COMSAE Phase 1 Level 1 ASA 111i NEWEST UPDATED 2026-2027
ACTUAL FINAL EXAM WITH WELL ELLABORATED 100 PRACTICE
QUESTIONS AND 100% CORRECT ANSWERS TO SCORE 97% AND ABOVE
A+ GRADE GUARANTEE BRAND NEW!!!
1. A 64-year-old man with hypertension presents with acute-onset
left-sided weakness and facial droop. Symptoms began 1.5 hours
ago. CT head shows no hemorrhage. Which is the most
appropriate next step?
A) Aspirin 325 mg
B) IV tissue plasminogen activator
C) Mechanical thrombectomy
D) Clopidogrel 300 mg
Answer: B
Rationale: IV tPA is indicated within 3 hours of ischemic stroke
onset without contraindications.
2. A 37-year-old woman presents with episodic palpitations, anxiety,
and diaphoresis. BP during episode is 215/110 mmHg. CT
abdomen shows a 2.8-cm left adrenal mass. Which test is most
specific for diagnosis?
A) Urinary VMA
B) Plasma fractionated metanephrines
C) Serum cortisol
D) Plasma renin activity
Answer: B
Rationale: Plasma free metanephrines have the highest sensitivity
and specificity for pheochromocytoma.
,3. A 49-year-old man with alcohol use disorder presents with
confusion, ataxia, and bilateral nystagmus. Which vitamin
deficiency is most likely?
A) Vitamin B12
B) Thiamine
C) Niacin
D) Vitamin E
Answer: B
Rationale: Wernicke encephalopathy from thiamine deficiency
requires immediate parenteral thiamine.
4. A 73-year-old woman with atrial fibrillation on warfarin presents
with sudden severe headache. INR is 5.1. CT head shows a left
parietal intraparenchymal hemorrhage. Which is the most
appropriate immediate treatment?
A) Vitamin K 10 mg IV
B) Fresh frozen plasma
C) Prothrombin complex concentrate
D) Hold warfarin and observe
Answer: C
Rationale: PCC rapidly reverses warfarin in intracranial
hemorrhage; FFP is slower and less effective.
5. A 32-year-old G3P1 at 32 weeks gestation presents with BP
166/100 mmHg and 3+ proteinuria. She has no headache or visual
changes. Which is the most appropriate management?
A) Immediate cesarean delivery
B) Labetalol and expectant management until 34 weeks
C) Magnesium sulfate and delivery at 37 weeks
D) Methyldopa and outpatient monitoring
Answer: B
, Rationale: Severe preeclampsia before 34 weeks: expectant
management with antihypertensives and fetal monitoring.
6. A 59-year-old man with type 2 diabetes and CKD stage 3 (eGFR
43) has HbA1c 8.6% on metformin and glimepiride. Which
medication has been shown to reduce cardiovascular mortality
and slow CKD progression?
A) Sitagliptin
B) Empagliflozin
C) Pioglitazone
D) Insulin glargine
Answer: B
Rationale: SGLT2 inhibitors reduce cardiovascular death, heart
failure hospitalization, and slow eGFR decline.
7. A 25-year-old man presents with a first-time generalized seizure.
He has a history of binge drinking. Labs: Na 112 mEq/L, plasma
osmolality 236 mOsm/kg, urine osmolality 530 mOsm/kg. Which
is the most likely diagnosis?
A) SIADH
B) Adrenal insufficiency
C) Psychogenic polydipsia
D) Diabetes insipidus
Answer: A
Rationale: Euvolemic hyponatremia with inappropriately
concentrated urine suggests SIADH.
8. A 51-year-old woman presents with fatigue, weight gain,
constipation, and cold intolerance. TSH 94 mIU/L, free T4 low,
anti-TPO antibodies markedly elevated. Which is the most likely
diagnosis?
A) Subacute thyroiditis
, B) Hashimoto thyroiditis
C) Central hypothyroidism
D) Euthyroid sick syndrome
Answer: B
Rationale: Primary hypothyroidism with elevated anti-TPO
antibodies confirms Hashimoto thyroiditis.
9. A 37-year-old G4P2 at 33 weeks presents with painless vaginal
bleeding. Ultrasound shows complete placenta previa. Which is
the most appropriate next step?
A) Digital cervical exam
B) Speculum exam
C) Hospital admission and expectant management
D) Immediate cesarean section
Answer: C
Rationale: Painless previa before 36 weeks without active
bleeding: admit and observe until 36-37 weeks.
10. A 65-year-old man presents with acute right-sided weakness
and aphasia. Last known well 2 hours ago. CT head negative for
hemorrhage. BP 186/103 mmHg. Which additional finding would
exclude IV tPA?
A) Age 65
B) Glucose 43 mg/dL
C) History of hypertension
D) INR 1.2
Answer: B
Rationale: Hypoglycemia (glucose <50) mimics stroke and must be
corrected before tPA administration.
11. A 57-year-old woman with rheumatoid arthritis presents
with dry eyes and dry mouth. Schirmer test is abnormal. Which
ACTUAL FINAL EXAM WITH WELL ELLABORATED 100 PRACTICE
QUESTIONS AND 100% CORRECT ANSWERS TO SCORE 97% AND ABOVE
A+ GRADE GUARANTEE BRAND NEW!!!
1. A 64-year-old man with hypertension presents with acute-onset
left-sided weakness and facial droop. Symptoms began 1.5 hours
ago. CT head shows no hemorrhage. Which is the most
appropriate next step?
A) Aspirin 325 mg
B) IV tissue plasminogen activator
C) Mechanical thrombectomy
D) Clopidogrel 300 mg
Answer: B
Rationale: IV tPA is indicated within 3 hours of ischemic stroke
onset without contraindications.
2. A 37-year-old woman presents with episodic palpitations, anxiety,
and diaphoresis. BP during episode is 215/110 mmHg. CT
abdomen shows a 2.8-cm left adrenal mass. Which test is most
specific for diagnosis?
A) Urinary VMA
B) Plasma fractionated metanephrines
C) Serum cortisol
D) Plasma renin activity
Answer: B
Rationale: Plasma free metanephrines have the highest sensitivity
and specificity for pheochromocytoma.
,3. A 49-year-old man with alcohol use disorder presents with
confusion, ataxia, and bilateral nystagmus. Which vitamin
deficiency is most likely?
A) Vitamin B12
B) Thiamine
C) Niacin
D) Vitamin E
Answer: B
Rationale: Wernicke encephalopathy from thiamine deficiency
requires immediate parenteral thiamine.
4. A 73-year-old woman with atrial fibrillation on warfarin presents
with sudden severe headache. INR is 5.1. CT head shows a left
parietal intraparenchymal hemorrhage. Which is the most
appropriate immediate treatment?
A) Vitamin K 10 mg IV
B) Fresh frozen plasma
C) Prothrombin complex concentrate
D) Hold warfarin and observe
Answer: C
Rationale: PCC rapidly reverses warfarin in intracranial
hemorrhage; FFP is slower and less effective.
5. A 32-year-old G3P1 at 32 weeks gestation presents with BP
166/100 mmHg and 3+ proteinuria. She has no headache or visual
changes. Which is the most appropriate management?
A) Immediate cesarean delivery
B) Labetalol and expectant management until 34 weeks
C) Magnesium sulfate and delivery at 37 weeks
D) Methyldopa and outpatient monitoring
Answer: B
, Rationale: Severe preeclampsia before 34 weeks: expectant
management with antihypertensives and fetal monitoring.
6. A 59-year-old man with type 2 diabetes and CKD stage 3 (eGFR
43) has HbA1c 8.6% on metformin and glimepiride. Which
medication has been shown to reduce cardiovascular mortality
and slow CKD progression?
A) Sitagliptin
B) Empagliflozin
C) Pioglitazone
D) Insulin glargine
Answer: B
Rationale: SGLT2 inhibitors reduce cardiovascular death, heart
failure hospitalization, and slow eGFR decline.
7. A 25-year-old man presents with a first-time generalized seizure.
He has a history of binge drinking. Labs: Na 112 mEq/L, plasma
osmolality 236 mOsm/kg, urine osmolality 530 mOsm/kg. Which
is the most likely diagnosis?
A) SIADH
B) Adrenal insufficiency
C) Psychogenic polydipsia
D) Diabetes insipidus
Answer: A
Rationale: Euvolemic hyponatremia with inappropriately
concentrated urine suggests SIADH.
8. A 51-year-old woman presents with fatigue, weight gain,
constipation, and cold intolerance. TSH 94 mIU/L, free T4 low,
anti-TPO antibodies markedly elevated. Which is the most likely
diagnosis?
A) Subacute thyroiditis
, B) Hashimoto thyroiditis
C) Central hypothyroidism
D) Euthyroid sick syndrome
Answer: B
Rationale: Primary hypothyroidism with elevated anti-TPO
antibodies confirms Hashimoto thyroiditis.
9. A 37-year-old G4P2 at 33 weeks presents with painless vaginal
bleeding. Ultrasound shows complete placenta previa. Which is
the most appropriate next step?
A) Digital cervical exam
B) Speculum exam
C) Hospital admission and expectant management
D) Immediate cesarean section
Answer: C
Rationale: Painless previa before 36 weeks without active
bleeding: admit and observe until 36-37 weeks.
10. A 65-year-old man presents with acute right-sided weakness
and aphasia. Last known well 2 hours ago. CT head negative for
hemorrhage. BP 186/103 mmHg. Which additional finding would
exclude IV tPA?
A) Age 65
B) Glucose 43 mg/dL
C) History of hypertension
D) INR 1.2
Answer: B
Rationale: Hypoglycemia (glucose <50) mimics stroke and must be
corrected before tPA administration.
11. A 57-year-old woman with rheumatoid arthritis presents
with dry eyes and dry mouth. Schirmer test is abnormal. Which
