lOMoARcPSD|65953097
COMSAE PHASE 2 FORM 110
Exam Study Guide – Practice
Questions with Verified Answers
with Rationales. GRADED A+.
Latest 2026/2027 Update
1.
A 56-year-old man presents with substernal chest pain that began 1 hour ago while
he was mowing the lawn. The pain is pressure-like and radiates to the left arm. ECG
shows ST elevation in leads II, III, and aVF. Next best step in management?
• A. Give sublingual nitroglycerin
• B. Administer aspirin and activate cardiac catheterization lab
• C. Start IV heparin only
• D. Order a chest X-ray
Answer✔✔: B. Administer aspirin and activate cardiac catheterization lab ST
elevation in II, III, aVF = inferior STEMI. Reperfusion therapy is required (PCI if
available). Aspirin reduces mortality. Chest X-ray is not appropriate initially, and
nitro is supportive but not definitive.
,2.
A 25-year-old woman presents with fever, dysuria, and flank pain. Urinalysis shows
WBC casts. Best treatment?
• A. Oral nitrofurantoin
• B. IV ceftriaxone
• C. Oral ciprofloxacin
• D. IV vancomycin
Answer✔✔: B. IV ceftriaxone
WBC casts indicate pyelonephritis. Inpatient IV therapy (ceftriaxone) is indicated for
systemic symptoms. Nitrofurantoin is for simple cystitis, not pyelo.
3.
A 60-year-old man with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is most likely?
• A. Vitamin B1 (thiamine)
• B. Vitamin B6 (pyridoxine)
• C. Vitamin B12 (cobalamin)
• D. Vitamin C
Answer✔✔: A. Vitamin B1 (thiamine)
Classic Wernicke encephalopathy triad: confusion, ataxia, ophthalmoplegia →
thiamine deficiency.
4.
A 32-year-old woman presents with fatigue, weight gain, constipation, and dry skin.
TSH is elevated. Best treatment?
• A. Methimazole
, lOMoARcPSD|65953097
• B. Levothyroxine
• C. Radioactive iodine
• D. Propranolol
Answer✔✔: B. Levothyroxine
Primary hypothyroidism (high TSH). Levothyroxine is standard treatment.
5.
A 7-year-old boy has a sore throat, fever, and sandpaper-like rash. Rapid strep
antigen test is positive. Best treatment?
• A. Amoxicillin
• B. Azithromycin
• C. Ciprofloxacin
• D. Supportive care only
Answer✔✔: A. Amoxicillin
Scarlet fever is caused by Group A strep. Treat with penicillin or amoxicillin.
6.
A 19-year-old male presents after a motorcycle accident. He is hypotensive, has
distended neck veins, and tracheal deviation to the left. Best initial management?
• A. Endotracheal intubation
• B. Needle thoracostomy
• C. Chest tube placement
• D. IV fluids
Answer✔✔: B. Needle thoracostomy
Tension pneumothorax → immediate decompression with needle thoracostomy,
followed by chest tube.
, 7.
A 72-year-old man has a resting tremor, bradykinesia, and cogwheel rigidity. Most
appropriate initial therapy?
• A. Levodopa-carbidopa
• B. Bromocriptine
• C. Selegiline
• D. Amantadine
Answer✔✔: A. Levodopa-carbidopa
Parkinson’s first-line therapy in elderly is levodopa-carbidopa. Dopamine agonists
are more often used in younger patients.
8.
A 22-year-old woman presents with RLQ abdominal pain, fever, and leukocytosis.
What is the most likely diagnosis?
• A. Ectopic pregnancy
• B. Appendicitis
• C. Ovarian torsion
• D. Pelvic inflammatory disease
Answer✔✔: B. Appendicitis
Classic presentation of appendicitis in a young adult with RLQ pain and leukocytosis.
9.
A 3-year-old girl presents with a barking cough, stridor, and hoarseness. Symptoms
worsen at night. Best initial management?
• A. Racemic epinephrine
COMSAE PHASE 2 FORM 110
Exam Study Guide – Practice
Questions with Verified Answers
with Rationales. GRADED A+.
Latest 2026/2027 Update
1.
A 56-year-old man presents with substernal chest pain that began 1 hour ago while
he was mowing the lawn. The pain is pressure-like and radiates to the left arm. ECG
shows ST elevation in leads II, III, and aVF. Next best step in management?
• A. Give sublingual nitroglycerin
• B. Administer aspirin and activate cardiac catheterization lab
• C. Start IV heparin only
• D. Order a chest X-ray
Answer✔✔: B. Administer aspirin and activate cardiac catheterization lab ST
elevation in II, III, aVF = inferior STEMI. Reperfusion therapy is required (PCI if
available). Aspirin reduces mortality. Chest X-ray is not appropriate initially, and
nitro is supportive but not definitive.
,2.
A 25-year-old woman presents with fever, dysuria, and flank pain. Urinalysis shows
WBC casts. Best treatment?
• A. Oral nitrofurantoin
• B. IV ceftriaxone
• C. Oral ciprofloxacin
• D. IV vancomycin
Answer✔✔: B. IV ceftriaxone
WBC casts indicate pyelonephritis. Inpatient IV therapy (ceftriaxone) is indicated for
systemic symptoms. Nitrofurantoin is for simple cystitis, not pyelo.
3.
A 60-year-old man with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is most likely?
• A. Vitamin B1 (thiamine)
• B. Vitamin B6 (pyridoxine)
• C. Vitamin B12 (cobalamin)
• D. Vitamin C
Answer✔✔: A. Vitamin B1 (thiamine)
Classic Wernicke encephalopathy triad: confusion, ataxia, ophthalmoplegia →
thiamine deficiency.
4.
A 32-year-old woman presents with fatigue, weight gain, constipation, and dry skin.
TSH is elevated. Best treatment?
• A. Methimazole
, lOMoARcPSD|65953097
• B. Levothyroxine
• C. Radioactive iodine
• D. Propranolol
Answer✔✔: B. Levothyroxine
Primary hypothyroidism (high TSH). Levothyroxine is standard treatment.
5.
A 7-year-old boy has a sore throat, fever, and sandpaper-like rash. Rapid strep
antigen test is positive. Best treatment?
• A. Amoxicillin
• B. Azithromycin
• C. Ciprofloxacin
• D. Supportive care only
Answer✔✔: A. Amoxicillin
Scarlet fever is caused by Group A strep. Treat with penicillin or amoxicillin.
6.
A 19-year-old male presents after a motorcycle accident. He is hypotensive, has
distended neck veins, and tracheal deviation to the left. Best initial management?
• A. Endotracheal intubation
• B. Needle thoracostomy
• C. Chest tube placement
• D. IV fluids
Answer✔✔: B. Needle thoracostomy
Tension pneumothorax → immediate decompression with needle thoracostomy,
followed by chest tube.
, 7.
A 72-year-old man has a resting tremor, bradykinesia, and cogwheel rigidity. Most
appropriate initial therapy?
• A. Levodopa-carbidopa
• B. Bromocriptine
• C. Selegiline
• D. Amantadine
Answer✔✔: A. Levodopa-carbidopa
Parkinson’s first-line therapy in elderly is levodopa-carbidopa. Dopamine agonists
are more often used in younger patients.
8.
A 22-year-old woman presents with RLQ abdominal pain, fever, and leukocytosis.
What is the most likely diagnosis?
• A. Ectopic pregnancy
• B. Appendicitis
• C. Ovarian torsion
• D. Pelvic inflammatory disease
Answer✔✔: B. Appendicitis
Classic presentation of appendicitis in a young adult with RLQ pain and leukocytosis.
9.
A 3-year-old girl presents with a barking cough, stridor, and hoarseness. Symptoms
worsen at night. Best initial management?
• A. Racemic epinephrine
