2026 COMSAE Phase 2 Form 119 Exam
Questions with Verified Answers &
Concise Rationales
1.
A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffusely
enlarged thyroid and bilateral exophthalmos. Laboratory
studies show elevated free T4 and suppressed TSH. Which
mechanism best explains her condition?
A. Antibodies stimulating the TSH receptor
B. Antibodies destroying thyroid follicular cells
C. Excessive iodine-induced hormone synthesis
D. Autonomous thyroid hormone secretion from a toxic
nodule
Answer: A. Antibodies stimulating the TSH receptor
Rationale: Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, causing
diffuse thyroid enlargement and excessive hormone
production.
2.
A 67-year-old man with long-standing hypertension develops
sudden right-sided weakness and expressive aphasia. Imaging
,demonstrates an infarct involving the left middle cerebral
artery territory. Which artery is most likely affected?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Answer: B. Middle cerebral artery
Rationale: The dominant hemisphere MCA supplies Broca and
Wernicke areas and lateral motor cortex, producing aphasia
and contralateral face/upper-limb weakness.
3.
A patient with severe diarrhea develops metabolic acidosis.
Arterial blood gas shows pH 7.25, HCO₃⁻ 15 mEq/L, and PCO₂
30 mmHg. Which compensatory response is occurring?
A. Renal bicarbonate retention
B. Increased respiratory rate
C. Decreased hydrogen secretion
D. Reduced ammonium production
Answer: B. Increased respiratory rate
Rationale: Metabolic acidosis stimulates hyperventilation,
lowering PCO₂ to partially restore pH.
4.
,A 35-year-old woman develops proximal muscle weakness
and difficulty climbing stairs. Laboratory testing shows
elevated creatine kinase and antibodies against muscle-
specific kinase proteins. Which condition is most likely?
A. Polymyositis
B. Myasthenia gravis
C. Dermatomyositis
D. Lambert-Eaton syndrome
Answer: A. Polymyositis
Rationale: Polymyositis causes symmetric proximal muscle
weakness with elevated CK due to inflammatory skeletal
muscle injury.
5.
A 45-year-old man presents with severe epigastric pain
radiating to the back. Serum lipase is markedly elevated.
Which enzyme is primarily responsible for pancreatic fat
digestion?
A. Amylase
B. Lipase
C. Trypsin
D. Enterokinase
Answer: B. Lipase
Rationale: Pancreatic lipase hydrolyzes dietary triglycerides
into free fatty acids and monoglycerides.
, 6.
A 19-year-old college student develops fever, headache, neck
stiffness, and photophobia. CSF shows neutrophilic
predominance, elevated protein, and decreased glucose.
Which organism is most likely in a previously healthy young
adult?
A. Streptococcus pneumoniae
B. Neisseria meningitidis
C. Listeria monocytogenes
D. Cryptococcus neoformans
Answer: B. Neisseria meningitidis
Rationale: N. meningitidis is a major cause of bacterial
meningitis in adolescents and young adults and may cause
petechial rash.
7.
A patient develops jaundice after receiving a medication that
inhibits UDP-glucuronosyltransferase. Which substance
accumulates?
A. Conjugated bilirubin
B. Unconjugated bilirubin
C. Urobilinogen
D. Biliverdin
Answer: B. Unconjugated bilirubin
Rationale: Impaired bilirubin conjugation increases circulating
unconjugated bilirubin.
Questions with Verified Answers &
Concise Rationales
1.
A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffusely
enlarged thyroid and bilateral exophthalmos. Laboratory
studies show elevated free T4 and suppressed TSH. Which
mechanism best explains her condition?
A. Antibodies stimulating the TSH receptor
B. Antibodies destroying thyroid follicular cells
C. Excessive iodine-induced hormone synthesis
D. Autonomous thyroid hormone secretion from a toxic
nodule
Answer: A. Antibodies stimulating the TSH receptor
Rationale: Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, causing
diffuse thyroid enlargement and excessive hormone
production.
2.
A 67-year-old man with long-standing hypertension develops
sudden right-sided weakness and expressive aphasia. Imaging
,demonstrates an infarct involving the left middle cerebral
artery territory. Which artery is most likely affected?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Answer: B. Middle cerebral artery
Rationale: The dominant hemisphere MCA supplies Broca and
Wernicke areas and lateral motor cortex, producing aphasia
and contralateral face/upper-limb weakness.
3.
A patient with severe diarrhea develops metabolic acidosis.
Arterial blood gas shows pH 7.25, HCO₃⁻ 15 mEq/L, and PCO₂
30 mmHg. Which compensatory response is occurring?
A. Renal bicarbonate retention
B. Increased respiratory rate
C. Decreased hydrogen secretion
D. Reduced ammonium production
Answer: B. Increased respiratory rate
Rationale: Metabolic acidosis stimulates hyperventilation,
lowering PCO₂ to partially restore pH.
4.
,A 35-year-old woman develops proximal muscle weakness
and difficulty climbing stairs. Laboratory testing shows
elevated creatine kinase and antibodies against muscle-
specific kinase proteins. Which condition is most likely?
A. Polymyositis
B. Myasthenia gravis
C. Dermatomyositis
D. Lambert-Eaton syndrome
Answer: A. Polymyositis
Rationale: Polymyositis causes symmetric proximal muscle
weakness with elevated CK due to inflammatory skeletal
muscle injury.
5.
A 45-year-old man presents with severe epigastric pain
radiating to the back. Serum lipase is markedly elevated.
Which enzyme is primarily responsible for pancreatic fat
digestion?
A. Amylase
B. Lipase
C. Trypsin
D. Enterokinase
Answer: B. Lipase
Rationale: Pancreatic lipase hydrolyzes dietary triglycerides
into free fatty acids and monoglycerides.
, 6.
A 19-year-old college student develops fever, headache, neck
stiffness, and photophobia. CSF shows neutrophilic
predominance, elevated protein, and decreased glucose.
Which organism is most likely in a previously healthy young
adult?
A. Streptococcus pneumoniae
B. Neisseria meningitidis
C. Listeria monocytogenes
D. Cryptococcus neoformans
Answer: B. Neisseria meningitidis
Rationale: N. meningitidis is a major cause of bacterial
meningitis in adolescents and young adults and may cause
petechial rash.
7.
A patient develops jaundice after receiving a medication that
inhibits UDP-glucuronosyltransferase. Which substance
accumulates?
A. Conjugated bilirubin
B. Unconjugated bilirubin
C. Urobilinogen
D. Biliverdin
Answer: B. Unconjugated bilirubin
Rationale: Impaired bilirubin conjugation increases circulating
unconjugated bilirubin.
