COMSAE Phase 1 Form 104 Practice Exam
With Actual Questions & Verified Answers,
Plus Explained Rationales/Expert Verified
For Guaranteed 100% Pass 2026/Latest
Update/Instant Download Pdf
1. A 45-year-old man presents with chest pain radiating to the left
arm, diaphoresis, and nausea. ECG shows ST elevation in leads II,
III, and aVF. Which artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior wall MI (II, III, aVF) is most commonly due to
occlusion of the right coronary artery. It often also affects the AV node
causing bradycardia.
2. A newborn has cyanosis that improves when crying but worsens
when feeding. Which condition is most likely?
A. Tetralogy of Fallot
B. Transposition of great arteries
C. Tricuspid atresia
D. Patent ductus arteriosus
,Answer: A. Tetralogy of Fallot
Rationale: Hypercyanotic “tet spells” in Tetralogy of Fallot are relieved
by increased systemic vascular resistance such as crying.
3. A patient has chronic alcohol use and presents with confusion,
ataxia, and ophthalmoplegia. What is the most appropriate
immediate treatment?
A. Oral thiamine
B. IV glucose
C. IV thiamine before glucose
D. Diazepam
Answer: C. IV thiamine before glucose
Rationale: Wernicke encephalopathy requires immediate IV thiamine
before glucose to prevent worsening of neurologic injury.
4. Which antibody is most specific for systemic lupus
erythematosus?
A. Anti-histone
B. Anti-dsDNA
C. Anti-centromere
D. Anti-Smith (Sm)
Answer: D. Anti-Smith (Sm)
Rationale: Anti-Smith antibodies are highly specific for SLE, though
less sensitive than anti-dsDNA.
5. A 60-year-old smoker has hematuria and flank pain. Imaging
shows a renal mass in the upper pole. What is the most likely
, diagnosis?
A. Wilms tumor
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Angiomyolipoma
Answer: B. Renal cell carcinoma
Rationale: Renal cell carcinoma is associated with smoking and
presents with hematuria, flank pain, and a renal mass.
6. A patient presents with fever, headache, and neck stiffness. CSF
shows neutrophils, low glucose, and high protein. What is the
most likely organism?
A. Neisseria meningitidis
B. HSV-2
C. Cryptococcus neoformans
D. Toxoplasma gondii
Answer: A. Neisseria meningitidis
Rationale: Bacterial meningitis typically shows neutrophilic
predominance with low glucose and high protein.
7. Which structure is damaged in Horner syndrome?
A. Oculomotor nerve
B. Sympathetic chain
C. Optic nerve
D. Facial nerve
Answer: B. Sympathetic chain
Rationale: Horner syndrome results from disruption of sympathetic
innervation causing ptosis, miosis, and anhidrosis.
, 8. A patient has hypercalcemia, kidney stones, and bone pain. Which
hormone is elevated?
A. Calcitonin
B. Parathyroid hormone
C. Vitamin D
D. ACTH
Answer: B. Parathyroid hormone
Rationale: Primary hyperparathyroidism causes hypercalcemia
leading to stones, bones, abdominal groans, and psychiatric
overtones.
9. A child presents with slapped cheek rash. What is the causative
agent?
A. Rubella virus
B. Parvovirus B19
C. Measles virus
D. Coxsackievirus
Answer: B. Parvovirus B19
Rationale: Erythema infectiosum (fifth disease) is caused by
parvovirus B19.
10. A patient on long-term steroids develops osteoporosis.
What is the main mechanism?
A. Increased osteoblast activity
B. Increased calcium absorption
C. Decreased osteoblast activity
D. Increased PTH secretion
With Actual Questions & Verified Answers,
Plus Explained Rationales/Expert Verified
For Guaranteed 100% Pass 2026/Latest
Update/Instant Download Pdf
1. A 45-year-old man presents with chest pain radiating to the left
arm, diaphoresis, and nausea. ECG shows ST elevation in leads II,
III, and aVF. Which artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior wall MI (II, III, aVF) is most commonly due to
occlusion of the right coronary artery. It often also affects the AV node
causing bradycardia.
2. A newborn has cyanosis that improves when crying but worsens
when feeding. Which condition is most likely?
A. Tetralogy of Fallot
B. Transposition of great arteries
C. Tricuspid atresia
D. Patent ductus arteriosus
,Answer: A. Tetralogy of Fallot
Rationale: Hypercyanotic “tet spells” in Tetralogy of Fallot are relieved
by increased systemic vascular resistance such as crying.
3. A patient has chronic alcohol use and presents with confusion,
ataxia, and ophthalmoplegia. What is the most appropriate
immediate treatment?
A. Oral thiamine
B. IV glucose
C. IV thiamine before glucose
D. Diazepam
Answer: C. IV thiamine before glucose
Rationale: Wernicke encephalopathy requires immediate IV thiamine
before glucose to prevent worsening of neurologic injury.
4. Which antibody is most specific for systemic lupus
erythematosus?
A. Anti-histone
B. Anti-dsDNA
C. Anti-centromere
D. Anti-Smith (Sm)
Answer: D. Anti-Smith (Sm)
Rationale: Anti-Smith antibodies are highly specific for SLE, though
less sensitive than anti-dsDNA.
5. A 60-year-old smoker has hematuria and flank pain. Imaging
shows a renal mass in the upper pole. What is the most likely
, diagnosis?
A. Wilms tumor
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Angiomyolipoma
Answer: B. Renal cell carcinoma
Rationale: Renal cell carcinoma is associated with smoking and
presents with hematuria, flank pain, and a renal mass.
6. A patient presents with fever, headache, and neck stiffness. CSF
shows neutrophils, low glucose, and high protein. What is the
most likely organism?
A. Neisseria meningitidis
B. HSV-2
C. Cryptococcus neoformans
D. Toxoplasma gondii
Answer: A. Neisseria meningitidis
Rationale: Bacterial meningitis typically shows neutrophilic
predominance with low glucose and high protein.
7. Which structure is damaged in Horner syndrome?
A. Oculomotor nerve
B. Sympathetic chain
C. Optic nerve
D. Facial nerve
Answer: B. Sympathetic chain
Rationale: Horner syndrome results from disruption of sympathetic
innervation causing ptosis, miosis, and anhidrosis.
, 8. A patient has hypercalcemia, kidney stones, and bone pain. Which
hormone is elevated?
A. Calcitonin
B. Parathyroid hormone
C. Vitamin D
D. ACTH
Answer: B. Parathyroid hormone
Rationale: Primary hyperparathyroidism causes hypercalcemia
leading to stones, bones, abdominal groans, and psychiatric
overtones.
9. A child presents with slapped cheek rash. What is the causative
agent?
A. Rubella virus
B. Parvovirus B19
C. Measles virus
D. Coxsackievirus
Answer: B. Parvovirus B19
Rationale: Erythema infectiosum (fifth disease) is caused by
parvovirus B19.
10. A patient on long-term steroids develops osteoporosis.
What is the main mechanism?
A. Increased osteoblast activity
B. Increased calcium absorption
C. Decreased osteoblast activity
D. Increased PTH secretion
