COMSAE Phase 3 Form CSA 120 Advanced Clinical
Synthesis Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 67-year-old man with hypertension presents with sudden
severe chest pain described as tearing and radiating to his back.
Blood pressure differs between arms. Chest X-ray shows widened
mediastinum. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Acute tearing chest pain with radiation to the back,
pulse/BP discrepancies, and widened mediastinum are classic findings
of aortic dissection. CT angiography is commonly used for
confirmation in stable patients.
2. A 54-year-old woman with diabetes presents with fever, right
upper quadrant pain, and jaundice. Ultrasound shows gallstones
and dilation of the common bile duct. What is the next best
management?
A. Immediate cholecystectomy only
B. ERCP
,C. Colonoscopy
D. Observation
Answer: B. ERCP
Rationale: Charcot triad (fever, RUQ pain, jaundice) with common bile
duct obstruction suggests ascending cholangitis. ERCP allows biliary
decompression and treatment.
3. A patient develops confusion, hypotension, and fever after a
urinary tract infection. Lactate is elevated. What is the initial
management?
A. IV antibiotics and fluid resuscitation
B. Immediate surgery
C. Corticosteroids only
D. Diuretics
Answer: A. IV antibiotics and fluid resuscitation
Rationale: Septic shock requires rapid recognition, IV crystalloid fluids,
broad-spectrum antibiotics, and monitoring for organ dysfunction.
4. A 25-year-old woman has amenorrhea, galactorrhea, and
headaches. What is the first diagnostic test?
A. MRI brain
B. Serum prolactin
C. Pregnancy test
D. CT head
Answer: C. Pregnancy test
,Rationale: Pregnancy must always be excluded first in evaluation of
amenorrhea before investigating endocrine causes.
5. A 72-year-old man develops unilateral weakness and aphasia 45
minutes ago. CT shows no hemorrhage. What is the next step?
A. Aspirin only
B. IV thrombolytic therapy if eligible
C. Carotid surgery
D. EEG
Answer: B. IV thrombolytic therapy if eligible
Rationale: Acute ischemic stroke within the treatment window may
benefit from thrombolysis after hemorrhage is excluded.
6. A patient with COPD presents with worsening dyspnea. ABG
shows pH 7.28 and elevated CO₂. What acid-base disorder is
present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Answer: B. Respiratory acidosis
Rationale: COPD exacerbations cause hypoventilation leading to CO₂
retention and respiratory acidosis.
7. A 30-year-old patient has painless hematuria and is a long-term
smoker. What is the most likely diagnosis?
, A. Kidney stone
B. Bladder carcinoma
C. UTI
D. Glomerulonephritis
Answer: B. Bladder carcinoma
Rationale: Painless gross hematuria in a smoker is a classic
presentation of urothelial carcinoma.
8. A patient taking warfarin develops significant bleeding with
elevated INR. Which medication reverses the effect?
A. Protamine
B. Vitamin K
C. Naloxone
D. Atropine
Answer: B. Vitamin K
Rationale: Vitamin K reverses warfarin-induced anticoagulation.
Severe bleeding may also require additional reversal agents.
9. A 5-year-old child has barking cough and inspiratory stridor. What
is the diagnosis?
A. Epiglottitis
B. Croup
C. Asthma
D. Pneumonia
Answer: B. Croup
Synthesis Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 67-year-old man with hypertension presents with sudden
severe chest pain described as tearing and radiating to his back.
Blood pressure differs between arms. Chest X-ray shows widened
mediastinum. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Acute tearing chest pain with radiation to the back,
pulse/BP discrepancies, and widened mediastinum are classic findings
of aortic dissection. CT angiography is commonly used for
confirmation in stable patients.
2. A 54-year-old woman with diabetes presents with fever, right
upper quadrant pain, and jaundice. Ultrasound shows gallstones
and dilation of the common bile duct. What is the next best
management?
A. Immediate cholecystectomy only
B. ERCP
,C. Colonoscopy
D. Observation
Answer: B. ERCP
Rationale: Charcot triad (fever, RUQ pain, jaundice) with common bile
duct obstruction suggests ascending cholangitis. ERCP allows biliary
decompression and treatment.
3. A patient develops confusion, hypotension, and fever after a
urinary tract infection. Lactate is elevated. What is the initial
management?
A. IV antibiotics and fluid resuscitation
B. Immediate surgery
C. Corticosteroids only
D. Diuretics
Answer: A. IV antibiotics and fluid resuscitation
Rationale: Septic shock requires rapid recognition, IV crystalloid fluids,
broad-spectrum antibiotics, and monitoring for organ dysfunction.
4. A 25-year-old woman has amenorrhea, galactorrhea, and
headaches. What is the first diagnostic test?
A. MRI brain
B. Serum prolactin
C. Pregnancy test
D. CT head
Answer: C. Pregnancy test
,Rationale: Pregnancy must always be excluded first in evaluation of
amenorrhea before investigating endocrine causes.
5. A 72-year-old man develops unilateral weakness and aphasia 45
minutes ago. CT shows no hemorrhage. What is the next step?
A. Aspirin only
B. IV thrombolytic therapy if eligible
C. Carotid surgery
D. EEG
Answer: B. IV thrombolytic therapy if eligible
Rationale: Acute ischemic stroke within the treatment window may
benefit from thrombolysis after hemorrhage is excluded.
6. A patient with COPD presents with worsening dyspnea. ABG
shows pH 7.28 and elevated CO₂. What acid-base disorder is
present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Answer: B. Respiratory acidosis
Rationale: COPD exacerbations cause hypoventilation leading to CO₂
retention and respiratory acidosis.
7. A 30-year-old patient has painless hematuria and is a long-term
smoker. What is the most likely diagnosis?
, A. Kidney stone
B. Bladder carcinoma
C. UTI
D. Glomerulonephritis
Answer: B. Bladder carcinoma
Rationale: Painless gross hematuria in a smoker is a classic
presentation of urothelial carcinoma.
8. A patient taking warfarin develops significant bleeding with
elevated INR. Which medication reverses the effect?
A. Protamine
B. Vitamin K
C. Naloxone
D. Atropine
Answer: B. Vitamin K
Rationale: Vitamin K reverses warfarin-induced anticoagulation.
Severe bleeding may also require additional reversal agents.
9. A 5-year-old child has barking cough and inspiratory stridor. What
is the diagnosis?
A. Epiglottitis
B. Croup
C. Asthma
D. Pneumonia
Answer: B. Croup
