COMSAE Phase 3 Form CSA 109 Advanced Clinical
Synthesis Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 67-year-old man presents with crushing substernal chest pain
radiating to the left arm for 2 hours. ECG demonstrates ST-
segment elevations in leads II, III, and aVF. Blood pressure is
84/50 mm Hg, jugular venous distention is present, and lungs are
clear. Which coronary vessel is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction with hypotension,
elevated jugular venous pressure, and clear lungs suggests right
ventricular infarction. The right coronary artery supplies the right
ventricle in most individuals.
2. A 54-year-old woman with long-standing hypertension develops
sudden tearing chest pain radiating to the back. Blood pressure is
190/110 mm Hg in the right arm and 150/90 mm Hg in the left
arm. What is the most likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Esophageal spasm
,Answer: C. Aortic dissection
Rationale: Sudden severe tearing chest pain with unequal arm blood
pressures is highly suggestive of acute aortic dissection involving
major arterial branches.
3. A 23-year-old woman presents with fever, malar rash, hematuria,
and proteinuria. Laboratory evaluation reveals anti-double-
stranded DNA antibodies. Which renal lesion is most likely?
A. Minimal change disease
B. Diffuse proliferative glomerulonephritis
C. Membranous nephropathy
D. Focal segmental glomerulosclerosis
Answer: B. Diffuse proliferative glomerulonephritis
Rationale: Diffuse proliferative glomerulonephritis is the most severe
and common nephritic manifestation of systemic lupus
erythematosus.
4. A 71-year-old smoker develops painless hematuria. Cystoscopy
identifies a bladder mass. Which risk factor is most strongly
associated with this condition?
A. Alcohol use
B. Tobacco smoking
C. High-fat diet
D. Hyperthyroidism
Answer: B. Tobacco smoking
Rationale: Cigarette smoking is the most significant risk factor for
transitional cell carcinoma of the bladder.
5. A hospitalized patient receiving broad-spectrum antibiotics
develops profuse watery diarrhea and abdominal cramping. Stool
, assay is positive for toxin production. What is the preferred initial
therapy?
A. Ciprofloxacin
B. Oral vancomycin
C. Amoxicillin
D. Metronidazole IV alone
Answer: B. Oral vancomycin
Rationale: Oral vancomycin is first-line treatment for Clostridioides
difficile infection.
6. A 60-year-old man experiences resting tremor, cogwheel rigidity,
and bradykinesia. Degeneration of which brain structure is
responsible?
A. Caudate nucleus
B. Substantia nigra pars compacta
C. Hippocampus
D. Amygdala
Answer: B. Substantia nigra pars compacta
Rationale: Parkinson disease results from degeneration of
dopaminergic neurons in the substantia nigra pars compacta.
7. A patient develops hypercalcemia, kidney stones, abdominal pain,
and psychiatric disturbances. Which endocrine disorder is most
likely?
A. Secondary hyperparathyroidism
B. Primary hyperparathyroidism
C. Hypoparathyroidism
D. Addison disease
Answer: B. Primary hyperparathyroidism
, Rationale: Hypercalcemia with nephrolithiasis and neuropsychiatric
symptoms classically indicates primary hyperparathyroidism.
8. A 35-year-old woman presents with exophthalmos, heat
intolerance, and diffuse thyroid enlargement. Which antibody is
responsible?
A. Anti-thyroglobulin antibody
B. Thyroid-stimulating immunoglobulin
C. Anti-mitochondrial antibody
D. Anti-centromere antibody
Answer: B. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from antibodies stimulating the TSH
receptor.
9. A 65-year-old diabetic presents with fever, flank pain, and
costovertebral angle tenderness. Urinalysis demonstrates white
blood cell casts. Diagnosis?
A. Cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Interstitial nephritis
Answer: B. Pyelonephritis
Rationale: White blood cell casts are characteristic of upper urinary
tract infection involving the renal parenchyma.
10. A patient develops acute unilateral weakness and aphasia.
CT scan excludes hemorrhage. Symptoms began 90 minutes
earlier. Appropriate management?
A. Aspirin only
B. Immediate thrombolytic therapy evaluation
Synthesis Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 67-year-old man presents with crushing substernal chest pain
radiating to the left arm for 2 hours. ECG demonstrates ST-
segment elevations in leads II, III, and aVF. Blood pressure is
84/50 mm Hg, jugular venous distention is present, and lungs are
clear. Which coronary vessel is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction with hypotension,
elevated jugular venous pressure, and clear lungs suggests right
ventricular infarction. The right coronary artery supplies the right
ventricle in most individuals.
2. A 54-year-old woman with long-standing hypertension develops
sudden tearing chest pain radiating to the back. Blood pressure is
190/110 mm Hg in the right arm and 150/90 mm Hg in the left
arm. What is the most likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Esophageal spasm
,Answer: C. Aortic dissection
Rationale: Sudden severe tearing chest pain with unequal arm blood
pressures is highly suggestive of acute aortic dissection involving
major arterial branches.
3. A 23-year-old woman presents with fever, malar rash, hematuria,
and proteinuria. Laboratory evaluation reveals anti-double-
stranded DNA antibodies. Which renal lesion is most likely?
A. Minimal change disease
B. Diffuse proliferative glomerulonephritis
C. Membranous nephropathy
D. Focal segmental glomerulosclerosis
Answer: B. Diffuse proliferative glomerulonephritis
Rationale: Diffuse proliferative glomerulonephritis is the most severe
and common nephritic manifestation of systemic lupus
erythematosus.
4. A 71-year-old smoker develops painless hematuria. Cystoscopy
identifies a bladder mass. Which risk factor is most strongly
associated with this condition?
A. Alcohol use
B. Tobacco smoking
C. High-fat diet
D. Hyperthyroidism
Answer: B. Tobacco smoking
Rationale: Cigarette smoking is the most significant risk factor for
transitional cell carcinoma of the bladder.
5. A hospitalized patient receiving broad-spectrum antibiotics
develops profuse watery diarrhea and abdominal cramping. Stool
, assay is positive for toxin production. What is the preferred initial
therapy?
A. Ciprofloxacin
B. Oral vancomycin
C. Amoxicillin
D. Metronidazole IV alone
Answer: B. Oral vancomycin
Rationale: Oral vancomycin is first-line treatment for Clostridioides
difficile infection.
6. A 60-year-old man experiences resting tremor, cogwheel rigidity,
and bradykinesia. Degeneration of which brain structure is
responsible?
A. Caudate nucleus
B. Substantia nigra pars compacta
C. Hippocampus
D. Amygdala
Answer: B. Substantia nigra pars compacta
Rationale: Parkinson disease results from degeneration of
dopaminergic neurons in the substantia nigra pars compacta.
7. A patient develops hypercalcemia, kidney stones, abdominal pain,
and psychiatric disturbances. Which endocrine disorder is most
likely?
A. Secondary hyperparathyroidism
B. Primary hyperparathyroidism
C. Hypoparathyroidism
D. Addison disease
Answer: B. Primary hyperparathyroidism
, Rationale: Hypercalcemia with nephrolithiasis and neuropsychiatric
symptoms classically indicates primary hyperparathyroidism.
8. A 35-year-old woman presents with exophthalmos, heat
intolerance, and diffuse thyroid enlargement. Which antibody is
responsible?
A. Anti-thyroglobulin antibody
B. Thyroid-stimulating immunoglobulin
C. Anti-mitochondrial antibody
D. Anti-centromere antibody
Answer: B. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from antibodies stimulating the TSH
receptor.
9. A 65-year-old diabetic presents with fever, flank pain, and
costovertebral angle tenderness. Urinalysis demonstrates white
blood cell casts. Diagnosis?
A. Cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Interstitial nephritis
Answer: B. Pyelonephritis
Rationale: White blood cell casts are characteristic of upper urinary
tract infection involving the renal parenchyma.
10. A patient develops acute unilateral weakness and aphasia.
CT scan excludes hemorrhage. Symptoms began 90 minutes
earlier. Appropriate management?
A. Aspirin only
B. Immediate thrombolytic therapy evaluation
