COMSAE Phase 3 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 atrial fibrillation (on warfarin)
presents with acute onset of right leg pain, pallor, and pulselessness. His INR
is 2.8. What is the most appropriate initial management?
• A) Heparin infusion
• B) Surgical embolectomy
• C) IV tPA
• D) Compression ultrasound
Correct ,,,answer,,,: B
Rationale: Acute limb ischemia from an arterial embolus (cardiac source) is a
surgical emergency. Emergent embolectomy is indicated to salvage the limb.
2. A 55-year-old woman with a history of rheumatoid arthritis presents with a
2-week history of dry eyes and dry mouth. She also notes swelling in both
parotid glands. Which autoantibody is most likely positive?
• A) Anti-CCP
• B) Anti-SSA (Ro)
• C) Anti-dsDNA
• D) Anti-Scl-70
,Correct ,,,answer,,,: B
Rationale: Sicca symptoms (dry eyes, dry mouth) and parotid enlargement suggest
Sjögren syndrome. Anti-SSA (Ro) is highly associated.
3. A 72-year-old man with a history of hypertension and type 2 diabetes
presents with a 2-hour history of left-sided weakness and facial droop. BP
185/105 mm Hg. Non-contrast head CT shows no hemorrhage. What is the
most appropriate next step?
• A) IV labetalol to lower BP to 140/90
• B) IV tPA (alteplase)
• C) Aspirin 325 mg
• D) Obtain MRI brain
Correct ,,,answer,,,: B
Rationale: For acute ischemic stroke within 3 hours, IV tPA is indicated if BP can
be lowered to <185/110 mm Hg. The BP is at threshold; tPA should be given.
4. A 45-year-old man with a history of alcohol use disorder presents with
acute-onset severe epigastric pain radiating to the back. Serum lipase is 1,200
U/L. He is started on IV fluids. Which lab value predicts severity at 48 hours?
• A) Serum amylase
• B) C-reactive protein
• C) Blood urea nitrogen (BUN)
• D) Serum calcium
,Correct ,,,answer,,,: C
Rationale: BUN level at 24-48 hours and the BUN/creatinine ratio are part of the
Ranson criteria for pancreatitis severity.
5. A 35-year-old woman who is 32 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: Severe preeclampsia (BP ≥160/110 with neurologic symptoms)
requires magnesium sulfate for seizure prophylaxis and delivery at ≥34 weeks.
6. A 60-year-old man with COPD has an FEV₁/FVC ratio of 0.65 and FEV₁
45% of predicted. He has frequent exacerbations. Which medication reduces
exacerbations and improves survival?
• 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. Inhaled corticosteroids + LABA reduce exacerbations but not mortality.
7. 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 malignancy (e.g., squamous cell lung cancer, myeloma).
8. A 55-year-old man with hypertension on lisinopril 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 often resolves with a
switch to an ARB (losartan) because ARBs do not increase bradykinin.
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 atrial fibrillation (on warfarin)
presents with acute onset of right leg pain, pallor, and pulselessness. His INR
is 2.8. What is the most appropriate initial management?
• A) Heparin infusion
• B) Surgical embolectomy
• C) IV tPA
• D) Compression ultrasound
Correct ,,,answer,,,: B
Rationale: Acute limb ischemia from an arterial embolus (cardiac source) is a
surgical emergency. Emergent embolectomy is indicated to salvage the limb.
2. A 55-year-old woman with a history of rheumatoid arthritis presents with a
2-week history of dry eyes and dry mouth. She also notes swelling in both
parotid glands. Which autoantibody is most likely positive?
• A) Anti-CCP
• B) Anti-SSA (Ro)
• C) Anti-dsDNA
• D) Anti-Scl-70
,Correct ,,,answer,,,: B
Rationale: Sicca symptoms (dry eyes, dry mouth) and parotid enlargement suggest
Sjögren syndrome. Anti-SSA (Ro) is highly associated.
3. A 72-year-old man with a history of hypertension and type 2 diabetes
presents with a 2-hour history of left-sided weakness and facial droop. BP
185/105 mm Hg. Non-contrast head CT shows no hemorrhage. What is the
most appropriate next step?
• A) IV labetalol to lower BP to 140/90
• B) IV tPA (alteplase)
• C) Aspirin 325 mg
• D) Obtain MRI brain
Correct ,,,answer,,,: B
Rationale: For acute ischemic stroke within 3 hours, IV tPA is indicated if BP can
be lowered to <185/110 mm Hg. The BP is at threshold; tPA should be given.
4. A 45-year-old man with a history of alcohol use disorder presents with
acute-onset severe epigastric pain radiating to the back. Serum lipase is 1,200
U/L. He is started on IV fluids. Which lab value predicts severity at 48 hours?
• A) Serum amylase
• B) C-reactive protein
• C) Blood urea nitrogen (BUN)
• D) Serum calcium
,Correct ,,,answer,,,: C
Rationale: BUN level at 24-48 hours and the BUN/creatinine ratio are part of the
Ranson criteria for pancreatitis severity.
5. A 35-year-old woman who is 32 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: Severe preeclampsia (BP ≥160/110 with neurologic symptoms)
requires magnesium sulfate for seizure prophylaxis and delivery at ≥34 weeks.
6. A 60-year-old man with COPD has an FEV₁/FVC ratio of 0.65 and FEV₁
45% of predicted. He has frequent exacerbations. Which medication reduces
exacerbations and improves survival?
• 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. Inhaled corticosteroids + LABA reduce exacerbations but not mortality.
7. 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 malignancy (e.g., squamous cell lung cancer, myeloma).
8. A 55-year-old man with hypertension on lisinopril 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 often resolves with a
switch to an ARB (losartan) because ARBs do not increase bradykinin.
