COMSAE Phase 2 Form BSA 124 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man presents to the emergency department with
crushing substernal chest pain radiating to his left arm for 45
minutes. ECG demonstrates ST-segment elevations in leads II, III,
and aVF. Blood pressure is 90/60 mmHg. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior myocardial infarction involving leads II, III, and aVF is
most commonly due to occlusion of the right coronary artery.
Associated findings include hypotension and possible right ventricular
infarction.
2. A 34-year-old woman develops sudden pleuritic chest pain and
dyspnea two weeks after knee surgery. Oxygen saturation is 88%.
ECG shows sinus tachycardia. The next best diagnostic study is:
A. Chest x-ray
B. Echocardiography
,C. CT pulmonary angiography
D. Bronchoscopy
E. Spirometry
Answer: C. CT pulmonary angiography
Rationale: Postoperative patients are at high risk for pulmonary
embolism. CT pulmonary angiography is the preferred diagnostic
modality in hemodynamically stable patients.
3. A 60-year-old man with hypertension develops tearing chest pain
radiating to the back. Blood pressure differs significantly between
arms. Initial management includes:
A. Aspirin
B. Alteplase
C. Immediate beta blockade
D. Heparin infusion
E. Clopidogrel
Answer: C. Immediate beta blockade
Rationale: Aortic dissection requires rapid reduction of shear stress
using intravenous beta blockers such as esmolol before additional
antihypertensive therapy.
4. A patient with diabetic ketoacidosis receives insulin infusion.
Which electrolyte must be monitored most closely?
A. Calcium
B. Sodium
C. Magnesium
D. Potassium
E. Chloride
Answer: D. Potassium
,Rationale: Insulin drives potassium intracellularly, potentially causing
life-threatening hypokalemia during DKA treatment.
5. A 24-year-old woman presents with fever, dysuria, flank pain, and
CVA tenderness. Urinalysis reveals WBC casts. Most likely
diagnosis?
A. Cystitis
B. Nephrolithiasis
C. Acute pyelonephritis
D. Interstitial cystitis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Fever, flank pain, CVA tenderness, and WBC casts strongly
indicate upper urinary tract infection.
6. A patient has nephrotic syndrome characterized by edema and
proteinuria exceeding 3.5 g/day. Which complication is most
likely?
A. Polycythemia
B. Hypercoagulability
C. Hypercalcemia
D. Neutropenia
E. Metabolic acidosis
Answer: B. Hypercoagulability
Rationale: Urinary loss of antithrombin III creates a prothrombotic
state, increasing risk for renal vein thrombosis and DVT.
7. A 52-year-old woman has fatigue, cold intolerance, and
constipation. Labs show elevated TSH and low free T4. Diagnosis?
, A. Graves disease
B. Central hypothyroidism
C. Primary hypothyroidism
D. Thyroid storm
E. Subacute thyroiditis
Answer: C. Primary hypothyroidism
Rationale: Elevated TSH with low T4 indicates thyroid gland failure,
most commonly Hashimoto thyroiditis.
8. A patient develops tremor, weight loss, and palpitations. Which
laboratory profile is expected?
A. High TSH, low T4
B. Low TSH, high T4
C. High TSH, high T4
D. Low TSH, low T4
E. Normal TSH, normal T4
Answer: B. Low TSH, high T4
Rationale: Hyperthyroidism suppresses pituitary TSH secretion while
increasing thyroid hormone levels.
9. Severe epigastric pain radiating to the back with elevated lipase
indicates:
A. Cholecystitis
B. Gastritis
C. Acute pancreatitis
D. GERD
E. Hepatitis
Answer: C. Acute pancreatitis
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man presents to the emergency department with
crushing substernal chest pain radiating to his left arm for 45
minutes. ECG demonstrates ST-segment elevations in leads II, III,
and aVF. Blood pressure is 90/60 mmHg. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior myocardial infarction involving leads II, III, and aVF is
most commonly due to occlusion of the right coronary artery.
Associated findings include hypotension and possible right ventricular
infarction.
2. A 34-year-old woman develops sudden pleuritic chest pain and
dyspnea two weeks after knee surgery. Oxygen saturation is 88%.
ECG shows sinus tachycardia. The next best diagnostic study is:
A. Chest x-ray
B. Echocardiography
,C. CT pulmonary angiography
D. Bronchoscopy
E. Spirometry
Answer: C. CT pulmonary angiography
Rationale: Postoperative patients are at high risk for pulmonary
embolism. CT pulmonary angiography is the preferred diagnostic
modality in hemodynamically stable patients.
3. A 60-year-old man with hypertension develops tearing chest pain
radiating to the back. Blood pressure differs significantly between
arms. Initial management includes:
A. Aspirin
B. Alteplase
C. Immediate beta blockade
D. Heparin infusion
E. Clopidogrel
Answer: C. Immediate beta blockade
Rationale: Aortic dissection requires rapid reduction of shear stress
using intravenous beta blockers such as esmolol before additional
antihypertensive therapy.
4. A patient with diabetic ketoacidosis receives insulin infusion.
Which electrolyte must be monitored most closely?
A. Calcium
B. Sodium
C. Magnesium
D. Potassium
E. Chloride
Answer: D. Potassium
,Rationale: Insulin drives potassium intracellularly, potentially causing
life-threatening hypokalemia during DKA treatment.
5. A 24-year-old woman presents with fever, dysuria, flank pain, and
CVA tenderness. Urinalysis reveals WBC casts. Most likely
diagnosis?
A. Cystitis
B. Nephrolithiasis
C. Acute pyelonephritis
D. Interstitial cystitis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Fever, flank pain, CVA tenderness, and WBC casts strongly
indicate upper urinary tract infection.
6. A patient has nephrotic syndrome characterized by edema and
proteinuria exceeding 3.5 g/day. Which complication is most
likely?
A. Polycythemia
B. Hypercoagulability
C. Hypercalcemia
D. Neutropenia
E. Metabolic acidosis
Answer: B. Hypercoagulability
Rationale: Urinary loss of antithrombin III creates a prothrombotic
state, increasing risk for renal vein thrombosis and DVT.
7. A 52-year-old woman has fatigue, cold intolerance, and
constipation. Labs show elevated TSH and low free T4. Diagnosis?
, A. Graves disease
B. Central hypothyroidism
C. Primary hypothyroidism
D. Thyroid storm
E. Subacute thyroiditis
Answer: C. Primary hypothyroidism
Rationale: Elevated TSH with low T4 indicates thyroid gland failure,
most commonly Hashimoto thyroiditis.
8. A patient develops tremor, weight loss, and palpitations. Which
laboratory profile is expected?
A. High TSH, low T4
B. Low TSH, high T4
C. High TSH, high T4
D. Low TSH, low T4
E. Normal TSH, normal T4
Answer: B. Low TSH, high T4
Rationale: Hyperthyroidism suppresses pituitary TSH secretion while
increasing thyroid hormone levels.
9. Severe epigastric pain radiating to the back with elevated lipase
indicates:
A. Cholecystitis
B. Gastritis
C. Acute pancreatitis
D. GERD
E. Hepatitis
Answer: C. Acute pancreatitis
