COMSAE PHASE 1 GENERAL PRINCIPLES OF
MEDICINE PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
Question 1
A 24-year-old man is brought to the emergency department after
sustaining extensive burns over approximately 40% of his total body
surface area. During the first several hours after the injury, his blood
pressure decreases and his heart rate increases. Laboratory studies
demonstrate hemoconcentration. Which of the following best explains
the primary mechanism responsible for his early hemodynamic changes?
A. Increased plasma oncotic pressure caused by hepatic protein
synthesis
B. Decreased systemic vascular resistance caused by nitric oxide release
C. Increased capillary permeability causing movement of protein-rich
fluid into the interstitial space
D. Decreased lymphatic drainage caused by sympathetic activation
E. Increased renal sodium retention causing expansion of plasma volume
Answer: C. Increased capillary permeability causing movement of
protein-rich fluid into the interstitial space
Rationale: Major burns produce a systemic inflammatory response
that markedly increases microvascular permeability. Plasma proteins
and fluid leave the intravascular compartment and enter the
interstitial space, producing hypovolemia, hemoconcentration, reduced
1
,venous return, and decreased cardiac output. This phenomenon is
particularly important during the early phase of severe burn injury.
Question 2
A 67-year-old man with long-standing hypertension develops
progressive exertional dyspnea. Echocardiography demonstrates
concentric left ventricular hypertrophy. Which of the following cellular
adaptations most directly accounts for the increased myocardial mass?
A. Hyperplasia of ventricular cardiomyocytes
B. Hypertrophy caused by increased synthesis of structural proteins
C. Metaplasia of cardiac fibroblasts into cardiomyocytes
D. Dysplasia caused by accumulated genetic mutations
E. Atrophy caused by reduced contractile protein degradation
Answer: B. Hypertrophy caused by increased synthesis of structural
proteins
Rationale: Cardiac myocytes are terminally differentiated cells with
very limited capacity for cell division. Chronic pressure overload
therefore produces hypertrophy rather than hyperplasia. Increased
mechanical stress stimulates signaling pathways that increase protein
synthesis and cellular size, producing concentric ventricular
hypertrophy.
Question 3
A 35-year-old woman develops jaundice after receiving a medication
that causes oxidative stress. She has anemia, elevated lactate
dehydrogenase, indirect hyperbilirubinemia, and numerous bite cells on
peripheral smear. Which biochemical pathway is most directly
impaired?
2
,A. Conversion of pyruvate to acetyl-CoA
B. Generation of NADPH through the pentose phosphate pathway
C. Conversion of succinyl-CoA to succinate
D. Oxidation of fatty acids through β-oxidation
E. Conversion of glucose-6-phosphate to fructose-6-phosphate
Answer: B. Generation of NADPH through the pentose phosphate
pathway
Rationale: Glucose-6-phosphate dehydrogenase deficiency decreases
production of NADPH, which is required to maintain glutathione in
its reduced form. Reduced glutathione protects erythrocytes from
oxidative damage. Oxidative stress can therefore produce hemolysis,
Heinz bodies, and bite cells.
Question 4
A hospitalized patient receives an intravenous medication that produces
a rapid decrease in blood pressure. The medication causes relaxation of
vascular smooth muscle by increasing intracellular cyclic GMP. Which
mechanism most directly produces this effect?
A. Activation of protein kinase A
B. Inhibition of phosphodiesterase-3
C. Activation of soluble guanylyl cyclase
D. Activation of receptor tyrosine kinase
E. Stimulation of phospholipase C
Answer: C. Activation of soluble guanylyl cyclase
Rationale: Nitric oxide activates soluble guanylyl cyclase, increasing
cyclic GMP in vascular smooth muscle. cGMP activates protein kinase
G, which ultimately lowers intracellular calcium and promotes
smooth-muscle relaxation.
3
, Question 5
A 19-year-old woman experiences recurrent episodes of severe
abdominal pain, peripheral neuropathy, and dark-colored urine. Her
symptoms worsen after beginning a low-calorie diet. Laboratory studies
demonstrate increased urinary porphobilinogen. Which enzyme
deficiency is most likely responsible?
A. Ferrochelatase
B. Porphobilinogen deaminase
C. ALA dehydratase
D. Uroporphyrinogen decarboxylase
E. Coproporphyrinogen oxidase
Answer: B. Porphobilinogen deaminase
Rationale: Acute intermittent porphyria results from deficiency of
porphobilinogen deaminase, also called hydroxymethylbilane
synthase. Accumulation of ALA and porphobilinogen causes episodic
neurovisceral symptoms, including abdominal pain and peripheral
neuropathy. Fasting and certain medications can precipitate attacks.
Question 6
A 58-year-old man with chronic obstructive pulmonary disease has an
arterial blood gas showing pH 7.36, PaCO₂ 58 mm Hg, and HCO₃⁻ 32
mEq/L. Which of the following best describes his acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with renal compensation
C. Acute metabolic alkalosis
D. Chronic metabolic acidosis with respiratory compensation
E. Mixed respiratory and metabolic acidosis
Answer: B. Chronic respiratory acidosis with renal compensation
4
MEDICINE PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
Question 1
A 24-year-old man is brought to the emergency department after
sustaining extensive burns over approximately 40% of his total body
surface area. During the first several hours after the injury, his blood
pressure decreases and his heart rate increases. Laboratory studies
demonstrate hemoconcentration. Which of the following best explains
the primary mechanism responsible for his early hemodynamic changes?
A. Increased plasma oncotic pressure caused by hepatic protein
synthesis
B. Decreased systemic vascular resistance caused by nitric oxide release
C. Increased capillary permeability causing movement of protein-rich
fluid into the interstitial space
D. Decreased lymphatic drainage caused by sympathetic activation
E. Increased renal sodium retention causing expansion of plasma volume
Answer: C. Increased capillary permeability causing movement of
protein-rich fluid into the interstitial space
Rationale: Major burns produce a systemic inflammatory response
that markedly increases microvascular permeability. Plasma proteins
and fluid leave the intravascular compartment and enter the
interstitial space, producing hypovolemia, hemoconcentration, reduced
1
,venous return, and decreased cardiac output. This phenomenon is
particularly important during the early phase of severe burn injury.
Question 2
A 67-year-old man with long-standing hypertension develops
progressive exertional dyspnea. Echocardiography demonstrates
concentric left ventricular hypertrophy. Which of the following cellular
adaptations most directly accounts for the increased myocardial mass?
A. Hyperplasia of ventricular cardiomyocytes
B. Hypertrophy caused by increased synthesis of structural proteins
C. Metaplasia of cardiac fibroblasts into cardiomyocytes
D. Dysplasia caused by accumulated genetic mutations
E. Atrophy caused by reduced contractile protein degradation
Answer: B. Hypertrophy caused by increased synthesis of structural
proteins
Rationale: Cardiac myocytes are terminally differentiated cells with
very limited capacity for cell division. Chronic pressure overload
therefore produces hypertrophy rather than hyperplasia. Increased
mechanical stress stimulates signaling pathways that increase protein
synthesis and cellular size, producing concentric ventricular
hypertrophy.
Question 3
A 35-year-old woman develops jaundice after receiving a medication
that causes oxidative stress. She has anemia, elevated lactate
dehydrogenase, indirect hyperbilirubinemia, and numerous bite cells on
peripheral smear. Which biochemical pathway is most directly
impaired?
2
,A. Conversion of pyruvate to acetyl-CoA
B. Generation of NADPH through the pentose phosphate pathway
C. Conversion of succinyl-CoA to succinate
D. Oxidation of fatty acids through β-oxidation
E. Conversion of glucose-6-phosphate to fructose-6-phosphate
Answer: B. Generation of NADPH through the pentose phosphate
pathway
Rationale: Glucose-6-phosphate dehydrogenase deficiency decreases
production of NADPH, which is required to maintain glutathione in
its reduced form. Reduced glutathione protects erythrocytes from
oxidative damage. Oxidative stress can therefore produce hemolysis,
Heinz bodies, and bite cells.
Question 4
A hospitalized patient receives an intravenous medication that produces
a rapid decrease in blood pressure. The medication causes relaxation of
vascular smooth muscle by increasing intracellular cyclic GMP. Which
mechanism most directly produces this effect?
A. Activation of protein kinase A
B. Inhibition of phosphodiesterase-3
C. Activation of soluble guanylyl cyclase
D. Activation of receptor tyrosine kinase
E. Stimulation of phospholipase C
Answer: C. Activation of soluble guanylyl cyclase
Rationale: Nitric oxide activates soluble guanylyl cyclase, increasing
cyclic GMP in vascular smooth muscle. cGMP activates protein kinase
G, which ultimately lowers intracellular calcium and promotes
smooth-muscle relaxation.
3
, Question 5
A 19-year-old woman experiences recurrent episodes of severe
abdominal pain, peripheral neuropathy, and dark-colored urine. Her
symptoms worsen after beginning a low-calorie diet. Laboratory studies
demonstrate increased urinary porphobilinogen. Which enzyme
deficiency is most likely responsible?
A. Ferrochelatase
B. Porphobilinogen deaminase
C. ALA dehydratase
D. Uroporphyrinogen decarboxylase
E. Coproporphyrinogen oxidase
Answer: B. Porphobilinogen deaminase
Rationale: Acute intermittent porphyria results from deficiency of
porphobilinogen deaminase, also called hydroxymethylbilane
synthase. Accumulation of ALA and porphobilinogen causes episodic
neurovisceral symptoms, including abdominal pain and peripheral
neuropathy. Fasting and certain medications can precipitate attacks.
Question 6
A 58-year-old man with chronic obstructive pulmonary disease has an
arterial blood gas showing pH 7.36, PaCO₂ 58 mm Hg, and HCO₃⁻ 32
mEq/L. Which of the following best describes his acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with renal compensation
C. Acute metabolic alkalosis
D. Chronic metabolic acidosis with respiratory compensation
E. Mixed respiratory and metabolic acidosis
Answer: B. Chronic respiratory acidosis with renal compensation
4
