COMSAE Phase 2 – Form 113i (Student
Version) Exam Questions With Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf.
1. A 67-year-old man presents with crushing substernal chest pain
radiating to his left arm. ECG shows ST-segment elevations in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Obtuse marginal artery
Rationale: ST-segment elevations in leads II, III, and aVF indicate an
inferior wall myocardial infarction. The right coronary artery supplies
the inferior wall in the majority of patients. Prompt reperfusion therapy
is indicated to restore blood flow and limit myocardial damage.
2. A 24-year-old woman presents with tremor, weight loss, heat
intolerance, and palpitations. Physical examination reveals
exophthalmos and a diffusely enlarged thyroid. What is the most
likely diagnosis?
,A. Toxic multinodular goiter
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Graves disease
E. Thyroid adenoma
Rationale: Graves disease is an autoimmune condition caused by
thyroid-stimulating immunoglobulins that activate the TSH receptor.
Characteristic findings include hyperthyroidism, diffuse goiter, and
ophthalmopathy. Exophthalmos is particularly suggestive of Graves
disease.
3. A patient with diabetes develops microalbuminuria. Which
medication is most appropriate to slow progression of diabetic
nephropathy?
A. Hydrochlorothiazide
B. Furosemide
C. Amlodipine
D. Metoprolol
E. Lisinopril
Rationale: ACE inhibitors reduce intraglomerular pressure and
proteinuria, thereby slowing progression of diabetic nephropathy. They
are recommended even in patients with normal blood pressure when
persistent microalbuminuria is present.
, 4. A 4-year-old child presents with fever, drooling, and difficulty
swallowing. Examination reveals a toxic appearance and
inspiratory stridor. What is the next best step?
A. Throat culture
B. Lateral neck radiograph
C. Oral examination with tongue depressor
D. Secure the airway
E. Administer corticosteroids only
Rationale: This presentation is classic for epiglottitis. Airway
compromise can occur rapidly; therefore, airway stabilization is the first
priority. Diagnostic testing should not delay definitive airway
management.
5. A 72-year-old smoker presents with painless hematuria. Which
diagnosis should be considered most strongly?
A. Nephrolithiasis
B. Pyelonephritis
C. Benign prostatic hyperplasia
D. Glomerulonephritis
E. Bladder cancer
Rationale: Painless gross hematuria in an older smoker is bladder cancer
until proven otherwise. Smoking is the strongest risk factor for urothelial
carcinoma, and cystoscopic evaluation is warranted.
, 6. Which organism is the most common cause of community-
acquired pneumonia in adults?
A. Staphylococcus aureus
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Haemophilus influenzae
E. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most common cause
of community-acquired pneumonia across most adult populations.
Typical symptoms include fever, productive cough, and lobar infiltrates.
7. A patient presents with sudden onset of severe unilateral eye
pain, headache, nausea, and a fixed mid-dilated pupil. What is the
diagnosis?
A. Retinal detachment
B. Temporal arteritis
C. Optic neuritis
D. Central retinal artery occlusion
E. Acute angle-closure glaucoma
Rationale: Acute angle-closure glaucoma is an ophthalmologic
emergency characterized by increased intraocular pressure, severe pain,
nausea, blurred vision, and a fixed mid-dilated pupil. Immediate
treatment is required to prevent permanent vision loss.
Version) Exam Questions With Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf.
1. A 67-year-old man presents with crushing substernal chest pain
radiating to his left arm. ECG shows ST-segment elevations in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Obtuse marginal artery
Rationale: ST-segment elevations in leads II, III, and aVF indicate an
inferior wall myocardial infarction. The right coronary artery supplies
the inferior wall in the majority of patients. Prompt reperfusion therapy
is indicated to restore blood flow and limit myocardial damage.
2. A 24-year-old woman presents with tremor, weight loss, heat
intolerance, and palpitations. Physical examination reveals
exophthalmos and a diffusely enlarged thyroid. What is the most
likely diagnosis?
,A. Toxic multinodular goiter
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Graves disease
E. Thyroid adenoma
Rationale: Graves disease is an autoimmune condition caused by
thyroid-stimulating immunoglobulins that activate the TSH receptor.
Characteristic findings include hyperthyroidism, diffuse goiter, and
ophthalmopathy. Exophthalmos is particularly suggestive of Graves
disease.
3. A patient with diabetes develops microalbuminuria. Which
medication is most appropriate to slow progression of diabetic
nephropathy?
A. Hydrochlorothiazide
B. Furosemide
C. Amlodipine
D. Metoprolol
E. Lisinopril
Rationale: ACE inhibitors reduce intraglomerular pressure and
proteinuria, thereby slowing progression of diabetic nephropathy. They
are recommended even in patients with normal blood pressure when
persistent microalbuminuria is present.
, 4. A 4-year-old child presents with fever, drooling, and difficulty
swallowing. Examination reveals a toxic appearance and
inspiratory stridor. What is the next best step?
A. Throat culture
B. Lateral neck radiograph
C. Oral examination with tongue depressor
D. Secure the airway
E. Administer corticosteroids only
Rationale: This presentation is classic for epiglottitis. Airway
compromise can occur rapidly; therefore, airway stabilization is the first
priority. Diagnostic testing should not delay definitive airway
management.
5. A 72-year-old smoker presents with painless hematuria. Which
diagnosis should be considered most strongly?
A. Nephrolithiasis
B. Pyelonephritis
C. Benign prostatic hyperplasia
D. Glomerulonephritis
E. Bladder cancer
Rationale: Painless gross hematuria in an older smoker is bladder cancer
until proven otherwise. Smoking is the strongest risk factor for urothelial
carcinoma, and cystoscopic evaluation is warranted.
, 6. Which organism is the most common cause of community-
acquired pneumonia in adults?
A. Staphylococcus aureus
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Haemophilus influenzae
E. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most common cause
of community-acquired pneumonia across most adult populations.
Typical symptoms include fever, productive cough, and lobar infiltrates.
7. A patient presents with sudden onset of severe unilateral eye
pain, headache, nausea, and a fixed mid-dilated pupil. What is the
diagnosis?
A. Retinal detachment
B. Temporal arteritis
C. Optic neuritis
D. Central retinal artery occlusion
E. Acute angle-closure glaucoma
Rationale: Acute angle-closure glaucoma is an ophthalmologic
emergency characterized by increased intraocular pressure, severe pain,
nausea, blurred vision, and a fixed mid-dilated pupil. Immediate
treatment is required to prevent permanent vision loss.
