COMSAE Phase 2 – Form BSA 110 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with sudden-onset crushing
substernal chest pain radiating to the jaw. ECG shows ST
elevations in leads II, III, and aVF. He is hypotensive with clear
lungs and elevated JVP. Which additional study is most important
before nitroglycerin administration?
A. Chest CT angiography
B. Exercise stress test
C. Pulmonary angiography
D. Bedside echocardiogram evaluating right ventricular function
E. Cardiac MRI
Answer: D. Bedside echocardiogram evaluating right ventricular
function
Rationale: Inferior MI involving the right ventricle is preload dependent.
Nitroglycerin reduces preload and may precipitate profound
hypotension. Bedside echocardiography assessing RV involvement is
crucial before vasodilator therapy.
2. A 24-year-old woman presents with fever, dysuria, flank pain, and
nausea. Urinalysis reveals WBC casts. Which organism is most
likely responsible?
,A. Enterococcus faecalis
B. Proteus mirabilis
C. Staphylococcus saprophyticus
D. Escherichia coli
E. Candida albicans
Answer: D. Escherichia coli
Rationale: E. coli causes most cases of pyelonephritis. WBC casts
indicate renal parenchymal inflammation rather than isolated cystitis.
3. A 58-year-old smoker presents with hematuria without pain.
Which diagnosis is most concerning?
A. Nephrolithiasis
B. Renal infarction
C. Bladder carcinoma
D. Urethritis
E. Interstitial cystitis
Answer: C. Bladder carcinoma
Rationale: Painless gross hematuria in an older smoker should be
considered urothelial carcinoma until proven otherwise.
4. A patient with diabetic ketoacidosis has glucose 620 mg/dL,
potassium 5.7 mEq/L, and bicarbonate 9 mEq/L. What is the first
step?
A. Potassium replacement
B. IV insulin infusion
C. Sodium bicarbonate
D. Aggressive isotonic saline infusion
E. Dialysis
Answer: D. Aggressive isotonic saline infusion
,Rationale: Volume resuscitation is the initial management priority in
DKA. Insulin follows after adequate fluids and potassium assessment.
5. A 70-year-old develops sudden unilateral weakness and aphasia
45 minutes ago. CT head is negative. Next step?
A. Aspirin only
B. Heparin infusion
C. Intravenous thrombolysis
D. Carotid endarterectomy
E. Observation
Answer: C. Intravenous thrombolysis
Rationale: Patients within the therapeutic window and without
hemorrhage are candidates for thrombolytic therapy.
6. A 30-year-old woman at 34 weeks gestation has hypertension,
proteinuria, headache, and visual disturbances. Most appropriate
treatment?
A. Methyldopa only
B. Immediate discharge
C. Magnesium sulfate and delivery planning
D. Aspirin therapy
E. Observation
Answer: C. Magnesium sulfate and delivery planning
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and prompt delivery after stabilization.
7. A child has fever, conjunctivitis, strawberry tongue, and cervical
lymphadenopathy for 6 days. Diagnosis?
A. Scarlet fever
B. Kawasaki disease
, C. Measles
D. EBV infection
E. Roseola
Answer: B. Kawasaki disease
Rationale: Kawasaki disease presents with prolonged fever and
mucocutaneous inflammation. IVIG reduces coronary artery aneurysm
risk.
8. A trauma patient becomes hypotensive with distended neck veins
and muffled heart sounds. Diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Septic shock
D. Myocardial infarction
E. Aortic dissection
Answer: B. Cardiac tamponade
Rationale: Beck triad—hypotension, JVD, and muffled heart sounds—is
classic for tamponade.
9. A patient suddenly develops pleuritic chest pain and dyspnea
after a long flight. Most likely diagnosis?
A. Pneumonia
B. Pericarditis
C. Pulmonary embolism
D. Asthma
E. GERD
Answer: C. Pulmonary embolism
Rationale: Immobilization and sudden dyspnea with pleuritic pain
strongly suggest PE.
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with sudden-onset crushing
substernal chest pain radiating to the jaw. ECG shows ST
elevations in leads II, III, and aVF. He is hypotensive with clear
lungs and elevated JVP. Which additional study is most important
before nitroglycerin administration?
A. Chest CT angiography
B. Exercise stress test
C. Pulmonary angiography
D. Bedside echocardiogram evaluating right ventricular function
E. Cardiac MRI
Answer: D. Bedside echocardiogram evaluating right ventricular
function
Rationale: Inferior MI involving the right ventricle is preload dependent.
Nitroglycerin reduces preload and may precipitate profound
hypotension. Bedside echocardiography assessing RV involvement is
crucial before vasodilator therapy.
2. A 24-year-old woman presents with fever, dysuria, flank pain, and
nausea. Urinalysis reveals WBC casts. Which organism is most
likely responsible?
,A. Enterococcus faecalis
B. Proteus mirabilis
C. Staphylococcus saprophyticus
D. Escherichia coli
E. Candida albicans
Answer: D. Escherichia coli
Rationale: E. coli causes most cases of pyelonephritis. WBC casts
indicate renal parenchymal inflammation rather than isolated cystitis.
3. A 58-year-old smoker presents with hematuria without pain.
Which diagnosis is most concerning?
A. Nephrolithiasis
B. Renal infarction
C. Bladder carcinoma
D. Urethritis
E. Interstitial cystitis
Answer: C. Bladder carcinoma
Rationale: Painless gross hematuria in an older smoker should be
considered urothelial carcinoma until proven otherwise.
4. A patient with diabetic ketoacidosis has glucose 620 mg/dL,
potassium 5.7 mEq/L, and bicarbonate 9 mEq/L. What is the first
step?
A. Potassium replacement
B. IV insulin infusion
C. Sodium bicarbonate
D. Aggressive isotonic saline infusion
E. Dialysis
Answer: D. Aggressive isotonic saline infusion
,Rationale: Volume resuscitation is the initial management priority in
DKA. Insulin follows after adequate fluids and potassium assessment.
5. A 70-year-old develops sudden unilateral weakness and aphasia
45 minutes ago. CT head is negative. Next step?
A. Aspirin only
B. Heparin infusion
C. Intravenous thrombolysis
D. Carotid endarterectomy
E. Observation
Answer: C. Intravenous thrombolysis
Rationale: Patients within the therapeutic window and without
hemorrhage are candidates for thrombolytic therapy.
6. A 30-year-old woman at 34 weeks gestation has hypertension,
proteinuria, headache, and visual disturbances. Most appropriate
treatment?
A. Methyldopa only
B. Immediate discharge
C. Magnesium sulfate and delivery planning
D. Aspirin therapy
E. Observation
Answer: C. Magnesium sulfate and delivery planning
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and prompt delivery after stabilization.
7. A child has fever, conjunctivitis, strawberry tongue, and cervical
lymphadenopathy for 6 days. Diagnosis?
A. Scarlet fever
B. Kawasaki disease
, C. Measles
D. EBV infection
E. Roseola
Answer: B. Kawasaki disease
Rationale: Kawasaki disease presents with prolonged fever and
mucocutaneous inflammation. IVIG reduces coronary artery aneurysm
risk.
8. A trauma patient becomes hypotensive with distended neck veins
and muffled heart sounds. Diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Septic shock
D. Myocardial infarction
E. Aortic dissection
Answer: B. Cardiac tamponade
Rationale: Beck triad—hypotension, JVD, and muffled heart sounds—is
classic for tamponade.
9. A patient suddenly develops pleuritic chest pain and dyspnea
after a long flight. Most likely diagnosis?
A. Pneumonia
B. Pericarditis
C. Pulmonary embolism
D. Asthma
E. GERD
Answer: C. Pulmonary embolism
Rationale: Immobilization and sudden dyspnea with pleuritic pain
strongly suggest PE.
