COMSAE Phase 2 – BSA 117 Practice Exam
Ultimate Prep Guide: Comprehensive
Questions, Answers, & Rationales for High-
Yield COMLEX Review
Question 1
A 64-year-old male presents with acute onset of severe pain,
swelling, and erythema in his right first metatarsophalangeal joint.
Arthrocentesis reveals negatively birefringent, needle-shaped
crystals. He has a history of hypertension managed with
hydrochlorothiazide. What is the most appropriate initial
pharmaceutical management for this acute flare?
A) Allopurinol
B) Indomethacin
C) Colchicine
D) Probenecid
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
indomethacin are first-line agents for acute gouty arthritis.
Allopurinol is a xanthine oxidase inhibitor used for chronic
management and should not be initiated during an acute flare as it
can worsen symptoms by shifting uric acid levels.
Question 2
A 42-year-old female presents with fatigue, cold intolerance, weight
gain, and a diffusely enlarged, non-tender thyroid gland. Serum TSH
is elevated, and free T4 is decreased. Anti-thyroid peroxidase (anti-
,TPO) antibodies are strongly positive. What is the most likely
diagnosis?
A) Graves' disease
B) Subacute granulomatous thyroiditis
C) Hashimoto's thyroiditis
D) Iodine deficiency thyroiditis
Rationale: Hashimoto's thyroiditis is the most common cause of
hypothyroidism in iodine-sufficient areas and is characterized by
positive anti-TPO antibodies and a diffuse, non-tender goiter.
Question 3
A 28-year-old pregnant female at 32 weeks gestation presents with a
blood pressure of 162/110 mmHg on two readings taken 4 hours
apart. Her urinalysis reveals 3+ protein. She denies visual changes,
headache, or right upper quadrant pain. What is the most
appropriate next step in management?
A) Oral outpatient labetalol therapy
B) Immediate emergency cesarean section
C) Hospitalization, intravenous magnesium sulfate, and blood
pressure control
D) Expectant outpatient management with weekly follow-up
Rationale: Severe preeclampsia (BP ≥ 160/110 mmHg with
proteinuria) requires hospitalization, seizure prophylaxis with
magnesium sulfate, antihypertensive therapy, and planning for
delivery around 34 weeks gestation or sooner if maternal-fetal
decompensation occurs.
Question 4
,A 45-year-old male presents to the clinic for a routine check-up.
Structural examination reveals a tissue texture abnormality at the
T5–T9 levels bilaterally, characterized by increased warmth, ropiness,
and restriction of motion. Viscerosomatic reflex from which of the
following organs is most likely responsible for these findings?
A) Stomach
B) Kidneys
C) Descending colon
D) Urinary bladder
Rationale: The stomach receives sympathetic innervation from the
T5–T9 spinal segments via the greater splanchnic nerve, making it the
primary source for viscerosomatic changes in this region.
Question 5
A 72-year-old male with a history of chronic atrial fibrillation presents
with sudden, severe abdominal pain out of proportion to physical
exam findings. He has vomited twice. Vital signs reveal a heart rate of
115 bpm (irregularly irregular) and blood pressure of 105/70 mmHg.
What is the definitive diagnostic modality for this patient's suspected
condition?
A) Abdominal ultrasound
B) Plain abdominal X-ray series
C) CT angiography of the abdomen
D) Colonoscopy
Rationale: Acute mesenteric ischemia typically presents with severe
abdominal pain out of proportion to physical exam findings in a
patient with an embolic source (like atrial fibrillation); CT
angiography is the diagnostic modality of choice to visualize
mesenteric vessel occlusion.
, Question 6
A 3-year-old boy is brought to the emergency department due to a
barky, seal-like cough and inspiratory stridor that worsens when he is
agitated. He has a low-grade fever and coryza. An anteroposterior
neck X-ray reveals subglottic narrowing (the steeple sign). What is the
first-line treatment for moderate symptoms of this condition?
A) Intravenous ampicillin
B) Albuterol nebulization
C) Nebulized epinephrine and oral dexamethasone
D) Inhaled nitric oxide
Rationale: Laryngotracheobronchitis (croup), caused typically by
parainfluenza virus, is managed with corticosteroids
(dexamethasone) to reduce airway inflammation and nebulized
racemic epinephrine for moderate-to-severe respiratory distress.
Question 7
A 52-year-old female presents with progressive shortness of breath
and a dry cough. Her pulmonary function tests demonstrate a
FEV1/FVC ratio of 85%, decreased forced vital capacity (FVC), and a
decreased diffusing capacity for carbon monoxide (DLCO). Which of
the following conditions is most consistent with these findings?
A) Chronic bronchitis
B) Asthma
C) Emphysema
D) Idiopathic pulmonary fibrosis
Rationale: A normal or elevated FEV1/FVC ratio (>70%) paired with
reduced lung volumes (FVC) indicates a restrictive lung pattern, and a
decreased DLCO further pinpoints intrinsic lung disease such as
idiopathic pulmonary fibrosis.
Ultimate Prep Guide: Comprehensive
Questions, Answers, & Rationales for High-
Yield COMLEX Review
Question 1
A 64-year-old male presents with acute onset of severe pain,
swelling, and erythema in his right first metatarsophalangeal joint.
Arthrocentesis reveals negatively birefringent, needle-shaped
crystals. He has a history of hypertension managed with
hydrochlorothiazide. What is the most appropriate initial
pharmaceutical management for this acute flare?
A) Allopurinol
B) Indomethacin
C) Colchicine
D) Probenecid
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
indomethacin are first-line agents for acute gouty arthritis.
Allopurinol is a xanthine oxidase inhibitor used for chronic
management and should not be initiated during an acute flare as it
can worsen symptoms by shifting uric acid levels.
Question 2
A 42-year-old female presents with fatigue, cold intolerance, weight
gain, and a diffusely enlarged, non-tender thyroid gland. Serum TSH
is elevated, and free T4 is decreased. Anti-thyroid peroxidase (anti-
,TPO) antibodies are strongly positive. What is the most likely
diagnosis?
A) Graves' disease
B) Subacute granulomatous thyroiditis
C) Hashimoto's thyroiditis
D) Iodine deficiency thyroiditis
Rationale: Hashimoto's thyroiditis is the most common cause of
hypothyroidism in iodine-sufficient areas and is characterized by
positive anti-TPO antibodies and a diffuse, non-tender goiter.
Question 3
A 28-year-old pregnant female at 32 weeks gestation presents with a
blood pressure of 162/110 mmHg on two readings taken 4 hours
apart. Her urinalysis reveals 3+ protein. She denies visual changes,
headache, or right upper quadrant pain. What is the most
appropriate next step in management?
A) Oral outpatient labetalol therapy
B) Immediate emergency cesarean section
C) Hospitalization, intravenous magnesium sulfate, and blood
pressure control
D) Expectant outpatient management with weekly follow-up
Rationale: Severe preeclampsia (BP ≥ 160/110 mmHg with
proteinuria) requires hospitalization, seizure prophylaxis with
magnesium sulfate, antihypertensive therapy, and planning for
delivery around 34 weeks gestation or sooner if maternal-fetal
decompensation occurs.
Question 4
,A 45-year-old male presents to the clinic for a routine check-up.
Structural examination reveals a tissue texture abnormality at the
T5–T9 levels bilaterally, characterized by increased warmth, ropiness,
and restriction of motion. Viscerosomatic reflex from which of the
following organs is most likely responsible for these findings?
A) Stomach
B) Kidneys
C) Descending colon
D) Urinary bladder
Rationale: The stomach receives sympathetic innervation from the
T5–T9 spinal segments via the greater splanchnic nerve, making it the
primary source for viscerosomatic changes in this region.
Question 5
A 72-year-old male with a history of chronic atrial fibrillation presents
with sudden, severe abdominal pain out of proportion to physical
exam findings. He has vomited twice. Vital signs reveal a heart rate of
115 bpm (irregularly irregular) and blood pressure of 105/70 mmHg.
What is the definitive diagnostic modality for this patient's suspected
condition?
A) Abdominal ultrasound
B) Plain abdominal X-ray series
C) CT angiography of the abdomen
D) Colonoscopy
Rationale: Acute mesenteric ischemia typically presents with severe
abdominal pain out of proportion to physical exam findings in a
patient with an embolic source (like atrial fibrillation); CT
angiography is the diagnostic modality of choice to visualize
mesenteric vessel occlusion.
, Question 6
A 3-year-old boy is brought to the emergency department due to a
barky, seal-like cough and inspiratory stridor that worsens when he is
agitated. He has a low-grade fever and coryza. An anteroposterior
neck X-ray reveals subglottic narrowing (the steeple sign). What is the
first-line treatment for moderate symptoms of this condition?
A) Intravenous ampicillin
B) Albuterol nebulization
C) Nebulized epinephrine and oral dexamethasone
D) Inhaled nitric oxide
Rationale: Laryngotracheobronchitis (croup), caused typically by
parainfluenza virus, is managed with corticosteroids
(dexamethasone) to reduce airway inflammation and nebulized
racemic epinephrine for moderate-to-severe respiratory distress.
Question 7
A 52-year-old female presents with progressive shortness of breath
and a dry cough. Her pulmonary function tests demonstrate a
FEV1/FVC ratio of 85%, decreased forced vital capacity (FVC), and a
decreased diffusing capacity for carbon monoxide (DLCO). Which of
the following conditions is most consistent with these findings?
A) Chronic bronchitis
B) Asthma
C) Emphysema
D) Idiopathic pulmonary fibrosis
Rationale: A normal or elevated FEV1/FVC ratio (>70%) paired with
reduced lung volumes (FVC) indicates a restrictive lung pattern, and a
decreased DLCO further pinpoints intrinsic lung disease such as
idiopathic pulmonary fibrosis.
