COMSAE Phase 3 Form CSA 113 Advanced
Clinical Synthesis Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with hypertension, hyperlipidemia, and
tobacco use presents with sudden severe tearing chest pain
radiating to the back. Blood pressure is 190/110 mm Hg in the
right arm and 160/90 mm Hg in the left arm. Chest radiograph
demonstrates mediastinal widening. Which is the most
appropriate next diagnostic step?
A. Exercise stress testing
B. Transthoracic echocardiography only
C. CT angiography of the chest
D. Coronary angiography
Answer: C. CT angiography of the chest
Rationale: Acute aortic dissection should be suspected in patients with
tearing chest pain, pulse or blood pressure discrepancies, and
mediastinal widening. CT angiography is the preferred diagnostic
modality in hemodynamically stable patients because it rapidly
identifies the location and extent of dissection. Stress testing is
contraindicated, and coronary angiography may delay diagnosis.
2. A 58-year-old woman with diabetes presents with crushing
substernal chest pain. ECG reveals ST-segment elevations in leads
, II, III, and aVF. Blood pressure is 82/54 mm Hg. Which medication
should be avoided?
A. Aspirin
B. Clopidogrel
C. Nitroglycerin
D. Heparin
Answer: C. Nitroglycerin
Rationale: Inferior wall myocardial infarction may involve the right
ventricle. Nitroglycerin decreases preload and can precipitate
profound hypotension in right ventricular infarction. Aspirin,
anticoagulation, and antiplatelet therapy remain indicated.
3. A 26-year-old woman presents with fever, dysuria, flank pain, and
costovertebral angle tenderness. Urinalysis reveals leukocyte
esterase positivity and numerous white blood cells. What is the
most likely diagnosis?
A. Interstitial cystitis
B. Acute pyelonephritis
C. Urethritis
D. Nephrolithiasis
Answer: B. Acute pyelonephritis
Rationale: Fever, flank pain, pyuria, and CVA tenderness strongly
indicate pyelonephritis. Lower urinary tract infections generally lack
systemic symptoms.
4. A 72-year-old hospitalized patient develops acute dyspnea. ECG
shows sinus tachycardia. CT pulmonary angiography reveals a
large pulmonary embolism. Which physiologic change is
expected?
,A. Increased pulmonary perfusion
B. Increased dead-space ventilation
C. Increased left atrial pressure
D. Increased oxygen extraction by alveoli
Answer: B. Increased dead-space ventilation
Rationale: Pulmonary embolism obstructs blood flow to ventilated
alveoli, producing ventilation-perfusion mismatch and increased
physiologic dead space.
5. A 4-year-old child develops barking cough, inspiratory stridor, and
hoarseness. Symptoms worsen at night. Which is the most likely
diagnosis?
A. Epiglottitis
B. Croup
C. Foreign body aspiration
D. Bacterial tracheitis
Answer: B. Croup
Rationale: Viral croup classically presents with barking cough,
hoarseness, and inspiratory stridor. It is most commonly caused by
parainfluenza virus.
6. A patient with diabetic ketoacidosis has the following laboratory
values: glucose 620 mg/dL, bicarbonate 10 mEq/L, potassium 5.8
mEq/L. What is the first step in management?
A. Intravenous insulin
B. Intravenous fluids
C. Sodium bicarbonate
D. Potassium supplementation
Answer: B. Intravenous fluids
, Rationale: Aggressive isotonic fluid resuscitation is the initial
treatment for DKA because severe dehydration contributes
significantly to morbidity.
7. A 34-year-old woman presents with tremor, heat intolerance,
weight loss, and diffuse goiter. TSH is suppressed. What is the
most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Pituitary adenoma
Answer: B. Graves disease
Rationale: Diffuse goiter, hyperthyroid symptoms, and suppressed TSH
are characteristic of Graves disease, an autoimmune disorder
involving thyroid-stimulating immunoglobulins.
8. A patient develops severe hyperkalemia with peaked T waves.
Which medication should be administered immediately?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Calcium gluconate
D. Insulin alone
Answer: C. Calcium gluconate
Rationale: Intravenous calcium stabilizes myocardial membranes and
is the first treatment for life-threatening hyperkalemia with ECG
changes.
9. A 65-year-old smoker presents with painless gross hematuria.
Which diagnosis should be considered most strongly?
Clinical Synthesis Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with hypertension, hyperlipidemia, and
tobacco use presents with sudden severe tearing chest pain
radiating to the back. Blood pressure is 190/110 mm Hg in the
right arm and 160/90 mm Hg in the left arm. Chest radiograph
demonstrates mediastinal widening. Which is the most
appropriate next diagnostic step?
A. Exercise stress testing
B. Transthoracic echocardiography only
C. CT angiography of the chest
D. Coronary angiography
Answer: C. CT angiography of the chest
Rationale: Acute aortic dissection should be suspected in patients with
tearing chest pain, pulse or blood pressure discrepancies, and
mediastinal widening. CT angiography is the preferred diagnostic
modality in hemodynamically stable patients because it rapidly
identifies the location and extent of dissection. Stress testing is
contraindicated, and coronary angiography may delay diagnosis.
2. A 58-year-old woman with diabetes presents with crushing
substernal chest pain. ECG reveals ST-segment elevations in leads
, II, III, and aVF. Blood pressure is 82/54 mm Hg. Which medication
should be avoided?
A. Aspirin
B. Clopidogrel
C. Nitroglycerin
D. Heparin
Answer: C. Nitroglycerin
Rationale: Inferior wall myocardial infarction may involve the right
ventricle. Nitroglycerin decreases preload and can precipitate
profound hypotension in right ventricular infarction. Aspirin,
anticoagulation, and antiplatelet therapy remain indicated.
3. A 26-year-old woman presents with fever, dysuria, flank pain, and
costovertebral angle tenderness. Urinalysis reveals leukocyte
esterase positivity and numerous white blood cells. What is the
most likely diagnosis?
A. Interstitial cystitis
B. Acute pyelonephritis
C. Urethritis
D. Nephrolithiasis
Answer: B. Acute pyelonephritis
Rationale: Fever, flank pain, pyuria, and CVA tenderness strongly
indicate pyelonephritis. Lower urinary tract infections generally lack
systemic symptoms.
4. A 72-year-old hospitalized patient develops acute dyspnea. ECG
shows sinus tachycardia. CT pulmonary angiography reveals a
large pulmonary embolism. Which physiologic change is
expected?
,A. Increased pulmonary perfusion
B. Increased dead-space ventilation
C. Increased left atrial pressure
D. Increased oxygen extraction by alveoli
Answer: B. Increased dead-space ventilation
Rationale: Pulmonary embolism obstructs blood flow to ventilated
alveoli, producing ventilation-perfusion mismatch and increased
physiologic dead space.
5. A 4-year-old child develops barking cough, inspiratory stridor, and
hoarseness. Symptoms worsen at night. Which is the most likely
diagnosis?
A. Epiglottitis
B. Croup
C. Foreign body aspiration
D. Bacterial tracheitis
Answer: B. Croup
Rationale: Viral croup classically presents with barking cough,
hoarseness, and inspiratory stridor. It is most commonly caused by
parainfluenza virus.
6. A patient with diabetic ketoacidosis has the following laboratory
values: glucose 620 mg/dL, bicarbonate 10 mEq/L, potassium 5.8
mEq/L. What is the first step in management?
A. Intravenous insulin
B. Intravenous fluids
C. Sodium bicarbonate
D. Potassium supplementation
Answer: B. Intravenous fluids
, Rationale: Aggressive isotonic fluid resuscitation is the initial
treatment for DKA because severe dehydration contributes
significantly to morbidity.
7. A 34-year-old woman presents with tremor, heat intolerance,
weight loss, and diffuse goiter. TSH is suppressed. What is the
most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Pituitary adenoma
Answer: B. Graves disease
Rationale: Diffuse goiter, hyperthyroid symptoms, and suppressed TSH
are characteristic of Graves disease, an autoimmune disorder
involving thyroid-stimulating immunoglobulins.
8. A patient develops severe hyperkalemia with peaked T waves.
Which medication should be administered immediately?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Calcium gluconate
D. Insulin alone
Answer: C. Calcium gluconate
Rationale: Intravenous calcium stabilizes myocardial membranes and
is the first treatment for life-threatening hyperkalemia with ECG
changes.
9. A 65-year-old smoker presents with painless gross hematuria.
Which diagnosis should be considered most strongly?
