COMSAE Phase 2 – BSA 116 Questions With
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant Download Pdf
Question 1
A 65-year-old man presents with crushing substernal chest pain
radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Answer: B. Right coronary artery
Rationale: Inferior wall myocardial infarction is classically associated
with ST elevation in leads II, III, and aVF. The right coronary artery
supplies the inferior wall in most individuals. LAD occlusion typically
causes anterior MI, while LCX causes lateral wall MI. The posterior
descending artery may be involved but is usually a branch of the RCA.
,Question 2
A 24-year-old woman presents with heat intolerance, weight loss, and
exophthalmos. Lab studies show low TSH and elevated free T4. What is
the most likely diagnosis?
A. Hashimoto thyroiditis
B. Subacute thyroiditis
C. Graves disease
D. Toxic multinodular goiter
Answer: C. Graves disease
Rationale: Graves disease is an autoimmune hyperthyroidism caused
by TSH receptor-stimulating antibodies. Exophthalmos is a key
distinguishing feature. Hashimoto typically causes hypothyroidism.
Subacute thyroiditis is painful and self-limited, and toxic multinodular
goiter usually occurs in older patients without eye findings.
Question 3
A newborn fails to pass meconium within 48 hours and has abdominal
distension. Rectal biopsy shows absence of ganglion cells. What is the
diagnosis?
A. Meconium ileus
B. Hirschsprung disease
,C. Pyloric stenosis
D. Necrotizing enterocolitis
Answer: B. Hirschsprung disease
Rationale: Hirschsprung disease is caused by failure of neural crest cell
migration leading to absence of ganglion cells in the distal colon. This
results in functional obstruction and delayed passage of meconium.
Meconium ileus is associated with cystic fibrosis. NEC occurs in
premature infants.
Question 4
A patient presents with tremor that improves with alcohol use. Which
condition is most likely?
A. Parkinson disease
B. Essential tremor
C. Huntington disease
D. Wilson disease
Answer: B. Essential tremor
Rationale: Essential tremor is an action tremor that often improves
with alcohol and worsens with purposeful movement. Parkinson
disease is a resting tremor. Huntington disease involves chorea, and
Wilson disease involves hepatic and neurologic dysfunction.
, Question 5
A 30-year-old woman presents with episodic headaches, sweating, and
palpitations. Which test is best for diagnosis?
A. Serum cortisol
B. Plasma metanephrines
C. Serum calcium
D. Urine ketones
Answer: B. Plasma metanephrines
Rationale: The triad suggests pheochromocytoma. Plasma free
metanephrines are the most sensitive screening test. Cortisol
evaluates Cushing syndrome. Calcium is unrelated, and ketones are
used in diabetic ketoacidosis.
Question 6
Which organism is most commonly associated with community-
acquired pneumonia in adults?
A. Klebsiella pneumoniae
B. Streptococcus pneumoniae
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant Download Pdf
Question 1
A 65-year-old man presents with crushing substernal chest pain
radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Answer: B. Right coronary artery
Rationale: Inferior wall myocardial infarction is classically associated
with ST elevation in leads II, III, and aVF. The right coronary artery
supplies the inferior wall in most individuals. LAD occlusion typically
causes anterior MI, while LCX causes lateral wall MI. The posterior
descending artery may be involved but is usually a branch of the RCA.
,Question 2
A 24-year-old woman presents with heat intolerance, weight loss, and
exophthalmos. Lab studies show low TSH and elevated free T4. What is
the most likely diagnosis?
A. Hashimoto thyroiditis
B. Subacute thyroiditis
C. Graves disease
D. Toxic multinodular goiter
Answer: C. Graves disease
Rationale: Graves disease is an autoimmune hyperthyroidism caused
by TSH receptor-stimulating antibodies. Exophthalmos is a key
distinguishing feature. Hashimoto typically causes hypothyroidism.
Subacute thyroiditis is painful and self-limited, and toxic multinodular
goiter usually occurs in older patients without eye findings.
Question 3
A newborn fails to pass meconium within 48 hours and has abdominal
distension. Rectal biopsy shows absence of ganglion cells. What is the
diagnosis?
A. Meconium ileus
B. Hirschsprung disease
,C. Pyloric stenosis
D. Necrotizing enterocolitis
Answer: B. Hirschsprung disease
Rationale: Hirschsprung disease is caused by failure of neural crest cell
migration leading to absence of ganglion cells in the distal colon. This
results in functional obstruction and delayed passage of meconium.
Meconium ileus is associated with cystic fibrosis. NEC occurs in
premature infants.
Question 4
A patient presents with tremor that improves with alcohol use. Which
condition is most likely?
A. Parkinson disease
B. Essential tremor
C. Huntington disease
D. Wilson disease
Answer: B. Essential tremor
Rationale: Essential tremor is an action tremor that often improves
with alcohol and worsens with purposeful movement. Parkinson
disease is a resting tremor. Huntington disease involves chorea, and
Wilson disease involves hepatic and neurologic dysfunction.
, Question 5
A 30-year-old woman presents with episodic headaches, sweating, and
palpitations. Which test is best for diagnosis?
A. Serum cortisol
B. Plasma metanephrines
C. Serum calcium
D. Urine ketones
Answer: B. Plasma metanephrines
Rationale: The triad suggests pheochromocytoma. Plasma free
metanephrines are the most sensitive screening test. Cortisol
evaluates Cushing syndrome. Calcium is unrelated, and ketones are
used in diabetic ketoacidosis.
Question 6
Which organism is most commonly associated with community-
acquired pneumonia in adults?
A. Klebsiella pneumoniae
B. Streptococcus pneumoniae
