1
COMSAE Phase 3 Form 113 Practice
Exam 176 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2025|2026 Q&A | Instant
Download Pdf
Question 1
A 72-year-old man with a history of hypertension presents with acute onset of
severe, tearing chest pain radiating to the back. BP is 190/100 mmHg in the right
arm and 110/70 mmHg in the left arm. ECG shows no ST elevation. What is the
most appropriate next step in management?
A) Administer IV thrombolytics
B) Obtain a transthoracic echocardiogram
C) Obtain a CT angiography of the chest
D) Administer IV heparin
Rationale & Explanation:
This patient presents with classic findings of aortic dissection (tearing chest pain,
BP differential between arms). CT angiography of the chest is the study of
choice for diagnosing aortic dissection and should be obtained emergently.
Thrombolytics are contraindicated (can worsen dissection). TTE has lower
sensitivity for aortic dissection. Heparin is not indicated.
,2
Question 2
A patient with atrial fibrillation is on warfarin for stroke prophylaxis. The INR is
1.2. What is the most appropriate management?
A) Continue current warfarin dose and recheck INR in 1 month
B) Increase warfarin dose and recheck INR in 1 week
C) Administer vitamin K 10 mg IM
D) Hold warfarin for 3 days then restart
Rationale & Explanation:
The target INR for atrial fibrillation is 2.0-3.0. An INR of 1.2 is subtherapeutic.
The most appropriate management is to increase the warfarin dose and recheck
INR in 1 week (typical warfarin adjustment protocol). Vitamin K is for reversing
over-anticoagulation, not under-anticoagulation. Holding warfarin would lower
INR further.
Question 3
A 55-year-old man with a history of heart failure with reduced ejection fraction
(HFrEF) presents with worsening dyspnea and weight gain. He is on lisinopril,
carvedilol, and furosemide. His potassium is 5.8 mEq/L. Which medication should
be held?
A) Lisinopril
B) Carvedilol
C) Furosemide
D) Spironolactone
,3
Rationale & Explanation:
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia,
especially when combined with ACE inhibitors (lisinopril). With potassium 5.8
mEq/L, spironolactone should be held to prevent further potassium elevation and
risk of arrhythmias. Lisinopril may also contribute but is essential for HF
management. Carvedilol does not affect potassium. Furosemide lowers potassium.
Question 4
A 68-year-old woman with T2DM, HTN, and hyperlipidemia. Menopause at age
52. DXA scan shows T-score -2.1 at the femoral neck. In addition to calcium and
vitamin D, which medication should be added to prevent osteoporotic fractures?
A) Alendronate
B) Raloxifene
C) Estrogen therapy
D) Teriparatide
Rationale & Explanation:
This patient has osteopenia (T-score between -1.0 and -2.5) with multiple risk
factors (age >65, diabetes). Alendronate, a bisphosphonate, inhibits osteoclast
activity and reduces bone resorption. It is first-line therapy for both osteoporosis
and high-risk osteopenia. Raloxifene (SERM) is second-line. Estrogen therapy has
risks (breast cancer, DVT). Teriparatide is for severe osteoporosis or
bisphosphonate failure.
Question 5
, 4
A 45-year-old man presents with an episode of syncope lasting less than 1 minute.
He has a pacemaker. No tongue biting or urinary incontinence. What is the most
likely cause of his syncope?
A) Idioventricular rhythm due to pacemaker failure
B) Vasovagal syncope
C) Seizure
D) Orthostatic hypotension
Rationale & Explanation:
In a patient with a pacemaker, syncope is most likely due to pacemaker
failure leading to an idioventricular escape rhythm (20-40 bpm) causing sudden
drop in cerebral perfusion. The rapid recovery (<1 minute) and absence of seizure
features (tongue biting, incontinence) support cardiac syncope over seizure.
Vasovagal syncope typically has a prodrome. Orthostatic hypotension would have
positional symptoms.
Question 6
A patient with chronic heart failure presents with progressive dyspnea, orthopnea,
and peripheral edema. Which two factors influence the Starling curve?
A) Afterload and contractility
B) Heart rate and afterload
C) Preload (EDV) on x-axis and stroke volume on y-axis
D) Contractility and preload
Rationale & Explanation:
The Frank-Starling curve plots preload (end-diastolic volume) on the x-axis
against stroke volume or cardiac output on the y-axis . It demonstrates that
COMSAE Phase 3 Form 113 Practice
Exam 176 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2025|2026 Q&A | Instant
Download Pdf
Question 1
A 72-year-old man with a history of hypertension presents with acute onset of
severe, tearing chest pain radiating to the back. BP is 190/100 mmHg in the right
arm and 110/70 mmHg in the left arm. ECG shows no ST elevation. What is the
most appropriate next step in management?
A) Administer IV thrombolytics
B) Obtain a transthoracic echocardiogram
C) Obtain a CT angiography of the chest
D) Administer IV heparin
Rationale & Explanation:
This patient presents with classic findings of aortic dissection (tearing chest pain,
BP differential between arms). CT angiography of the chest is the study of
choice for diagnosing aortic dissection and should be obtained emergently.
Thrombolytics are contraindicated (can worsen dissection). TTE has lower
sensitivity for aortic dissection. Heparin is not indicated.
,2
Question 2
A patient with atrial fibrillation is on warfarin for stroke prophylaxis. The INR is
1.2. What is the most appropriate management?
A) Continue current warfarin dose and recheck INR in 1 month
B) Increase warfarin dose and recheck INR in 1 week
C) Administer vitamin K 10 mg IM
D) Hold warfarin for 3 days then restart
Rationale & Explanation:
The target INR for atrial fibrillation is 2.0-3.0. An INR of 1.2 is subtherapeutic.
The most appropriate management is to increase the warfarin dose and recheck
INR in 1 week (typical warfarin adjustment protocol). Vitamin K is for reversing
over-anticoagulation, not under-anticoagulation. Holding warfarin would lower
INR further.
Question 3
A 55-year-old man with a history of heart failure with reduced ejection fraction
(HFrEF) presents with worsening dyspnea and weight gain. He is on lisinopril,
carvedilol, and furosemide. His potassium is 5.8 mEq/L. Which medication should
be held?
A) Lisinopril
B) Carvedilol
C) Furosemide
D) Spironolactone
,3
Rationale & Explanation:
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia,
especially when combined with ACE inhibitors (lisinopril). With potassium 5.8
mEq/L, spironolactone should be held to prevent further potassium elevation and
risk of arrhythmias. Lisinopril may also contribute but is essential for HF
management. Carvedilol does not affect potassium. Furosemide lowers potassium.
Question 4
A 68-year-old woman with T2DM, HTN, and hyperlipidemia. Menopause at age
52. DXA scan shows T-score -2.1 at the femoral neck. In addition to calcium and
vitamin D, which medication should be added to prevent osteoporotic fractures?
A) Alendronate
B) Raloxifene
C) Estrogen therapy
D) Teriparatide
Rationale & Explanation:
This patient has osteopenia (T-score between -1.0 and -2.5) with multiple risk
factors (age >65, diabetes). Alendronate, a bisphosphonate, inhibits osteoclast
activity and reduces bone resorption. It is first-line therapy for both osteoporosis
and high-risk osteopenia. Raloxifene (SERM) is second-line. Estrogen therapy has
risks (breast cancer, DVT). Teriparatide is for severe osteoporosis or
bisphosphonate failure.
Question 5
, 4
A 45-year-old man presents with an episode of syncope lasting less than 1 minute.
He has a pacemaker. No tongue biting or urinary incontinence. What is the most
likely cause of his syncope?
A) Idioventricular rhythm due to pacemaker failure
B) Vasovagal syncope
C) Seizure
D) Orthostatic hypotension
Rationale & Explanation:
In a patient with a pacemaker, syncope is most likely due to pacemaker
failure leading to an idioventricular escape rhythm (20-40 bpm) causing sudden
drop in cerebral perfusion. The rapid recovery (<1 minute) and absence of seizure
features (tongue biting, incontinence) support cardiac syncope over seizure.
Vasovagal syncope typically has a prodrome. Orthostatic hypotension would have
positional symptoms.
Question 6
A patient with chronic heart failure presents with progressive dyspnea, orthopnea,
and peripheral edema. Which two factors influence the Starling curve?
A) Afterload and contractility
B) Heart rate and afterload
C) Preload (EDV) on x-axis and stroke volume on y-axis
D) Contractility and preload
Rationale & Explanation:
The Frank-Starling curve plots preload (end-diastolic volume) on the x-axis
against stroke volume or cardiac output on the y-axis . It demonstrates that
