COMSAE 115 EXAM 2026/2027 COMPLETE
ACCURATE TEST EXAM ACTUAL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES
(VERIFIEDSOLUTIONS)
2026 EDITION -GRADED GRADE A+
|BEST DOCUMENT FOR EXAM-TESTBANK
A 62-year-old man presents to the ED with crushing substernal chest pain radiating to
the left arm and diaphoresis. ECG shows ST-segment elevation in leads II, III, and aVF.
What is the most appropriate next step in management?
a. Start IV antibiotics
b. Immediate percutaneous coronary intervention (PCI)
c. Schedule outpatient stress test
d. Give oral beta-blocker only
✔️ Correct Answer: B
Rationale:
ST-elevation myocardial infarction (STEMI) requires urgent reperfusion therapy. PCI is
preferred within 90 minutes of first medical contact as it restores coronary blood flow
and reduces myocardial damage. Delays significantly increase mortality. Thrombolytics
are considered only if PCI is unavailable within the recommended time window. Option
A is incorrect because antibiotics are not indicated for STEMI. Option C is incorrect
because outpatient stress testing would delay life-saving treatment. Option D is
incorrect because beta-blockers are adjunctive therapy, not the primary intervention.
,Inferior STEMI (leads II, III, aVF) suggests right coronary artery occlusion and may
present with bradycardia and hypotension.
A 24-year-old woman presents with fever, dysuria, and flank pain. Urinalysis shows
nitrites, leukocyte esterase, and WBC casts. What is the most likely diagnosis?
a. Cystitis
b. Pyelonephritis
c. Glomerulonephritis
d. Urethritis
✔️ Correct Answer: B
Rationale:
Fever, flank pain, and WBC casts indicate upper urinary tract infection involving the
kidneys. Pyelonephritis is commonly caused by E. coli and requires systemic antibiotics.
Option A (Cystitis) presents with dysuria and frequency but without fever or flank pain.
Option C (Glomerulonephritis) presents with hematuria and proteinuria, not WBC casts.
Option D (Urethritis) presents with dysuria but without flank pain or fever. WBC casts are
specifically indicative of renal parenchymal inflammation.
A newborn fails to pass meconium within 48 hours and develops abdominal distension.
What is the most likely diagnosis?
a. Hirschsprung disease
b. Pyloric stenosis
c. Meconium ileus
d. Intussusception
✔️ Correct Answer: A
Rationale:
Congenital absence of ganglion cells leads to functional obstruction of the colon,
causing delayed meconium passage and intestinal dilation. Option B (Pyloric stenosis)
presents with projectile vomiting at 2-8 weeks of age. Option C (Meconium ileus) is
associated with cystic fibrosis and presents with bilious vomiting. Option D
,(Intussusception) occurs in older infants with currant jelly stools. Hirschsprung disease is
diagnosed with rectal biopsy showing absence of ganglion cells.
A patient presents with tremor at rest, rigidity, and bradykinesia. Which brain structure is
primarily affected?
a. Cerebellum
b. Substantia nigra
c. Hippocampus
d. Thalamus
✔️ Correct Answer: B
Rationale:
Parkinson disease results from degeneration of dopaminergic neurons in the substantia
nigra pars compacta, leading to decreased dopamine in the basal ganglia. Option A
(Cerebellum) is affected in ataxia. Option C (Hippocampus) is affected in Alzheimer
disease. Option D (Thalamus) is involved in sensory relay. The classic triad of resting
tremor, rigidity, and bradykinesia is characteristic of Parkinson disease. Lewy bodies are
the pathological hallmark.
A 19-year-old man presents with fever, neck stiffness, and petechial rash. What
organism is most likely responsible?
a. Streptococcus pneumoniae
b. Neisseria meningitidis
c. Listeria monocytogenes
d. Haemophilus influenzae
✔️ Correct Answer: B
Rationale:
Meningococcal meningitis presents with fever, meningismus, and petechial rash due to
endotoxin-mediated vascular injury. Option A (S. pneumoniae) is more common in
elderly and does not typically cause petechial rash. Option C (L. monocytogenes) is seen
in neonates, elderly, and immunocompromised. Option D (H. influenzae) is now less
, common due to vaccination. Petechial rash in meningitis is a medical emergency
requiring immediate antibiotics.
A patient with COPD develops worsening hypoxia. Which oxygen delivery method is
most appropriate initially?
a. High-flow non-rebreather mask
b. Venturi mask
c. Bag-valve mask
d. Room air only
✔️ Correct Answer: B
Rationale:
COPD patients require controlled oxygen delivery to avoid CO₂ retention. Venturi masks
allow precise FiO₂ titration. Option A (Non-rebreather mask) delivers high oxygen
concentrations that can suppress the hypoxic drive in COPD patients. Option C (Bag-
valve mask) is for respiratory arrest. Option D (Room air) is insufficient for hypoxia. The
target oxygen saturation for COPD patients is typically 88-92%.
A 30-year-old woman presents with heat intolerance, weight loss, and exophthalmos.
Labs show low TSH and high T4. What is the underlying mechanism?
a. Destruction of thyroid follicles
b. Autoimmune stimulation of TSH receptor
c. Thyroid hormone deficiency
d. Pituitary adenoma secreting TSH
✔️ Correct Answer: B
Rationale:
Graves disease is caused by thyroid-stimulating immunoglobulins that activate the TSH
receptor, increasing thyroid hormone production. Option A (Destruction of follicles)
describes Hashimoto thyroiditis. Option C (Thyroid hormone deficiency) describes
hypothyroidism. Option D (Pituitary adenoma) is a rare cause of hyperthyroidism. Graves
disease is the most common cause of hyperthyroidism and is associated with
ophthalmopathy and diffuse goiter.
ACCURATE TEST EXAM ACTUAL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES
(VERIFIEDSOLUTIONS)
2026 EDITION -GRADED GRADE A+
|BEST DOCUMENT FOR EXAM-TESTBANK
A 62-year-old man presents to the ED with crushing substernal chest pain radiating to
the left arm and diaphoresis. ECG shows ST-segment elevation in leads II, III, and aVF.
What is the most appropriate next step in management?
a. Start IV antibiotics
b. Immediate percutaneous coronary intervention (PCI)
c. Schedule outpatient stress test
d. Give oral beta-blocker only
✔️ Correct Answer: B
Rationale:
ST-elevation myocardial infarction (STEMI) requires urgent reperfusion therapy. PCI is
preferred within 90 minutes of first medical contact as it restores coronary blood flow
and reduces myocardial damage. Delays significantly increase mortality. Thrombolytics
are considered only if PCI is unavailable within the recommended time window. Option
A is incorrect because antibiotics are not indicated for STEMI. Option C is incorrect
because outpatient stress testing would delay life-saving treatment. Option D is
incorrect because beta-blockers are adjunctive therapy, not the primary intervention.
,Inferior STEMI (leads II, III, aVF) suggests right coronary artery occlusion and may
present with bradycardia and hypotension.
A 24-year-old woman presents with fever, dysuria, and flank pain. Urinalysis shows
nitrites, leukocyte esterase, and WBC casts. What is the most likely diagnosis?
a. Cystitis
b. Pyelonephritis
c. Glomerulonephritis
d. Urethritis
✔️ Correct Answer: B
Rationale:
Fever, flank pain, and WBC casts indicate upper urinary tract infection involving the
kidneys. Pyelonephritis is commonly caused by E. coli and requires systemic antibiotics.
Option A (Cystitis) presents with dysuria and frequency but without fever or flank pain.
Option C (Glomerulonephritis) presents with hematuria and proteinuria, not WBC casts.
Option D (Urethritis) presents with dysuria but without flank pain or fever. WBC casts are
specifically indicative of renal parenchymal inflammation.
A newborn fails to pass meconium within 48 hours and develops abdominal distension.
What is the most likely diagnosis?
a. Hirschsprung disease
b. Pyloric stenosis
c. Meconium ileus
d. Intussusception
✔️ Correct Answer: A
Rationale:
Congenital absence of ganglion cells leads to functional obstruction of the colon,
causing delayed meconium passage and intestinal dilation. Option B (Pyloric stenosis)
presents with projectile vomiting at 2-8 weeks of age. Option C (Meconium ileus) is
associated with cystic fibrosis and presents with bilious vomiting. Option D
,(Intussusception) occurs in older infants with currant jelly stools. Hirschsprung disease is
diagnosed with rectal biopsy showing absence of ganglion cells.
A patient presents with tremor at rest, rigidity, and bradykinesia. Which brain structure is
primarily affected?
a. Cerebellum
b. Substantia nigra
c. Hippocampus
d. Thalamus
✔️ Correct Answer: B
Rationale:
Parkinson disease results from degeneration of dopaminergic neurons in the substantia
nigra pars compacta, leading to decreased dopamine in the basal ganglia. Option A
(Cerebellum) is affected in ataxia. Option C (Hippocampus) is affected in Alzheimer
disease. Option D (Thalamus) is involved in sensory relay. The classic triad of resting
tremor, rigidity, and bradykinesia is characteristic of Parkinson disease. Lewy bodies are
the pathological hallmark.
A 19-year-old man presents with fever, neck stiffness, and petechial rash. What
organism is most likely responsible?
a. Streptococcus pneumoniae
b. Neisseria meningitidis
c. Listeria monocytogenes
d. Haemophilus influenzae
✔️ Correct Answer: B
Rationale:
Meningococcal meningitis presents with fever, meningismus, and petechial rash due to
endotoxin-mediated vascular injury. Option A (S. pneumoniae) is more common in
elderly and does not typically cause petechial rash. Option C (L. monocytogenes) is seen
in neonates, elderly, and immunocompromised. Option D (H. influenzae) is now less
, common due to vaccination. Petechial rash in meningitis is a medical emergency
requiring immediate antibiotics.
A patient with COPD develops worsening hypoxia. Which oxygen delivery method is
most appropriate initially?
a. High-flow non-rebreather mask
b. Venturi mask
c. Bag-valve mask
d. Room air only
✔️ Correct Answer: B
Rationale:
COPD patients require controlled oxygen delivery to avoid CO₂ retention. Venturi masks
allow precise FiO₂ titration. Option A (Non-rebreather mask) delivers high oxygen
concentrations that can suppress the hypoxic drive in COPD patients. Option C (Bag-
valve mask) is for respiratory arrest. Option D (Room air) is insufficient for hypoxia. The
target oxygen saturation for COPD patients is typically 88-92%.
A 30-year-old woman presents with heat intolerance, weight loss, and exophthalmos.
Labs show low TSH and high T4. What is the underlying mechanism?
a. Destruction of thyroid follicles
b. Autoimmune stimulation of TSH receptor
c. Thyroid hormone deficiency
d. Pituitary adenoma secreting TSH
✔️ Correct Answer: B
Rationale:
Graves disease is caused by thyroid-stimulating immunoglobulins that activate the TSH
receptor, increasing thyroid hormone production. Option A (Destruction of follicles)
describes Hashimoto thyroiditis. Option C (Thyroid hormone deficiency) describes
hypothyroidism. Option D (Pituitary adenoma) is a rare cause of hyperthyroidism. Graves
disease is the most common cause of hyperthyroidism and is associated with
ophthalmopathy and diffuse goiter.
