COMSAE PHASE 1 FORM 116 EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a 40-pack-year smoking history presents with a 2-month history of progressive
hoarseness and a non-productive cough. On examination, a fixed, immobile left vocal fold is noted. This
finding is most suggestive of a lesion affecting which structure?
A. Recurrent laryngeal nerve
B. Vagus nerve
C. Superior laryngeal nerve
D. Hypoglossal nerve
🟢 Correct Answer: A. Recurrent laryngeal nerve
🔴 RATIONALE: The recurrent laryngeal nerve provides motor innervation to all intrinsic laryngeal muscles
except the cricothyroid. A left-sided lesion, commonly due to a thoracic malignancy (e.g., lung cancer), results in
ipsilateral vocal fold paralysis causing hoarseness .
2. A 55-year-old woman presents with a 3-month history of muscle pain, stiffness in her shoulders and hips,
and a low-grade fever. Her erythrocyte sedimentation rate (ESR) is 95 mm/hr. Which of the following is the
most appropriate initial pharmacologic treatment?
A. Low-dose methotrexate
,B. High-dose prednisone
C. Ibuprofen
D. Hydroxychloroquine
🟢 Correct Answer: B. High-dose prednisone
🔴 RATIONALE: The presentation is classic for polymyalgia rheumatica (PMR). The standard of care for PMR is a
low-to-moderate initial dose of corticosteroids, typically prednisone, which often leads to a dramatic and rapid
clinical improvement.
3. A 32-year-old male is found to have a non-tender, firm, nodular thyroid gland on a routine physical
examination. Fine-needle aspiration reveals a cellular lesion with a "ground-glass" appearance of the nuclei.
This finding is most characteristic of which thyroid neoplasm?
A. Anaplastic carcinoma
B. Follicular adenoma
C. Medullary carcinoma
D. Papillary carcinoma
🟢 Correct Answer: D. Papillary carcinoma
🔴 RATIONALE: Papillary thyroid carcinoma is the most common type of thyroid cancer. Its characteristic
histologic feature is the presence of Orphan Annie eye nuclei, which have a clear, "ground-glass" appearance
due to chromatin clearing .
4. A 45-year-old man with a history of alcohol use disorder presents with a chief complaint of abdominal
pain. He is found to have ascites and jaundice. His serum AST is 90 U/L and ALT is 45 U/L. This pattern of
transaminitis is most consistent with which of the following conditions?
A. Acute viral hepatitis
B. Alcoholic liver disease
,C. Primary biliary cholangitis
D. Biliary obstruction
🟢 Correct Answer: B. Alcoholic liver disease
🔴 RATIONALE: In alcoholic liver disease, the AST-to-ALT ratio is typically > 2:1, often with an AST level that is
elevated out of proportion to the ALT. This is due to the mitochondrial damage and the effects of alcohol on
ALT metabolism.
5. A 72-year-old woman is diagnosed with giant cell arteritis (GCA). She has no other significant past medical
history. Which of the following is the most common serious complication of untreated GCA?
A. Aortic dissection
B. Hearing loss
C. Ischemic optic neuropathy
D. Stroke
🟢 Correct Answer: C. Ischemic optic neuropathy
🔴 RATIONALE: Untreated giant cell arteritis (GCA) can lead to blindness due to arteritic ischemic optic
neuropathy (AION). This results from inflammation and occlusion of the posterior ciliary arteries, which supply
the optic nerve .
6. A 5-year-old child is brought to the emergency department with a 1-day history of stridor, cough, and
low-grade fever. On examination, he appears anxious and is drooling. Which of the following is the most
appropriate next step in management?
A. Direct laryngoscopy in the operating room
B. Lateral neck X-ray
C. Nebulized racemic epinephrine
D. Oral dexamethasone and observation
, 🟢 Correct Answer: A. Direct laryngoscopy in the operating room
🔴 RATIONALE: The child's presentation (stridor, drooling, anxious appearance) is suggestive of acute
epiglottitis, which is a medical emergency. The airway should be secured by a skilled practitioner in a controlled
setting (e.g., operating room). Examination of the airway should not be attempted in the emergency
department due to the risk of complete airway obstruction.
7. A 19-year-old male presents with a 2-week history of progressive exertional dyspnea and lower extremity
edema. Echocardiography reveals concentric left ventricular hypertrophy and a mid-systolic murmur that
increases with Valsalva. Which of the following is the most likely diagnosis?
A. Aortic stenosis
B. Hypertrophic cardiomyopathy
C. Dilated cardiomyopathy
D. Mitral valve prolapse
🟢 Correct Answer: B. Hypertrophic cardiomyopathy
🔴 RATIONALE: Hypertrophic cardiomyopathy (HCM) is an autosomal dominant condition characterized by
unexplained left ventricular hypertrophy. The classic murmur of HCM is a systolic ejection murmur that
increases with maneuvers that decrease preload (like Valsalva) and decreases with squatting.
8. A 60-year-old male with chronic kidney disease is noted to have a serum calcium of 7.8 mg/dL (normal
8.5-10.2 mg/dL), phosphorus of 5.2 mg/dL (normal 2.5-4.5 mg/dL), and an elevated PTH level. This
laboratory pattern is most consistent with which of the following?
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism
D. Hypoparathyroidism
RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a 40-pack-year smoking history presents with a 2-month history of progressive
hoarseness and a non-productive cough. On examination, a fixed, immobile left vocal fold is noted. This
finding is most suggestive of a lesion affecting which structure?
A. Recurrent laryngeal nerve
B. Vagus nerve
C. Superior laryngeal nerve
D. Hypoglossal nerve
🟢 Correct Answer: A. Recurrent laryngeal nerve
🔴 RATIONALE: The recurrent laryngeal nerve provides motor innervation to all intrinsic laryngeal muscles
except the cricothyroid. A left-sided lesion, commonly due to a thoracic malignancy (e.g., lung cancer), results in
ipsilateral vocal fold paralysis causing hoarseness .
2. A 55-year-old woman presents with a 3-month history of muscle pain, stiffness in her shoulders and hips,
and a low-grade fever. Her erythrocyte sedimentation rate (ESR) is 95 mm/hr. Which of the following is the
most appropriate initial pharmacologic treatment?
A. Low-dose methotrexate
,B. High-dose prednisone
C. Ibuprofen
D. Hydroxychloroquine
🟢 Correct Answer: B. High-dose prednisone
🔴 RATIONALE: The presentation is classic for polymyalgia rheumatica (PMR). The standard of care for PMR is a
low-to-moderate initial dose of corticosteroids, typically prednisone, which often leads to a dramatic and rapid
clinical improvement.
3. A 32-year-old male is found to have a non-tender, firm, nodular thyroid gland on a routine physical
examination. Fine-needle aspiration reveals a cellular lesion with a "ground-glass" appearance of the nuclei.
This finding is most characteristic of which thyroid neoplasm?
A. Anaplastic carcinoma
B. Follicular adenoma
C. Medullary carcinoma
D. Papillary carcinoma
🟢 Correct Answer: D. Papillary carcinoma
🔴 RATIONALE: Papillary thyroid carcinoma is the most common type of thyroid cancer. Its characteristic
histologic feature is the presence of Orphan Annie eye nuclei, which have a clear, "ground-glass" appearance
due to chromatin clearing .
4. A 45-year-old man with a history of alcohol use disorder presents with a chief complaint of abdominal
pain. He is found to have ascites and jaundice. His serum AST is 90 U/L and ALT is 45 U/L. This pattern of
transaminitis is most consistent with which of the following conditions?
A. Acute viral hepatitis
B. Alcoholic liver disease
,C. Primary biliary cholangitis
D. Biliary obstruction
🟢 Correct Answer: B. Alcoholic liver disease
🔴 RATIONALE: In alcoholic liver disease, the AST-to-ALT ratio is typically > 2:1, often with an AST level that is
elevated out of proportion to the ALT. This is due to the mitochondrial damage and the effects of alcohol on
ALT metabolism.
5. A 72-year-old woman is diagnosed with giant cell arteritis (GCA). She has no other significant past medical
history. Which of the following is the most common serious complication of untreated GCA?
A. Aortic dissection
B. Hearing loss
C. Ischemic optic neuropathy
D. Stroke
🟢 Correct Answer: C. Ischemic optic neuropathy
🔴 RATIONALE: Untreated giant cell arteritis (GCA) can lead to blindness due to arteritic ischemic optic
neuropathy (AION). This results from inflammation and occlusion of the posterior ciliary arteries, which supply
the optic nerve .
6. A 5-year-old child is brought to the emergency department with a 1-day history of stridor, cough, and
low-grade fever. On examination, he appears anxious and is drooling. Which of the following is the most
appropriate next step in management?
A. Direct laryngoscopy in the operating room
B. Lateral neck X-ray
C. Nebulized racemic epinephrine
D. Oral dexamethasone and observation
, 🟢 Correct Answer: A. Direct laryngoscopy in the operating room
🔴 RATIONALE: The child's presentation (stridor, drooling, anxious appearance) is suggestive of acute
epiglottitis, which is a medical emergency. The airway should be secured by a skilled practitioner in a controlled
setting (e.g., operating room). Examination of the airway should not be attempted in the emergency
department due to the risk of complete airway obstruction.
7. A 19-year-old male presents with a 2-week history of progressive exertional dyspnea and lower extremity
edema. Echocardiography reveals concentric left ventricular hypertrophy and a mid-systolic murmur that
increases with Valsalva. Which of the following is the most likely diagnosis?
A. Aortic stenosis
B. Hypertrophic cardiomyopathy
C. Dilated cardiomyopathy
D. Mitral valve prolapse
🟢 Correct Answer: B. Hypertrophic cardiomyopathy
🔴 RATIONALE: Hypertrophic cardiomyopathy (HCM) is an autosomal dominant condition characterized by
unexplained left ventricular hypertrophy. The classic murmur of HCM is a systolic ejection murmur that
increases with maneuvers that decrease preload (like Valsalva) and decreases with squatting.
8. A 60-year-old male with chronic kidney disease is noted to have a serum calcium of 7.8 mg/dL (normal
8.5-10.2 mg/dL), phosphorus of 5.2 mg/dL (normal 2.5-4.5 mg/dL), and an elevated PTH level. This
laboratory pattern is most consistent with which of the following?
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism
D. Hypoparathyroidism
