COMSAE PHASE 2 FORM 104 QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2025/2026 Q&A | INSTANT DOWNLOAD PDF
1.
A 65-year-old man presents with substernal chest pain that occurs with exertion
and is relieved by rest. ECG is normal. Which of the following is the most likely
diagnosis?
• A. Acute myocardial infarction
• B. Prinzmetal angina
• C. Stable angina
• D. Unstable angina
Answer: C. Stable angina
Stable angina presents with exertional chest pain relieved by rest/nitroglycerin,
due to fixed atherosclerotic narrowing. Unstable angina presents with pain at rest,
and MI would show ECG/troponin changes.
2.
A 22-year-old woman has acute right lower quadrant abdominal pain, fever, and
leukocytosis. The most likely diagnosis is:
• A. Ovarian torsion
• B. Ruptured ectopic pregnancy
• C. Appendicitis
• D. Crohn’s disease flare
Answer: C. Appendicitis
,Classic presentation is periumbilical pain migrating to RLQ with fever and
leukocytosis. Ectopic pregnancy must be ruled out in women of reproductive age
with β-hCG, but this case best fits appendicitis.
3.
A newborn has a continuous "machine-like" murmur best heard at the left
infraclavicular area. What congenital condition is this?
• A. Ventricular septal defect
• B. Atrial septal defect
• C. Patent ductus arteriosus
• D. Coarctation of the aorta
Answer: C. Patent ductus arteriosus
PDA presents with a continuous, machinery murmur, due to persistent connection
between the aorta and pulmonary artery.
4.
A 30-year-old woman presents with tremor, heat intolerance, weight loss, and
exophthalmos. Which is the most likely diagnosis?
• A. Toxic multinodular goiter
• B. Subacute thyroiditis
• C. Graves disease
• D. Hashimoto thyroiditis
Answer: C. Graves disease
Exophthalmos and pretibial myxedema are unique to Graves, caused by TSH
receptor–stimulating autoantibodies.
5.
,A 54-year-old man with chronic alcoholism presents with confusion, ataxia, and
ophthalmoplegia. What is the best next step in management?
• A. Give IV glucose
• B. Give IV fluids only
• C. Give IV thiamine
• D. Intubate immediately
Answer: C. Give IV thiamine
This is Wernicke encephalopathy (B1 deficiency). Always give thiamine before
glucose to avoid precipitating acute encephalopathy.
6.
A 72-year-old woman presents with sudden onset painless vision loss in her right
eye. Fundoscopy shows a pale retina with a cherry-red spot at the macula. What is
the diagnosis?
• A. Retinal detachment
• B. Central retinal vein occlusion
• C. Central retinal artery occlusion
• D. Macular degeneration
Answer: C. Central retinal artery occlusion
CRAO presents with acute, painless vision loss and a cherry-red spot, due to
embolism or thrombosis.
7.
A 17-year-old boy presents with recurrent nosebleeds and visible telangiectasias
on his lips. What is the most likely diagnosis?
• A. Von Willebrand disease
• B. Hemophilia A
, • C. Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
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m
• D. ITP
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Answer: C. Hereditary hemorrhagic telangiectasia
m m m m m
Presents with mucocutaneous telangiectasias, recurrent epistaxis, and possible
m m m m m m m
mAV malformations.
m m
m
8. m
Which vitamin deficiency is associated with megaloblastic anemia and
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neurologic deficits?
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• A. Folate
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• B. Vitamin B12
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• C. Vitamin B6
m m m
• D. Vitamin C
m m m
Answer: B. Vitamin B12
m m m m
B12 deficiency causes megaloblastic anemia and neurologic symptoms
m m m m m m m
m(posterior column/corticospinal involvement). Folate deficiency lacks neurologic
m m m m m m
mfindings. m
m
9. m
A patient presents with dyspnea, orthopnea, and paroxysmal nocturnal
m m m m m m m m
mdyspnea. On exam, there are bibasilar crackles and an S3 heart sound. Which
m m m m m m m m m m m m
mis the most likely diagnosis?
m m m m m
• A. COPD exacerbation
m m m
• B. Pulmonary embolism
m m m
• C. Left-sided heart failure
m m m m
• D. Right-sided heart failure
m m m m
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2025/2026 Q&A | INSTANT DOWNLOAD PDF
1.
A 65-year-old man presents with substernal chest pain that occurs with exertion
and is relieved by rest. ECG is normal. Which of the following is the most likely
diagnosis?
• A. Acute myocardial infarction
• B. Prinzmetal angina
• C. Stable angina
• D. Unstable angina
Answer: C. Stable angina
Stable angina presents with exertional chest pain relieved by rest/nitroglycerin,
due to fixed atherosclerotic narrowing. Unstable angina presents with pain at rest,
and MI would show ECG/troponin changes.
2.
A 22-year-old woman has acute right lower quadrant abdominal pain, fever, and
leukocytosis. The most likely diagnosis is:
• A. Ovarian torsion
• B. Ruptured ectopic pregnancy
• C. Appendicitis
• D. Crohn’s disease flare
Answer: C. Appendicitis
,Classic presentation is periumbilical pain migrating to RLQ with fever and
leukocytosis. Ectopic pregnancy must be ruled out in women of reproductive age
with β-hCG, but this case best fits appendicitis.
3.
A newborn has a continuous "machine-like" murmur best heard at the left
infraclavicular area. What congenital condition is this?
• A. Ventricular septal defect
• B. Atrial septal defect
• C. Patent ductus arteriosus
• D. Coarctation of the aorta
Answer: C. Patent ductus arteriosus
PDA presents with a continuous, machinery murmur, due to persistent connection
between the aorta and pulmonary artery.
4.
A 30-year-old woman presents with tremor, heat intolerance, weight loss, and
exophthalmos. Which is the most likely diagnosis?
• A. Toxic multinodular goiter
• B. Subacute thyroiditis
• C. Graves disease
• D. Hashimoto thyroiditis
Answer: C. Graves disease
Exophthalmos and pretibial myxedema are unique to Graves, caused by TSH
receptor–stimulating autoantibodies.
5.
,A 54-year-old man with chronic alcoholism presents with confusion, ataxia, and
ophthalmoplegia. What is the best next step in management?
• A. Give IV glucose
• B. Give IV fluids only
• C. Give IV thiamine
• D. Intubate immediately
Answer: C. Give IV thiamine
This is Wernicke encephalopathy (B1 deficiency). Always give thiamine before
glucose to avoid precipitating acute encephalopathy.
6.
A 72-year-old woman presents with sudden onset painless vision loss in her right
eye. Fundoscopy shows a pale retina with a cherry-red spot at the macula. What is
the diagnosis?
• A. Retinal detachment
• B. Central retinal vein occlusion
• C. Central retinal artery occlusion
• D. Macular degeneration
Answer: C. Central retinal artery occlusion
CRAO presents with acute, painless vision loss and a cherry-red spot, due to
embolism or thrombosis.
7.
A 17-year-old boy presents with recurrent nosebleeds and visible telangiectasias
on his lips. What is the most likely diagnosis?
• A. Von Willebrand disease
• B. Hemophilia A
, • C. Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
m m m m
m
• D. ITP
m m
Answer: C. Hereditary hemorrhagic telangiectasia
m m m m m
Presents with mucocutaneous telangiectasias, recurrent epistaxis, and possible
m m m m m m m
mAV malformations.
m m
m
8. m
Which vitamin deficiency is associated with megaloblastic anemia and
m m m m m m m m
neurologic deficits?
m m m
• A. Folate
m m
• B. Vitamin B12
m m m
• C. Vitamin B6
m m m
• D. Vitamin C
m m m
Answer: B. Vitamin B12
m m m m
B12 deficiency causes megaloblastic anemia and neurologic symptoms
m m m m m m m
m(posterior column/corticospinal involvement). Folate deficiency lacks neurologic
m m m m m m
mfindings. m
m
9. m
A patient presents with dyspnea, orthopnea, and paroxysmal nocturnal
m m m m m m m m
mdyspnea. On exam, there are bibasilar crackles and an S3 heart sound. Which
m m m m m m m m m m m m
mis the most likely diagnosis?
m m m m m
• A. COPD exacerbation
m m m
• B. Pulmonary embolism
m m m
• C. Left-sided heart failure
m m m m
• D. Right-sided heart failure
m m m m
