
Rationale: Lipase is most specific for pancreatitis.
12. Which cranial nerve controls facial expression?
A. CN V
B. CN VII
C. CN IX
D. CN X
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Rationale: Facial nerve controls facial muscles.
13. A patient with kidney failure has anemia due to decreased:
A. Iron intake
B. Vitamin B12
C. Erythropoietin
D. Platelets
Rationale: Kidneys produce erythropoietin.
14. Which condition causes barrel chest?
A. Asthma
B. COPD (emphysema)
C. Pneumonia
D. Pulmonary edema
Rationale: Hyperinflation increases AP chest diameter.
15. A patient has hematuria and proteinuria after strep infection.
Diagnosis?
A. Nephrotic syndrome
B. Post-streptococcal glomerulonephritis
C. Pyelonephritis
D. Kidney stones
Rationale: Immune complex deposition after strep infection.
16. Which vitamin deficiency causes night blindness?
A. Vitamin C
B. Vitamin A
C. Vitamin D
D. Vitamin K
Rationale: Vitamin A is required for retinal function.
17. A patient has Parkinson disease. What neurotransmitter is
decreased?
COMSAE 114 (COMLEX-USA STYLE)
ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
ALREADY A GRADED |NEW AND
REVISED
1. A 65-year-old patient presents with crushing substernal chest pain
radiating to the left arm. Which biomarker rises first in myocardial
infarction?
A. Troponin I
B. Myoglobin
C. CK-MB
D. LDH
Rationale: Myoglobin rises earliest after myocardial injury due to
rapid release from damaged muscle.
2. A patient with COPD retains CO₂. What acid-base disorder is
expected?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Respiratory alkalosis
Rationale: CO₂ retention leads to respiratory acidosis.
3. A child presents with barking cough and stridor. Most likely
diagnosis?
A. Asthma
B. Croup (laryngotracheobronchitis)
,2|Page
C. Epiglottitis
D. Bronchitis
Rationale: Croup causes inspiratory stridor and barking cough.
4. Which organism most commonly causes urinary tract infection?
A. Staphylococcus aureus
B. Escherichia coli
C. Pseudomonas aeruginosa
D. Streptococcus pneumoniae
Rationale: E. coli is the most common UTI pathogen.
5. A patient with diabetes has fruity breath odor. What is the cause?
A. Lactic acidosis
B. Hypoglycemia
C. Ketone production
D. Renal failure
Rationale: Ketoacidosis produces acetone breath.
6. Which valve is most commonly affected in rheumatic fever?
A. Tricuspid
B. Mitral
C. Pulmonic
D. Aortic only
Rationale: Mitral valve is most frequently affected.
7. A patient has right lower quadrant pain and rebound tenderness.
Diagnosis?
A. Cholecystitis
B. Appendicitis
C. Pancreatitis
D. Diverticulitis
Rationale: RLQ pain is classic for appendicitis.
,3|Page
8. Which condition causes decreased cortisol and hyperpigmentation?
A. Cushing syndrome
B. Addison disease
C. Hyperthyroidism
D. SIADH
Rationale: ACTH excess causes pigmentation in Addison disease.
9. A patient with asthma has wheezing due to:
A. Fluid in alveoli
B. Bronchoconstriction
C. Pleural effusion
D. Pulmonary fibrosis
Rationale: Airway narrowing causes wheezing.
10. Which electrolyte abnormality causes peaked T waves?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Rationale: Hyperkalemia alters cardiac conduction.
11. A patient with pancreatitis has elevated:
A. Troponin
B. Lipase
C. Amylase only never lipase
D. BNP
Rationale: Lipase is most specific for pancreatitis.
12. Which cranial nerve controls facial expression?
A. CN V
B. CN VII
C. CN IX
D. CN X
, 4|Page
Rationale: Facial nerve controls facial muscles.
13. A patient with kidney failure has anemia due to decreased:
A. Iron intake
B. Vitamin B12
C. Erythropoietin
D. Platelets
Rationale: Kidneys produce erythropoietin.
14. Which condition causes barrel chest?
A. Asthma
B. COPD (emphysema)
C. Pneumonia
D. Pulmonary edema
Rationale: Hyperinflation increases AP chest diameter.
15. A patient has hematuria and proteinuria after strep infection.
Diagnosis?
A. Nephrotic syndrome
B. Post-streptococcal glomerulonephritis
C. Pyelonephritis
D. Kidney stones
Rationale: Immune complex deposition after strep infection.
16. Which vitamin deficiency causes night blindness?
A. Vitamin C
B. Vitamin A
C. Vitamin D
D. Vitamin K
Rationale: Vitamin A is required for retinal function.
17. A patient has Parkinson disease. What neurotransmitter is
decreased?
