COMSAE Phase 2 – Form 114i (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 sudden onset of right-sided
weakness and aphasia. Symptoms began 90 minutes ago. CT scan
shows no hemorrhage. Which is the most appropriate next step?
A. Administer aspirin only
B. Start heparin infusion
C. Perform carotid endarterectomy immediately
D. Administer intravenous alteplase if eligible
E. Observe for 24 hours
Rationale: This patient has an acute ischemic stroke within the
treatment window for thrombolytic therapy. After excluding
hemorrhage and contraindications, intravenous alteplase is indicated to
improve neurologic outcomes. Aspirin is used when thrombolysis is not
indicated or after thrombolytic treatment protocols are completed.
2. A 24-year-old woman presents with fatigue, pallor, and heavy
menstrual bleeding. Laboratory studies show microcytic anemia
with low ferritin. Which diagnosis is most likely?
A. Thalassemia minor
B. Sideroblastic anemia
,C. Anemia of chronic disease
D. Vitamin B12 deficiency
E. Iron deficiency anemia
Rationale: Iron deficiency anemia typically presents with microcytic
anemia, low ferritin, low serum iron, and increased total iron-binding
capacity. Heavy menstrual bleeding is a common cause in reproductive-
age women.
3. A patient with diabetes develops nephrotic-range proteinuria.
Which glomerular lesion is classically associated with diabetic
nephropathy?
A. Crescents
B. Wire-loop lesions
C. Subepithelial humps
D. Kimmelstiel-Wilson nodules
E. Tram-track appearance
Rationale: Nodular glomerulosclerosis characterized by Kimmelstiel-
Wilson nodules is a hallmark of diabetic nephropathy. These nodules
consist of mesangial matrix expansion resulting from chronic
hyperglycemia.
4. A newborn develops respiratory distress shortly after birth. Chest
radiograph reveals diffuse ground-glass opacities. The underlying
cause is most likely deficiency of:
A. Alpha-1 antitrypsin
B. Elastase
C. Immunoglobulin A
,D. Surfactant protein C receptor
E. Pulmonary surfactant
Rationale: Neonatal respiratory distress syndrome results from
insufficient surfactant production, particularly in premature infants.
Lack of surfactant increases alveolar surface tension and promotes
collapse.
5. A 58-year-old smoker presents with hematuria. Cystoscopy reveals
bladder carcinoma. Which risk factor is most strongly associated
with transitional cell carcinoma?
A. Schistosomiasis
B. HPV infection
C. Ulcerative colitis
D. Asbestos exposure
E. Cigarette smoking
Rationale: Cigarette smoking is the most important risk factor for
urothelial (transitional cell) carcinoma of the bladder. Carcinogens are
concentrated in urine and damage the urothelium.
6. A patient develops fever, hypotension, and warm extremities after
gram-negative bacteremia. Which mediator plays a major role in
septic shock?
A. Histamine alone
B. Bradykinin only
C. Leukotriene B4
D. Tumor necrosis factor-alpha
E. Interferon-gamma
, Rationale: TNF-alpha is a key cytokine in septic shock, promoting
vasodilation, capillary leak, and activation of inflammatory pathways
that contribute to hypotension and organ dysfunction.
7. A 42-year-old woman presents with exophthalmos, weight loss,
and heat intolerance. Which antibody is responsible for her
condition?
A. Anti-thyroglobulin antibody
B. Anti-mitochondrial antibody
C. Anti-centromere antibody
D. Thyroid-stimulating immunoglobulin
E. Anti-dsDNA antibody
Rationale: Graves disease is caused by thyroid-stimulating
immunoglobulins that activate TSH receptors, leading to
hyperthyroidism and characteristic findings such as exophthalmos.
8. A patient experiences crushing substernal chest pain. Troponin
levels are elevated. Which cellular process is most directly
responsible for irreversible myocardial injury?
A. Glycogen depletion
B. Cell swelling
C. Fatty change
D. Ribosome detachment
E. Membrane damage with calcium influx
Rationale: Irreversible cell injury occurs when membrane integrity is
lost, allowing uncontrolled calcium entry that activates destructive
enzymes and triggers cell death.
version) Exam Questions With Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf.
1. A 67-year-old man presents with sudden onset of right-sided
weakness and aphasia. Symptoms began 90 minutes ago. CT scan
shows no hemorrhage. Which is the most appropriate next step?
A. Administer aspirin only
B. Start heparin infusion
C. Perform carotid endarterectomy immediately
D. Administer intravenous alteplase if eligible
E. Observe for 24 hours
Rationale: This patient has an acute ischemic stroke within the
treatment window for thrombolytic therapy. After excluding
hemorrhage and contraindications, intravenous alteplase is indicated to
improve neurologic outcomes. Aspirin is used when thrombolysis is not
indicated or after thrombolytic treatment protocols are completed.
2. A 24-year-old woman presents with fatigue, pallor, and heavy
menstrual bleeding. Laboratory studies show microcytic anemia
with low ferritin. Which diagnosis is most likely?
A. Thalassemia minor
B. Sideroblastic anemia
,C. Anemia of chronic disease
D. Vitamin B12 deficiency
E. Iron deficiency anemia
Rationale: Iron deficiency anemia typically presents with microcytic
anemia, low ferritin, low serum iron, and increased total iron-binding
capacity. Heavy menstrual bleeding is a common cause in reproductive-
age women.
3. A patient with diabetes develops nephrotic-range proteinuria.
Which glomerular lesion is classically associated with diabetic
nephropathy?
A. Crescents
B. Wire-loop lesions
C. Subepithelial humps
D. Kimmelstiel-Wilson nodules
E. Tram-track appearance
Rationale: Nodular glomerulosclerosis characterized by Kimmelstiel-
Wilson nodules is a hallmark of diabetic nephropathy. These nodules
consist of mesangial matrix expansion resulting from chronic
hyperglycemia.
4. A newborn develops respiratory distress shortly after birth. Chest
radiograph reveals diffuse ground-glass opacities. The underlying
cause is most likely deficiency of:
A. Alpha-1 antitrypsin
B. Elastase
C. Immunoglobulin A
,D. Surfactant protein C receptor
E. Pulmonary surfactant
Rationale: Neonatal respiratory distress syndrome results from
insufficient surfactant production, particularly in premature infants.
Lack of surfactant increases alveolar surface tension and promotes
collapse.
5. A 58-year-old smoker presents with hematuria. Cystoscopy reveals
bladder carcinoma. Which risk factor is most strongly associated
with transitional cell carcinoma?
A. Schistosomiasis
B. HPV infection
C. Ulcerative colitis
D. Asbestos exposure
E. Cigarette smoking
Rationale: Cigarette smoking is the most important risk factor for
urothelial (transitional cell) carcinoma of the bladder. Carcinogens are
concentrated in urine and damage the urothelium.
6. A patient develops fever, hypotension, and warm extremities after
gram-negative bacteremia. Which mediator plays a major role in
septic shock?
A. Histamine alone
B. Bradykinin only
C. Leukotriene B4
D. Tumor necrosis factor-alpha
E. Interferon-gamma
, Rationale: TNF-alpha is a key cytokine in septic shock, promoting
vasodilation, capillary leak, and activation of inflammatory pathways
that contribute to hypotension and organ dysfunction.
7. A 42-year-old woman presents with exophthalmos, weight loss,
and heat intolerance. Which antibody is responsible for her
condition?
A. Anti-thyroglobulin antibody
B. Anti-mitochondrial antibody
C. Anti-centromere antibody
D. Thyroid-stimulating immunoglobulin
E. Anti-dsDNA antibody
Rationale: Graves disease is caused by thyroid-stimulating
immunoglobulins that activate TSH receptors, leading to
hyperthyroidism and characteristic findings such as exophthalmos.
8. A patient experiences crushing substernal chest pain. Troponin
levels are elevated. Which cellular process is most directly
responsible for irreversible myocardial injury?
A. Glycogen depletion
B. Cell swelling
C. Fatty change
D. Ribosome detachment
E. Membrane damage with calcium influx
Rationale: Irreversible cell injury occurs when membrane integrity is
lost, allowing uncontrolled calcium entry that activates destructive
enzymes and triggers cell death.
