COMSAE Phase 5 Clinical Practice Exam
2026 Edition Questions with Correct
Answers and Detailed Rationales
1.
A 64-year-old man with a 40-pack-year smoking history
presents with progressive dyspnea and chronic productive
cough. Pulmonary function testing shows an FEV₁/FVC ratio of
55% that improves minimally after bronchodilator
administration. Which of the following is the most
appropriate initial pharmacologic therapy for stable
symptoms?
A. Inhaled corticosteroid monotherapy
B. Long-acting bronchodilator
C. Oral prednisone
D. Leukotriene receptor antagonist
Answer: B. Long-acting bronchodilator
The patient has chronic obstructive pulmonary disease
(COPD) characterized by persistent airflow limitation and
minimal reversibility. A long-acting bronchodilator, either a
long-acting β₂-agonist or long-acting muscarinic antagonist,
is appropriate maintenance therapy. Inhaled corticosteroids
are generally added for selected patients with frequent
exacerbations or evidence of eosinophilic inflammation.
,2.
A 23-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffusely
enlarged thyroid and bilateral exophthalmos. Laboratory
studies show suppressed TSH and elevated free T₄. Which
mechanism best explains her condition?
A. Antibodies against thyroid peroxidase causing gland
destruction
B. Antibodies stimulating the TSH receptor
C. Antibodies against thyroglobulin blocking hormone
synthesis
D. T-cell destruction of thyroid follicular cells
Answer: B. Antibodies stimulating the TSH receptor
Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, producing
diffuse thyroid enlargement and excessive thyroid hormone
synthesis. Ophthalmopathy results from autoimmune
activation of orbital fibroblasts.
3.
A 71-year-old woman develops sudden right-sided weakness
and aphasia. CT imaging reveals an acute infarction in the left
middle cerebral artery territory. Which vascular risk factor
most strongly contributes to this patient's condition?
,A. Hyperthyroidism
B. Chronic hypertension
C. Iron deficiency
D. Hypocalcemia
Answer: B. Chronic hypertension
Chronic hypertension is a major modifiable risk factor for
ischemic and hemorrhagic stroke. It promotes endothelial
injury, atherosclerosis, and small-vessel disease.
4.
A 58-year-old man presents with crushing substernal chest
pain radiating to the left arm. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Inferior-wall myocardial infarction is typically caused by
occlusion of the right coronary artery, although a dominant
left circumflex artery can occasionally be responsible. ST
elevation in leads II, III, and aVF indicates inferior myocardial
injury.
5.
, A 36-year-old woman presents with recurrent episodes of
wheezing, cough, and chest tightness triggered by exercise
and cold air. Spirometry demonstrates reversible airflow
obstruction. Which inflammatory cell is most strongly
associated with this condition?
A. Neutrophil
B. Eosinophil
C. Monocyte
D. Cytotoxic T cell
Answer: B. Eosinophil
Asthma commonly involves type 2 helper T-cell inflammation,
with increased IL-4, IL-5, and IL-13 activity. IL-5 promotes
eosinophil proliferation and survival, making eosinophilic
inflammation a characteristic feature of many asthma
phenotypes.
6.
A 49-year-old man with cirrhosis presents with hematemesis
and hypotension. Endoscopy reveals actively bleeding
esophageal varices. Which medication should be
administered to reduce portal venous pressure?
A. Propranolol
B. Octreotide
C. Furosemide
D. Lisinopril
Answer: B. Octreotide
2026 Edition Questions with Correct
Answers and Detailed Rationales
1.
A 64-year-old man with a 40-pack-year smoking history
presents with progressive dyspnea and chronic productive
cough. Pulmonary function testing shows an FEV₁/FVC ratio of
55% that improves minimally after bronchodilator
administration. Which of the following is the most
appropriate initial pharmacologic therapy for stable
symptoms?
A. Inhaled corticosteroid monotherapy
B. Long-acting bronchodilator
C. Oral prednisone
D. Leukotriene receptor antagonist
Answer: B. Long-acting bronchodilator
The patient has chronic obstructive pulmonary disease
(COPD) characterized by persistent airflow limitation and
minimal reversibility. A long-acting bronchodilator, either a
long-acting β₂-agonist or long-acting muscarinic antagonist,
is appropriate maintenance therapy. Inhaled corticosteroids
are generally added for selected patients with frequent
exacerbations or evidence of eosinophilic inflammation.
,2.
A 23-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffusely
enlarged thyroid and bilateral exophthalmos. Laboratory
studies show suppressed TSH and elevated free T₄. Which
mechanism best explains her condition?
A. Antibodies against thyroid peroxidase causing gland
destruction
B. Antibodies stimulating the TSH receptor
C. Antibodies against thyroglobulin blocking hormone
synthesis
D. T-cell destruction of thyroid follicular cells
Answer: B. Antibodies stimulating the TSH receptor
Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, producing
diffuse thyroid enlargement and excessive thyroid hormone
synthesis. Ophthalmopathy results from autoimmune
activation of orbital fibroblasts.
3.
A 71-year-old woman develops sudden right-sided weakness
and aphasia. CT imaging reveals an acute infarction in the left
middle cerebral artery territory. Which vascular risk factor
most strongly contributes to this patient's condition?
,A. Hyperthyroidism
B. Chronic hypertension
C. Iron deficiency
D. Hypocalcemia
Answer: B. Chronic hypertension
Chronic hypertension is a major modifiable risk factor for
ischemic and hemorrhagic stroke. It promotes endothelial
injury, atherosclerosis, and small-vessel disease.
4.
A 58-year-old man presents with crushing substernal chest
pain radiating to the left arm. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Inferior-wall myocardial infarction is typically caused by
occlusion of the right coronary artery, although a dominant
left circumflex artery can occasionally be responsible. ST
elevation in leads II, III, and aVF indicates inferior myocardial
injury.
5.
, A 36-year-old woman presents with recurrent episodes of
wheezing, cough, and chest tightness triggered by exercise
and cold air. Spirometry demonstrates reversible airflow
obstruction. Which inflammatory cell is most strongly
associated with this condition?
A. Neutrophil
B. Eosinophil
C. Monocyte
D. Cytotoxic T cell
Answer: B. Eosinophil
Asthma commonly involves type 2 helper T-cell inflammation,
with increased IL-4, IL-5, and IL-13 activity. IL-5 promotes
eosinophil proliferation and survival, making eosinophilic
inflammation a characteristic feature of many asthma
phenotypes.
6.
A 49-year-old man with cirrhosis presents with hematemesis
and hypotension. Endoscopy reveals actively bleeding
esophageal varices. Which medication should be
administered to reduce portal venous pressure?
A. Propranolol
B. Octreotide
C. Furosemide
D. Lisinopril
Answer: B. Octreotide
