COMSAE Phase 1 Form 116
Exam Test Bank – Newest 2026
Edition actual!!!!
Question 1
A 72-year-old male with a 50-pack-year smoking history presents with progressive dyspnea and
a chronic productive cough. Pulmonary function tests reveal a reduced FEV1/FVC ratio and
increased total lung capacity. Which of the following is the most likely underlying pathologic
finding?
A) Inflammation and fibrosis of the alveolar walls
B) Destruction of alveolar septae without fibrosis
C) Mucus hypersecretion and goblet cell hyperplasia
D) Thickening of the basement membrane with eosinophilia
E) Granulomatous inflammation with caseous necrosis
ANSWER: B
Rationale: This patient has clinical and PFT findings consistent with emphysema (COPD).
Emphysema is characterized by destruction of alveolar septae without significant fibrosis,
leading to loss of elastic recoil and air trapping. Option A describes interstitial pulmonary
fibrosis. Option C describes chronic bronchitis. Option D describes asthma. Option E describes
tuberculosis.
,Question 2
A 45-year-old female with systemic lupus erythematosus develops progressive shortness of
breath and pleuritic chest pain. ECG shows diffuse ST-segment elevations. Cardiac enzymes are
normal. Which of the following is the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
E) Esophageal spasm
ANSWER: B
Rationale: This patient has SLE, which predisposes to pericarditis. Pericarditis presents with
pleuritic chest pain and diffuse ST-segment elevations on ECG without elevation of cardiac
enzymes. Option A would show regional ST changes and elevated enzymes. Option C would
show tachycardia and hypoxia. Option D would show widened mediastinum. Option E would
show normal ECG.
Question 3
A 28-year-old male presents with testicular pain and swelling. Ultrasound reveals a
heterogeneous mass. Serum alpha-fetoprotein is markedly elevated, and beta-hCG is slightly
elevated. Which of the following is the most likely diagnosis?
A) Seminoma
B) Embryonal carcinoma
C) Yolk sac tumor
D) Choriocarcinoma
E) Teratoma
,ANSWER: C
Rationale: Yolk sac tumors are the most common testicular tumor in children but can occur in
adults. They are characterized by elevated alpha-fetoprotein (AFP). Option A (seminoma)
typically presents with elevated beta-hCG only. Option B (embryonal carcinoma) can elevate
both AFP and beta-hCG but is less common. Option D (choriocarcinoma) elevates beta-hCG
markedly without AFP elevation. Option E (teratoma) may elevate AFP but is less common.
Question 4
A 65-year-old female with osteoporosis presents with acute-onset severe back pain after lifting
a heavy object. X-ray shows a wedge-shaped vertebral compression fracture. Which of the
following is the most appropriate initial treatment?
A) Bed rest and analgesics
B) Surgical decompression
C) Radiation therapy
D) Chemotherapy
E) Corticosteroid injection
ANSWER: A
Rationale: Acute vertebral compression fractures are typically managed conservatively with bed
rest, analgesics, and gradual mobilization. Option B is reserved for neurologic compromise.
Options C and D are for malignancies. Option E is used for inflammatory conditions.
Question 5
A 52-year-old male with a history of alcohol abuse presents with jaundice, ascites, and
confusion. Laboratory studies reveal elevated AST and ALT with an AST/ALT ratio greater than
2. Which of the following is the most likely diagnosis?
A) Viral hepatitis
B) Alcoholic hepatitis
, C) Primary biliary cirrhosis
D) Hemochromatosis
E) Wilson's disease
ANSWER: B
Rationale: Alcoholic hepatitis typically presents with an AST/ALT ratio > 2 in patients with
alcohol abuse. Viral hepatitis typically has lower ratios. Primary biliary cirrhosis presents with
antimitochondrial antibodies. Hemochromatosis presents with elevated iron studies. Wilson's
disease presents with Kayser-Fleischer rings.
Question 6
A 30-year-old female presents with fatigue, weight gain, cold intolerance, and constipation.
Physical examination reveals a bradycardia and dry skin. Laboratory studies show elevated TSH
and low free T4. Which of the following is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Thyroiditis
D) Thyroid cancer
E) Pituitary adenoma
ANSWER: B
Rationale: This patient has symptoms and laboratory findings consistent with primary
hypothyroidism: elevated TSH with low free T4. Option A would show low TSH and high T4.
Option C could present similarly but would typically have a tender thyroid. Option D would
present with a nodule. Option E would show low TSH and low T4.
Question 7
A 55-year-old male with a history of hypertension presents with acute-onset severe headache,
nausea, and vomiting. Blood pressure is 220/120 mmHg. Fundoscopic examination reveals
Exam Test Bank – Newest 2026
Edition actual!!!!
Question 1
A 72-year-old male with a 50-pack-year smoking history presents with progressive dyspnea and
a chronic productive cough. Pulmonary function tests reveal a reduced FEV1/FVC ratio and
increased total lung capacity. Which of the following is the most likely underlying pathologic
finding?
A) Inflammation and fibrosis of the alveolar walls
B) Destruction of alveolar septae without fibrosis
C) Mucus hypersecretion and goblet cell hyperplasia
D) Thickening of the basement membrane with eosinophilia
E) Granulomatous inflammation with caseous necrosis
ANSWER: B
Rationale: This patient has clinical and PFT findings consistent with emphysema (COPD).
Emphysema is characterized by destruction of alveolar septae without significant fibrosis,
leading to loss of elastic recoil and air trapping. Option A describes interstitial pulmonary
fibrosis. Option C describes chronic bronchitis. Option D describes asthma. Option E describes
tuberculosis.
,Question 2
A 45-year-old female with systemic lupus erythematosus develops progressive shortness of
breath and pleuritic chest pain. ECG shows diffuse ST-segment elevations. Cardiac enzymes are
normal. Which of the following is the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
E) Esophageal spasm
ANSWER: B
Rationale: This patient has SLE, which predisposes to pericarditis. Pericarditis presents with
pleuritic chest pain and diffuse ST-segment elevations on ECG without elevation of cardiac
enzymes. Option A would show regional ST changes and elevated enzymes. Option C would
show tachycardia and hypoxia. Option D would show widened mediastinum. Option E would
show normal ECG.
Question 3
A 28-year-old male presents with testicular pain and swelling. Ultrasound reveals a
heterogeneous mass. Serum alpha-fetoprotein is markedly elevated, and beta-hCG is slightly
elevated. Which of the following is the most likely diagnosis?
A) Seminoma
B) Embryonal carcinoma
C) Yolk sac tumor
D) Choriocarcinoma
E) Teratoma
,ANSWER: C
Rationale: Yolk sac tumors are the most common testicular tumor in children but can occur in
adults. They are characterized by elevated alpha-fetoprotein (AFP). Option A (seminoma)
typically presents with elevated beta-hCG only. Option B (embryonal carcinoma) can elevate
both AFP and beta-hCG but is less common. Option D (choriocarcinoma) elevates beta-hCG
markedly without AFP elevation. Option E (teratoma) may elevate AFP but is less common.
Question 4
A 65-year-old female with osteoporosis presents with acute-onset severe back pain after lifting
a heavy object. X-ray shows a wedge-shaped vertebral compression fracture. Which of the
following is the most appropriate initial treatment?
A) Bed rest and analgesics
B) Surgical decompression
C) Radiation therapy
D) Chemotherapy
E) Corticosteroid injection
ANSWER: A
Rationale: Acute vertebral compression fractures are typically managed conservatively with bed
rest, analgesics, and gradual mobilization. Option B is reserved for neurologic compromise.
Options C and D are for malignancies. Option E is used for inflammatory conditions.
Question 5
A 52-year-old male with a history of alcohol abuse presents with jaundice, ascites, and
confusion. Laboratory studies reveal elevated AST and ALT with an AST/ALT ratio greater than
2. Which of the following is the most likely diagnosis?
A) Viral hepatitis
B) Alcoholic hepatitis
, C) Primary biliary cirrhosis
D) Hemochromatosis
E) Wilson's disease
ANSWER: B
Rationale: Alcoholic hepatitis typically presents with an AST/ALT ratio > 2 in patients with
alcohol abuse. Viral hepatitis typically has lower ratios. Primary biliary cirrhosis presents with
antimitochondrial antibodies. Hemochromatosis presents with elevated iron studies. Wilson's
disease presents with Kayser-Fleischer rings.
Question 6
A 30-year-old female presents with fatigue, weight gain, cold intolerance, and constipation.
Physical examination reveals a bradycardia and dry skin. Laboratory studies show elevated TSH
and low free T4. Which of the following is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Thyroiditis
D) Thyroid cancer
E) Pituitary adenoma
ANSWER: B
Rationale: This patient has symptoms and laboratory findings consistent with primary
hypothyroidism: elevated TSH with low free T4. Option A would show low TSH and high T4.
Option C could present similarly but would typically have a tender thyroid. Option D would
present with a nodule. Option E would show low TSH and low T4.
Question 7
A 55-year-old male with a history of hypertension presents with acute-onset severe headache,
nausea, and vomiting. Blood pressure is 220/120 mmHg. Fundoscopic examination reveals
