COMSAE Phase 2 – BSA 115i (2026 Update): High-Yield Practice Exam with Questions, Answers, and Detailed Rationales

COMSAE Phase 2 – BSA 115i (2026 Update):
High-Yield Practice Exam with Questions,
Answers, and Detailed Rationales

Question 1
A 68-year-old man presents with sudden onset left-sided
weakness and aphasia. CT scan shows no hemorrhage.
Symptoms began 90 minutes ago. Blood pressure is 178/96
mmHg. Which is the most appropriate next step?
A. Aspirin therapy immediately
B. Heparin infusion
C. Lower blood pressure to <120/80 before treatment
D. Administer alteplase if no contraindications
Rationale: Acute ischemic stroke within the therapeutic
window (<4.5 hours) is treated with IV alteplase after
exclusion of contraindications. Blood pressure below 185/110
mmHg is acceptable for thrombolysis. Aspirin is delayed for
24 hours after alteplase administration.


Question 2
A patient with chronic alcohol use develops confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is
most likely responsible?
A. Pyridoxine
B. Vitamin B12

,C. Folate
D. Thiamine
Rationale: Wernicke encephalopathy results from thiamine
deficiency. The classic triad includes confusion,
ophthalmoplegia, and ataxia. Immediate thiamine
administration before glucose is essential to prevent
progression.


Question 3
A 32-year-old woman develops hypertension, proteinuria,
and edema at 34 weeks gestation. She suddenly experiences
a generalized tonic-clonic seizure. What is the first-line
treatment?
A. Diazepam
B. Phenytoin
C. Phenobarbital
D. Magnesium sulfate
Rationale: Eclampsia is defined as seizures in a patient with
preeclampsia. Magnesium sulfate is the treatment of choice
for seizure control and prevention of recurrent seizures.


Question 4
A patient presents with fever, hypotension, elevated lactate,
and positive blood cultures. Which hemodynamic parameter
is most characteristic of septic shock?

,A. Increased systemic vascular resistance
B. Decreased cardiac output
C. Increased preload
D. Decreased systemic vascular resistance
Rationale: Septic shock produces profound vasodilation
resulting in reduced systemic vascular resistance. Cardiac
output may initially be elevated due to compensatory
mechanisms.


Question 5
A 54-year-old smoker develops hematuria. Cystoscopy reveals
a bladder tumor. Which histologic type is most common in
the United States?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Small-cell carcinoma
D. Transitional cell carcinoma
Rationale: Urothelial (transitional cell) carcinoma is the most
common bladder cancer in developed countries. Smoking is
the strongest risk factor.


Question 6
A patient with atrial fibrillation develops sudden abdominal
pain that is out of proportion to physical examination
findings. Which diagnosis is most likely?

, A. Acute pancreatitis
B. Diverticulitis
C. Cholecystitis
D. Mesenteric ischemia
Rationale: Emboli from atrial fibrillation commonly lodge in
the superior mesenteric artery, causing severe pain with
minimal abdominal findings early in the disease.


Question 7
A patient presents with hypercalcemia, nephrolithiasis, and
osteoporosis. Laboratory studies show elevated PTH levels.
What is the most likely diagnosis?
A. Multiple myeloma
B. Vitamin D intoxication
C. Sarcoidosis
D. Primary hyperparathyroidism
Rationale: Elevated calcium and elevated PTH strongly
indicate primary hyperparathyroidism, most commonly
caused by a parathyroid adenoma.


Question 8
A child develops a rash beginning on the face and spreading
downward. Koplik spots are present. Which organism is
responsible?
A. Rubella virus
B. Parvovirus B19