COMSAE 115I (RATIONALES) EXAM
P R O F E S S I O N A L P R A C T I C E M AT E R I A L S
COMSAE 115i (Rationales)
Verified Answers Exam Ready With Rationales
83 QUESTIONS
DOCUMENT OVERVIEW
This document contains 83 verified questions with correct answers and detailed rationales focused on
cardiovascular and gastrointestinal topics. Each question is paired with an explanation that enhances
understanding, making it suitable for exam preparation, comprehensive review, and certification study. The
inclusion of diagrams and images further enriches the learning experience.
CONTENTS
01 Cardiac Murmurs Q1–Q8
02 Neurological Assessments Q9–Q14
03 Gastrointestinal Disorders Q15–Q20
04 Respiratory Conditions Q21–Q26
05 Endocrine Disorders Q27–Q30
06 Infectious Diseases Q31–Q36
07 Pediatric Care Q37–Q39
08 Toxicology and Poisoning Q40–Q43
09 Additional Questions Q44–Q83
Page 1
, E XA M Q U EST I O N S
Q1 QUESTION 1 OF 83
Murmur heard BEST at the apex?
CORRECT ANSWER
Think MITRAL
MR = holosystolic
MS = diastolic rumble
Apex = Mitral until proven otherwise
RATIONALE
Murmurs best heard at the apex typically indicate mitral valve involvement, as this area is anatomically aligned with
the mitral valve's function; holosystolic murmurs suggest mitral regurgitation, while diastolic rumbling indicates
mitral stenosis, both reinforcing the need to prioritize mitral pathology in such assessments.
Page 2
, Q2 QUESTION 2 OF 83
The 3 holosystolic murmurs?
CORRECT ANSWER
MR
Apex
Radiates to axilla
TR
Left lower sternal border
Gets louder with inspiration
VSD
Harsh
Left sternal border
RATIONALE
Holosystolic murmurs indicate continuous blood flow from high-pressure chambers to low-pressure areas during
systole, commonly seen in mitral regurgitation (MR), tricuspid regurgitation (TR), and ventricular septal defect (VSD).
Each murmur has characteristic locations and radiation patterns that aid in differential diagnosis and reflect
underlying hemodynamic changes.
Q3 QUESTION 3 OF 83
New murmur after MI?
CORRECT ANSWER
-Papillary muscle rupture → MR
-VSD rupture
-Free wall rupture
Most tested: ➡️ Papillary muscle rupture → acute MR
Especially inferior MI
RATIONALE
Acute mitral regurgitation following a myocardial infarction, particularly an inferior MI, often results from papillary
muscle rupture, leading to volume overload and heart failure. This complication arises due to ischemic damage to
the muscle, which disrupts the normal function of the mitral valve apparatus.
Q4 QUESTION 4 OF 83
Page 3
, Classic AS triad?
CORRECT ANSWER
Syncope
Angina
Dyspnea
Murmur:
Crescendo-decrescendo systolic
Right upper sternal border
Radiates to carotids
RATIONALE
Aortic stenosis presents with a characteristic triad of symptoms: syncope, angina, and dyspnea, resulting from
impaired blood flow and increased left ventricular pressure. The associated crescendo-decrescendo murmur at the
right upper sternal border, radiating to the carotids, signifies turbulent flow through the narrowed valve, reinforcing
the diagnosis.
Q5 QUESTION 5 OF 83
How do I recognize AR?
CORRECT ANSWER
Early diastolic decrescendo
Bounding pulses
Wide pulse pressure
Head bobbing
RATIONALE
Early diastolic decrescendo indicates regurgitant flow in aortic regurgitation, while bounding pulses and wide pulse
pressure reflect increased stroke volume and decreased systemic vascular resistance. Head bobbing, or De Musset's
sign, results from rapid changes in blood pressure and volume, showcasing the hemodynamic alterations
characteristic of this condition.
Q6 QUESTION 6 OF 83
What murmurs are loudest at:
Apex =
Page 4
P R O F E S S I O N A L P R A C T I C E M AT E R I A L S
COMSAE 115i (Rationales)
Verified Answers Exam Ready With Rationales
83 QUESTIONS
DOCUMENT OVERVIEW
This document contains 83 verified questions with correct answers and detailed rationales focused on
cardiovascular and gastrointestinal topics. Each question is paired with an explanation that enhances
understanding, making it suitable for exam preparation, comprehensive review, and certification study. The
inclusion of diagrams and images further enriches the learning experience.
CONTENTS
01 Cardiac Murmurs Q1–Q8
02 Neurological Assessments Q9–Q14
03 Gastrointestinal Disorders Q15–Q20
04 Respiratory Conditions Q21–Q26
05 Endocrine Disorders Q27–Q30
06 Infectious Diseases Q31–Q36
07 Pediatric Care Q37–Q39
08 Toxicology and Poisoning Q40–Q43
09 Additional Questions Q44–Q83
Page 1
, E XA M Q U EST I O N S
Q1 QUESTION 1 OF 83
Murmur heard BEST at the apex?
CORRECT ANSWER
Think MITRAL
MR = holosystolic
MS = diastolic rumble
Apex = Mitral until proven otherwise
RATIONALE
Murmurs best heard at the apex typically indicate mitral valve involvement, as this area is anatomically aligned with
the mitral valve's function; holosystolic murmurs suggest mitral regurgitation, while diastolic rumbling indicates
mitral stenosis, both reinforcing the need to prioritize mitral pathology in such assessments.
Page 2
, Q2 QUESTION 2 OF 83
The 3 holosystolic murmurs?
CORRECT ANSWER
MR
Apex
Radiates to axilla
TR
Left lower sternal border
Gets louder with inspiration
VSD
Harsh
Left sternal border
RATIONALE
Holosystolic murmurs indicate continuous blood flow from high-pressure chambers to low-pressure areas during
systole, commonly seen in mitral regurgitation (MR), tricuspid regurgitation (TR), and ventricular septal defect (VSD).
Each murmur has characteristic locations and radiation patterns that aid in differential diagnosis and reflect
underlying hemodynamic changes.
Q3 QUESTION 3 OF 83
New murmur after MI?
CORRECT ANSWER
-Papillary muscle rupture → MR
-VSD rupture
-Free wall rupture
Most tested: ➡️ Papillary muscle rupture → acute MR
Especially inferior MI
RATIONALE
Acute mitral regurgitation following a myocardial infarction, particularly an inferior MI, often results from papillary
muscle rupture, leading to volume overload and heart failure. This complication arises due to ischemic damage to
the muscle, which disrupts the normal function of the mitral valve apparatus.
Q4 QUESTION 4 OF 83
Page 3
, Classic AS triad?
CORRECT ANSWER
Syncope
Angina
Dyspnea
Murmur:
Crescendo-decrescendo systolic
Right upper sternal border
Radiates to carotids
RATIONALE
Aortic stenosis presents with a characteristic triad of symptoms: syncope, angina, and dyspnea, resulting from
impaired blood flow and increased left ventricular pressure. The associated crescendo-decrescendo murmur at the
right upper sternal border, radiating to the carotids, signifies turbulent flow through the narrowed valve, reinforcing
the diagnosis.
Q5 QUESTION 5 OF 83
How do I recognize AR?
CORRECT ANSWER
Early diastolic decrescendo
Bounding pulses
Wide pulse pressure
Head bobbing
RATIONALE
Early diastolic decrescendo indicates regurgitant flow in aortic regurgitation, while bounding pulses and wide pulse
pressure reflect increased stroke volume and decreased systemic vascular resistance. Head bobbing, or De Musset's
sign, results from rapid changes in blood pressure and volume, showcasing the hemodynamic alterations
characteristic of this condition.
Q6 QUESTION 6 OF 83
What murmurs are loudest at:
Apex =
Page 4
