COMSAE Phase 2-Form BSA 117 Clinical
Simulation 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 his left shoulder for 45 minutes. He is diaphoretic and
nauseated. ECG demonstrates ST-segment elevation in leads II, III,
and aVF. Blood pressure is 92/58 mmHg. Which of the following is
the most appropriate next step?
A. Exercise stress test
B. Immediate percutaneous coronary intervention
C. Intravenous beta-blocker
D. Echocardiogram only
E. Repeat ECG in 6 hours
Answer: B. Immediate percutaneous coronary intervention
Rationale: Inferior STEMI with hypotension requires emergent
reperfusion therapy. PCI is the preferred definitive treatment when
available promptly. Stress testing is contraindicated during acute MI.
Beta-blockers may worsen hypotension. Time to reperfusion is the
major determinant of myocardial salvage.
2. A 29-year-old woman presents with sudden right lower quadrant
pain and amenorrhea for 7 weeks. β-hCG is positive. Transvaginal
ultrasound reveals no intrauterine pregnancy and a right adnexal
mass. Most likely diagnosis?
,A. Ovarian torsion
B. Ruptured ovarian cyst
C. Ectopic pregnancy
D. Endometriosis
E. PID
Answer: C. Ectopic pregnancy
Rationale: Positive pregnancy test with empty uterus above
discriminatory β-hCG level plus adnexal mass strongly suggests
ectopic pregnancy. Tubal implantation is most common. Delay in
diagnosis risks life-threatening hemorrhage.
3. A newborn develops cyanosis during feeding that improves when
crying. Examination reveals excessive salivation and inability to
pass a nasogastric tube. Diagnosis?
A. Duodenal atresia
B. Esophageal atresia with tracheoesophageal fistula
C. Hirschsprung disease
D. Choanal atresia
E. Pyloric stenosis
Answer: B. Esophageal atresia with tracheoesophageal fistula
Rationale: Excessive secretions, feeding difficulties, cyanosis, and
inability to pass NG tube are classic findings. Polyhydramnios is
commonly present prenatally.
4. A 58-year-old woman with long-standing GERD develops
progressive dysphagia. Endoscopy reveals salmon-colored mucosa
in the distal esophagus. Histology demonstrates intestinal
metaplasia. Diagnosis?
,A. Squamous cell carcinoma
B. Achalasia
C. Barrett esophagus
D. Zenker diverticulum
E. Diffuse esophageal spasm
Answer: C. Barrett esophagus
Rationale: Chronic GERD causes replacement of squamous epithelium
with intestinal-type columnar epithelium. This condition increases risk
of esophageal adenocarcinoma.
5. A 24-year-old woman presents with fatigue, pallor, and pica.
Laboratory findings:
Hemoglobin: 8.8 g/dL
MCV: 68 fL
Ferritin: Low
TIBC: Elevated
Most likely diagnosis?
A. Anemia of chronic disease
B. Iron deficiency anemia
C. Thalassemia
D. Sideroblastic anemia
E. Lead poisoning
Answer: B. Iron deficiency anemia
Rationale: Low ferritin is highly specific for iron deficiency. Increased
TIBC reflects increased transferrin production in response to iron
depletion.
, 6. A patient develops unilateral facial paralysis involving the
forehead after a viral illness. Taste sensation is decreased over the
anterior tongue.
A. Stroke
B. Bell palsy
C. Trigeminal neuralgia
D. Myasthenia gravis
E. Horner syndrome
Answer: B. Bell palsy
Rationale: Entire facial weakness including forehead involvement
indicates peripheral CN VII lesion. Forehead sparing would suggest
central stroke.
7. A 72-year-old smoker presents with hematuria without pain. Next
best diagnostic test?
A. Urinalysis only
B. Urine culture
C. Cystoscopy
D. Kidney biopsy
E. Repeat urine dipstick
Answer: C. Cystoscopy
Rationale: Painless hematuria in an older smoker is bladder cancer
until proven otherwise. Cystoscopy is the diagnostic gold standard.
8. A pregnant woman at 36 weeks develops hypertension,
proteinuria, headaches, and visual disturbances. Best definitive
treatment?
A. Methyldopa
B. Magnesium sulfate only
Simulation 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 his left shoulder for 45 minutes. He is diaphoretic and
nauseated. ECG demonstrates ST-segment elevation in leads II, III,
and aVF. Blood pressure is 92/58 mmHg. Which of the following is
the most appropriate next step?
A. Exercise stress test
B. Immediate percutaneous coronary intervention
C. Intravenous beta-blocker
D. Echocardiogram only
E. Repeat ECG in 6 hours
Answer: B. Immediate percutaneous coronary intervention
Rationale: Inferior STEMI with hypotension requires emergent
reperfusion therapy. PCI is the preferred definitive treatment when
available promptly. Stress testing is contraindicated during acute MI.
Beta-blockers may worsen hypotension. Time to reperfusion is the
major determinant of myocardial salvage.
2. A 29-year-old woman presents with sudden right lower quadrant
pain and amenorrhea for 7 weeks. β-hCG is positive. Transvaginal
ultrasound reveals no intrauterine pregnancy and a right adnexal
mass. Most likely diagnosis?
,A. Ovarian torsion
B. Ruptured ovarian cyst
C. Ectopic pregnancy
D. Endometriosis
E. PID
Answer: C. Ectopic pregnancy
Rationale: Positive pregnancy test with empty uterus above
discriminatory β-hCG level plus adnexal mass strongly suggests
ectopic pregnancy. Tubal implantation is most common. Delay in
diagnosis risks life-threatening hemorrhage.
3. A newborn develops cyanosis during feeding that improves when
crying. Examination reveals excessive salivation and inability to
pass a nasogastric tube. Diagnosis?
A. Duodenal atresia
B. Esophageal atresia with tracheoesophageal fistula
C. Hirschsprung disease
D. Choanal atresia
E. Pyloric stenosis
Answer: B. Esophageal atresia with tracheoesophageal fistula
Rationale: Excessive secretions, feeding difficulties, cyanosis, and
inability to pass NG tube are classic findings. Polyhydramnios is
commonly present prenatally.
4. A 58-year-old woman with long-standing GERD develops
progressive dysphagia. Endoscopy reveals salmon-colored mucosa
in the distal esophagus. Histology demonstrates intestinal
metaplasia. Diagnosis?
,A. Squamous cell carcinoma
B. Achalasia
C. Barrett esophagus
D. Zenker diverticulum
E. Diffuse esophageal spasm
Answer: C. Barrett esophagus
Rationale: Chronic GERD causes replacement of squamous epithelium
with intestinal-type columnar epithelium. This condition increases risk
of esophageal adenocarcinoma.
5. A 24-year-old woman presents with fatigue, pallor, and pica.
Laboratory findings:
Hemoglobin: 8.8 g/dL
MCV: 68 fL
Ferritin: Low
TIBC: Elevated
Most likely diagnosis?
A. Anemia of chronic disease
B. Iron deficiency anemia
C. Thalassemia
D. Sideroblastic anemia
E. Lead poisoning
Answer: B. Iron deficiency anemia
Rationale: Low ferritin is highly specific for iron deficiency. Increased
TIBC reflects increased transferrin production in response to iron
depletion.
, 6. A patient develops unilateral facial paralysis involving the
forehead after a viral illness. Taste sensation is decreased over the
anterior tongue.
A. Stroke
B. Bell palsy
C. Trigeminal neuralgia
D. Myasthenia gravis
E. Horner syndrome
Answer: B. Bell palsy
Rationale: Entire facial weakness including forehead involvement
indicates peripheral CN VII lesion. Forehead sparing would suggest
central stroke.
7. A 72-year-old smoker presents with hematuria without pain. Next
best diagnostic test?
A. Urinalysis only
B. Urine culture
C. Cystoscopy
D. Kidney biopsy
E. Repeat urine dipstick
Answer: C. Cystoscopy
Rationale: Painless hematuria in an older smoker is bladder cancer
until proven otherwise. Cystoscopy is the diagnostic gold standard.
8. A pregnant woman at 36 weeks develops hypertension,
proteinuria, headaches, and visual disturbances. Best definitive
treatment?
A. Methyldopa
B. Magnesium sulfate only
