COMSAE Phase 2-Form BSA 116 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents to the emergency department with
crushing substernal chest pain for 45 minutes. ECG demonstrates
ST-segment elevation in leads V1-V4. Blood pressure is 84/56
mmHg, pulse is 110/min, and oxygen saturation is 93%. What is
the most appropriate next step?
A. Intravenous heparin only
B. Immediate PCI
C. Exercise stress testing
D. Echocardiography
E. CT angiography
Answer: B. Immediate PCI
Rationale: Anterior STEMI with hypotension represents cardiogenic
shock until proven otherwise. Immediate reperfusion with
percutaneous coronary intervention is the standard of care. Stress
testing is contraindicated in acute MI. Echocardiography may be
helpful later but should not delay reperfusion.
2. A 29-year-old woman presents with fever, dysuria, nausea, and
flank pain. Urinalysis reveals positive nitrites, leukocyte esterase,
and WBC casts. Which diagnosis is most likely?
,A. Cystitis
B. Interstitial nephritis
C. Acute pyelonephritis
D. Nephrolithiasis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Flank pain, fever, pyuria, and WBC casts indicate upper
urinary tract infection involving the renal parenchyma. WBC casts are
highly suggestive of pyelonephritis.
3. A 55-year-old man develops unilateral facial weakness involving
the forehead after an upper respiratory infection. Taste sensation
is diminished on the anterior two-thirds of the tongue. What is
the diagnosis?
A. Stroke
B. Trigeminal neuralgia
C. Bell palsy
D. Multiple sclerosis
E. Temporal arteritis
Answer: C. Bell palsy
Rationale: Bell palsy is a peripheral CN VII palsy causing ipsilateral
facial weakness including the forehead, hyperacusis, and altered taste
sensation. Forehead involvement distinguishes it from an upper
motor neuron lesion.
4. A 32-year-old woman at 34 weeks gestation presents with blood
pressure of 170/110 mmHg, headache, visual disturbances, and
proteinuria. The most appropriate initial treatment is:
,A. Oral nifedipine alone
B. Magnesium sulfate and antihypertensive therapy
C. Aspirin therapy
D. Observation
E. Oxytocin infusion
Answer: B. Magnesium sulfate and antihypertensive therapy
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and blood pressure control. Delivery planning
follows maternal stabilization.
5. A 4-year-old child develops barking cough, inspiratory stridor, and
hoarseness after several days of URI symptoms. Which diagnosis
is most likely?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Asthma
E. Foreign body aspiration
Answer: C. Croup
Rationale: Parainfluenza virus causes croup, characterized by barking
cough, inspiratory stridor, and steeple sign on neck radiograph.
6. A patient with COPD presents with pH 7.29, PaCO₂ 62 mmHg,
PaO₂ 58 mmHg, and increasing respiratory distress. What is the
preferred initial treatment?
A. Immediate intubation
B. High-flow oxygen only
C. BiPAP
, D. Nebulized saline
E. Bronchoscopy
Answer: C. BiPAP
Rationale: Noninvasive positive-pressure ventilation reduces
mortality and intubation rates in acute hypercapnic COPD
exacerbations.
7. A 62-year-old man with atrial fibrillation develops sudden left-
sided weakness and aphasia. CT head is negative for hemorrhage,
and symptoms began 90 minutes ago. What is the best next step?
A. Aspirin only
B. Heparin infusion
C. Alteplase administration
D. Carotid endarterectomy
E. Observation
Answer: C. Alteplase administration
Rationale: The patient is within the thrombolytic window with no
evidence of intracranial hemorrhage. IV alteplase is indicated.
8. A newborn is cyanotic shortly after birth. Cyanosis improves
minimally with oxygen administration. Chest X-ray reveals an egg-
on-a-string appearance. Diagnosis?
A. Tetralogy of Fallot
B. TGA
C. Tricuspid atresia
D. VSD
E. TAPVR
Answer: B. TGA
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents to the emergency department with
crushing substernal chest pain for 45 minutes. ECG demonstrates
ST-segment elevation in leads V1-V4. Blood pressure is 84/56
mmHg, pulse is 110/min, and oxygen saturation is 93%. What is
the most appropriate next step?
A. Intravenous heparin only
B. Immediate PCI
C. Exercise stress testing
D. Echocardiography
E. CT angiography
Answer: B. Immediate PCI
Rationale: Anterior STEMI with hypotension represents cardiogenic
shock until proven otherwise. Immediate reperfusion with
percutaneous coronary intervention is the standard of care. Stress
testing is contraindicated in acute MI. Echocardiography may be
helpful later but should not delay reperfusion.
2. A 29-year-old woman presents with fever, dysuria, nausea, and
flank pain. Urinalysis reveals positive nitrites, leukocyte esterase,
and WBC casts. Which diagnosis is most likely?
,A. Cystitis
B. Interstitial nephritis
C. Acute pyelonephritis
D. Nephrolithiasis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Flank pain, fever, pyuria, and WBC casts indicate upper
urinary tract infection involving the renal parenchyma. WBC casts are
highly suggestive of pyelonephritis.
3. A 55-year-old man develops unilateral facial weakness involving
the forehead after an upper respiratory infection. Taste sensation
is diminished on the anterior two-thirds of the tongue. What is
the diagnosis?
A. Stroke
B. Trigeminal neuralgia
C. Bell palsy
D. Multiple sclerosis
E. Temporal arteritis
Answer: C. Bell palsy
Rationale: Bell palsy is a peripheral CN VII palsy causing ipsilateral
facial weakness including the forehead, hyperacusis, and altered taste
sensation. Forehead involvement distinguishes it from an upper
motor neuron lesion.
4. A 32-year-old woman at 34 weeks gestation presents with blood
pressure of 170/110 mmHg, headache, visual disturbances, and
proteinuria. The most appropriate initial treatment is:
,A. Oral nifedipine alone
B. Magnesium sulfate and antihypertensive therapy
C. Aspirin therapy
D. Observation
E. Oxytocin infusion
Answer: B. Magnesium sulfate and antihypertensive therapy
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and blood pressure control. Delivery planning
follows maternal stabilization.
5. A 4-year-old child develops barking cough, inspiratory stridor, and
hoarseness after several days of URI symptoms. Which diagnosis
is most likely?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Asthma
E. Foreign body aspiration
Answer: C. Croup
Rationale: Parainfluenza virus causes croup, characterized by barking
cough, inspiratory stridor, and steeple sign on neck radiograph.
6. A patient with COPD presents with pH 7.29, PaCO₂ 62 mmHg,
PaO₂ 58 mmHg, and increasing respiratory distress. What is the
preferred initial treatment?
A. Immediate intubation
B. High-flow oxygen only
C. BiPAP
, D. Nebulized saline
E. Bronchoscopy
Answer: C. BiPAP
Rationale: Noninvasive positive-pressure ventilation reduces
mortality and intubation rates in acute hypercapnic COPD
exacerbations.
7. A 62-year-old man with atrial fibrillation develops sudden left-
sided weakness and aphasia. CT head is negative for hemorrhage,
and symptoms began 90 minutes ago. What is the best next step?
A. Aspirin only
B. Heparin infusion
C. Alteplase administration
D. Carotid endarterectomy
E. Observation
Answer: C. Alteplase administration
Rationale: The patient is within the thrombolytic window with no
evidence of intracranial hemorrhage. IV alteplase is indicated.
8. A newborn is cyanotic shortly after birth. Cyanosis improves
minimally with oxygen administration. Chest X-ray reveals an egg-
on-a-string appearance. Diagnosis?
A. Tetralogy of Fallot
B. TGA
C. Tricuspid atresia
D. VSD
E. TAPVR
Answer: B. TGA
