2026 EDITION COMSAE Phase 3 Clinical
Practice Exam 2026 Edition Questions
with Correct Answers and Detailed
Rationales
1.
A 67-year-old man with hypertension and hyperlipidemia
presents with 45 minutes of crushing substernal chest pain
radiating to his left arm. ECG shows ST-segment elevations in
leads II, III, and aVF. Blood pressure is 88/56 mm Hg, and
jugular venous pressure is elevated. Lungs are clear. Which
intervention is most appropriate initially?
A. Intravenous furosemide
B. Sublingual nitroglycerin
C. Intravenous isotonic saline
D. Intravenous metoprolol
Answer: C. Intravenous isotonic saline
The patient has an inferior myocardial infarction with right
ventricular involvement, suggested by hypotension, elevated
JVP, and clear lungs. Right ventricular infarction causes
preload dependence, so cautious intravenous fluid
administration is appropriate. Nitrates and diuretics can
worsen hypotension by reducing preload.
,2.
A 24-year-old woman presents with fatigue, weight loss,
tremor, heat intolerance, and palpitations. Examination
reveals a diffuse, nontender goiter and bilateral
exophthalmos. Laboratory testing shows suppressed TSH and
elevated free T4. Which antibody is most likely responsible?
A. Anti-thyroid peroxidase antibody
B. Anti-thyroglobulin antibody
C. Thyroid-stimulating immunoglobulin
D. Anti-centromere antibody
Answer: C. Thyroid-stimulating immunoglobulin
Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, producing
diffuse thyroid hyperplasia and excess thyroid hormone
production. Ophthalmopathy is particularly characteristic of
Graves disease.
3.
A 72-year-old woman develops sudden right-sided weakness
and expressive aphasia 90 minutes ago. CT of the head shows
no hemorrhage. Blood pressure is 172/96 mm Hg, and
glucose is normal. Which is the most appropriate next step?
A. Administer intravenous alteplase if no contraindications
exist
B. Administer intravenous heparin
,C. Perform immediate carotid endarterectomy
D. Administer aspirin and delay reperfusion therapy
Answer: A. Administer intravenous alteplase if no
contraindications exist
This patient has an acute ischemic stroke presenting within
the standard thrombolytic treatment window. After
hemorrhage is excluded and eligibility criteria are confirmed,
intravenous thrombolysis should be considered.
Anticoagulation is not routinely used acutely for ischemic
stroke.
4.
A 29-year-old woman presents with fever, flank pain, nausea,
and dysuria. She has costovertebral angle tenderness.
Urinalysis shows pyuria and white blood cell casts. Which
organism is most likely responsible?
A. Enterococcus faecalis
B. Escherichia coli
C. Staphylococcus saprophyticus
D. Candida albicans
Answer: B. Escherichia coli
Acute pyelonephritis is most commonly caused by ascending
infection with E. coli. White blood cell casts indicate renal
parenchymal involvement and help distinguish pyelonephritis
from isolated cystitis.
, 5.
A 45-year-old man with cirrhosis presents with confusion and
asterixis. Laboratory testing reveals elevated serum
ammonia. Which treatment most directly reduces intestinal
ammonia absorption?
A. Lactulose
B. Omeprazole
C. Spironolactone
D. Propranolol
Answer: A. Lactulose
Lactulose acidifies colonic contents and converts ammonia
(NH₃) into ammonium (NH₄⁺), which is poorly absorbed. It is
first-line therapy for acute hepatic encephalopathy.
6.
A 35-year-old woman has recurrent episodes of abdominal
pain, diarrhea, and weight loss. Colonoscopy demonstrates
continuous inflammation beginning at the rectum and
extending proximally. Which diagnosis is most likely?
A. Crohn disease
B. Ulcerative colitis
C. Celiac disease
D. Ischemic colitis
Answer: B. Ulcerative colitis
Ulcerative colitis causes continuous mucosal inflammation
beginning in the rectum and extending proximally. Crohn
Practice Exam 2026 Edition Questions
with Correct Answers and Detailed
Rationales
1.
A 67-year-old man with hypertension and hyperlipidemia
presents with 45 minutes of crushing substernal chest pain
radiating to his left arm. ECG shows ST-segment elevations in
leads II, III, and aVF. Blood pressure is 88/56 mm Hg, and
jugular venous pressure is elevated. Lungs are clear. Which
intervention is most appropriate initially?
A. Intravenous furosemide
B. Sublingual nitroglycerin
C. Intravenous isotonic saline
D. Intravenous metoprolol
Answer: C. Intravenous isotonic saline
The patient has an inferior myocardial infarction with right
ventricular involvement, suggested by hypotension, elevated
JVP, and clear lungs. Right ventricular infarction causes
preload dependence, so cautious intravenous fluid
administration is appropriate. Nitrates and diuretics can
worsen hypotension by reducing preload.
,2.
A 24-year-old woman presents with fatigue, weight loss,
tremor, heat intolerance, and palpitations. Examination
reveals a diffuse, nontender goiter and bilateral
exophthalmos. Laboratory testing shows suppressed TSH and
elevated free T4. Which antibody is most likely responsible?
A. Anti-thyroid peroxidase antibody
B. Anti-thyroglobulin antibody
C. Thyroid-stimulating immunoglobulin
D. Anti-centromere antibody
Answer: C. Thyroid-stimulating immunoglobulin
Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, producing
diffuse thyroid hyperplasia and excess thyroid hormone
production. Ophthalmopathy is particularly characteristic of
Graves disease.
3.
A 72-year-old woman develops sudden right-sided weakness
and expressive aphasia 90 minutes ago. CT of the head shows
no hemorrhage. Blood pressure is 172/96 mm Hg, and
glucose is normal. Which is the most appropriate next step?
A. Administer intravenous alteplase if no contraindications
exist
B. Administer intravenous heparin
,C. Perform immediate carotid endarterectomy
D. Administer aspirin and delay reperfusion therapy
Answer: A. Administer intravenous alteplase if no
contraindications exist
This patient has an acute ischemic stroke presenting within
the standard thrombolytic treatment window. After
hemorrhage is excluded and eligibility criteria are confirmed,
intravenous thrombolysis should be considered.
Anticoagulation is not routinely used acutely for ischemic
stroke.
4.
A 29-year-old woman presents with fever, flank pain, nausea,
and dysuria. She has costovertebral angle tenderness.
Urinalysis shows pyuria and white blood cell casts. Which
organism is most likely responsible?
A. Enterococcus faecalis
B. Escherichia coli
C. Staphylococcus saprophyticus
D. Candida albicans
Answer: B. Escherichia coli
Acute pyelonephritis is most commonly caused by ascending
infection with E. coli. White blood cell casts indicate renal
parenchymal involvement and help distinguish pyelonephritis
from isolated cystitis.
, 5.
A 45-year-old man with cirrhosis presents with confusion and
asterixis. Laboratory testing reveals elevated serum
ammonia. Which treatment most directly reduces intestinal
ammonia absorption?
A. Lactulose
B. Omeprazole
C. Spironolactone
D. Propranolol
Answer: A. Lactulose
Lactulose acidifies colonic contents and converts ammonia
(NH₃) into ammonium (NH₄⁺), which is poorly absorbed. It is
first-line therapy for acute hepatic encephalopathy.
6.
A 35-year-old woman has recurrent episodes of abdominal
pain, diarrhea, and weight loss. Colonoscopy demonstrates
continuous inflammation beginning at the rectum and
extending proximally. Which diagnosis is most likely?
A. Crohn disease
B. Ulcerative colitis
C. Celiac disease
D. Ischemic colitis
Answer: B. Ulcerative colitis
Ulcerative colitis causes continuous mucosal inflammation
beginning in the rectum and extending proximally. Crohn
