COMSAE Phase 3 Form 114 Practice Exam
200 Questions And Correct Answers (Verified
Answers) Plus Rationales 2025|2026 Q&A |
Instant Download Pdf,,
1. A 72-year-old male with a history of heart failure (ejection
fraction 35%) and coronary artery disease is prescribed lisinopril,
carvedilol, furosemide, and spironolactone. He presents with
generalized weakness and muscle cramps. Lab results: K+ = 5.9
mEq/L, BUN = 38 mg/dL, Cr = 1.8 mg/dL. Which medication should
be held first?
A) Lisinopril
B) Carvedilol
C) Furosemide
D) Spironolactone
Correct ,,,answer,,,: D
Rationale: The combination of an ACE inhibitor (lisinopril) and a
potassium-sparing diuretic (spironolactone) can cause severe
,hyperkalemia. Spironolactone should be held first, as it is the more
direct cause.
2. In Fryette's Type I mechanics, when the spine is in a neutral
position, what is the relationship between side bending and rotation?
A) Side bending and rotation occur in opposite directions
B) Side bending and rotation occur in the same direction
C) Side bending occurs alone
D) Rotation occurs alone
Correct ,,,answer,,,: B
Rationale: In Fryette's Type I mechanics, when the spine is in a neutral
position, side bending and rotation occur in the same direction. This rule
applies to groups of vertebrae.
3. A 45-year-old male with a history of GERD for 5 years presents
for a follow-up. He has been on omeprazole 20 mg daily, which
controls his symptoms well. He has no alarm features. What is the
most appropriate management?
A) Continue omeprazole and repeat EGD in 3 years
B) Stop omeprazole and prescribe lifestyle modifications only
C) Add a prokinetic agent
D) Refer for surgical fundoplication
Correct ,,,answer,,,: A
Rationale: Patients with chronic GERD without alarm features can
continue effective PPI therapy. Routine surveillance endoscopy is not
needed without Barrett's esophagus or other risk factors.
,4. A 68-year-old woman with a history of hypertension and type 2
diabetes presents with acute onset of dysarthria and left-sided
weakness. Her symptoms began 2 hours ago. Her BP is 185/100
mmHg. 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 mmHg
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 mmHg. Although
her BP is elevated, it is at the threshold where tPA can be given.
5. A 55-year-old male with a history of alcohol use disorder presents
with jaundice, ascites, and asterixis. Liver biopsy reveals steatosis,
Mallory bodies, and neutrophilic inflammation. What is the most
likely diagnosis?
A) Alcoholic hepatitis
B) Nonalcoholic steatohepatitis (NASH)
C) Cirrhosis
D) Acute viral hepatitis
Correct ,,,answer,,,: A
Rationale: Alcoholic hepatitis is characterized by steatosis, Mallory-
Denk bodies, and neutrophilic infiltration in a patient with heavy alcohol
use.
, 6. A 25-year-old woman with a history of migraines with aura
presents with an acute episode of right-sided weakness and aphasia
that completely resolved after 45 minutes. She is now asymptomatic.
What is the most appropriate next step?
A) Aspirin 325 mg daily
B) MRI brain with diffusion-weighted imaging
C) Carotid ultrasound
D) Transthoracic echocardiogram
Correct ,,,answer,,,: B
Rationale: This is a transient ischemic attack (TIA) until proven
otherwise. MRI brain with DWI is the best imaging to detect acute
infarction, even with symptom resolution.
7. A 32-year-old man with a history of intravenous drug use presents
with fever, chills, and a new murmur. Blood cultures
grow Staphylococcus aureus. An echocardiogram shows a 1.5 cm
vegetation on the tricuspid valve. What is the most appropriate
management?
A) Outpatient oral antibiotics
B) IV antibiotics alone
C) Surgical valve replacement
D) IV antibiotics and surgical evaluation
Correct ,,,answer,,,: D
Rationale: Tricuspid valve endocarditis due to S. aureus with a large
vegetation (>1 cm) is at high risk for embolization. IV antibiotics and
surgical evaluation are indicated.
200 Questions And Correct Answers (Verified
Answers) Plus Rationales 2025|2026 Q&A |
Instant Download Pdf,,
1. A 72-year-old male with a history of heart failure (ejection
fraction 35%) and coronary artery disease is prescribed lisinopril,
carvedilol, furosemide, and spironolactone. He presents with
generalized weakness and muscle cramps. Lab results: K+ = 5.9
mEq/L, BUN = 38 mg/dL, Cr = 1.8 mg/dL. Which medication should
be held first?
A) Lisinopril
B) Carvedilol
C) Furosemide
D) Spironolactone
Correct ,,,answer,,,: D
Rationale: The combination of an ACE inhibitor (lisinopril) and a
potassium-sparing diuretic (spironolactone) can cause severe
,hyperkalemia. Spironolactone should be held first, as it is the more
direct cause.
2. In Fryette's Type I mechanics, when the spine is in a neutral
position, what is the relationship between side bending and rotation?
A) Side bending and rotation occur in opposite directions
B) Side bending and rotation occur in the same direction
C) Side bending occurs alone
D) Rotation occurs alone
Correct ,,,answer,,,: B
Rationale: In Fryette's Type I mechanics, when the spine is in a neutral
position, side bending and rotation occur in the same direction. This rule
applies to groups of vertebrae.
3. A 45-year-old male with a history of GERD for 5 years presents
for a follow-up. He has been on omeprazole 20 mg daily, which
controls his symptoms well. He has no alarm features. What is the
most appropriate management?
A) Continue omeprazole and repeat EGD in 3 years
B) Stop omeprazole and prescribe lifestyle modifications only
C) Add a prokinetic agent
D) Refer for surgical fundoplication
Correct ,,,answer,,,: A
Rationale: Patients with chronic GERD without alarm features can
continue effective PPI therapy. Routine surveillance endoscopy is not
needed without Barrett's esophagus or other risk factors.
,4. A 68-year-old woman with a history of hypertension and type 2
diabetes presents with acute onset of dysarthria and left-sided
weakness. Her symptoms began 2 hours ago. Her BP is 185/100
mmHg. 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 mmHg
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 mmHg. Although
her BP is elevated, it is at the threshold where tPA can be given.
5. A 55-year-old male with a history of alcohol use disorder presents
with jaundice, ascites, and asterixis. Liver biopsy reveals steatosis,
Mallory bodies, and neutrophilic inflammation. What is the most
likely diagnosis?
A) Alcoholic hepatitis
B) Nonalcoholic steatohepatitis (NASH)
C) Cirrhosis
D) Acute viral hepatitis
Correct ,,,answer,,,: A
Rationale: Alcoholic hepatitis is characterized by steatosis, Mallory-
Denk bodies, and neutrophilic infiltration in a patient with heavy alcohol
use.
, 6. A 25-year-old woman with a history of migraines with aura
presents with an acute episode of right-sided weakness and aphasia
that completely resolved after 45 minutes. She is now asymptomatic.
What is the most appropriate next step?
A) Aspirin 325 mg daily
B) MRI brain with diffusion-weighted imaging
C) Carotid ultrasound
D) Transthoracic echocardiogram
Correct ,,,answer,,,: B
Rationale: This is a transient ischemic attack (TIA) until proven
otherwise. MRI brain with DWI is the best imaging to detect acute
infarction, even with symptom resolution.
7. A 32-year-old man with a history of intravenous drug use presents
with fever, chills, and a new murmur. Blood cultures
grow Staphylococcus aureus. An echocardiogram shows a 1.5 cm
vegetation on the tricuspid valve. What is the most appropriate
management?
A) Outpatient oral antibiotics
B) IV antibiotics alone
C) Surgical valve replacement
D) IV antibiotics and surgical evaluation
Correct ,,,answer,,,: D
Rationale: Tricuspid valve endocarditis due to S. aureus with a large
vegetation (>1 cm) is at high risk for embolization. IV antibiotics and
surgical evaluation are indicated.
