COMSAE PHASE 1 (FORM 101) LEVEL 1 NEWEST
EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS A NEW UPDATED VERSION LATEST 2026-
2027 (100%CORRECT VERIFIED ANSWERS) ALREADY
GRADED A+ MOST RECENT!!!
1. A 65-year-old man presents with chest pain radiating to the left arm. ECG shows ST
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Rationale: Leads II, III, and aVF represent the inferior wall of the heart, which is most
commonly supplied by the right coronary artery (RCA). Occlusion of the RCA leads to an
inferior wall myocardial infarction.
2. A 55-year-old man presents with progressive exertional dyspnea and orthopnea; exam
shows bibasilar crackles and an S3 heart sound. Which mechanism best explains his
symptoms?
A. Decreased left ventricular ejection fraction leading to increased left atrial pressure
,B. Pulmonary arterial vasoconstriction from hypoxia
C. Isolated right ventricular infarction causing systemic venous congestion
D. Primary pulmonary parenchymal fibrosis decreasing diffusion capacity
Rationale: S3 gallop and pulmonary edema with orthopnea are classic for left ventricular
systolic dysfunction causing elevated left-sided filling pressures and pulmonary venous
congestion .
3. A newborn shows a continuous machinery murmur on cardiac exam. Which congenital
lesion is most likely?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Atrial septal defect
D. Tetralogy of Fallot
Rationale: Patent ductus arteriosus (PDA) produces a continuous "machinery" murmur due to
persistent connection between the aorta and pulmonary artery.
4. A 72-year-old man with hypertension and coronary artery disease presents with dyspnea
on exertion. On auscultation, you hear a harsh, crescendo-decrescendo systolic murmur at
the right upper sternal border that radiates to the carotids. Which maneuver increases the
murmur intensity?
A. Valsalva maneuver
B. Sudden squatting
C. Handgrip
D. Standing abruptly
Rationale: This describes aortic stenosis. Squatting increases preload and afterload, which
increases the intensity of the aortic stenosis murmur .
5. A 68-year-old smoker has FEV1/FVC ratio of 55% (normal >70%), FEV1 40%
predicted, and TLC is 120% predicted. Which condition is most likely?
A. Idiopathic pulmonary fibrosis
B. COPD
C. Sarcoidosis
, D. Neuromuscular disease
Rationale: A low FEV1/FVC ratio indicates obstruction, while increased total lung capacity
(TLC) indicates hyperinflation, which is classic for COPD.
6. A 68-year-old man with COPD presents with increasing dyspnea and peripheral edema.
Jugular venous pressure is elevated. Which physical exam finding is most specific for right
ventricular failure?
A. Hepatojugular reflux
B. Pulsus paradoxus
C. Apical impulse displaced laterally
D. Systolic ejection murmur at left sternal border
Rationale: Hepatojugular reflux is a highly specific sign of right ventricular failure, indicating
elevated right-sided filling pressures.
7. Which vitamin deficiency is associated with Wernicke-Korsakoff syndrome?
A. Vitamin B1 (Thiamine)
B. Vitamin B6 (Pyridoxine)
C. Vitamin B12 (Cobalamin)
D. Vitamin C (Ascorbic acid)
Rationale: Thiamine deficiency, often seen in alcohol use disorder, causes Wernicke-Korsakoff
syndrome characterized by confusion, nystagmus, ataxia, and memory impairment.
8. Which neurotransmitter is decreased in Parkinson disease?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. Acetylcholine
Rationale: Parkinson disease results from degeneration of dopaminergic neurons in the
EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS A NEW UPDATED VERSION LATEST 2026-
2027 (100%CORRECT VERIFIED ANSWERS) ALREADY
GRADED A+ MOST RECENT!!!
1. A 65-year-old man presents with chest pain radiating to the left arm. ECG shows ST
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Rationale: Leads II, III, and aVF represent the inferior wall of the heart, which is most
commonly supplied by the right coronary artery (RCA). Occlusion of the RCA leads to an
inferior wall myocardial infarction.
2. A 55-year-old man presents with progressive exertional dyspnea and orthopnea; exam
shows bibasilar crackles and an S3 heart sound. Which mechanism best explains his
symptoms?
A. Decreased left ventricular ejection fraction leading to increased left atrial pressure
,B. Pulmonary arterial vasoconstriction from hypoxia
C. Isolated right ventricular infarction causing systemic venous congestion
D. Primary pulmonary parenchymal fibrosis decreasing diffusion capacity
Rationale: S3 gallop and pulmonary edema with orthopnea are classic for left ventricular
systolic dysfunction causing elevated left-sided filling pressures and pulmonary venous
congestion .
3. A newborn shows a continuous machinery murmur on cardiac exam. Which congenital
lesion is most likely?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Atrial septal defect
D. Tetralogy of Fallot
Rationale: Patent ductus arteriosus (PDA) produces a continuous "machinery" murmur due to
persistent connection between the aorta and pulmonary artery.
4. A 72-year-old man with hypertension and coronary artery disease presents with dyspnea
on exertion. On auscultation, you hear a harsh, crescendo-decrescendo systolic murmur at
the right upper sternal border that radiates to the carotids. Which maneuver increases the
murmur intensity?
A. Valsalva maneuver
B. Sudden squatting
C. Handgrip
D. Standing abruptly
Rationale: This describes aortic stenosis. Squatting increases preload and afterload, which
increases the intensity of the aortic stenosis murmur .
5. A 68-year-old smoker has FEV1/FVC ratio of 55% (normal >70%), FEV1 40%
predicted, and TLC is 120% predicted. Which condition is most likely?
A. Idiopathic pulmonary fibrosis
B. COPD
C. Sarcoidosis
, D. Neuromuscular disease
Rationale: A low FEV1/FVC ratio indicates obstruction, while increased total lung capacity
(TLC) indicates hyperinflation, which is classic for COPD.
6. A 68-year-old man with COPD presents with increasing dyspnea and peripheral edema.
Jugular venous pressure is elevated. Which physical exam finding is most specific for right
ventricular failure?
A. Hepatojugular reflux
B. Pulsus paradoxus
C. Apical impulse displaced laterally
D. Systolic ejection murmur at left sternal border
Rationale: Hepatojugular reflux is a highly specific sign of right ventricular failure, indicating
elevated right-sided filling pressures.
7. Which vitamin deficiency is associated with Wernicke-Korsakoff syndrome?
A. Vitamin B1 (Thiamine)
B. Vitamin B6 (Pyridoxine)
C. Vitamin B12 (Cobalamin)
D. Vitamin C (Ascorbic acid)
Rationale: Thiamine deficiency, often seen in alcohol use disorder, causes Wernicke-Korsakoff
syndrome characterized by confusion, nystagmus, ataxia, and memory impairment.
8. Which neurotransmitter is decreased in Parkinson disease?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. Acetylcholine
Rationale: Parkinson disease results from degeneration of dopaminergic neurons in the
