COMSAE Phase 2 Form BSA 121 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1
A 58-year-old man presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea for 45 minutes. ECG
shows ST elevation in leads II, III, and aVF. What is the most appropriate
next step in management?
A. IV heparin only
B. Thrombolytic therapy immediately
C. Emergent PCI (percutaneous coronary intervention)
D. Observation and repeat ECG in 6 hours
Answer: C
Rationale: Inferior STEMI requires immediate reperfusion therapy, and
PCI within 90 minutes is preferred over thrombolytics when available.
2
A 23-year-old woman presents with fever, flank pain, and dysuria. CVA
tenderness is present. Urinalysis shows WBC casts. What is the best
treatment?
,A. Oral nitrofurantoin
B. IV ceftriaxone
C. Oral amoxicillin
D. No antibiotics required
Answer: B
Rationale: Pyelonephritis with systemic symptoms requires IV
antibiotics such as ceftriaxone due to upper urinary tract involvement.
3
A 65-year-old smoker has painless gross hematuria. Urinalysis shows
RBCs without casts. What is the most likely diagnosis?
A. Bladder cancer
B. Acute glomerulonephritis
C. Kidney stones
D. UTI
Answer: A
Rationale: Painless hematuria in an older smoker is highly suggestive
of urothelial (bladder) carcinoma.
4
A 4-year-old child presents with barking cough, inspiratory stridor, and
hoarseness worse at night. What is the first-line treatment?
A. Antibiotics
B. Nebulized epinephrine + dexamethasone
C. Bronchodilators only
D. Antihistamines
,Answer: B
Rationale: Croup (parainfluenza) is treated with steroids and
nebulized epinephrine for airway inflammation and obstruction.
5
A 72-year-old man has sudden tearing chest pain radiating to the back
and unequal blood pressures in both arms. Diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: Classic presentation of aortic dissection includes tearing
pain and BP discrepancy due to aortic intimal tear.
6
A patient with COPD has ABG: pH 7.32, PaCO₂ 60, HCO₃⁻ 34. What is the
disorder?
A. Acute respiratory alkalosis
B. Chronic respiratory acidosis with compensation
C. Metabolic acidosis
D. Mixed disorder
Answer: B
Rationale: Elevated CO₂ with elevated bicarbonate indicates chronic
compensation in COPD.
, 7
A 25-year-old woman presents with malar rash, arthralgia, and
photosensitivity. Which antibody is most specific?
A. Anti-dsDNA
B. Anti-CCP
C. Anti-Jo1
D. Anti-histone
Answer: A
Rationale: Anti-dsDNA is highly specific for systemic lupus
erythematosus and correlates with disease activity.
8
A patient develops hypocalcemia after thyroid surgery. What is the
mechanism?
A. Thyroid hormone deficiency
B. Parathyroid injury
C. Vitamin D excess
D. Calcitonin excess
Answer: B
Rationale: Accidental removal or damage to parathyroid glands
causes low PTH and hypocalcemia.
9
A child presents with slapped-cheek rash. What is the causative agent?
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1
A 58-year-old man presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea for 45 minutes. ECG
shows ST elevation in leads II, III, and aVF. What is the most appropriate
next step in management?
A. IV heparin only
B. Thrombolytic therapy immediately
C. Emergent PCI (percutaneous coronary intervention)
D. Observation and repeat ECG in 6 hours
Answer: C
Rationale: Inferior STEMI requires immediate reperfusion therapy, and
PCI within 90 minutes is preferred over thrombolytics when available.
2
A 23-year-old woman presents with fever, flank pain, and dysuria. CVA
tenderness is present. Urinalysis shows WBC casts. What is the best
treatment?
,A. Oral nitrofurantoin
B. IV ceftriaxone
C. Oral amoxicillin
D. No antibiotics required
Answer: B
Rationale: Pyelonephritis with systemic symptoms requires IV
antibiotics such as ceftriaxone due to upper urinary tract involvement.
3
A 65-year-old smoker has painless gross hematuria. Urinalysis shows
RBCs without casts. What is the most likely diagnosis?
A. Bladder cancer
B. Acute glomerulonephritis
C. Kidney stones
D. UTI
Answer: A
Rationale: Painless hematuria in an older smoker is highly suggestive
of urothelial (bladder) carcinoma.
4
A 4-year-old child presents with barking cough, inspiratory stridor, and
hoarseness worse at night. What is the first-line treatment?
A. Antibiotics
B. Nebulized epinephrine + dexamethasone
C. Bronchodilators only
D. Antihistamines
,Answer: B
Rationale: Croup (parainfluenza) is treated with steroids and
nebulized epinephrine for airway inflammation and obstruction.
5
A 72-year-old man has sudden tearing chest pain radiating to the back
and unequal blood pressures in both arms. Diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: Classic presentation of aortic dissection includes tearing
pain and BP discrepancy due to aortic intimal tear.
6
A patient with COPD has ABG: pH 7.32, PaCO₂ 60, HCO₃⁻ 34. What is the
disorder?
A. Acute respiratory alkalosis
B. Chronic respiratory acidosis with compensation
C. Metabolic acidosis
D. Mixed disorder
Answer: B
Rationale: Elevated CO₂ with elevated bicarbonate indicates chronic
compensation in COPD.
, 7
A 25-year-old woman presents with malar rash, arthralgia, and
photosensitivity. Which antibody is most specific?
A. Anti-dsDNA
B. Anti-CCP
C. Anti-Jo1
D. Anti-histone
Answer: A
Rationale: Anti-dsDNA is highly specific for systemic lupus
erythematosus and correlates with disease activity.
8
A patient develops hypocalcemia after thyroid surgery. What is the
mechanism?
A. Thyroid hormone deficiency
B. Parathyroid injury
C. Vitamin D excess
D. Calcitonin excess
Answer: B
Rationale: Accidental removal or damage to parathyroid glands
causes low PTH and hypocalcemia.
9
A child presents with slapped-cheek rash. What is the causative agent?
