COMSAE PHASE II FORM 114 PRACTICE EXAM –
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Internal Medicine
Pediatrics
Obstetrics and Gynecology
Surgery
Psychiatry
Emergency Medicine
Family Medicine
Preventive Medicine
Medical Ethics and Jurisprudence
Healthcare Systems and Quality Improvement
Introduction
This comprehensive examination is designed to assess clinical knowledge,
diagnostic reasoning, and patient management skills essential for success in the
COMSAE Phase II. The assessment evaluates foundational medical sciences, applied
clinical practice, ethical decision-making, regulatory compliance, and critical
thinking in complex medical scenarios. Candidates will encounter multiple-choice
questions that integrate basic science principles with clinical presentations,
emphasizing real-world application and evidence-based decision-making. The
examination reflects current standards in medical education and practice, preparing
candidates for the challenges of clinical medicine. Each question incorporates
professional standards, legal considerations, and ethical frameworks essential for
competent medical practice.
SECTION ONE: QUESTIONS 1–100
,Question 1
A 45-year-old male with a history of hypertension presents with acute onset of
severe, tearing chest pain radiating to the back. Blood pressure is 180/110 mmHg
in the right arm and 130/80 mmHg in the left arm. Which of the following is the
most appropriate initial diagnostic study?
A. Chest X-ray
B. Electrocardiogram
C. CT angiography
D. Transesophageal echocardiography
🟢 C. CT angiography
🔴 Explanation: CT angiography is the preferred initial diagnostic study for
suspected aortic dissection due to its high sensitivity and specificity, rapid
acquisition, and ability to assess the entire aorta. The blood pressure differential
between arms is a classic finding. Transesophageal echocardiography is useful but
more invasive and operator-dependent, while chest X-ray and ECG are less
specific and may be normal in many cases.
Question 2
A 28-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Physical examination reveals a bradycardia and delayed deep tendon
reflexes. Laboratory studies show elevated TSH and low free T4. What is the most
likely diagnosis?
A. Graves' disease
B. Subacute thyroiditis
C. Primary hypothyroidism
D. Secondary hypothyroidism
🟢 C. Primary hypothyroidism
🔴 Explanation: Primary hypothyroidism is characterized by elevated TSH with
low free T4, consistent with the patient's symptoms of fatigue, weight gain,
constipation, and cold intolerance. Graves' disease causes hyperthyroidism,
subacute thyroiditis typically presents with transient hyperthyroidism, and
secondary hypothyroidism would show low or normal TSH with low free T4.
,Question 3
A 62-year-old male with a 40-pack-year smoking history presents with a chronic
cough, hemoptysis, and weight loss. CT chest reveals a solitary pulmonary nodule
in the right upper lobe. Which of the following is the most important prognostic
factor?
A. Tumor size
B. Histological type
C. Lymph node involvement
D. Patient's age
🟢 C. Lymph node involvement
🔴 Explanation: Lymph node involvement (N stage) is the most important
prognostic factor in non-small cell lung cancer, with survival rates significantly
decreasing with nodal metastasis. While tumor size, histological type, and age are
relevant, nodal status is the strongest predictor of prognosis and guides
treatment decisions.
Question 4
A 55-year-old diabetic patient presents with a non-healing ulcer on the plantar
surface of the foot. On examination, the ulcer is surrounded by erythema and
there is purulent drainage. The patient has diminished sensation in the foot.
Which of the following is the most appropriate initial management?
A. Oral antibiotics and wound debridement
B. Surgical amputation
C. Hyperbaric oxygen therapy
D. Growth factor application
🟢 A. Oral antibiotics and wound debridement
🔴 Explanation: The initial management of a diabetic foot ulcer with signs of
infection includes wound debridement and antibiotic therapy. Surgical
amputation is reserved for severe, non-salvageable infections. Hyperbaric oxygen
and growth factors are adjunctive therapies and not first-line treatment.
, Question 5
A 32-year-old pregnant woman at 28 weeks gestation presents with elevated
blood pressure, proteinuria, and headaches. What is the most appropriate initial
management?
A. Immediate delivery
B. Bed rest and close monitoring
C. Magnesium sulfate and antihypertensives
D. Low-dose aspirin
🟢 C. Magnesium sulfate and antihypertensives
🔴 Explanation: The patient is presenting with preeclampsia, and management
includes magnesium sulfate for seizure prophylaxis and antihypertensives to
control blood pressure. Immediate delivery is only indicated for severe features or
eclampsia. Bed rest is not effective, and low-dose aspirin is used for prevention,
not treatment of established disease.
Question 6
A 7-year-old boy presents with a fever, sore throat, and a fine, erythematous rash
on the trunk. The rash has a sandpaper-like texture and appears to be worse in
the flexural areas. Which of the following is the most likely causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Parvovirus B19
🟢 B. Streptococcus pyogenes
🔴 Explanation: The presentation of fever, sore throat, and a fine, erythematous
sandpaper-like rash, particularly in the flexural areas, is classic for scarlet fever
caused by group A Streptococcus pyogenes. Staphylococcus aureus can cause a
similar rash but is less common in this presentation, while viral infections have
different rash characteristics.
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Internal Medicine
Pediatrics
Obstetrics and Gynecology
Surgery
Psychiatry
Emergency Medicine
Family Medicine
Preventive Medicine
Medical Ethics and Jurisprudence
Healthcare Systems and Quality Improvement
Introduction
This comprehensive examination is designed to assess clinical knowledge,
diagnostic reasoning, and patient management skills essential for success in the
COMSAE Phase II. The assessment evaluates foundational medical sciences, applied
clinical practice, ethical decision-making, regulatory compliance, and critical
thinking in complex medical scenarios. Candidates will encounter multiple-choice
questions that integrate basic science principles with clinical presentations,
emphasizing real-world application and evidence-based decision-making. The
examination reflects current standards in medical education and practice, preparing
candidates for the challenges of clinical medicine. Each question incorporates
professional standards, legal considerations, and ethical frameworks essential for
competent medical practice.
SECTION ONE: QUESTIONS 1–100
,Question 1
A 45-year-old male with a history of hypertension presents with acute onset of
severe, tearing chest pain radiating to the back. Blood pressure is 180/110 mmHg
in the right arm and 130/80 mmHg in the left arm. Which of the following is the
most appropriate initial diagnostic study?
A. Chest X-ray
B. Electrocardiogram
C. CT angiography
D. Transesophageal echocardiography
🟢 C. CT angiography
🔴 Explanation: CT angiography is the preferred initial diagnostic study for
suspected aortic dissection due to its high sensitivity and specificity, rapid
acquisition, and ability to assess the entire aorta. The blood pressure differential
between arms is a classic finding. Transesophageal echocardiography is useful but
more invasive and operator-dependent, while chest X-ray and ECG are less
specific and may be normal in many cases.
Question 2
A 28-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Physical examination reveals a bradycardia and delayed deep tendon
reflexes. Laboratory studies show elevated TSH and low free T4. What is the most
likely diagnosis?
A. Graves' disease
B. Subacute thyroiditis
C. Primary hypothyroidism
D. Secondary hypothyroidism
🟢 C. Primary hypothyroidism
🔴 Explanation: Primary hypothyroidism is characterized by elevated TSH with
low free T4, consistent with the patient's symptoms of fatigue, weight gain,
constipation, and cold intolerance. Graves' disease causes hyperthyroidism,
subacute thyroiditis typically presents with transient hyperthyroidism, and
secondary hypothyroidism would show low or normal TSH with low free T4.
,Question 3
A 62-year-old male with a 40-pack-year smoking history presents with a chronic
cough, hemoptysis, and weight loss. CT chest reveals a solitary pulmonary nodule
in the right upper lobe. Which of the following is the most important prognostic
factor?
A. Tumor size
B. Histological type
C. Lymph node involvement
D. Patient's age
🟢 C. Lymph node involvement
🔴 Explanation: Lymph node involvement (N stage) is the most important
prognostic factor in non-small cell lung cancer, with survival rates significantly
decreasing with nodal metastasis. While tumor size, histological type, and age are
relevant, nodal status is the strongest predictor of prognosis and guides
treatment decisions.
Question 4
A 55-year-old diabetic patient presents with a non-healing ulcer on the plantar
surface of the foot. On examination, the ulcer is surrounded by erythema and
there is purulent drainage. The patient has diminished sensation in the foot.
Which of the following is the most appropriate initial management?
A. Oral antibiotics and wound debridement
B. Surgical amputation
C. Hyperbaric oxygen therapy
D. Growth factor application
🟢 A. Oral antibiotics and wound debridement
🔴 Explanation: The initial management of a diabetic foot ulcer with signs of
infection includes wound debridement and antibiotic therapy. Surgical
amputation is reserved for severe, non-salvageable infections. Hyperbaric oxygen
and growth factors are adjunctive therapies and not first-line treatment.
, Question 5
A 32-year-old pregnant woman at 28 weeks gestation presents with elevated
blood pressure, proteinuria, and headaches. What is the most appropriate initial
management?
A. Immediate delivery
B. Bed rest and close monitoring
C. Magnesium sulfate and antihypertensives
D. Low-dose aspirin
🟢 C. Magnesium sulfate and antihypertensives
🔴 Explanation: The patient is presenting with preeclampsia, and management
includes magnesium sulfate for seizure prophylaxis and antihypertensives to
control blood pressure. Immediate delivery is only indicated for severe features or
eclampsia. Bed rest is not effective, and low-dose aspirin is used for prevention,
not treatment of established disease.
Question 6
A 7-year-old boy presents with a fever, sore throat, and a fine, erythematous rash
on the trunk. The rash has a sandpaper-like texture and appears to be worse in
the flexural areas. Which of the following is the most likely causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Parvovirus B19
🟢 B. Streptococcus pyogenes
🔴 Explanation: The presentation of fever, sore throat, and a fine, erythematous
sandpaper-like rash, particularly in the flexural areas, is classic for scarlet fever
caused by group A Streptococcus pyogenes. Staphylococcus aureus can cause a
similar rash but is less common in this presentation, while viral infections have
different rash characteristics.
