COMSAE Phase 2 – Form BSA 101 (Legacy
Core Clinical Presentations Index) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
Question 1
A 67-year-old man presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG demonstrates ST-
segment elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior wall myocardial infarctions involve leads II, III, and
aVF and are most commonly caused by occlusion of the right
coronary artery. The LAD supplies the anterior wall, while the
circumflex commonly supplies the lateral wall.
Question 2
A 25-year-old woman presents with dysuria, urinary frequency, and
urgency. Urinalysis reveals positive leukocyte esterase and nitrites.
What is the most likely pathogen?
A. Staphylococcus saprophyticus
B. Enterococcus faecalis
,C. Proteus mirabilis
D. Escherichia coli
Rationale: E. coli is responsible for approximately 80–85% of
uncomplicated urinary tract infections. Nitrite positivity suggests
infection with nitrate-reducing gram-negative organisms such as E.
coli.
Question 3
A patient develops fever, productive cough, and pleuritic chest pain.
Chest radiograph reveals right lower lobe consolidation. Which
diagnosis is most likely?
A. Pulmonary embolism
B. Community-acquired pneumonia
C. Pneumothorax
D. Sarcoidosis
Rationale: Fever, productive cough, pleuritic chest pain, and lobar
consolidation are classic features of community-acquired pneumonia.
Question 4
A 32-year-old woman presents with weight loss, heat intolerance,
and palpitations. Laboratory testing reveals decreased TSH and
elevated free T4. What is the diagnosis?
A. Hashimoto thyroiditis
B. Secondary hypothyroidism
C. Euthyroid sick syndrome
D. Hyperthyroidism
Rationale: Low TSH and elevated free T4 indicate primary
hyperthyroidism, commonly caused by Graves disease.
,Question 5
A 60-year-old smoker develops hematuria without pain. Which
condition must be ruled out first?
A. Nephrolithiasis
B. Glomerulonephritis
C. Bladder carcinoma
D. Pyelonephritis
Rationale: Painless gross hematuria in an older smoker is highly
suspicious for urothelial carcinoma until proven otherwise.
Question 6
A patient with diabetes mellitus develops microalbuminuria. Which
medication best slows progression of diabetic nephropathy?
A. Hydrochlorothiazide
B. Furosemide
C. Metoprolol
D. Lisinopril
Rationale: ACE inhibitors reduce intraglomerular pressure and slow
progression of diabetic nephropathy, especially in patients with
albuminuria.
Question 7
A 22-year-old college student presents with fever, headache, nuchal
rigidity, and photophobia. What is the next best step?
A. Oral antibiotics
B. Observation
, C. Immediate empiric intravenous antibiotics
D. Outpatient follow-up
Rationale: Suspected bacterial meningitis requires prompt empiric
intravenous antibiotics to reduce mortality and neurologic
complications.
Question 8
A patient presents with sudden onset unilateral facial paralysis
affecting both the forehead and lower face. What is the diagnosis?
A. Stroke
B. Trigeminal neuralgia
C. Multiple sclerosis
D. Bell palsy
Rationale: Bell palsy involves the entire ipsilateral face including the
forehead due to lower motor neuron dysfunction of cranial nerve VII.
Question 9
A 72-year-old woman falls and sustains a femoral neck fracture.
Which underlying condition is most likely present?
A. Osteoarthritis
B. Osteomyelitis
C. Osteoporosis
D. Rheumatoid arthritis
Rationale: Fragility fractures involving the hip are classic
complications of osteoporosis, particularly in elderly women.
Question 10
Core Clinical Presentations Index) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
Question 1
A 67-year-old man presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG demonstrates ST-
segment elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior wall myocardial infarctions involve leads II, III, and
aVF and are most commonly caused by occlusion of the right
coronary artery. The LAD supplies the anterior wall, while the
circumflex commonly supplies the lateral wall.
Question 2
A 25-year-old woman presents with dysuria, urinary frequency, and
urgency. Urinalysis reveals positive leukocyte esterase and nitrites.
What is the most likely pathogen?
A. Staphylococcus saprophyticus
B. Enterococcus faecalis
,C. Proteus mirabilis
D. Escherichia coli
Rationale: E. coli is responsible for approximately 80–85% of
uncomplicated urinary tract infections. Nitrite positivity suggests
infection with nitrate-reducing gram-negative organisms such as E.
coli.
Question 3
A patient develops fever, productive cough, and pleuritic chest pain.
Chest radiograph reveals right lower lobe consolidation. Which
diagnosis is most likely?
A. Pulmonary embolism
B. Community-acquired pneumonia
C. Pneumothorax
D. Sarcoidosis
Rationale: Fever, productive cough, pleuritic chest pain, and lobar
consolidation are classic features of community-acquired pneumonia.
Question 4
A 32-year-old woman presents with weight loss, heat intolerance,
and palpitations. Laboratory testing reveals decreased TSH and
elevated free T4. What is the diagnosis?
A. Hashimoto thyroiditis
B. Secondary hypothyroidism
C. Euthyroid sick syndrome
D. Hyperthyroidism
Rationale: Low TSH and elevated free T4 indicate primary
hyperthyroidism, commonly caused by Graves disease.
,Question 5
A 60-year-old smoker develops hematuria without pain. Which
condition must be ruled out first?
A. Nephrolithiasis
B. Glomerulonephritis
C. Bladder carcinoma
D. Pyelonephritis
Rationale: Painless gross hematuria in an older smoker is highly
suspicious for urothelial carcinoma until proven otherwise.
Question 6
A patient with diabetes mellitus develops microalbuminuria. Which
medication best slows progression of diabetic nephropathy?
A. Hydrochlorothiazide
B. Furosemide
C. Metoprolol
D. Lisinopril
Rationale: ACE inhibitors reduce intraglomerular pressure and slow
progression of diabetic nephropathy, especially in patients with
albuminuria.
Question 7
A 22-year-old college student presents with fever, headache, nuchal
rigidity, and photophobia. What is the next best step?
A. Oral antibiotics
B. Observation
, C. Immediate empiric intravenous antibiotics
D. Outpatient follow-up
Rationale: Suspected bacterial meningitis requires prompt empiric
intravenous antibiotics to reduce mortality and neurologic
complications.
Question 8
A patient presents with sudden onset unilateral facial paralysis
affecting both the forehead and lower face. What is the diagnosis?
A. Stroke
B. Trigeminal neuralgia
C. Multiple sclerosis
D. Bell palsy
Rationale: Bell palsy involves the entire ipsilateral face including the
forehead due to lower motor neuron dysfunction of cranial nerve VII.
Question 9
A 72-year-old woman falls and sustains a femoral neck fracture.
Which underlying condition is most likely present?
A. Osteoarthritis
B. Osteomyelitis
C. Osteoporosis
D. Rheumatoid arthritis
Rationale: Fragility fractures involving the hip are classic
complications of osteoporosis, particularly in elderly women.
Question 10
