COMSAE Phase 2 – Form BSA 111 (Integrative Clinical Skills Review) (2026 Edition): Comprehensive Multiple-Choice Questions, Answers, and Detailed Rationales

COMSAE Phase 2 – Form BSA 111 (Integrative
Clinical Skills Review) (2026 Edition):
Comprehensive Multiple-Choice Questions,
Answers, and Detailed Rationales

Question 1
A 62-year-old man presents with chest pain radiating to the
left arm and diaphoresis. ECG shows ST-elevation in leads II,
III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Correct Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction (II, III, aVF) is
most commonly due to occlusion of the right coronary artery,
which typically supplies the inferior myocardium in right-
dominant circulation.


Question 2
A patient presents with fatigue, pallor, and a low MCV. Lab
studies show increased TIBC and low ferritin. What is the
most likely diagnosis?

,A. Anemia of chronic disease
B. Iron deficiency anemia
C. Thalassemia trait
D. Sideroblastic anemia
Correct Answer: B. Iron deficiency anemia
Rationale: Low ferritin and high TIBC are classic for iron
deficiency anemia, reflecting depleted iron stores and
increased transferrin availability.


Question 3
A 45-year-old woman presents with tremor, weight loss, and
heat intolerance. Labs show low TSH and high T3/T4. What is
the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Thyroid cancer
Correct Answer: B. Graves disease
Rationale: Graves disease is the most common cause of
hyperthyroidism with suppressed TSH and elevated thyroid
hormones, often with autoimmune stimulation of TSH
receptors.


Question 4

,A patient develops severe shortness of breath and
hypotension after trauma. Jugular venous distension is
present, and breath sounds are absent on the right. What is
the next best step?
A. Chest X-ray
B. CT angiography
C. Needle decompression
D. Bronchoscopy
Correct Answer: C. Needle decompression
Rationale: This is tension pneumothorax requiring immediate
decompression; diagnosis is clinical and treatment should not
be delayed for imaging.


Question 5
A 28-year-old man presents with episodic headaches,
palpitations, and sweating. Which tumor is most likely
responsible?
A. Adrenal cortical adenoma
B. Pheochromocytoma
C. Pituitary adenoma
D. Medullary thyroid carcinoma
Correct Answer: B. Pheochromocytoma
Rationale: The triad of episodic headache, sweating, and
palpitations is classic for catecholamine-secreting
pheochromocytoma.

, Question 6
A newborn has projectile vomiting and a palpable olive-
shaped mass in the abdomen. What is the most likely
diagnosis?
A. Intussusception
B. Pyloric stenosis
C. Malrotation with volvulus
D. Necrotizing enterocolitis
Correct Answer: B. Pyloric stenosis
Rationale: Hypertrophic pyloric stenosis presents in infants
with projectile non-bilious vomiting and a palpable “olive”
mass.


Question 7
A patient with COPD has increasing dyspnea and hypercapnia.
What is the primary mechanism of CO₂ retention?
A. Increased respiratory drive
B. Alveolar hypoventilation
C. Increased diffusion capacity
D. Pulmonary embolism
Correct Answer: B. Alveolar hypoventilation
Rationale: COPD leads to air trapping and reduced alveolar
ventilation, causing CO₂ retention and respiratory acidosis.


Question 8