COMSAE PHASE 1 FORM 113 EXAM / COMSAE FORM 113 ACTUAL
PHASE 1 EXAM 2026/2027 COMPLETE ACCURATE EXAM APPROVED
QUESTIONS WITH WELL ELABORATED ANSWERS AND
RATIONALES (100% CORRECT VERIFIED SOLUTIONS) NEWEST
UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+ |INSTANT
DOWNLOAD PDF |FULL REVISED
1. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. A chest CT shows a 4 cm
right hilar mass with mediastinal lymphadenopathy. Biopsy reveals small cell
carcinoma. Which paraneoplastic syndrome is most commonly associated
with this tumor type?
A) Hypercalcemia
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Hypertrophic pulmonary osteoarthropathy
D) Acanthosis Nigerians
CORRECT ANSWER: B) SIADH is the most common paraneoplastic syndrome
in small cell lung cancer, due to ectopic ADH secretion. Hypercalcemia (A) is
more common in squamous cell carcinoma. Hypertrophic pulmonary
osteoarthropathy (C) is linked with non-small cell lung cancer. Acanthosis
Nigerians (D) is associated with gastric and other adenocarcinomas.
Rationale: Small cell carcinoma frequently produces ectopic ADH, leading to
hyponatremia. Recognizing this guides management and avoids volume repletion
that could worsen hyponatremia.
2. A 23-year-old woman with no prior medical history experiences sudden-
onset, severe, unilateral, throbbing headache, photophobia, and nausea. She
reports that her mother has similar episodes. Physical exam is unremarkable
between episodes. What is the first-line acute treatment for her most likely
diagnosis?
A) Oral propranolol
B) Intranasal sumatriptan
C) Intravenous methylprednisolone
D) Oral verapamil
,CORRECT ANSWER: B) Intranasal sumatriptan is first-line acute treatment for
migraine with or without aura. Propranolol (A) and verapamil (D) are preventive.
Methylprednisolone (C) is not first-line for acute migraine.
Rationale: Migraine with aura is suggested by family history and unilateral
throbbing pain. Trip tans abort the attack by serotonin receptor agonist,
vasoconstriction dilated cranial vessels.
3. A 68-year-old man with hypertension and type 2 diabetes presents with
progressive dyspnea on exertion, orthopnea, and bilateral lower extremity
edema. An echocardiogram shows left ventricular ejection fraction (LVEF) of
35%. Which medication class has been shown to reduce mortality in this
condition and should be initiated first?
A) Loop diuretics
B) Digoxin
C) Beta-blockers
D) Hydralazine-nitrate combination
CORRECT ANSWER: C) Beta-blockers (carvedilol, metoprolol succinate,
bisoprolol) reduce mortality in heart failure with reduced EF (Here). Loop diuretics
(A) control symptoms but do not improve mortality. Digoxin (B) reduces
hospitalizations but not mortality. Hydralazine-nitrate (D) is adjunctive in African
Americans with persistent symptoms.
Rationale: Chronic sympathetic activation worsens Here; beta-blockade reverses
remodeling. Guidelines mandate initiation before discharge unless contraindicated.
4. A 52-year-old woman presents with fatigue, arthralgia’s, facial rash sparing
the nasolabial folds, and oral ulcers. Labs show ANA positive, anti-dsDNA
positive, and low C3/C4. She is diagnosed with systemic lupus erythematosus.
Which renal pathology is most specific for this disease?
A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Diffuse proliferative glomerulonephritis
D) Minimal change disease
CORRECT ANSWER: C) Diffuse proliferative glomerulonephritis (class IV
lupus nephritis) is the most common and severe form, specific to SLE. Focal
segmental glomerulosclerosis (A) is not specific. Membranous nephropathy (B)
occurs in SLE but is less specific and often class V. Minimal change disease (D) is
not linked to SLE.
,Rationale: Immune complex deposition in SLE causes diffuse proliferative GN,
shown by “wire loop” lesions on EM. Prompt immunosuppression prevents renal
failure.
5. A 65-year-old man with a history of coronary artery disease presents with
acute onset of left-sided chest pain that is worse when lying flat and improves
when leaning forward. He had a myocardial infarction 2 weeks ago. An ECG
shows diffuse ST-segment elevations without reciprocal changes. Which is the
most likely diagnosis?
A) Acute pericarditis
B) Recurrent myocardial infarction
C) Pulmonary embolism
D) Aortic dissection
CORRECT ANSWER: A) Acute pericarditis, likely post-myocardial infarction
pericarditis (Dressler syndrome or early post-infarction pericarditis). Positional
pain and diffuse ST elevation without reciprocal changes are classic. Recurrent MI
(B) shows focal ST changes. Pulmonary embolism (C) causes right heart strain.
Aortic dissection (D) presents with tearing pain.
Rationale: Post-MI pericarditis occurs 2–3 weeks after infarction (autoimmune-
mediated). NSAIDs are first-line unless contraindicated.
6. A 28-year-old man presents with hematemesis and melena. He reports
heavy alcohol use. On exam, he has spider animas, palmar erythema, and
splenomegaly. Laboratory studies show thrombocytopenia, elevated INR, and
low albumin. Which finding on upper endoscopy would confirm the source of
bleeding?
A) Gastric antral vascular ectasia
B) Esophageal varices
C) Dieulafoy lesion
D) Duodenal ulcer
CORRECT ANSWER: B) Esophageal varices are the source in cirrhotic portal
hypertension, indicated by stigmata of chronic liver disease. Gastric antral vascular
ectasia (A) (“watermelon stomach”) is less common. Dieulafoy lesion (C) is a rare
submucosal artery. Duodenal ulcer (D) is not linked to stigmata shown.
, Rationale: Portal hypertension from alcohol-induced cirrhosis causes varietal
bleeding. Band ligation is definitive acute management.
7. A 72-year-old woman with osteoporosis is found to have a serum calcium of
11.2 mg/ld. (normal 8.5–10.2), PTH elevated at 120 pg./mL (normal 10–65),
and 25-hydroxyvitamin D normal. What is the most likely diagnosis?
A) Primary hyperparathyroidism
B) Malignancy-associated hypercalcemia
C) Familial hypocalciuric hypercalcemia
D) Secondary hyperparathyroidism
CORRECT ANSWER: A) Primary hyperparathyroidism presents with
hypercalcemia + elevated PTH. Malignancy (B) typically suppresses PTH.
Familial hypocalciuric hypercalcemia (C) is benign with low urine calcium.
Secondary hyperparathyroidism (D) has low/normal calcium.
Rationale: Postmenopausal osteoporosis and hypercalcemia with inappropriately
normal/elevated PTH = primary hyperparathyroidism until proven otherwise. Para
thyroidectomy if symptomatic or calcium >1 mg/ld. above normal.
8. A 34-year-old woman with a history of Graves’ disease treated with
methimazole presents with fever, sore throat, and fatigue. Her WBC count is
1,200/mm³ with an absolute neutrophil count of 400/mm³. What is the most
appropriate next step?
A) Increase methimazole dose
B) Administer broad-spectrum antibiotics
C) Discontinue methimazole and start propylthiouracil
D) Discontinue methimazole and initiate radioactive iodine
CORRECT ANSWER: D) Agranulocytosis (ANC <500) from methimazole
requires immediate discontinuation. Radioactive iodine is definitive treatment.
Increasing dose (A) worsens condition. Antibiotics (B) are supportive but not the
primary step. Propylthiouracil (C) can also cause agranulocytosis; avoid cross-
reaction.
PHASE 1 EXAM 2026/2027 COMPLETE ACCURATE EXAM APPROVED
QUESTIONS WITH WELL ELABORATED ANSWERS AND
RATIONALES (100% CORRECT VERIFIED SOLUTIONS) NEWEST
UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+ |INSTANT
DOWNLOAD PDF |FULL REVISED
1. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. A chest CT shows a 4 cm
right hilar mass with mediastinal lymphadenopathy. Biopsy reveals small cell
carcinoma. Which paraneoplastic syndrome is most commonly associated
with this tumor type?
A) Hypercalcemia
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Hypertrophic pulmonary osteoarthropathy
D) Acanthosis Nigerians
CORRECT ANSWER: B) SIADH is the most common paraneoplastic syndrome
in small cell lung cancer, due to ectopic ADH secretion. Hypercalcemia (A) is
more common in squamous cell carcinoma. Hypertrophic pulmonary
osteoarthropathy (C) is linked with non-small cell lung cancer. Acanthosis
Nigerians (D) is associated with gastric and other adenocarcinomas.
Rationale: Small cell carcinoma frequently produces ectopic ADH, leading to
hyponatremia. Recognizing this guides management and avoids volume repletion
that could worsen hyponatremia.
2. A 23-year-old woman with no prior medical history experiences sudden-
onset, severe, unilateral, throbbing headache, photophobia, and nausea. She
reports that her mother has similar episodes. Physical exam is unremarkable
between episodes. What is the first-line acute treatment for her most likely
diagnosis?
A) Oral propranolol
B) Intranasal sumatriptan
C) Intravenous methylprednisolone
D) Oral verapamil
,CORRECT ANSWER: B) Intranasal sumatriptan is first-line acute treatment for
migraine with or without aura. Propranolol (A) and verapamil (D) are preventive.
Methylprednisolone (C) is not first-line for acute migraine.
Rationale: Migraine with aura is suggested by family history and unilateral
throbbing pain. Trip tans abort the attack by serotonin receptor agonist,
vasoconstriction dilated cranial vessels.
3. A 68-year-old man with hypertension and type 2 diabetes presents with
progressive dyspnea on exertion, orthopnea, and bilateral lower extremity
edema. An echocardiogram shows left ventricular ejection fraction (LVEF) of
35%. Which medication class has been shown to reduce mortality in this
condition and should be initiated first?
A) Loop diuretics
B) Digoxin
C) Beta-blockers
D) Hydralazine-nitrate combination
CORRECT ANSWER: C) Beta-blockers (carvedilol, metoprolol succinate,
bisoprolol) reduce mortality in heart failure with reduced EF (Here). Loop diuretics
(A) control symptoms but do not improve mortality. Digoxin (B) reduces
hospitalizations but not mortality. Hydralazine-nitrate (D) is adjunctive in African
Americans with persistent symptoms.
Rationale: Chronic sympathetic activation worsens Here; beta-blockade reverses
remodeling. Guidelines mandate initiation before discharge unless contraindicated.
4. A 52-year-old woman presents with fatigue, arthralgia’s, facial rash sparing
the nasolabial folds, and oral ulcers. Labs show ANA positive, anti-dsDNA
positive, and low C3/C4. She is diagnosed with systemic lupus erythematosus.
Which renal pathology is most specific for this disease?
A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Diffuse proliferative glomerulonephritis
D) Minimal change disease
CORRECT ANSWER: C) Diffuse proliferative glomerulonephritis (class IV
lupus nephritis) is the most common and severe form, specific to SLE. Focal
segmental glomerulosclerosis (A) is not specific. Membranous nephropathy (B)
occurs in SLE but is less specific and often class V. Minimal change disease (D) is
not linked to SLE.
,Rationale: Immune complex deposition in SLE causes diffuse proliferative GN,
shown by “wire loop” lesions on EM. Prompt immunosuppression prevents renal
failure.
5. A 65-year-old man with a history of coronary artery disease presents with
acute onset of left-sided chest pain that is worse when lying flat and improves
when leaning forward. He had a myocardial infarction 2 weeks ago. An ECG
shows diffuse ST-segment elevations without reciprocal changes. Which is the
most likely diagnosis?
A) Acute pericarditis
B) Recurrent myocardial infarction
C) Pulmonary embolism
D) Aortic dissection
CORRECT ANSWER: A) Acute pericarditis, likely post-myocardial infarction
pericarditis (Dressler syndrome or early post-infarction pericarditis). Positional
pain and diffuse ST elevation without reciprocal changes are classic. Recurrent MI
(B) shows focal ST changes. Pulmonary embolism (C) causes right heart strain.
Aortic dissection (D) presents with tearing pain.
Rationale: Post-MI pericarditis occurs 2–3 weeks after infarction (autoimmune-
mediated). NSAIDs are first-line unless contraindicated.
6. A 28-year-old man presents with hematemesis and melena. He reports
heavy alcohol use. On exam, he has spider animas, palmar erythema, and
splenomegaly. Laboratory studies show thrombocytopenia, elevated INR, and
low albumin. Which finding on upper endoscopy would confirm the source of
bleeding?
A) Gastric antral vascular ectasia
B) Esophageal varices
C) Dieulafoy lesion
D) Duodenal ulcer
CORRECT ANSWER: B) Esophageal varices are the source in cirrhotic portal
hypertension, indicated by stigmata of chronic liver disease. Gastric antral vascular
ectasia (A) (“watermelon stomach”) is less common. Dieulafoy lesion (C) is a rare
submucosal artery. Duodenal ulcer (D) is not linked to stigmata shown.
, Rationale: Portal hypertension from alcohol-induced cirrhosis causes varietal
bleeding. Band ligation is definitive acute management.
7. A 72-year-old woman with osteoporosis is found to have a serum calcium of
11.2 mg/ld. (normal 8.5–10.2), PTH elevated at 120 pg./mL (normal 10–65),
and 25-hydroxyvitamin D normal. What is the most likely diagnosis?
A) Primary hyperparathyroidism
B) Malignancy-associated hypercalcemia
C) Familial hypocalciuric hypercalcemia
D) Secondary hyperparathyroidism
CORRECT ANSWER: A) Primary hyperparathyroidism presents with
hypercalcemia + elevated PTH. Malignancy (B) typically suppresses PTH.
Familial hypocalciuric hypercalcemia (C) is benign with low urine calcium.
Secondary hyperparathyroidism (D) has low/normal calcium.
Rationale: Postmenopausal osteoporosis and hypercalcemia with inappropriately
normal/elevated PTH = primary hyperparathyroidism until proven otherwise. Para
thyroidectomy if symptomatic or calcium >1 mg/ld. above normal.
8. A 34-year-old woman with a history of Graves’ disease treated with
methimazole presents with fever, sore throat, and fatigue. Her WBC count is
1,200/mm³ with an absolute neutrophil count of 400/mm³. What is the most
appropriate next step?
A) Increase methimazole dose
B) Administer broad-spectrum antibiotics
C) Discontinue methimazole and start propylthiouracil
D) Discontinue methimazole and initiate radioactive iodine
CORRECT ANSWER: D) Agranulocytosis (ANC <500) from methimazole
requires immediate discontinuation. Radioactive iodine is definitive treatment.
Increasing dose (A) worsens condition. Antibiotics (B) are supportive but not the
primary step. Propylthiouracil (C) can also cause agranulocytosis; avoid cross-
reaction.
