COMSAE PHASE 1 FORM 113 EXAM / COMSAE FORM 113 ACTUAL PHASE 1
EXAM 2026/2027 COMPLETE ACCURATE EXAM APPROVED QUESTIONS
WITH WELL ELABORATED ANSWERS AND RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) NEWEST UPDATED VERSION 2026 EDITION
|GUARANTEED
1. A 22-year-old develops episodic wheezing, cough, and chest tightness after exposure to cat
dander. Spirometry shows reversible airflow obstruction. Which mediator is most responsible for the
early bronchoconstrictive response?
A. Histamine
B. Leukotriene C4
C. Prostaglandin E2
D. Bradykinin
Correct Answer: B
Rationale: Cysteinyl leukotrienes released by mast cells cause potent bronchoconstriction and
increased mucus production in allergic asthma.
2. A patient with diabetic ketoacidosis has Kussmaul respirations. Which physiologic change most
directly stimulates the increased ventilation?
A. Increased arterial bicarbonate
B. Increased CSF pH
C. Increased arterial hydrogen ion concentration
D. Decreased carotid-body perfusion
Correct Answer: C
Rationale: Metabolic acidosis increases hydrogen ion concentration; peripheral chemoreceptors
detect the fall in arterial pH and increase ventilation to lower PaCO2.
3. A 45-year-old with hypertension begins an ACE inhibitor and develops a persistent dry cough.
Which substance accumulates and contributes to this adverse effect?
A. Angiotensin II
B. Bradykinin
C. Aldosterone
D. Renin
Correct Answer: B
Rationale: ACE normally degrades bradykinin. ACE inhibition increases bradykinin, which can
produce cough and, rarely, angioedema.
4. A 7-year-old has fever, sore throat, tender anterior cervical nodes, and tonsillar exudates without
cough. Which organism is most likely?
A. Corynebacterium diphtheriae
B. Epstein-Barr virus
C. Group A Streptococcus
D. Fusobacterium necrophorum
,Correct Answer: C
Rationale: Group A Streptococcus commonly causes acute pharyngitis with fever, tonsillar
exudates, and tender anterior cervical adenopathy without cough.
5. A patient has ptosis, diplopia, and fatigable weakness that worsens late in the day. Which
structure is primarily affected?
A. Presynaptic voltage-gated calcium channels
B. Postsynaptic nicotinic acetylcholine receptors
C. Peripheral myelin
D. Muscle ryanodine receptors
Correct Answer: B
Rationale: Myasthenia gravis is caused by antibodies against postsynaptic nicotinic acetylcholine
receptors, producing fluctuating skeletal-muscle weakness.
6. A 64-year-old suddenly develops right facial droop and right arm weakness. Speech is nonfluent,
but comprehension is preserved. Which cortical region is most likely affected?
A. Dominant inferior frontal gyrus
B. Dominant posterior temporal gyrus
C. Nondominant parietal cortex
D. Hippocampus
Correct Answer: A
Rationale: Broca aphasia is a nonfluent expressive aphasia with relatively preserved comprehension
and localizes to the dominant inferior frontal gyrus.
7. A patient with chronic alcoholism develops confusion, ophthalmoplegia, and gait ataxia. Which
deficiency is most likely?
A. Folate
B. Niacin
C. Thiamine
D. Vitamin B6
Correct Answer: C
Rationale: Thiamine deficiency causes Wernicke encephalopathy, classically presenting with
confusion, ophthalmoplegia, and ataxia.
8. A newborn has severe jaundice, hypotonia, and kernicterus after hemolysis. Which bilirubin
fraction is most likely elevated?
A. Conjugated bilirubin
B. Unconjugated bilirubin
C. Delta bilirubin only
D. Urinary bilirubin
Correct Answer: B
Rationale: Hemolysis increases production of unconjugated bilirubin, which is lipid-soluble and can
cross the blood-brain barrier in severe neonatal hyperbilirubinemia.
9. A 30-year-old has episodic flank pain radiating to the groin and hematuria. CT shows a small
radiopaque stone. Which stone is most likely?
A. Uric acid
, B. Cystine
C. Calcium oxalate
D. Struvite
Correct Answer: C
Rationale: Calcium oxalate stones are the most common renal calculi and are radiopaque.
10. A patient has weakness, hyperpigmentation, hypotension, hyponatremia, and hyperkalemia.
Which hormone deficiency best explains the findings?
A. Cortisol only
B. Aldosterone only
C. Cortisol and aldosterone
D. Growth hormone
Correct Answer: C
Rationale: Primary adrenal insufficiency causes deficient cortisol and aldosterone. Aldosterone loss
causes hyperkalemia and volume depletion.
11. A 58-year-old has crushing substernal chest pain and ST elevations in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main coronary artery
Correct Answer: B
Rationale: Inferior-wall myocardial infarction produces ST elevation in II, III, and aVF and is most
commonly due to right coronary artery occlusion.
12. A patient with nephrotic syndrome develops a renal vein thrombosis. Loss of which plasma
protein most contributes to the hypercoagulable state?
A. Albumin
B. Antithrombin III
C. Fibrinogen
D. Factor VIII
Correct Answer: B
Rationale: Nephrotic syndrome causes urinary loss of anticoagulant proteins including antithrombin
III, increasing thrombotic risk.
13. A 19-year-old has fever, migratory polyarthritis, and a new murmur several weeks after untreated
pharyngitis. Which mechanism is responsible?
A. Direct bacterial invasion of valves
B. Immune cross-reactivity against host tissues
C. Endotoxin-mediated shock
D. IgE-mediated mast-cell activation
Correct Answer: B
Rationale: Acute rheumatic fever follows group A streptococcal pharyngitis because immune
responses cross-react with host tissues.
, 14. A patient taking warfarin develops a markedly elevated INR. Which coagulation factor has the
longest half-life and is therefore least rapidly affected when therapy begins?
A. Factor II
B. Factor VII
C. Factor IX
D. Factor X
Correct Answer: A
Rationale: Factor II has the longest half-life among the vitamin K-dependent factors, so its activity
declines relatively slowly after warfarin begins.
15. A 70-year-old with atrial fibrillation has sudden severe abdominal pain out of proportion to
examination findings. Which diagnosis is most likely?
A. Diverticulitis
B. Mesenteric ischemia
C. Pancreatitis
D. Peptic ulcer disease
Correct Answer: B
Rationale: Atrial fibrillation can produce arterial emboli to the mesenteric circulation, causing acute
mesenteric ischemia with pain out of proportion to early examination.
16. A patient has proximal muscle weakness, hypertension, hypokalemia, and metabolic alkalosis.
Which hormone excess is most likely?
A. Cortisol
B. Insulin
C. Parathyroid hormone
D. Prolactin
Correct Answer: A
Rationale: Excess cortisol can activate mineralocorticoid receptors at high concentrations,
producing hypertension, hypokalemia, and metabolic alkalosis.
17. A 28-year-old has a painless testicular mass. Serum AFP is elevated. Which tumor is most likely?
A. Seminoma
B. Embryonal carcinoma
C. Choriocarcinoma
D. Leydig-cell tumor
Correct Answer: B
Rationale: Nonseminomatous germ-cell tumors, including embryonal carcinoma, can elevate AFP.
Pure seminoma does not.
18. A patient has a malar rash, photosensitivity, arthritis, and proteinuria. Which autoantibody is
most specific for the underlying disease?
A. Anti-centromere
B. Anti-dsDNA
C. Anti-histone
D. Anti-CCP
Correct Answer: B
EXAM 2026/2027 COMPLETE ACCURATE EXAM APPROVED QUESTIONS
WITH WELL ELABORATED ANSWERS AND RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) NEWEST UPDATED VERSION 2026 EDITION
|GUARANTEED
1. A 22-year-old develops episodic wheezing, cough, and chest tightness after exposure to cat
dander. Spirometry shows reversible airflow obstruction. Which mediator is most responsible for the
early bronchoconstrictive response?
A. Histamine
B. Leukotriene C4
C. Prostaglandin E2
D. Bradykinin
Correct Answer: B
Rationale: Cysteinyl leukotrienes released by mast cells cause potent bronchoconstriction and
increased mucus production in allergic asthma.
2. A patient with diabetic ketoacidosis has Kussmaul respirations. Which physiologic change most
directly stimulates the increased ventilation?
A. Increased arterial bicarbonate
B. Increased CSF pH
C. Increased arterial hydrogen ion concentration
D. Decreased carotid-body perfusion
Correct Answer: C
Rationale: Metabolic acidosis increases hydrogen ion concentration; peripheral chemoreceptors
detect the fall in arterial pH and increase ventilation to lower PaCO2.
3. A 45-year-old with hypertension begins an ACE inhibitor and develops a persistent dry cough.
Which substance accumulates and contributes to this adverse effect?
A. Angiotensin II
B. Bradykinin
C. Aldosterone
D. Renin
Correct Answer: B
Rationale: ACE normally degrades bradykinin. ACE inhibition increases bradykinin, which can
produce cough and, rarely, angioedema.
4. A 7-year-old has fever, sore throat, tender anterior cervical nodes, and tonsillar exudates without
cough. Which organism is most likely?
A. Corynebacterium diphtheriae
B. Epstein-Barr virus
C. Group A Streptococcus
D. Fusobacterium necrophorum
,Correct Answer: C
Rationale: Group A Streptococcus commonly causes acute pharyngitis with fever, tonsillar
exudates, and tender anterior cervical adenopathy without cough.
5. A patient has ptosis, diplopia, and fatigable weakness that worsens late in the day. Which
structure is primarily affected?
A. Presynaptic voltage-gated calcium channels
B. Postsynaptic nicotinic acetylcholine receptors
C. Peripheral myelin
D. Muscle ryanodine receptors
Correct Answer: B
Rationale: Myasthenia gravis is caused by antibodies against postsynaptic nicotinic acetylcholine
receptors, producing fluctuating skeletal-muscle weakness.
6. A 64-year-old suddenly develops right facial droop and right arm weakness. Speech is nonfluent,
but comprehension is preserved. Which cortical region is most likely affected?
A. Dominant inferior frontal gyrus
B. Dominant posterior temporal gyrus
C. Nondominant parietal cortex
D. Hippocampus
Correct Answer: A
Rationale: Broca aphasia is a nonfluent expressive aphasia with relatively preserved comprehension
and localizes to the dominant inferior frontal gyrus.
7. A patient with chronic alcoholism develops confusion, ophthalmoplegia, and gait ataxia. Which
deficiency is most likely?
A. Folate
B. Niacin
C. Thiamine
D. Vitamin B6
Correct Answer: C
Rationale: Thiamine deficiency causes Wernicke encephalopathy, classically presenting with
confusion, ophthalmoplegia, and ataxia.
8. A newborn has severe jaundice, hypotonia, and kernicterus after hemolysis. Which bilirubin
fraction is most likely elevated?
A. Conjugated bilirubin
B. Unconjugated bilirubin
C. Delta bilirubin only
D. Urinary bilirubin
Correct Answer: B
Rationale: Hemolysis increases production of unconjugated bilirubin, which is lipid-soluble and can
cross the blood-brain barrier in severe neonatal hyperbilirubinemia.
9. A 30-year-old has episodic flank pain radiating to the groin and hematuria. CT shows a small
radiopaque stone. Which stone is most likely?
A. Uric acid
, B. Cystine
C. Calcium oxalate
D. Struvite
Correct Answer: C
Rationale: Calcium oxalate stones are the most common renal calculi and are radiopaque.
10. A patient has weakness, hyperpigmentation, hypotension, hyponatremia, and hyperkalemia.
Which hormone deficiency best explains the findings?
A. Cortisol only
B. Aldosterone only
C. Cortisol and aldosterone
D. Growth hormone
Correct Answer: C
Rationale: Primary adrenal insufficiency causes deficient cortisol and aldosterone. Aldosterone loss
causes hyperkalemia and volume depletion.
11. A 58-year-old has crushing substernal chest pain and ST elevations in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main coronary artery
Correct Answer: B
Rationale: Inferior-wall myocardial infarction produces ST elevation in II, III, and aVF and is most
commonly due to right coronary artery occlusion.
12. A patient with nephrotic syndrome develops a renal vein thrombosis. Loss of which plasma
protein most contributes to the hypercoagulable state?
A. Albumin
B. Antithrombin III
C. Fibrinogen
D. Factor VIII
Correct Answer: B
Rationale: Nephrotic syndrome causes urinary loss of anticoagulant proteins including antithrombin
III, increasing thrombotic risk.
13. A 19-year-old has fever, migratory polyarthritis, and a new murmur several weeks after untreated
pharyngitis. Which mechanism is responsible?
A. Direct bacterial invasion of valves
B. Immune cross-reactivity against host tissues
C. Endotoxin-mediated shock
D. IgE-mediated mast-cell activation
Correct Answer: B
Rationale: Acute rheumatic fever follows group A streptococcal pharyngitis because immune
responses cross-react with host tissues.
, 14. A patient taking warfarin develops a markedly elevated INR. Which coagulation factor has the
longest half-life and is therefore least rapidly affected when therapy begins?
A. Factor II
B. Factor VII
C. Factor IX
D. Factor X
Correct Answer: A
Rationale: Factor II has the longest half-life among the vitamin K-dependent factors, so its activity
declines relatively slowly after warfarin begins.
15. A 70-year-old with atrial fibrillation has sudden severe abdominal pain out of proportion to
examination findings. Which diagnosis is most likely?
A. Diverticulitis
B. Mesenteric ischemia
C. Pancreatitis
D. Peptic ulcer disease
Correct Answer: B
Rationale: Atrial fibrillation can produce arterial emboli to the mesenteric circulation, causing acute
mesenteric ischemia with pain out of proportion to early examination.
16. A patient has proximal muscle weakness, hypertension, hypokalemia, and metabolic alkalosis.
Which hormone excess is most likely?
A. Cortisol
B. Insulin
C. Parathyroid hormone
D. Prolactin
Correct Answer: A
Rationale: Excess cortisol can activate mineralocorticoid receptors at high concentrations,
producing hypertension, hypokalemia, and metabolic alkalosis.
17. A 28-year-old has a painless testicular mass. Serum AFP is elevated. Which tumor is most likely?
A. Seminoma
B. Embryonal carcinoma
C. Choriocarcinoma
D. Leydig-cell tumor
Correct Answer: B
Rationale: Nonseminomatous germ-cell tumors, including embryonal carcinoma, can elevate AFP.
Pure seminoma does not.
18. A patient has a malar rash, photosensitivity, arthritis, and proteinuria. Which autoantibody is
most specific for the underlying disease?
A. Anti-centromere
B. Anti-dsDNA
C. Anti-histone
D. Anti-CCP
Correct Answer: B
