COMSAE Phase 3 Form CSA 121 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 presents with sudden
tearing chest pain radiating to his back. Blood pressure is 210/110
mm Hg in the right arm and 170/90 mm Hg in the left arm. Chest
radiograph shows widened mediastinum. Which is the most
appropriate initial diagnostic study?
A. Exercise stress test
B. CT angiography of the chest
C. Echocardiography only
D. Coronary angiography
Answer: B. CT angiography of the chest
Rationale: Acute aortic dissection is suspected due to abrupt severe
pain, pulse/BP differential, and widened mediastinum. CT
angiography is the preferred rapid diagnostic test in stable patients.
2. A 54-year-old woman with type 2 diabetes presents with fever,
flank pain, and dysuria. Urinalysis shows leukocyte esterase and
nitrites. She is hypotensive and confused. Which management is
most appropriate?
,A. Oral nitrofurantoin
B. IV fluids and broad-spectrum IV antibiotics
C. Outpatient follow-up
D. Immediate cystoscopy
Answer: B. IV fluids and broad-spectrum IV antibiotics
Rationale: This patient has septic pyelonephritis. Initial management
requires stabilization with fluids and prompt empiric IV antibiotics.
3. A 35-year-old man develops progressive weakness beginning in
the legs after a gastrointestinal infection. Examination reveals
symmetric ascending paralysis and absent reflexes. What is the
diagnosis?
A. Multiple sclerosis
B. Guillain-Barré syndrome
C. Myasthenia gravis
D. Amyotrophic lateral sclerosis
Answer: B. Guillain-Barré syndrome
Rationale: Ascending weakness with areflexia following infection is
classic for Guillain-Barré syndrome due to peripheral nerve
demyelination.
4. A 72-year-old man presents with painless gross hematuria. He has
a 50-pack-year smoking history. The most likely diagnosis is:
A. Nephrolithiasis
B. Bladder urothelial carcinoma
C. Acute cystitis
D. Benign prostatic hyperplasia
,Answer: B. Bladder urothelial carcinoma
Rationale: Painless hematuria in an older smoker is a classic
presentation of bladder cancer and requires evaluation.
5. A 25-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory studies show elevated
TSH and decreased free T4. Diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Secondary adrenal insufficiency
D. Cushing syndrome
Answer: B. Primary hypothyroidism
Rationale: Elevated TSH with low free T4 indicates failure of the
thyroid gland itself.
6. A patient with COPD presents with worsening dyspnea and
increased sputum production. Which medication combination is
most appropriate for an acute exacerbation?
A. Long-term oxygen only
B. Bronchodilators, corticosteroids, and antibiotics when indicated
C. Antihistamines
D. Diuretics alone
Answer: B. Bronchodilators, corticosteroids, and antibiotics when
indicated
, Rationale: COPD exacerbations are treated with increased
bronchodilation, systemic steroids, and antibiotics when bacterial
infection is suspected.
7. A 60-year-old woman develops unilateral leg swelling and pain
after a long flight. Which finding most strongly supports deep vein
thrombosis?
A. Bilateral ankle edema
B. Unilateral calf tenderness and swelling
C. Bradycardia
D. Chronic cough
Answer: B. Unilateral calf tenderness and swelling
Rationale: Acute unilateral swelling and tenderness are classic signs of
DVT.
8. A 45-year-old man has severe epigastric pain radiating to the
back. Lipase is markedly elevated. Diagnosis?
A. Cholecystitis
B. Pancreatitis
C. Appendicitis
D. Diverticulitis
Answer: B. Pancreatitis
Rationale: Severe epigastric pain radiating to the back with elevated
lipase is diagnostic of acute pancreatitis.
Clinical Synthesis Exam Practice Questions
& [Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with hypertension presents with sudden
tearing chest pain radiating to his back. Blood pressure is 210/110
mm Hg in the right arm and 170/90 mm Hg in the left arm. Chest
radiograph shows widened mediastinum. Which is the most
appropriate initial diagnostic study?
A. Exercise stress test
B. CT angiography of the chest
C. Echocardiography only
D. Coronary angiography
Answer: B. CT angiography of the chest
Rationale: Acute aortic dissection is suspected due to abrupt severe
pain, pulse/BP differential, and widened mediastinum. CT
angiography is the preferred rapid diagnostic test in stable patients.
2. A 54-year-old woman with type 2 diabetes presents with fever,
flank pain, and dysuria. Urinalysis shows leukocyte esterase and
nitrites. She is hypotensive and confused. Which management is
most appropriate?
,A. Oral nitrofurantoin
B. IV fluids and broad-spectrum IV antibiotics
C. Outpatient follow-up
D. Immediate cystoscopy
Answer: B. IV fluids and broad-spectrum IV antibiotics
Rationale: This patient has septic pyelonephritis. Initial management
requires stabilization with fluids and prompt empiric IV antibiotics.
3. A 35-year-old man develops progressive weakness beginning in
the legs after a gastrointestinal infection. Examination reveals
symmetric ascending paralysis and absent reflexes. What is the
diagnosis?
A. Multiple sclerosis
B. Guillain-Barré syndrome
C. Myasthenia gravis
D. Amyotrophic lateral sclerosis
Answer: B. Guillain-Barré syndrome
Rationale: Ascending weakness with areflexia following infection is
classic for Guillain-Barré syndrome due to peripheral nerve
demyelination.
4. A 72-year-old man presents with painless gross hematuria. He has
a 50-pack-year smoking history. The most likely diagnosis is:
A. Nephrolithiasis
B. Bladder urothelial carcinoma
C. Acute cystitis
D. Benign prostatic hyperplasia
,Answer: B. Bladder urothelial carcinoma
Rationale: Painless hematuria in an older smoker is a classic
presentation of bladder cancer and requires evaluation.
5. A 25-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory studies show elevated
TSH and decreased free T4. Diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Secondary adrenal insufficiency
D. Cushing syndrome
Answer: B. Primary hypothyroidism
Rationale: Elevated TSH with low free T4 indicates failure of the
thyroid gland itself.
6. A patient with COPD presents with worsening dyspnea and
increased sputum production. Which medication combination is
most appropriate for an acute exacerbation?
A. Long-term oxygen only
B. Bronchodilators, corticosteroids, and antibiotics when indicated
C. Antihistamines
D. Diuretics alone
Answer: B. Bronchodilators, corticosteroids, and antibiotics when
indicated
, Rationale: COPD exacerbations are treated with increased
bronchodilation, systemic steroids, and antibiotics when bacterial
infection is suspected.
7. A 60-year-old woman develops unilateral leg swelling and pain
after a long flight. Which finding most strongly supports deep vein
thrombosis?
A. Bilateral ankle edema
B. Unilateral calf tenderness and swelling
C. Bradycardia
D. Chronic cough
Answer: B. Unilateral calf tenderness and swelling
Rationale: Acute unilateral swelling and tenderness are classic signs of
DVT.
8. A 45-year-old man has severe epigastric pain radiating to the
back. Lipase is markedly elevated. Diagnosis?
A. Cholecystitis
B. Pancreatitis
C. Appendicitis
D. Diverticulitis
Answer: B. Pancreatitis
Rationale: Severe epigastric pain radiating to the back with elevated
lipase is diagnostic of acute pancreatitis.
