COMSAE Form ASA 116 Practice
Examination with Verified Questions,
Detailed Answers & Clinical Rationales
| High-Yield 2026 edition
1. A 68-year-old man presents with resting tremor,
bradykinesia, and cogwheel rigidity. Degeneration of which
structure is most responsible for his symptoms?
A. Caudate nucleus
B. Subthalamic nucleus
C. Substantia nigra pars compacta
D. Globus pallidus externus
E. Putamen
Answer: C. Substantia nigra pars compacta
Rationale: Parkinson disease results from degeneration of
dopaminergic neurons in the substantia nigra pars
compacta. Dopamine normally stimulates the direct
pathway and inhibits the indirect pathway, facilitating
movement. Loss of dopamine produces bradykinesia,
rigidity, resting tremor, and postural instability.
2. A patient develops severe chest pain radiating to the left
arm. Troponin levels are elevated. Which cellular change is
irreversible?
,A. Cell swelling
B. Fatty change
C. Ribosomal detachment
D. Nuclear pyknosis
E. Glycogen depletion
Answer: D. Nuclear pyknosis
Rationale: Pyknosis, karyorrhexis, and karyolysis represent
irreversible nuclear injury associated with cell death. Cell
swelling, fatty change, glycogen depletion, and ribosomal
detachment are reversible changes.
3. Which electrolyte abnormality is most likely to cause
peaked T waves on ECG?
A. Hypocalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
E. Hyponatremia
Answer: B. Hyperkalemia
Rationale: Hyperkalemia classically causes peaked T waves,
widening of the QRS complex, prolonged PR interval, and
eventually a sine-wave pattern. It is a potentially life-
threatening electrolyte disturbance requiring prompt
treatment.
,4. A woman with autoimmune destruction of the thyroid
gland is most likely to have which laboratory finding?
A. Increased T3 and decreased TSH
B. Increased T4 and increased TSH
C. Decreased T4 and increased TSH
D. Increased calcitonin
E. Decreased thyroglobulin antibodies
Answer: C. Decreased T4 and increased TSH
Rationale: Hashimoto thyroiditis causes primary
hypothyroidism. Reduced thyroid hormone production
decreases T4 levels, leading to compensatory elevation of
TSH. Antithyroid peroxidase and antithyroglobulin
antibodies are often present.
5. Which cranial nerve carries parasympathetic fibers
responsible for pupillary constriction?
A. CN II
B. CN III
C. CN IV
D. CN V
E. CN VI
Answer: B. CN III
Rationale: The oculomotor nerve carries parasympathetic
fibers from the Edinger-Westphal nucleus to the sphincter
pupillae muscle. Damage causes a dilated pupil, ptosis, and
impaired eye movement.
, 6. A patient with nephrotic syndrome is at increased risk for
which complication?
A. Polycythemia
B. Hypercoagulability
C. Hypercalcemia
D. Metabolic alkalosis
E. Thrombocytopenia
Answer: B. Hypercoagulability
Rationale: Nephrotic syndrome causes urinary loss of
antithrombin III and other anticoagulant proteins,
increasing the risk of venous thrombosis. Renal vein
thrombosis is a classic complication.
7. Which organism is the most common cause of
community-acquired pneumonia?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Mycoplasma pneumoniae
D. Streptococcus pneumoniae
E. Klebsiella pneumoniae
Answer: D. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the leading
cause of community-acquired pneumonia in adults. It is a
gram-positive lancet-shaped diplococcus and commonly
presents with lobar consolidation.
Examination with Verified Questions,
Detailed Answers & Clinical Rationales
| High-Yield 2026 edition
1. A 68-year-old man presents with resting tremor,
bradykinesia, and cogwheel rigidity. Degeneration of which
structure is most responsible for his symptoms?
A. Caudate nucleus
B. Subthalamic nucleus
C. Substantia nigra pars compacta
D. Globus pallidus externus
E. Putamen
Answer: C. Substantia nigra pars compacta
Rationale: Parkinson disease results from degeneration of
dopaminergic neurons in the substantia nigra pars
compacta. Dopamine normally stimulates the direct
pathway and inhibits the indirect pathway, facilitating
movement. Loss of dopamine produces bradykinesia,
rigidity, resting tremor, and postural instability.
2. A patient develops severe chest pain radiating to the left
arm. Troponin levels are elevated. Which cellular change is
irreversible?
,A. Cell swelling
B. Fatty change
C. Ribosomal detachment
D. Nuclear pyknosis
E. Glycogen depletion
Answer: D. Nuclear pyknosis
Rationale: Pyknosis, karyorrhexis, and karyolysis represent
irreversible nuclear injury associated with cell death. Cell
swelling, fatty change, glycogen depletion, and ribosomal
detachment are reversible changes.
3. Which electrolyte abnormality is most likely to cause
peaked T waves on ECG?
A. Hypocalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
E. Hyponatremia
Answer: B. Hyperkalemia
Rationale: Hyperkalemia classically causes peaked T waves,
widening of the QRS complex, prolonged PR interval, and
eventually a sine-wave pattern. It is a potentially life-
threatening electrolyte disturbance requiring prompt
treatment.
,4. A woman with autoimmune destruction of the thyroid
gland is most likely to have which laboratory finding?
A. Increased T3 and decreased TSH
B. Increased T4 and increased TSH
C. Decreased T4 and increased TSH
D. Increased calcitonin
E. Decreased thyroglobulin antibodies
Answer: C. Decreased T4 and increased TSH
Rationale: Hashimoto thyroiditis causes primary
hypothyroidism. Reduced thyroid hormone production
decreases T4 levels, leading to compensatory elevation of
TSH. Antithyroid peroxidase and antithyroglobulin
antibodies are often present.
5. Which cranial nerve carries parasympathetic fibers
responsible for pupillary constriction?
A. CN II
B. CN III
C. CN IV
D. CN V
E. CN VI
Answer: B. CN III
Rationale: The oculomotor nerve carries parasympathetic
fibers from the Edinger-Westphal nucleus to the sphincter
pupillae muscle. Damage causes a dilated pupil, ptosis, and
impaired eye movement.
, 6. A patient with nephrotic syndrome is at increased risk for
which complication?
A. Polycythemia
B. Hypercoagulability
C. Hypercalcemia
D. Metabolic alkalosis
E. Thrombocytopenia
Answer: B. Hypercoagulability
Rationale: Nephrotic syndrome causes urinary loss of
antithrombin III and other anticoagulant proteins,
increasing the risk of venous thrombosis. Renal vein
thrombosis is a classic complication.
7. Which organism is the most common cause of
community-acquired pneumonia?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Mycoplasma pneumoniae
D. Streptococcus pneumoniae
E. Klebsiella pneumoniae
Answer: D. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the leading
cause of community-acquired pneumonia in adults. It is a
gram-positive lancet-shaped diplococcus and commonly
presents with lobar consolidation.
