COMSAE Phase 3 Form CSA 117 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 sudden onset of severe chest
pain radiating to the back. Blood pressure is 190/100 mm Hg in
the right arm and 150/90 mm Hg in the left arm. Chest radiograph
demonstrates a widened mediastinum. What is the most
appropriate next diagnostic step?
A. Coronary angiography
B. CT angiography of the chest
C. Ventilation-perfusion scan
D. Stress echocardiography
Answer: B. CT angiography of the chest
Rationale: The patient's presentation is classic for acute aortic
dissection. CT angiography is the diagnostic study of choice in
hemodynamically stable patients because it rapidly visualizes the
extent of the dissection and guides management.
2. A 58-year-old woman with cirrhosis develops hematemesis and
hypotension. Upper endoscopy confirms actively bleeding
esophageal varices. Which medication should be initiated
immediately?
,A. Pantoprazole
B. Octreotide
C. Metoclopramide
D. Sucralfate
Answer: B. Octreotide
Rationale: Octreotide decreases portal venous pressure through
splanchnic vasoconstriction and is first-line pharmacologic therapy for
acute variceal hemorrhage.
3. A 25-year-old woman presents with fever, pelvic pain, and cervical
motion tenderness. Pregnancy test is negative. Which diagnosis is
most likely?
A. Endometriosis
B. Ovarian torsion
C. Pelvic inflammatory disease
D. Ectopic pregnancy
Answer: C. Pelvic inflammatory disease
Rationale: Fever, pelvic pain, and cervical motion tenderness are
hallmark findings of PID, most commonly caused by Neisseria
gonorrhoeae or Chlamydia trachomatis.
4. A hospitalized patient develops sudden dyspnea, tachycardia, and
pleuritic chest pain 5 days after hip surgery. What is the most
likely diagnosis?
A. Pneumonia
B. Pulmonary embolism
,C. Congestive heart failure
D. Pericarditis
Answer: B. Pulmonary embolism
Rationale: Recent orthopedic surgery is a major risk factor for venous
thromboembolism. Sudden dyspnea and pleuritic chest pain strongly
suggest pulmonary embolism.
5. A 63-year-old smoker presents with painless gross hematuria.
Which diagnosis should be considered first?
A. Nephrolithiasis
B. Pyelonephritis
C. Bladder cancer
D. Benign prostatic hyperplasia
Answer: C. Bladder cancer
Rationale: Painless hematuria in an older smoker is highly suggestive
of urothelial carcinoma until proven otherwise.
6. A patient develops fever, hypotension, and diffuse erythema after
nasal packing for epistaxis. What organism is most likely
responsible?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Haemophilus influenzae
D. Pseudomonas aeruginosa
Answer: B. Staphylococcus aureus
, Rationale: Toxic shock syndrome is classically associated with toxin-
producing Staphylococcus aureus and may occur after nasal packing.
7. A 70-year-old woman presents with sudden painless loss of vision
in one eye. Fundoscopy reveals a pale retina with a cherry-red
spot. What is the diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Acute glaucoma
D. Macular degeneration
Answer: B. Central retinal artery occlusion
Rationale: The classic finding of a cherry-red spot on fundoscopic
examination indicates central retinal artery occlusion, an
ophthalmologic emergency.
8. A diabetic patient presents with confusion, dehydration, glucose
of 850 mg/dL, and minimal ketones. What is the diagnosis?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Insulinoma
D. Adrenal crisis
Answer: B. Hyperosmolar hyperglycemic state
Rationale: Severe hyperglycemia, dehydration, altered mental status,
and absence of significant ketosis characterize HHS.
Clinical Synthesis Exam Practice Questions
& [Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with sudden onset of severe chest
pain radiating to the back. Blood pressure is 190/100 mm Hg in
the right arm and 150/90 mm Hg in the left arm. Chest radiograph
demonstrates a widened mediastinum. What is the most
appropriate next diagnostic step?
A. Coronary angiography
B. CT angiography of the chest
C. Ventilation-perfusion scan
D. Stress echocardiography
Answer: B. CT angiography of the chest
Rationale: The patient's presentation is classic for acute aortic
dissection. CT angiography is the diagnostic study of choice in
hemodynamically stable patients because it rapidly visualizes the
extent of the dissection and guides management.
2. A 58-year-old woman with cirrhosis develops hematemesis and
hypotension. Upper endoscopy confirms actively bleeding
esophageal varices. Which medication should be initiated
immediately?
,A. Pantoprazole
B. Octreotide
C. Metoclopramide
D. Sucralfate
Answer: B. Octreotide
Rationale: Octreotide decreases portal venous pressure through
splanchnic vasoconstriction and is first-line pharmacologic therapy for
acute variceal hemorrhage.
3. A 25-year-old woman presents with fever, pelvic pain, and cervical
motion tenderness. Pregnancy test is negative. Which diagnosis is
most likely?
A. Endometriosis
B. Ovarian torsion
C. Pelvic inflammatory disease
D. Ectopic pregnancy
Answer: C. Pelvic inflammatory disease
Rationale: Fever, pelvic pain, and cervical motion tenderness are
hallmark findings of PID, most commonly caused by Neisseria
gonorrhoeae or Chlamydia trachomatis.
4. A hospitalized patient develops sudden dyspnea, tachycardia, and
pleuritic chest pain 5 days after hip surgery. What is the most
likely diagnosis?
A. Pneumonia
B. Pulmonary embolism
,C. Congestive heart failure
D. Pericarditis
Answer: B. Pulmonary embolism
Rationale: Recent orthopedic surgery is a major risk factor for venous
thromboembolism. Sudden dyspnea and pleuritic chest pain strongly
suggest pulmonary embolism.
5. A 63-year-old smoker presents with painless gross hematuria.
Which diagnosis should be considered first?
A. Nephrolithiasis
B. Pyelonephritis
C. Bladder cancer
D. Benign prostatic hyperplasia
Answer: C. Bladder cancer
Rationale: Painless hematuria in an older smoker is highly suggestive
of urothelial carcinoma until proven otherwise.
6. A patient develops fever, hypotension, and diffuse erythema after
nasal packing for epistaxis. What organism is most likely
responsible?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Haemophilus influenzae
D. Pseudomonas aeruginosa
Answer: B. Staphylococcus aureus
, Rationale: Toxic shock syndrome is classically associated with toxin-
producing Staphylococcus aureus and may occur after nasal packing.
7. A 70-year-old woman presents with sudden painless loss of vision
in one eye. Fundoscopy reveals a pale retina with a cherry-red
spot. What is the diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Acute glaucoma
D. Macular degeneration
Answer: B. Central retinal artery occlusion
Rationale: The classic finding of a cherry-red spot on fundoscopic
examination indicates central retinal artery occlusion, an
ophthalmologic emergency.
8. A diabetic patient presents with confusion, dehydration, glucose
of 850 mg/dL, and minimal ketones. What is the diagnosis?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Insulinoma
D. Adrenal crisis
Answer: B. Hyperosmolar hyperglycemic state
Rationale: Severe hyperglycemia, dehydration, altered mental status,
and absence of significant ketosis characterize HHS.
