COMSAE Phase 1 Form 115 Practice
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Question 1
A 64-year-old male presents to the emergency department with severe, crushing
chest pain that radiates to his left arm. An electrocardiogram (ECG) reveals ST-
segment elevations in leads II, III, and aVF. Which of the following coronary
arteries is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Rationale: ST-segment elevations in leads II, III, and aVF indicate an
acute inferior wall myocardial infarction. The right coronary artery (RCA)
supplies the inferior wall of the ventricles in the majority of patients (right-
dominant circulation). Occlusion of the left anterior descending artery would
present with changes in the anterior leads (V1-V4), while the left circumflex artery
affects the lateral leads (I, aVL, V5-V6).
Question 2
A 60-year-old man presents with sudden-onset chest pain radiating to the left arm.
ECG shows ST-elevation in leads II, III, and aVF. What is the most likely
diagnosis?
,A) Anterior MI
B) Inferior MI
C) Lateral MI
D) Posterior MI
Rationale: This pattern of ST elevation in the inferior leads (II, III, aVF) is
diagnostic of an inferior wall myocardial infarction, typically caused by
occlusion of the right coronary artery.
Question 3
A 25-year-old man presents with acute onset of shortness of breath and chest pain
after a long flight. He has no significant past medical history. His vital signs are:
BP 110/70 mm Hg, HR 110 bpm, RR 24/min, SpO₂ 90% on room air. A CTA
chest reveals a filling defect in the right main pulmonary artery. Which of the
following is the most appropriate initial management?
A) Thrombolytics
B) Anticoagulation with heparin
C) Embolectomy
D) Inferior vena cava filter placement
Rationale: The patient has a pulmonary embolism (PE) with hemodynamic
stability (BP >90, no signs of shock). Initial management is anticoagulation with
heparin. Thrombolytics are reserved for massive PE with hemodynamic instability.
Embolectomy is considered if thrombolytics fail or are contraindicated. IVC filters
are for patients with contraindications to anticoagulation.
Question 4
A 55-year-old woman with a history of hypertension presents with acute-onset
severe, tearing chest pain radiating to her back. Her blood pressure is 180/100 mm
Hg in the right arm and 140/80 mm Hg in the left arm. A chest x-ray shows a
widened mediastinum. What is the most appropriate next step?
,A) Administer tPA
B) Immediate surgical consultation
C) Obtain a CT angiography of the chest
D) Start IV nitroglycerin
Rationale: The presentation is concerning for aortic dissection. A CT angiogram
is the imaging study of choice to confirm the diagnosis and determine the extent of
the dissection. While surgical consultation is important, diagnosis must be
confirmed first.
Question 5
A 32-year-old woman with a history of systemic lupus erythematosus (SLE)
presents with fever, chest pain, and a pericardial friction rub. An echocardiogram
shows a moderate pericardial effusion. Which of the following is the most
appropriate initial treatment?
A) NSAIDs
B) Colchicine
C) Corticosteroids
D) Pericardiocentesis
Rationale: Pericarditis in SLE is typically treated with NSAIDs as first-line
therapy. Corticosteroids may be used for refractory cases or if there is significant
associated myocarditis. Pericardiocentesis is reserved for cardiac tamponade.
Question 6
A 55-year-old male with a history of chronic alcohol use presents with confusion,
ataxia, and horizontal nystagmus. On examination, he exhibits a loss of short-term
memory and invents stories to fill in the gaps. A deficiency in which of the
following cofactors is responsible for this presentation?
A) Thiamine
B) Niacin
, C) Cobalamin
D) Pyridoxine
Rationale: The presentation is classic for Wernicke encephalopathy (confusion,
ataxia, ophthalmoplegia) progressing to Korsakoff syndrome (memory loss,
confabulation). This is caused by thiamine (vitamin B1) deficiency, commonly
seen in chronic alcohol use disorder.
Question 7
A 45-year-old man with type 2 diabetes and hypertension presents with a chief
complaint of "not feeling well." Labs reveal a serum creatinine of 2.5 mg/dL
(baseline 1.0 mg/dL). He has been taking ibuprofen for knee pain. What is the most
likely mechanism of his acute kidney injury?
A) Acute tubular necrosis
B) Prerenal azotemia due to decreased renal perfusion
C) Postrenal obstruction
D) Interstitial nephritis
Rationale: NSAIDs (ibuprofen) inhibit prostaglandin synthesis, which normally
vasodilate the afferent arteriole. This leads to decreased renal perfusion,
especially in patients with underlying risk factors like diabetes and hypertension.
This typically causes prerenal azotemia.
Question 8
A patient presents with sudden-onset dyspnea, pleuritic chest pain, and hemoptysis.
Which test is most appropriate for initial diagnosis?
A) Chest X-ray
B) ECG
C) CT pulmonary angiography
D) Echocardiography
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Question 1
A 64-year-old male presents to the emergency department with severe, crushing
chest pain that radiates to his left arm. An electrocardiogram (ECG) reveals ST-
segment elevations in leads II, III, and aVF. Which of the following coronary
arteries is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Rationale: ST-segment elevations in leads II, III, and aVF indicate an
acute inferior wall myocardial infarction. The right coronary artery (RCA)
supplies the inferior wall of the ventricles in the majority of patients (right-
dominant circulation). Occlusion of the left anterior descending artery would
present with changes in the anterior leads (V1-V4), while the left circumflex artery
affects the lateral leads (I, aVL, V5-V6).
Question 2
A 60-year-old man presents with sudden-onset chest pain radiating to the left arm.
ECG shows ST-elevation in leads II, III, and aVF. What is the most likely
diagnosis?
,A) Anterior MI
B) Inferior MI
C) Lateral MI
D) Posterior MI
Rationale: This pattern of ST elevation in the inferior leads (II, III, aVF) is
diagnostic of an inferior wall myocardial infarction, typically caused by
occlusion of the right coronary artery.
Question 3
A 25-year-old man presents with acute onset of shortness of breath and chest pain
after a long flight. He has no significant past medical history. His vital signs are:
BP 110/70 mm Hg, HR 110 bpm, RR 24/min, SpO₂ 90% on room air. A CTA
chest reveals a filling defect in the right main pulmonary artery. Which of the
following is the most appropriate initial management?
A) Thrombolytics
B) Anticoagulation with heparin
C) Embolectomy
D) Inferior vena cava filter placement
Rationale: The patient has a pulmonary embolism (PE) with hemodynamic
stability (BP >90, no signs of shock). Initial management is anticoagulation with
heparin. Thrombolytics are reserved for massive PE with hemodynamic instability.
Embolectomy is considered if thrombolytics fail or are contraindicated. IVC filters
are for patients with contraindications to anticoagulation.
Question 4
A 55-year-old woman with a history of hypertension presents with acute-onset
severe, tearing chest pain radiating to her back. Her blood pressure is 180/100 mm
Hg in the right arm and 140/80 mm Hg in the left arm. A chest x-ray shows a
widened mediastinum. What is the most appropriate next step?
,A) Administer tPA
B) Immediate surgical consultation
C) Obtain a CT angiography of the chest
D) Start IV nitroglycerin
Rationale: The presentation is concerning for aortic dissection. A CT angiogram
is the imaging study of choice to confirm the diagnosis and determine the extent of
the dissection. While surgical consultation is important, diagnosis must be
confirmed first.
Question 5
A 32-year-old woman with a history of systemic lupus erythematosus (SLE)
presents with fever, chest pain, and a pericardial friction rub. An echocardiogram
shows a moderate pericardial effusion. Which of the following is the most
appropriate initial treatment?
A) NSAIDs
B) Colchicine
C) Corticosteroids
D) Pericardiocentesis
Rationale: Pericarditis in SLE is typically treated with NSAIDs as first-line
therapy. Corticosteroids may be used for refractory cases or if there is significant
associated myocarditis. Pericardiocentesis is reserved for cardiac tamponade.
Question 6
A 55-year-old male with a history of chronic alcohol use presents with confusion,
ataxia, and horizontal nystagmus. On examination, he exhibits a loss of short-term
memory and invents stories to fill in the gaps. A deficiency in which of the
following cofactors is responsible for this presentation?
A) Thiamine
B) Niacin
, C) Cobalamin
D) Pyridoxine
Rationale: The presentation is classic for Wernicke encephalopathy (confusion,
ataxia, ophthalmoplegia) progressing to Korsakoff syndrome (memory loss,
confabulation). This is caused by thiamine (vitamin B1) deficiency, commonly
seen in chronic alcohol use disorder.
Question 7
A 45-year-old man with type 2 diabetes and hypertension presents with a chief
complaint of "not feeling well." Labs reveal a serum creatinine of 2.5 mg/dL
(baseline 1.0 mg/dL). He has been taking ibuprofen for knee pain. What is the most
likely mechanism of his acute kidney injury?
A) Acute tubular necrosis
B) Prerenal azotemia due to decreased renal perfusion
C) Postrenal obstruction
D) Interstitial nephritis
Rationale: NSAIDs (ibuprofen) inhibit prostaglandin synthesis, which normally
vasodilate the afferent arteriole. This leads to decreased renal perfusion,
especially in patients with underlying risk factors like diabetes and hypertension.
This typically causes prerenal azotemia.
Question 8
A patient presents with sudden-onset dyspnea, pleuritic chest pain, and hemoptysis.
Which test is most appropriate for initial diagnosis?
A) Chest X-ray
B) ECG
C) CT pulmonary angiography
D) Echocardiography
