COMSAE Phase 2 Form 112 Practice
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf,
1. A 68-year-old man with a history of hypertension and type 2 diabetes
presents with acute onset of right-sided weakness and aphasia. His symptoms
began 2 hours ago. His blood pressure is 185/105 mm Hg. A non-contrast head
CT shows no hemorrhage. What is the most appropriate next step?
• A) Administer IV labetalol to lower BP to 140/90
• B) Administer IV tPA (alteplase)
• C) Administer aspirin 325 mg
• D) Obtain an MRI brain
Correct Answer: B
Rationale: For acute ischemic stroke within 3 hours of symptom onset, IV tPA is
indicated if BP can be lowered to <185/110 mm Hg. The patient’s BP is at the
threshold; tPA should be given.
2. A 55-year-old man with a history of heavy alcohol use presents with
jaundice, ascites, and asterixis. Liver biopsy shows steatosis, Mallory-Denk
bodies, and neutrophilic inflammation. What is the most likely diagnosis?
• A) Nonalcoholic steatohepatitis (NASH)
• B) Alcoholic hepatitis
, • C) Cirrhosis
• D) Acute viral hepatitis
Correct Answer: B
Rationale: Alcoholic hepatitis is characterized by steatosis, Mallory bodies, and
neutrophilic infiltration in a patient with significant alcohol use.
3. A 45-year-old woman with systemic lupus erythematosus (SLE) presents
with new-onset seizures and acute kidney injury. Urinalysis shows red blood
cell casts. What is the most appropriate initial immunosuppressive therapy?
• A) Hydroxychloroquine
• B) Mycophenolate mofetil
• C) Cyclophosphamide
• D) Rituximab
Correct Answer: C
Rationale: Severe lupus nephritis with active urinary sediment and CNS
involvement (seizures) requires aggressive induction therapy. Cyclophosphamide
is often preferred for severe disease.
4. A 30-year-old woman who is 34 weeks pregnant presents with a blood
pressure of 160/100 mm Hg and 3+ proteinuria. She reports a headache and
visual changes. What is the most appropriate management?
• A) Labetalol and outpatient monitoring
• B) Immediate delivery
• C) Magnesium sulfate and delivery
, • D) Methyldopa and expectant management
Correct Answer: C
Rationale: This is severe preeclampsia (BP ≥160/110 with neurologic symptoms).
Magnesium sulfate is given for seizure prophylaxis, and delivery is indicated at
≥34 weeks.
5. A 60-year-old man with COPD has an FEV₁/FVC ratio of 0.65 and FEV₁
45% of predicted. Which medication has been shown to improve survival in
COPD?
• A) Inhaled corticosteroids
• B) Long-acting beta-agonist (LABA) alone
• C) Long-acting muscarinic antagonist (LAMA)
• D) Theophylline
Correct Answer: C
Rationale: LAMAs (tiotropium) reduce exacerbations and improve survival in
COPD.
6. A 72-year-old woman with osteoporosis is found to have a serum calcium of
11.8 mg/dL and a PTH of 15 pg/mL (low). What is the most likely diagnosis?
• A) Primary hyperparathyroidism
• B) Hypercalcemia of malignancy
• C) Vitamin D toxicity
• D) Familial hypocalciuric hypercalcemia
, Correct Answer: B
Rationale: Low PTH with hypercalcemia indicates non-PTH-mediated
hypercalcemia, most often due to malignancy (e.g., squamous cell lung cancer,
breast cancer, myeloma).
7. A 55-year-old man with a history of hypertension is on lisinopril. He
develops a dry, irritating cough. What is the most appropriate substitution?
• A) Losartan
• B) Amlodipine
• C) Hydrochlorothiazide
• D) Carvedilol
Correct Answer: A
Rationale: ACE inhibitor-induced cough is common and typically resolves with a
switch to an ARB (losartan) because ARBs do not increase bradykinin.
8. A 28-year-old man with a history of IV drug use presents with fever, chills,
and a new heart murmur. Blood cultures grow Staphylococcus aureus. An
echocardiogram shows a 1.2-cm vegetation on the mitral valve. What is the
most appropriate next step?
• A) Outpatient oral antibiotics
• B) IV antibiotics alone
• C) Surgical valve replacement
• D) IV antibiotics and surgical consultation
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf,
1. A 68-year-old man with a history of hypertension and type 2 diabetes
presents with acute onset of right-sided weakness and aphasia. His symptoms
began 2 hours ago. His blood pressure is 185/105 mm Hg. A non-contrast head
CT shows no hemorrhage. What is the most appropriate next step?
• A) Administer IV labetalol to lower BP to 140/90
• B) Administer IV tPA (alteplase)
• C) Administer aspirin 325 mg
• D) Obtain an MRI brain
Correct Answer: B
Rationale: For acute ischemic stroke within 3 hours of symptom onset, IV tPA is
indicated if BP can be lowered to <185/110 mm Hg. The patient’s BP is at the
threshold; tPA should be given.
2. A 55-year-old man with a history of heavy alcohol use presents with
jaundice, ascites, and asterixis. Liver biopsy shows steatosis, Mallory-Denk
bodies, and neutrophilic inflammation. What is the most likely diagnosis?
• A) Nonalcoholic steatohepatitis (NASH)
• B) Alcoholic hepatitis
, • C) Cirrhosis
• D) Acute viral hepatitis
Correct Answer: B
Rationale: Alcoholic hepatitis is characterized by steatosis, Mallory bodies, and
neutrophilic infiltration in a patient with significant alcohol use.
3. A 45-year-old woman with systemic lupus erythematosus (SLE) presents
with new-onset seizures and acute kidney injury. Urinalysis shows red blood
cell casts. What is the most appropriate initial immunosuppressive therapy?
• A) Hydroxychloroquine
• B) Mycophenolate mofetil
• C) Cyclophosphamide
• D) Rituximab
Correct Answer: C
Rationale: Severe lupus nephritis with active urinary sediment and CNS
involvement (seizures) requires aggressive induction therapy. Cyclophosphamide
is often preferred for severe disease.
4. A 30-year-old woman who is 34 weeks pregnant presents with a blood
pressure of 160/100 mm Hg and 3+ proteinuria. She reports a headache and
visual changes. What is the most appropriate management?
• A) Labetalol and outpatient monitoring
• B) Immediate delivery
• C) Magnesium sulfate and delivery
, • D) Methyldopa and expectant management
Correct Answer: C
Rationale: This is severe preeclampsia (BP ≥160/110 with neurologic symptoms).
Magnesium sulfate is given for seizure prophylaxis, and delivery is indicated at
≥34 weeks.
5. A 60-year-old man with COPD has an FEV₁/FVC ratio of 0.65 and FEV₁
45% of predicted. Which medication has been shown to improve survival in
COPD?
• A) Inhaled corticosteroids
• B) Long-acting beta-agonist (LABA) alone
• C) Long-acting muscarinic antagonist (LAMA)
• D) Theophylline
Correct Answer: C
Rationale: LAMAs (tiotropium) reduce exacerbations and improve survival in
COPD.
6. A 72-year-old woman with osteoporosis is found to have a serum calcium of
11.8 mg/dL and a PTH of 15 pg/mL (low). What is the most likely diagnosis?
• A) Primary hyperparathyroidism
• B) Hypercalcemia of malignancy
• C) Vitamin D toxicity
• D) Familial hypocalciuric hypercalcemia
, Correct Answer: B
Rationale: Low PTH with hypercalcemia indicates non-PTH-mediated
hypercalcemia, most often due to malignancy (e.g., squamous cell lung cancer,
breast cancer, myeloma).
7. A 55-year-old man with a history of hypertension is on lisinopril. He
develops a dry, irritating cough. What is the most appropriate substitution?
• A) Losartan
• B) Amlodipine
• C) Hydrochlorothiazide
• D) Carvedilol
Correct Answer: A
Rationale: ACE inhibitor-induced cough is common and typically resolves with a
switch to an ARB (losartan) because ARBs do not increase bradykinin.
8. A 28-year-old man with a history of IV drug use presents with fever, chills,
and a new heart murmur. Blood cultures grow Staphylococcus aureus. An
echocardiogram shows a 1.2-cm vegetation on the mitral valve. What is the
most appropriate next step?
• A) Outpatient oral antibiotics
• B) IV antibiotics alone
• C) Surgical valve replacement
• D) IV antibiotics and surgical consultation
