COLLABORATIVE ONLINE INTERNATIONAL
LEARNING (COIL) ACTUAL EXAM 2026-2027
COMPLETE EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (100% CORRECT VERIFIED
ANSWERS) NEWEST UPDATED VERSION EDITION
2026 GUARANTEED PASS A+
1. A 45-year-old patient with a 30-pack-year smoking history presents with a
new right upper lobe mass. A CT-guided biopsy is performed. Which of the
following histopathological findings is most characteristic of small cell lung
carcinoma?
A) Glandular formation with mucin production
B) Keratin pearls and intercellular bridges
C) Neuroendocrine granules and crush artifact
D) Psammoma bodies and hobnail cells
E) Clear cells with abundant glycogen
Correct Answer: C
Rationale: Small cell lung carcinoma (SCLC) is characterized by small, round-
to-ovoid cells with scant cytoplasm, nuclear molding, and prominent crush
artifact due to fragility. Neuroendocrine granules are a key ultrastructural
feature. Option A describes adenocarcinoma; B describes squamous cell
carcinoma; D is seen in papillary thyroid carcinoma or mesothelioma; E is
characteristic of renal cell carcinoma or clear cell adenocarcinoma.
,2. A 60-year-old woman on long-term hormone replacement therapy develops
acute shortness of breath and pleuritic chest pain. A V/Q scan reveals a high-
probability defect. Which of the following is the most significant risk factor for
her current condition?
A) Hypertension
B) Diabetes mellitus
C) Estrogen use
D) Hyperlipidemia
E) Obesity
Correct Answer: C
Rationale: Estrogen use, especially in hormone replacement therapy, increases
the risk of venous thromboembolism (VTE) by promoting a prothrombotic
state. This patient's presentation is consistent with pulmonary embolism.
While obesity (E) and hypertension (A) are risk factors, estrogen use is the
most direct and significant contributor in this scenario. Diabetes (B) and
hyperlipidemia (D) are weaker risk factors for VTE.
3. A 55-year-old male with a history of alcohol use disorder presents with
hematemesis and ascites. On examination, spider angiomas and palmar
erythema are noted. Which of the following is the most likely cause of his
bleeding?
A) Duodenal ulcer
B) Gastric antral vascular ectasia
C) Esophageal varices
D) Mallory-Weiss tear
E) Dieulafoy's lesion
,Correct Answer: C
Rationale: The patient's history of alcohol use, ascites, spider angiomas, and
palmar erythema suggest portal hypertension due to cirrhosis. Esophageal
varices are the most common cause of upper GI bleeding in this setting.
Duodenal ulcers (A) are more common with NSAID or H. pylori use; GAVE
(B) is associated with cirrhosis but less common; Mallory-Weiss tears (D)
follow retching; Dieulafoy's lesion (E) is a rare vascular anomaly.
4. A 32-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. Laboratory studies show elevated TSH and low free T4.
Which of the following antibodies is most likely positive in this patient?
A) Anti-dsDNA
B) Anti-centromere
C) Anti-thyroglobulin
D) Anti-Jo-1
E) Anti-SSA/Ro
Correct Answer: C
Rationale: Primary hypothyroidism with elevated TSH and low free T4 is most
often due to Hashimoto's thyroiditis, which is associated with anti-
thyroglobulin and anti-thyroid peroxidase antibodies. Anti-dsDNA (A) is seen
in SLE; anti-centromere (B) in limited systemic sclerosis; anti-Jo-1 (D) in
polymyositis; anti-SSA/Ro (E) in Sjögren's syndrome and SLE.
5. A 70-year-old man with chronic kidney disease is started on a new
medication for anemia. He develops severe muscle pain and dark urine.
Laboratory findings show elevated creatine kinase and acute kidney injury.
Which medication is most likely responsible?
A) Erythropoietin
, B) Iron sulfate
C) Atorvastatin
D) Furosemide
E) Sevelamer
Correct Answer: C
Rationale: Atorvastatin, a statin, can cause rhabdomyolysis, presenting with
muscle pain, dark urine (myoglobinuria), elevated CK, and acute kidney
injury. Erythropoietin (A) treats anemia but doesn't cause rhabdomyolysis;
iron (B) causes GI upset; furosemide (D) can cause ototoxicity or electrolyte
disturbances; sevelamer (E) is a phosphate binder causing GI side effects.
6. A 28-year-old woman presents with episodic palpitations, sweating, and
headache. Her blood pressure is 180/110 mmHg during an episode. Urinary
metanephrines are markedly elevated. Which of the following is the most
appropriate definitive localization study?
A) CT abdomen with contrast
B) MRI abdomen without contrast
C) MIBG scintigraphy
D) PET-CT with FDG
E) Adrenal venous sampling
Correct Answer: C
Rationale: This patient has pheochromocytoma (episodic hypertension,
palpitations, elevated metanephrines). MIBG (metaiodobenzylguanidine)
scintigraphy is the gold standard for functional localization and detection of
extra-adrenal or metastatic disease. CT (A) or MRI (B) can localize but lack
specificity; PET-CT (D) is less specific; adrenal venous sampling (E) is used for
aldosteronoma lateralization.
LEARNING (COIL) ACTUAL EXAM 2026-2027
COMPLETE EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (100% CORRECT VERIFIED
ANSWERS) NEWEST UPDATED VERSION EDITION
2026 GUARANTEED PASS A+
1. A 45-year-old patient with a 30-pack-year smoking history presents with a
new right upper lobe mass. A CT-guided biopsy is performed. Which of the
following histopathological findings is most characteristic of small cell lung
carcinoma?
A) Glandular formation with mucin production
B) Keratin pearls and intercellular bridges
C) Neuroendocrine granules and crush artifact
D) Psammoma bodies and hobnail cells
E) Clear cells with abundant glycogen
Correct Answer: C
Rationale: Small cell lung carcinoma (SCLC) is characterized by small, round-
to-ovoid cells with scant cytoplasm, nuclear molding, and prominent crush
artifact due to fragility. Neuroendocrine granules are a key ultrastructural
feature. Option A describes adenocarcinoma; B describes squamous cell
carcinoma; D is seen in papillary thyroid carcinoma or mesothelioma; E is
characteristic of renal cell carcinoma or clear cell adenocarcinoma.
,2. A 60-year-old woman on long-term hormone replacement therapy develops
acute shortness of breath and pleuritic chest pain. A V/Q scan reveals a high-
probability defect. Which of the following is the most significant risk factor for
her current condition?
A) Hypertension
B) Diabetes mellitus
C) Estrogen use
D) Hyperlipidemia
E) Obesity
Correct Answer: C
Rationale: Estrogen use, especially in hormone replacement therapy, increases
the risk of venous thromboembolism (VTE) by promoting a prothrombotic
state. This patient's presentation is consistent with pulmonary embolism.
While obesity (E) and hypertension (A) are risk factors, estrogen use is the
most direct and significant contributor in this scenario. Diabetes (B) and
hyperlipidemia (D) are weaker risk factors for VTE.
3. A 55-year-old male with a history of alcohol use disorder presents with
hematemesis and ascites. On examination, spider angiomas and palmar
erythema are noted. Which of the following is the most likely cause of his
bleeding?
A) Duodenal ulcer
B) Gastric antral vascular ectasia
C) Esophageal varices
D) Mallory-Weiss tear
E) Dieulafoy's lesion
,Correct Answer: C
Rationale: The patient's history of alcohol use, ascites, spider angiomas, and
palmar erythema suggest portal hypertension due to cirrhosis. Esophageal
varices are the most common cause of upper GI bleeding in this setting.
Duodenal ulcers (A) are more common with NSAID or H. pylori use; GAVE
(B) is associated with cirrhosis but less common; Mallory-Weiss tears (D)
follow retching; Dieulafoy's lesion (E) is a rare vascular anomaly.
4. A 32-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. Laboratory studies show elevated TSH and low free T4.
Which of the following antibodies is most likely positive in this patient?
A) Anti-dsDNA
B) Anti-centromere
C) Anti-thyroglobulin
D) Anti-Jo-1
E) Anti-SSA/Ro
Correct Answer: C
Rationale: Primary hypothyroidism with elevated TSH and low free T4 is most
often due to Hashimoto's thyroiditis, which is associated with anti-
thyroglobulin and anti-thyroid peroxidase antibodies. Anti-dsDNA (A) is seen
in SLE; anti-centromere (B) in limited systemic sclerosis; anti-Jo-1 (D) in
polymyositis; anti-SSA/Ro (E) in Sjögren's syndrome and SLE.
5. A 70-year-old man with chronic kidney disease is started on a new
medication for anemia. He develops severe muscle pain and dark urine.
Laboratory findings show elevated creatine kinase and acute kidney injury.
Which medication is most likely responsible?
A) Erythropoietin
, B) Iron sulfate
C) Atorvastatin
D) Furosemide
E) Sevelamer
Correct Answer: C
Rationale: Atorvastatin, a statin, can cause rhabdomyolysis, presenting with
muscle pain, dark urine (myoglobinuria), elevated CK, and acute kidney
injury. Erythropoietin (A) treats anemia but doesn't cause rhabdomyolysis;
iron (B) causes GI upset; furosemide (D) can cause ototoxicity or electrolyte
disturbances; sevelamer (E) is a phosphate binder causing GI side effects.
6. A 28-year-old woman presents with episodic palpitations, sweating, and
headache. Her blood pressure is 180/110 mmHg during an episode. Urinary
metanephrines are markedly elevated. Which of the following is the most
appropriate definitive localization study?
A) CT abdomen with contrast
B) MRI abdomen without contrast
C) MIBG scintigraphy
D) PET-CT with FDG
E) Adrenal venous sampling
Correct Answer: C
Rationale: This patient has pheochromocytoma (episodic hypertension,
palpitations, elevated metanephrines). MIBG (metaiodobenzylguanidine)
scintigraphy is the gold standard for functional localization and detection of
extra-adrenal or metastatic disease. CT (A) or MRI (B) can localize but lack
specificity; PET-CT (D) is less specific; adrenal venous sampling (E) is used for
aldosteronoma lateralization.
