NBOME COMSAE Form 110: Simulated
Examination Questions and Explanatory
Answers
Section 1: Cardiovascular & Pulmonary Medicine
,Question 1
A 56-year-old man presents with substernal chest pain that began 1 hour ago while shoveling
snow. The pain is pressure-like and radiates to the left arm. ECG shows ST elevation in leads II,
III, and aVF. What is the most appropriate next step in management?
A) Sublingual nitroglycerin
B) Aspirin administration and activate cardiac catheterization lab
C) IV heparin only
D) Chest X-ray
Answer: B
Rationale: ST elevation in II, III, and aVF indicates an inferior STEMI. Reperfusion therapy is
required, with primary PCI being the preferred approach if available. Aspirin reduces mortality.
Nitroglycerin is supportive but not definitive. Chest X-ray is not appropriate initially.
,Question 2
A 65-year-old man with hypertension presents with acute onset of left-sided weakness and facial
droop. Symptoms began 1 hour ago. CT head shows no hemorrhage. What is the most
appropriate next step?
A) Aspirin 325 mg
B) IV tissue plasminogen activator
C) Mechanical thrombectomy
D) Clopidogrel 300 mg
Answer: B
Rationale: IV tPA is indicated within 3 hours of ischemic stroke onset without contraindications.
The patient is within the treatment window and has no evidence of hemorrhage on CT, making tPA
the appropriate choice.
, Question 3
A 23-year-old man presents with sudden onset pleuritic chest pain and dyspnea. He is tachycardic
and hypoxic. D-dimer is elevated. What is the best next test?
A) Chest X-ray
B) CT pulmonary angiography
C) V/Q scan
D) ECG
Answer: B
Rationale: In a hemodynamically stable patient with high suspicion for pulmonary embolism and
elevated D-dimer, CT pulmonary angiography is the diagnostic test of choice. It provides definitive
diagnosis and helps guide treatment decisions.
Examination Questions and Explanatory
Answers
Section 1: Cardiovascular & Pulmonary Medicine
,Question 1
A 56-year-old man presents with substernal chest pain that began 1 hour ago while shoveling
snow. The pain is pressure-like and radiates to the left arm. ECG shows ST elevation in leads II,
III, and aVF. What is the most appropriate next step in management?
A) Sublingual nitroglycerin
B) Aspirin administration and activate cardiac catheterization lab
C) IV heparin only
D) Chest X-ray
Answer: B
Rationale: ST elevation in II, III, and aVF indicates an inferior STEMI. Reperfusion therapy is
required, with primary PCI being the preferred approach if available. Aspirin reduces mortality.
Nitroglycerin is supportive but not definitive. Chest X-ray is not appropriate initially.
,Question 2
A 65-year-old man with hypertension presents with acute onset of left-sided weakness and facial
droop. Symptoms began 1 hour ago. CT head shows no hemorrhage. What is the most
appropriate next step?
A) Aspirin 325 mg
B) IV tissue plasminogen activator
C) Mechanical thrombectomy
D) Clopidogrel 300 mg
Answer: B
Rationale: IV tPA is indicated within 3 hours of ischemic stroke onset without contraindications.
The patient is within the treatment window and has no evidence of hemorrhage on CT, making tPA
the appropriate choice.
, Question 3
A 23-year-old man presents with sudden onset pleuritic chest pain and dyspnea. He is tachycardic
and hypoxic. D-dimer is elevated. What is the best next test?
A) Chest X-ray
B) CT pulmonary angiography
C) V/Q scan
D) ECG
Answer: B
Rationale: In a hemodynamically stable patient with high suspicion for pulmonary embolism and
elevated D-dimer, CT pulmonary angiography is the diagnostic test of choice. It provides definitive
diagnosis and helps guide treatment decisions.
