COMSAE Phase 2 BSA 117 Clinical
Knowledge Assessment Exam Questions
and Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A | Instant
Download Pdf.
Question 1
A 67-year-old man with a history of hypertension presents with sudden
right-sided weakness and aphasia. CT head without contrast shows no
hemorrhage. What is the most appropriate next step in management?
A. Aspirin only
B. IV heparin
C. IV alteplase (tPA)
D. Warfarin initiation
Rationale:
This patient presents with acute ischemic stroke within a likely
therapeutic window and no evidence of hemorrhage on CT. IV alteplase
(tPA) is indicated within 4.5 hours of symptom onset if no
contraindications exist. Anticoagulation with heparin or warfarin is not
first-line in acute stroke due to bleeding risk and lack of acute benefit.
Aspirin is used if tPA is contraindicated or after 24 hours post-
thrombolysis.
,Question 2
A 24-year-old woman presents with dysuria and urinary frequency.
Urinalysis shows leukocyte esterase and nitrites. What is the most likely
organism?
A. Staphylococcus saprophyticus
B. Escherichia coli
C. Enterococcus faecalis
D. Pseudomonas aeruginosa
Rationale:
Escherichia coli is the most common cause of uncomplicated urinary
tract infections, accounting for the majority of community-acquired
cases. It produces nitrites via nitrate reduction, a key diagnostic clue.
Staphylococcus saprophyticus is also a cause in young women but less
common. Pseudomonas is typically associated with hospital-acquired
infections.
Question 3
A 45-year-old man presents with chest pain relieved by leaning forward.
ECG shows diffuse ST elevation and PR depression. What is the
diagnosis?
A. Myocardial infarction
B. Acute pericarditis
C. Aortic dissection
D. Pulmonary embolism
,Rationale:
Acute pericarditis presents with pleuritic chest pain relieved by sitting
forward, diffuse ST elevation, and PR depression due to pericardial
inflammation. MI causes localized ST changes, not diffuse. Aortic
dissection presents with tearing pain radiating to the back.
Question 4
A newborn has cyanosis that improves with oxygen. Echocardiogram
shows a right-to-left shunt. Which condition is most likely?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Tetralogy of Fallot
D. Atrial septal defect
Rationale:
Tetralogy of Fallot causes right-to-left shunting due to pulmonary
stenosis and VSD, leading to cyanosis. VSD and ASD usually cause left-
to-right shunts initially. PDA typically causes a left-to-right shunt unless
severe pulmonary hypertension develops.
Question 5
A 30-year-old man has episodic headaches, palpitations, and sweating.
Labs show elevated catecholamines. What is the diagnosis?
A. Hyperthyroidism
B. Panic disorder
, C. Pheochromocytoma
D. Carcinoid syndrome
Rationale:
Pheochromocytoma is a catecholamine-secreting tumor of the adrenal
medulla causing episodic hypertension, headaches, diaphoresis, and
palpitations. Carcinoid syndrome causes flushing and diarrhea but not
catecholamine excess symptoms.
Question 6
A patient presents with tremor, weight loss, and heat intolerance. Labs
show low TSH and high T3/T4. What is the most likely diagnosis?
A. Hypothyroidism
B. Graves disease
C. Hashimoto thyroiditis
D. Thyroid cancer
Rationale:
Graves disease is an autoimmune condition with TSH receptor-
stimulating antibodies causing hyperthyroidism. Hashimoto typically
causes hypothyroidism.
Question 7
A 60-year-old smoker presents with hematuria. Cytology shows
malignant cells with papillary projections. What is the most likely
diagnosis?
Knowledge Assessment Exam Questions
and Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A | Instant
Download Pdf.
Question 1
A 67-year-old man with a history of hypertension presents with sudden
right-sided weakness and aphasia. CT head without contrast shows no
hemorrhage. What is the most appropriate next step in management?
A. Aspirin only
B. IV heparin
C. IV alteplase (tPA)
D. Warfarin initiation
Rationale:
This patient presents with acute ischemic stroke within a likely
therapeutic window and no evidence of hemorrhage on CT. IV alteplase
(tPA) is indicated within 4.5 hours of symptom onset if no
contraindications exist. Anticoagulation with heparin or warfarin is not
first-line in acute stroke due to bleeding risk and lack of acute benefit.
Aspirin is used if tPA is contraindicated or after 24 hours post-
thrombolysis.
,Question 2
A 24-year-old woman presents with dysuria and urinary frequency.
Urinalysis shows leukocyte esterase and nitrites. What is the most likely
organism?
A. Staphylococcus saprophyticus
B. Escherichia coli
C. Enterococcus faecalis
D. Pseudomonas aeruginosa
Rationale:
Escherichia coli is the most common cause of uncomplicated urinary
tract infections, accounting for the majority of community-acquired
cases. It produces nitrites via nitrate reduction, a key diagnostic clue.
Staphylococcus saprophyticus is also a cause in young women but less
common. Pseudomonas is typically associated with hospital-acquired
infections.
Question 3
A 45-year-old man presents with chest pain relieved by leaning forward.
ECG shows diffuse ST elevation and PR depression. What is the
diagnosis?
A. Myocardial infarction
B. Acute pericarditis
C. Aortic dissection
D. Pulmonary embolism
,Rationale:
Acute pericarditis presents with pleuritic chest pain relieved by sitting
forward, diffuse ST elevation, and PR depression due to pericardial
inflammation. MI causes localized ST changes, not diffuse. Aortic
dissection presents with tearing pain radiating to the back.
Question 4
A newborn has cyanosis that improves with oxygen. Echocardiogram
shows a right-to-left shunt. Which condition is most likely?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Tetralogy of Fallot
D. Atrial septal defect
Rationale:
Tetralogy of Fallot causes right-to-left shunting due to pulmonary
stenosis and VSD, leading to cyanosis. VSD and ASD usually cause left-
to-right shunts initially. PDA typically causes a left-to-right shunt unless
severe pulmonary hypertension develops.
Question 5
A 30-year-old man has episodic headaches, palpitations, and sweating.
Labs show elevated catecholamines. What is the diagnosis?
A. Hyperthyroidism
B. Panic disorder
, C. Pheochromocytoma
D. Carcinoid syndrome
Rationale:
Pheochromocytoma is a catecholamine-secreting tumor of the adrenal
medulla causing episodic hypertension, headaches, diaphoresis, and
palpitations. Carcinoid syndrome causes flushing and diarrhea but not
catecholamine excess symptoms.
Question 6
A patient presents with tremor, weight loss, and heat intolerance. Labs
show low TSH and high T3/T4. What is the most likely diagnosis?
A. Hypothyroidism
B. Graves disease
C. Hashimoto thyroiditis
D. Thyroid cancer
Rationale:
Graves disease is an autoimmune condition with TSH receptor-
stimulating antibodies causing hyperthyroidism. Hashimoto typically
causes hypothyroidism.
Question 7
A 60-year-old smoker presents with hematuria. Cytology shows
malignant cells with papillary projections. What is the most likely
diagnosis?
