COMSAE PHASE 1 FORM 112 EXAM ACTUAL TEST ACCURATE
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH DETAILED
RATIONALES (A NEW UPDATED VERSION 2026 EDITION)
|GURANTEED PASS A+ (BRAND NEW!) FULL REVISED COMSAE
PHASE 1 FORM 112 APPROVED EXAM
1. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. Chest CT shows a 4 cm right hilar
mass with mediastinal lymphadenopathy. Biopsy reveals small round blue cells.
Which immunohistochemically stain is most likely positive in this tumor?
A) Cytokeratin 7
B) Thyroid transcription factor-1 (TTF-1)
C) Chromogranin
D) p63
CORRECT ANSWER: C – Small cell lung cancer (small round blue cells) is a
neuroendocrine tumor; chromogranin, synaptophysin, and CD56 are positive. TTF-
1 is also often positive but less specific for neuroendocrine differentiation;
chromogranin is the classic neuroendocrine marker.
2. A 28-year-old woman with systemic lupus erythematosus presents with acute
onset of dyspnea and pleuritic chest pain. ECG shows sinus tachycardia. D-dimer
is elevated. CTPA reveals bilateral segmental filling defects. She is
hemodynamically stable. Which is the most appropriate initial anticoagulation?
A) Aspirin 325 mg daily
B) Unfractionated heparin IV bolus followed by infusion
C) Warfarin 5 mg daily
D) Clopidogrel 75 mg daily
,CORRECT ANSWER: B – In a stable patient with acute pulmonary embolism,
initial anticoagulation with heparin (UFH or LMWH) is indicated. Warfarin is
started later and overlapped with heparin.
3. A 56-year-old man with hypertension and type 2 diabetes presents with a non-
healing ulcer on his right great toe. Ankle-brachial index is 0.45. Which finding on
physical examination is most consistent with this condition?
A) Bounding dorsalis pedals pulses
B) Hair loss on the lower leg and shiny skin
C) Warm, erythematous toes with edema
D) Pigmentation around the ankles
CORRECT ANSWER: B – Chronic arterial insufficiency leads to loss of hair,
shiny atrophic skin, thickened nails, and cool extremities.
4. A 22-year-old college student presents with 3 days of watery diarrhea, vomiting,
and low-grade fever after attending a party. Stool studies are negative for ova,
parasites, and bacterial culture. Symptoms resolve spontaneously in 72 hours. Most
likely pathogen?
A) Giardia labia
B) Ent amoeba histolytic
C) Norovirus
D) Cyclosporine cayetanensis
CORRECT ANSWER: C – Norovirus causes acute, self-limited gastroenteritis
with vomiting and non-bloody diarrhea; incubation 12–48 hours, resolution in 2–3
days.
,5. A 68-year-old woman falls and sustains a left femoral neck fracture. She has a
history of rheumatoid arthritis treated with prednisone 10 mg daily for 2 years.
Bone density T-score is -3.2 at the hip. Which medication is most appropriate to
prevent future fractures?
A) Calcium carbonate alone
B) Raloxifene
C) Alendronate
D) Teriparatide
CORRECT ANSWER: C – Glucocorticoid-induced osteoporosis with fragility
fracture requires bisphosphonate (alendronate) as first-line therapy.
6. A 35-year-old man with HIV (CD4 count 120 cells/µL) presents with headache,
fever, and confusion. MRI brain shows multiple ring-enhancing lesions in the basal
ganglia. Which diagnostic test is most specific?
A) Serum Cryptococci antigen
B) Brain biopsy with PCR for Toxoplasma gundi
C) CSF VDRL
D) CSF Gram stain
CORRECT ANSWER: B – Toxoplasma encephalitis presents with ring-enhancing
lesions; PCR on CSF or biopsy is specific; empiric treatment often given without
biopsy.
7. A 50-year-old woman presents with episodic palpitations, sweating, and
headache. Blood pressure 210/110 mmHg during episode, normal between
episodes. Urinary metanephrines are elevated. Which imaging study is best to
localize the tumor?
A) CT chest without contrast
, B) MRI abdomen with contrast
C) Thyroid ultrasound
D) Octreotide scan
CORRECT ANSWER: B – Pheochromocytoma (adrenal or extra-adrenal) best
localized by MRI or CT of abdomen; MRI preferred due to no radiation and better
soft tissue characterization.
8. A 72-year-old man with chronic kidney disease stage 4 (eGFI 25 mL/min)
presents with fatigue, bone pain, and serum calcium 8.0 mg/ld., phosphorus 6.2
mg/ld., PTH 450 pg./mile Which medication reduces PTH in this setting?
A) Calcium acetate
B) Sevelamer
C) Calcitriol
D) Aluminum hydroxide
CORRECT ANSWER: C – Secondary hyperparathyroidism of CKD treated with
active vitamin D (calcitriol) to suppress PTH, along with phosphate binders.
9. A 30-year-old woman with a history of Graves’ disease treated with radioactive
iodine 6 months ago presents with fatigue, weight gain, and cold intolerance. TSH
45 µIU/mL, free T4 0.4 ng/ld. Which finding on physical exam is expected?
A) Tachycardia
B) Delayed relaxation of deep tendon reflexes
C) Warm, moist skin
D) Exophthalmos
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH DETAILED
RATIONALES (A NEW UPDATED VERSION 2026 EDITION)
|GURANTEED PASS A+ (BRAND NEW!) FULL REVISED COMSAE
PHASE 1 FORM 112 APPROVED EXAM
1. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. Chest CT shows a 4 cm right hilar
mass with mediastinal lymphadenopathy. Biopsy reveals small round blue cells.
Which immunohistochemically stain is most likely positive in this tumor?
A) Cytokeratin 7
B) Thyroid transcription factor-1 (TTF-1)
C) Chromogranin
D) p63
CORRECT ANSWER: C – Small cell lung cancer (small round blue cells) is a
neuroendocrine tumor; chromogranin, synaptophysin, and CD56 are positive. TTF-
1 is also often positive but less specific for neuroendocrine differentiation;
chromogranin is the classic neuroendocrine marker.
2. A 28-year-old woman with systemic lupus erythematosus presents with acute
onset of dyspnea and pleuritic chest pain. ECG shows sinus tachycardia. D-dimer
is elevated. CTPA reveals bilateral segmental filling defects. She is
hemodynamically stable. Which is the most appropriate initial anticoagulation?
A) Aspirin 325 mg daily
B) Unfractionated heparin IV bolus followed by infusion
C) Warfarin 5 mg daily
D) Clopidogrel 75 mg daily
,CORRECT ANSWER: B – In a stable patient with acute pulmonary embolism,
initial anticoagulation with heparin (UFH or LMWH) is indicated. Warfarin is
started later and overlapped with heparin.
3. A 56-year-old man with hypertension and type 2 diabetes presents with a non-
healing ulcer on his right great toe. Ankle-brachial index is 0.45. Which finding on
physical examination is most consistent with this condition?
A) Bounding dorsalis pedals pulses
B) Hair loss on the lower leg and shiny skin
C) Warm, erythematous toes with edema
D) Pigmentation around the ankles
CORRECT ANSWER: B – Chronic arterial insufficiency leads to loss of hair,
shiny atrophic skin, thickened nails, and cool extremities.
4. A 22-year-old college student presents with 3 days of watery diarrhea, vomiting,
and low-grade fever after attending a party. Stool studies are negative for ova,
parasites, and bacterial culture. Symptoms resolve spontaneously in 72 hours. Most
likely pathogen?
A) Giardia labia
B) Ent amoeba histolytic
C) Norovirus
D) Cyclosporine cayetanensis
CORRECT ANSWER: C – Norovirus causes acute, self-limited gastroenteritis
with vomiting and non-bloody diarrhea; incubation 12–48 hours, resolution in 2–3
days.
,5. A 68-year-old woman falls and sustains a left femoral neck fracture. She has a
history of rheumatoid arthritis treated with prednisone 10 mg daily for 2 years.
Bone density T-score is -3.2 at the hip. Which medication is most appropriate to
prevent future fractures?
A) Calcium carbonate alone
B) Raloxifene
C) Alendronate
D) Teriparatide
CORRECT ANSWER: C – Glucocorticoid-induced osteoporosis with fragility
fracture requires bisphosphonate (alendronate) as first-line therapy.
6. A 35-year-old man with HIV (CD4 count 120 cells/µL) presents with headache,
fever, and confusion. MRI brain shows multiple ring-enhancing lesions in the basal
ganglia. Which diagnostic test is most specific?
A) Serum Cryptococci antigen
B) Brain biopsy with PCR for Toxoplasma gundi
C) CSF VDRL
D) CSF Gram stain
CORRECT ANSWER: B – Toxoplasma encephalitis presents with ring-enhancing
lesions; PCR on CSF or biopsy is specific; empiric treatment often given without
biopsy.
7. A 50-year-old woman presents with episodic palpitations, sweating, and
headache. Blood pressure 210/110 mmHg during episode, normal between
episodes. Urinary metanephrines are elevated. Which imaging study is best to
localize the tumor?
A) CT chest without contrast
, B) MRI abdomen with contrast
C) Thyroid ultrasound
D) Octreotide scan
CORRECT ANSWER: B – Pheochromocytoma (adrenal or extra-adrenal) best
localized by MRI or CT of abdomen; MRI preferred due to no radiation and better
soft tissue characterization.
8. A 72-year-old man with chronic kidney disease stage 4 (eGFI 25 mL/min)
presents with fatigue, bone pain, and serum calcium 8.0 mg/ld., phosphorus 6.2
mg/ld., PTH 450 pg./mile Which medication reduces PTH in this setting?
A) Calcium acetate
B) Sevelamer
C) Calcitriol
D) Aluminum hydroxide
CORRECT ANSWER: C – Secondary hyperparathyroidism of CKD treated with
active vitamin D (calcitriol) to suppress PTH, along with phosphate binders.
9. A 30-year-old woman with a history of Graves’ disease treated with radioactive
iodine 6 months ago presents with fatigue, weight gain, and cold intolerance. TSH
45 µIU/mL, free T4 0.4 ng/ld. Which finding on physical exam is expected?
A) Tachycardia
B) Delayed relaxation of deep tendon reflexes
C) Warm, moist skin
D) Exophthalmos
