COMSAE Phase 2 – BSA 115i Intensive
Review: Exam-Focused Practice Questions,
Detailed Answer Keys, and Step-by-Step
Rationales (PDF)
1. A 62-year-old male with a history of COPD presents with
increased dyspnea, increased sputum production, and
change in sputum color over the past 24 hours. Vital
signs are stable but he is tachypneic. Which of the
following is the most appropriate initial pharmacologic
management?
A. Azithromycin
B. Inhaled corticosteroids
C. Oral prednisone
D. Supplemental oxygen only
Rationale: Acute exacerbations of COPD are frequently
triggered by respiratory infections; antibiotics such as
azithromycin are indicated when there is an increase in
sputum volume and purulence to improve outcomes.
2. A 35-year-old female presents with fatigue, cold
intolerance, and weight gain. Physical examination
reveals a diffuse, nontender goiter. TSH is elevated and
free T4 is low. Anti-thyroid peroxidase antibodies are
positive. What is the most likely diagnosis?
,A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Thyroid adenoma
Rationale: The presence of positive anti-thyroid peroxidase
antibodies in the setting of primary hypothyroidism is highly
specific for Hashimoto thyroiditis, the most common cause of
hypothyroidism in iodine-sufficient regions.
3. A 45-year-old male presents with severe, burning
epigastric pain that improves with eating. He has tried
over-the-counter antacids with only temporary relief.
What is the most accurate diagnostic test for the most
likely diagnosis?
A. Serum gastrin level
B. Urea breath test
C. Barium swallow
D. Plain abdominal X-ray
Rationale: The patient's presentation is characteristic of a
duodenal ulcer, most commonly caused by H. pylori infection;
the urea breath test is a non-invasive and highly sensitive
diagnostic method for this pathogen.
4. A 52-year-old female presents with right upper quadrant
pain radiating to the right scapula after eating a fatty
meal. Physical examination reveals a positive Murphy
, sign. Which of the following is the most appropriate next
diagnostic step?
A. CT scan of the abdomen
B. Right upper quadrant ultrasound
C. HIDA scan
D. ERCP
Rationale: A positive Murphy sign in the context of biliary
colic symptoms is highly suggestive of acute cholecystitis, for
which right upper quadrant ultrasound is the initial imaging
modality of choice.
5. A 75-year-old male presents with sudden onset of
"curtain coming down" over his right eye. He has a
history of atrial fibrillation but is not on anticoagulation.
Visual acuity is 20/200 in that eye. What is the most
likely diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Giant cell arteritis
D. Angle-closure glaucoma
Rationale: Sudden, painless, monocular vision loss in a patient
with a known risk factor like atrial fibrillation is classic for an
embolic event causing central retinal artery occlusion.
6. A 28-year-old female, G2P1, at 36 weeks gestation
presents with vaginal bleeding and abdominal pain.
Examination reveals a firm, tender uterus. Fetal heart
, rate tracing shows late decelerations. What is the most
likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Vasa previa
D. Uterine rupture
Rationale: The combination of vaginal bleeding, abdominal
pain, and a firm/tender uterus in the third trimester is the
clinical triad for placental abruption.
7. A 30-year-old male with a history of HIV (CD4 count 50
cells/mm³) presents with progressive confusion and
focal neurologic deficits. MRI of the brain reveals
multiple ring-enhancing lesions. Which of the following
is the most appropriate treatment?
A. Pyrimethamine and sulfadiazine
B. Fluconazole
C. Ganciclovir
D. Acyclovir
Rationale: In an immunocompromised patient with AIDS,
ring-enhancing brain lesions are strongly suggestive of
toxoplasmosis, which requires treatment with pyrimethamine
and sulfadiazine.
8. A 19-year-old male presents with fever, sore throat, and
posterior cervical lymphadenopathy. A heterophile
Review: Exam-Focused Practice Questions,
Detailed Answer Keys, and Step-by-Step
Rationales (PDF)
1. A 62-year-old male with a history of COPD presents with
increased dyspnea, increased sputum production, and
change in sputum color over the past 24 hours. Vital
signs are stable but he is tachypneic. Which of the
following is the most appropriate initial pharmacologic
management?
A. Azithromycin
B. Inhaled corticosteroids
C. Oral prednisone
D. Supplemental oxygen only
Rationale: Acute exacerbations of COPD are frequently
triggered by respiratory infections; antibiotics such as
azithromycin are indicated when there is an increase in
sputum volume and purulence to improve outcomes.
2. A 35-year-old female presents with fatigue, cold
intolerance, and weight gain. Physical examination
reveals a diffuse, nontender goiter. TSH is elevated and
free T4 is low. Anti-thyroid peroxidase antibodies are
positive. What is the most likely diagnosis?
,A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Thyroid adenoma
Rationale: The presence of positive anti-thyroid peroxidase
antibodies in the setting of primary hypothyroidism is highly
specific for Hashimoto thyroiditis, the most common cause of
hypothyroidism in iodine-sufficient regions.
3. A 45-year-old male presents with severe, burning
epigastric pain that improves with eating. He has tried
over-the-counter antacids with only temporary relief.
What is the most accurate diagnostic test for the most
likely diagnosis?
A. Serum gastrin level
B. Urea breath test
C. Barium swallow
D. Plain abdominal X-ray
Rationale: The patient's presentation is characteristic of a
duodenal ulcer, most commonly caused by H. pylori infection;
the urea breath test is a non-invasive and highly sensitive
diagnostic method for this pathogen.
4. A 52-year-old female presents with right upper quadrant
pain radiating to the right scapula after eating a fatty
meal. Physical examination reveals a positive Murphy
, sign. Which of the following is the most appropriate next
diagnostic step?
A. CT scan of the abdomen
B. Right upper quadrant ultrasound
C. HIDA scan
D. ERCP
Rationale: A positive Murphy sign in the context of biliary
colic symptoms is highly suggestive of acute cholecystitis, for
which right upper quadrant ultrasound is the initial imaging
modality of choice.
5. A 75-year-old male presents with sudden onset of
"curtain coming down" over his right eye. He has a
history of atrial fibrillation but is not on anticoagulation.
Visual acuity is 20/200 in that eye. What is the most
likely diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Giant cell arteritis
D. Angle-closure glaucoma
Rationale: Sudden, painless, monocular vision loss in a patient
with a known risk factor like atrial fibrillation is classic for an
embolic event causing central retinal artery occlusion.
6. A 28-year-old female, G2P1, at 36 weeks gestation
presents with vaginal bleeding and abdominal pain.
Examination reveals a firm, tender uterus. Fetal heart
, rate tracing shows late decelerations. What is the most
likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Vasa previa
D. Uterine rupture
Rationale: The combination of vaginal bleeding, abdominal
pain, and a firm/tender uterus in the third trimester is the
clinical triad for placental abruption.
7. A 30-year-old male with a history of HIV (CD4 count 50
cells/mm³) presents with progressive confusion and
focal neurologic deficits. MRI of the brain reveals
multiple ring-enhancing lesions. Which of the following
is the most appropriate treatment?
A. Pyrimethamine and sulfadiazine
B. Fluconazole
C. Ganciclovir
D. Acyclovir
Rationale: In an immunocompromised patient with AIDS,
ring-enhancing brain lesions are strongly suggestive of
toxoplasmosis, which requires treatment with pyrimethamine
and sulfadiazine.
8. A 19-year-old male presents with fever, sore throat, and
posterior cervical lymphadenopathy. A heterophile
