COMSAE PHASE 1 FORM 113 EXAM /
COMSAE FORM 113 ACTUAL PHASE 1 EXAM
2026/2027 COMPLETE ACCURATE EXAM
APPROVED QUESTIONS WITH WELL
ELABORATED ANSWERS AND RATIONALES
(100% CORRECT VERIFIED SOLUTIONS)
NEWEST UPDATED VERSION 2026 EDITION
GUARANTEED PASS A+ INSTANT
DOWNLOAD PDF FULL REVISED
1. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. A chest CT shows a 4
cm right hilar mass with mediastinal lymphadenopathy. Biopsy reveals
small cell carcinoma. Which paraneoplastic syndrome is most
commonly associated with this tumor type?
A) Hypercalcemia
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Hypertrophic pulmonary osteoarthropathy
D) Acanthosis Nigricans
CORRECT ANSWER: B) SIADH is the most common paraneoplastic
syndrome in small cell lung cancer, due to ectopic ADH secretion.
Hypercalcemia (A) is more common in squamous cell carcinoma.
Hypertrophic pulmonary osteoarthropathy (C) is linked with non-small
cell lung cancer. Acanthosis nigricans (D) is associated with gastric and
other adenocarcinomas.
Rationale: Small cell carcinoma frequently produces ectopic ADH,
leading to hyponatremia. Recognizing this guides management and
avoids volume repletion that could worsen hyponatremia.
,2. A 23-year-old woman with no prior medical history experiences
sudden-onset, severe, unilateral, throbbing headache, photophobia, and
nausea. She reports that her mother has similar episodes. Physical exam
is unremarkable between episodes. What is the first-line acute treatment
for her most likely diagnosis?
A) Oral propranolol
B) Intranasal sumatriptan
C) Intravenous methylprednisolone
D) Oral verapamil
CORRECT ANSWER: B) Intranasal sumatriptan is first-line acute
treatment for migraine with or without aura. Propranolol (A) and
verapamil (D) are preventive therapies. Methylprednisolone (C) is not
first-line for acute migraine.
Rationale: Migraine with aura is suggested by family history and
unilateral throbbing pain. Triptans abort the attack by serotonin receptor
agonism, causing vasoconstriction of dilated cranial vessels.
3. A 68-year-old man with hypertension and type 2 diabetes presents
with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. An echocardiogram shows left ventricular ejection
fraction (LVEF) of 35%. Which medication class has been shown to
reduce mortality in this condition and should be initiated first?
A) Loop diuretics
B) Digoxin
C) Beta-blockers
D) Hydralazine-nitrate combination
,CORRECT ANSWER: C) Beta-blockers (carvedilol, metoprolol
succinate, bisoprolol) reduce mortality in heart failure with reduced
ejection fraction (HFrEF). Loop diuretics (A) control symptoms but do
not improve mortality. Digoxin (B) reduces hospitalizations but not
mortality. Hydralazine-nitrate (D) is adjunctive in African Americans
with persistent symptoms.
Rationale: Chronic sympathetic activation worsens HFrEF; beta-
blockade reverses remodeling. Guidelines recommend initiation before
discharge unless contraindicated.
4. A 52-year-old woman presents with fatigue, arthralgias, facial rash
sparing the nasolabial folds, and oral ulcers. Laboratory studies show
positive ANA, positive anti-dsDNA antibodies, and low C3/C4 levels.
She is diagnosed with systemic lupus erythematosus. Which renal
pathology is most specific for this disease?
A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Diffuse proliferative glomerulonephritis
D) Minimal change disease
CORRECT ANSWER: C) Diffuse proliferative glomerulonephritis
(Class IV lupus nephritis) is the most common and severe form
associated with SLE. Focal segmental glomerulosclerosis (A) is not
specific. Membranous nephropathy (B) occurs in SLE but is less
common and is typically Class V. Minimal change disease (D) is not
linked to SLE.
Rationale: Immune complex deposition in SLE causes diffuse
proliferative glomerulonephritis, characterized by "wire-loop" lesions on
microscopy. Prompt immunosuppressive therapy helps prevent renal
failure.
, 5. A 65-year-old man with a history of coronary artery disease presents
with acute onset of left-sided chest pain that is worse when lying flat and
improves when leaning forward. He had a myocardial infarction 2 weeks
ago. An ECG shows diffuse ST-segment elevations without reciprocal
changes. Which is the most likely diagnosis?
A) Acute pericarditis
B) Recurrent myocardial infarction
C) Pulmonary embolism
D) Aortic dissection
CORRECT ANSWER: A) Acute pericarditis, likely post-myocardial
infarction pericarditis (Dressler syndrome or early post-infarction
pericarditis). Positional chest pain and diffuse ST-segment elevations
without reciprocal changes are classic. Recurrent MI (B) typically shows
focal ST changes. Pulmonary embolism (C) causes right heart strain.
Aortic dissection (D) presents with tearing chest pain.
Rationale: Post-MI pericarditis typically occurs 2–3 weeks after
infarction due to an autoimmune-mediated inflammatory response.
NSAIDs are first-line treatment unless contraindicated.
6. A 28-year-old man presents with hematemesis and melena. He reports
heavy alcohol use. On examination, he has spider angiomas, palmar
erythema, and splenomegaly. Laboratory studies show
thrombocytopenia, elevated INR, and low albumin. Which finding on
upper endoscopy would confirm the source of bleeding?
A) Gastric antral vascular ectasia
B) Esophageal varices
C) Dieulafoy lesion
D) Duodenal ulcer
COMSAE FORM 113 ACTUAL PHASE 1 EXAM
2026/2027 COMPLETE ACCURATE EXAM
APPROVED QUESTIONS WITH WELL
ELABORATED ANSWERS AND RATIONALES
(100% CORRECT VERIFIED SOLUTIONS)
NEWEST UPDATED VERSION 2026 EDITION
GUARANTEED PASS A+ INSTANT
DOWNLOAD PDF FULL REVISED
1. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. A chest CT shows a 4
cm right hilar mass with mediastinal lymphadenopathy. Biopsy reveals
small cell carcinoma. Which paraneoplastic syndrome is most
commonly associated with this tumor type?
A) Hypercalcemia
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Hypertrophic pulmonary osteoarthropathy
D) Acanthosis Nigricans
CORRECT ANSWER: B) SIADH is the most common paraneoplastic
syndrome in small cell lung cancer, due to ectopic ADH secretion.
Hypercalcemia (A) is more common in squamous cell carcinoma.
Hypertrophic pulmonary osteoarthropathy (C) is linked with non-small
cell lung cancer. Acanthosis nigricans (D) is associated with gastric and
other adenocarcinomas.
Rationale: Small cell carcinoma frequently produces ectopic ADH,
leading to hyponatremia. Recognizing this guides management and
avoids volume repletion that could worsen hyponatremia.
,2. A 23-year-old woman with no prior medical history experiences
sudden-onset, severe, unilateral, throbbing headache, photophobia, and
nausea. She reports that her mother has similar episodes. Physical exam
is unremarkable between episodes. What is the first-line acute treatment
for her most likely diagnosis?
A) Oral propranolol
B) Intranasal sumatriptan
C) Intravenous methylprednisolone
D) Oral verapamil
CORRECT ANSWER: B) Intranasal sumatriptan is first-line acute
treatment for migraine with or without aura. Propranolol (A) and
verapamil (D) are preventive therapies. Methylprednisolone (C) is not
first-line for acute migraine.
Rationale: Migraine with aura is suggested by family history and
unilateral throbbing pain. Triptans abort the attack by serotonin receptor
agonism, causing vasoconstriction of dilated cranial vessels.
3. A 68-year-old man with hypertension and type 2 diabetes presents
with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. An echocardiogram shows left ventricular ejection
fraction (LVEF) of 35%. Which medication class has been shown to
reduce mortality in this condition and should be initiated first?
A) Loop diuretics
B) Digoxin
C) Beta-blockers
D) Hydralazine-nitrate combination
,CORRECT ANSWER: C) Beta-blockers (carvedilol, metoprolol
succinate, bisoprolol) reduce mortality in heart failure with reduced
ejection fraction (HFrEF). Loop diuretics (A) control symptoms but do
not improve mortality. Digoxin (B) reduces hospitalizations but not
mortality. Hydralazine-nitrate (D) is adjunctive in African Americans
with persistent symptoms.
Rationale: Chronic sympathetic activation worsens HFrEF; beta-
blockade reverses remodeling. Guidelines recommend initiation before
discharge unless contraindicated.
4. A 52-year-old woman presents with fatigue, arthralgias, facial rash
sparing the nasolabial folds, and oral ulcers. Laboratory studies show
positive ANA, positive anti-dsDNA antibodies, and low C3/C4 levels.
She is diagnosed with systemic lupus erythematosus. Which renal
pathology is most specific for this disease?
A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Diffuse proliferative glomerulonephritis
D) Minimal change disease
CORRECT ANSWER: C) Diffuse proliferative glomerulonephritis
(Class IV lupus nephritis) is the most common and severe form
associated with SLE. Focal segmental glomerulosclerosis (A) is not
specific. Membranous nephropathy (B) occurs in SLE but is less
common and is typically Class V. Minimal change disease (D) is not
linked to SLE.
Rationale: Immune complex deposition in SLE causes diffuse
proliferative glomerulonephritis, characterized by "wire-loop" lesions on
microscopy. Prompt immunosuppressive therapy helps prevent renal
failure.
, 5. A 65-year-old man with a history of coronary artery disease presents
with acute onset of left-sided chest pain that is worse when lying flat and
improves when leaning forward. He had a myocardial infarction 2 weeks
ago. An ECG shows diffuse ST-segment elevations without reciprocal
changes. Which is the most likely diagnosis?
A) Acute pericarditis
B) Recurrent myocardial infarction
C) Pulmonary embolism
D) Aortic dissection
CORRECT ANSWER: A) Acute pericarditis, likely post-myocardial
infarction pericarditis (Dressler syndrome or early post-infarction
pericarditis). Positional chest pain and diffuse ST-segment elevations
without reciprocal changes are classic. Recurrent MI (B) typically shows
focal ST changes. Pulmonary embolism (C) causes right heart strain.
Aortic dissection (D) presents with tearing chest pain.
Rationale: Post-MI pericarditis typically occurs 2–3 weeks after
infarction due to an autoimmune-mediated inflammatory response.
NSAIDs are first-line treatment unless contraindicated.
6. A 28-year-old man presents with hematemesis and melena. He reports
heavy alcohol use. On examination, he has spider angiomas, palmar
erythema, and splenomegaly. Laboratory studies show
thrombocytopenia, elevated INR, and low albumin. Which finding on
upper endoscopy would confirm the source of bleeding?
A) Gastric antral vascular ectasia
B) Esophageal varices
C) Dieulafoy lesion
D) Duodenal ulcer
