COMSAE Phase 2 Form BSA 111 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with hypertension presents with abrupt onset
of severe tearing chest pain radiating to the interscapular region.
Blood pressure is 190/100 mmHg in the right arm and 160/90
mmHg in the left arm. Chest radiograph demonstrates a widened
mediastinum. Which is the most likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Acute aortic dissection
D. Tension pneumothorax
E. NSTEMI
Answer: C. Acute aortic dissection
Rationale: The hallmark findings of aortic dissection include abrupt
tearing chest pain radiating to the back, unequal arm blood pressures,
and mediastinal widening. Immediate blood pressure control with IV
beta blockers followed by surgical evaluation is indicated for Stanford
type A dissections.
2. A 29-year-old woman presents with amenorrhea, galactorrhea,
and headaches. MRI reveals a pituitary microadenoma. Which
hormone is elevated?
,A. ACTH
B. Growth hormone
C. Prolactin
D. TSH
E. LH
Answer: C. Prolactin
Rationale: Prolactinomas are the most common pituitary adenomas.
Hyperprolactinemia suppresses GnRH causing amenorrhea and
infertility. Dopamine agonists such as cabergoline are first-line therapy.
3. A 72-year-old man with COPD presents with somnolence. ABG: pH
7.31, PaCO₂ 65 mmHg, HCO₃⁻ 31 mEq/L. What acid-base disorder
is present?
A. Acute respiratory alkalosis
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis
D. Mixed respiratory alkalosis and metabolic acidosis
E. Metabolic alkalosis
Answer: B. Respiratory acidosis with metabolic compensation
Rationale: Elevated CO₂ with acidemia indicates respiratory acidosis.
Elevated bicarbonate demonstrates renal compensation consistent with
chronic CO₂ retention in COPD.
4. A 25-year-old woman presents with right lower quadrant pain,
vaginal spotting, and positive β-hCG. Transvaginal ultrasound
reveals no intrauterine pregnancy. What is the most likely
diagnosis?
A. Ovarian torsion
B. Ruptured ovarian cyst
,C. Ectopic pregnancy
D. Appendicitis
E. Endometriosis
Answer: C. Ectopic pregnancy
Rationale: Positive pregnancy test with an empty uterus and abdominal
pain should be considered ectopic pregnancy until proven otherwise.
Tubal implantation is the most common site.
5. A newborn develops bilious vomiting and abdominal distension
within hours after birth. Abdominal radiograph reveals a double-
bubble sign.
A. Hirschsprung disease
B. Duodenal atresia
C. Intussusception
D. Pyloric stenosis
E. Meconium ileus
Answer: B. Duodenal atresia
Rationale: The double-bubble sign represents air trapped in the
stomach and proximal duodenum due to duodenal obstruction. It is
strongly associated with trisomy 21.
6. A patient receiving lisinopril develops facial swelling and tongue
edema without urticaria. The mechanism is:
A. IgE-mediated allergy
B. Histamine release
C. Bradykinin accumulation
D. Complement deficiency
E. T-cell hypersensitivity
Answer: C. Bradykinin accumulation
, Rationale: ACE inhibitors block bradykinin degradation leading to
angioedema. Treatment includes discontinuation of the medication and
airway protection.
7. A 6-year-old child presents with fever, strawberry tongue,
circumoral pallor, and a sandpaper rash.
A. Rubella
B. Scarlet fever
C. Measles
D. Roseola
E. Kawasaki disease
Answer: B. Scarlet fever
Rationale: Group A Streptococcus produces erythrogenic toxin resulting
in a diffuse sandpaper rash, strawberry tongue, and pharyngitis.
8. A 35-year-old woman has heat intolerance, weight loss, and
exophthalmos. Which antibody is responsible?
A. Anti-thyroglobulin
B. Anti-TPO
C. TSH receptor stimulating antibody
D. Anti-dsDNA
E. Anti-centromere
Answer: C. TSH receptor stimulating antibody
Rationale: Graves disease results from IgG antibodies stimulating TSH
receptors, causing hyperthyroidism and ophthalmopathy.
9. A diabetic patient presents with chest pain. ECG shows ST
elevation in II, III, and aVF.
A. LAD occlusion
B. RCA occlusion
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with hypertension presents with abrupt onset
of severe tearing chest pain radiating to the interscapular region.
Blood pressure is 190/100 mmHg in the right arm and 160/90
mmHg in the left arm. Chest radiograph demonstrates a widened
mediastinum. Which is the most likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Acute aortic dissection
D. Tension pneumothorax
E. NSTEMI
Answer: C. Acute aortic dissection
Rationale: The hallmark findings of aortic dissection include abrupt
tearing chest pain radiating to the back, unequal arm blood pressures,
and mediastinal widening. Immediate blood pressure control with IV
beta blockers followed by surgical evaluation is indicated for Stanford
type A dissections.
2. A 29-year-old woman presents with amenorrhea, galactorrhea,
and headaches. MRI reveals a pituitary microadenoma. Which
hormone is elevated?
,A. ACTH
B. Growth hormone
C. Prolactin
D. TSH
E. LH
Answer: C. Prolactin
Rationale: Prolactinomas are the most common pituitary adenomas.
Hyperprolactinemia suppresses GnRH causing amenorrhea and
infertility. Dopamine agonists such as cabergoline are first-line therapy.
3. A 72-year-old man with COPD presents with somnolence. ABG: pH
7.31, PaCO₂ 65 mmHg, HCO₃⁻ 31 mEq/L. What acid-base disorder
is present?
A. Acute respiratory alkalosis
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis
D. Mixed respiratory alkalosis and metabolic acidosis
E. Metabolic alkalosis
Answer: B. Respiratory acidosis with metabolic compensation
Rationale: Elevated CO₂ with acidemia indicates respiratory acidosis.
Elevated bicarbonate demonstrates renal compensation consistent with
chronic CO₂ retention in COPD.
4. A 25-year-old woman presents with right lower quadrant pain,
vaginal spotting, and positive β-hCG. Transvaginal ultrasound
reveals no intrauterine pregnancy. What is the most likely
diagnosis?
A. Ovarian torsion
B. Ruptured ovarian cyst
,C. Ectopic pregnancy
D. Appendicitis
E. Endometriosis
Answer: C. Ectopic pregnancy
Rationale: Positive pregnancy test with an empty uterus and abdominal
pain should be considered ectopic pregnancy until proven otherwise.
Tubal implantation is the most common site.
5. A newborn develops bilious vomiting and abdominal distension
within hours after birth. Abdominal radiograph reveals a double-
bubble sign.
A. Hirschsprung disease
B. Duodenal atresia
C. Intussusception
D. Pyloric stenosis
E. Meconium ileus
Answer: B. Duodenal atresia
Rationale: The double-bubble sign represents air trapped in the
stomach and proximal duodenum due to duodenal obstruction. It is
strongly associated with trisomy 21.
6. A patient receiving lisinopril develops facial swelling and tongue
edema without urticaria. The mechanism is:
A. IgE-mediated allergy
B. Histamine release
C. Bradykinin accumulation
D. Complement deficiency
E. T-cell hypersensitivity
Answer: C. Bradykinin accumulation
, Rationale: ACE inhibitors block bradykinin degradation leading to
angioedema. Treatment includes discontinuation of the medication and
airway protection.
7. A 6-year-old child presents with fever, strawberry tongue,
circumoral pallor, and a sandpaper rash.
A. Rubella
B. Scarlet fever
C. Measles
D. Roseola
E. Kawasaki disease
Answer: B. Scarlet fever
Rationale: Group A Streptococcus produces erythrogenic toxin resulting
in a diffuse sandpaper rash, strawberry tongue, and pharyngitis.
8. A 35-year-old woman has heat intolerance, weight loss, and
exophthalmos. Which antibody is responsible?
A. Anti-thyroglobulin
B. Anti-TPO
C. TSH receptor stimulating antibody
D. Anti-dsDNA
E. Anti-centromere
Answer: C. TSH receptor stimulating antibody
Rationale: Graves disease results from IgG antibodies stimulating TSH
receptors, causing hyperthyroidism and ophthalmopathy.
9. A diabetic patient presents with chest pain. ECG shows ST
elevation in II, III, and aVF.
A. LAD occlusion
B. RCA occlusion
