ALL THE COMSAE COMPLETE EXAM /
QUESTIONS & VERIFIED SOLUTIONS
2025.
1. A 22-year-old presents with pharyngitis, fever, and tender anterior cervical
lymphadenopathy. The rapid strep test is negative. Next best step?
Answer: Perform a throat culture
Rationale: Rapid strep tests have ~90% sensitivity. A negative result in a
symptomatic patient requires throat culture to rule out Group A
Streptococcus.
2. A 65-year-old with chronic GERD presents with Barrett’s esophagus seen on
endoscopy. Recommended surveillance interval?
Answer: Every 3–5 years
Rationale: Non-dysplastic Barrett’s warrants surveillance endoscopy
every 3–5 years per guidelines.
3. Mechanism of action of heparin?
Answer: Potentiates antithrombin III, inhibiting thrombin and Xa
Rationale: Heparin enhances antithrombin activity, inhibiting factor Xa
and thrombin directly.
4. Which cranial nerve controls lateral rectus muscle?
,Answer: Abducens (VI)
Rationale: Abducens nerve innervates the lateral rectus muscle,
abduction of the eye.
5. A 30-year-old with new-onset hypertension and hearing loss. Suspect
diagnosis?
Answer: Coarctation of the aorta
Rationale: Adult coarctation can present with hypertension and head
murmurs/hearing issues due to collateral flow.
6. Best initial test for suspected hyperthyroidism?
Answer: TSH level
Rationale: TSH is first-line screening: low in primary hyperthyroidism
and evaluates pituitary function.
7. A patient has hemoglobin A1c of 8.2%. Diabetes is managed with metformin.
Next step?
Answer: Add a second oral agent or insulin
Rationale: A1c >7% on monotherapy indicates need for an additional
agent or insulin.
8. Pathogen commonly causing osteomyelitis in sickle cell patients?
Answer: Salmonella
Rationale: Salmonella species are more common causes of osteomyelitis
in sickle cell disease than Staphylococcus.
,9. Initial imaging for suspected pulmonary embolism?
Answer: CT pulmonary angiography
Rationale: CT pulmonary angiogram is preferred for stable patients with
suspected PE.
10. A 50-year-old with sharp, tearing chest pain radiating to the back. Suspected
diagnosis?
Answer: Aortic dissection
Rationale: Classic presentation: tearing chest/back pain—urgent
imaging and management indicated.
11. Drug that directly inhibits platelet aggregation?
Answer: Clopidogrel
Rationale: Clopidogrel inhibits P2Y₁₂ receptor on platelets, blocking ADP-
mediated aggregation.
12. First-line treatment for acute asthma exacerbation?
Answer: Inhaled short-acting β₂-agonist (albuterol)
Rationale: SABAs are first-line for quick relief in acute
bronchoconstriction.
13. 35-year-old with polyuria, polydipsia, normal glucose. Next best test?
Answer: Serum sodium and osmolality
Rationale: To distinguish diabetes insipidus from primary polydipsia and
underlying etiologies.
, 14. Diagnostic test for rheumatoid arthritis?
Answer: Anti-CCP antibody
Rationale: Anti-CCP has high specificity for RA; RF is more sensitive but
less specific.
15. Poisoning treated with atropine and pralidoxime?
Answer: Organophosphate poisoning
Rationale: Organophosphates inhibit acetylcholinesterase—treated
with atropine and oximes.
16. A 70-year-old with new-onset focal neurologic deficit. Most sensitive early
stroke imaging?
Answer: Diffusion-weighted MRI
Rationale: DWI MRI is most sensitive for early ischemic stroke detection.
17. Mechanism of loop diuretics?
Answer: Inhibit Na-K-2Cl in thick ascending loop
Rationale: They block NKCC in LOH, causing increased sodium, chloride,
and water excretion.
18. Broad-spectrum antibiotic safe in pregnancy for UTIs?
Answer: Nitrofurantoin
Rationale: Safe in pregnancy for lower UTIs, except near term due to
risk of neonatal hemolysis.
19. Best initial diagnostic test for suspected Cushing’s syndrome?
QUESTIONS & VERIFIED SOLUTIONS
2025.
1. A 22-year-old presents with pharyngitis, fever, and tender anterior cervical
lymphadenopathy. The rapid strep test is negative. Next best step?
Answer: Perform a throat culture
Rationale: Rapid strep tests have ~90% sensitivity. A negative result in a
symptomatic patient requires throat culture to rule out Group A
Streptococcus.
2. A 65-year-old with chronic GERD presents with Barrett’s esophagus seen on
endoscopy. Recommended surveillance interval?
Answer: Every 3–5 years
Rationale: Non-dysplastic Barrett’s warrants surveillance endoscopy
every 3–5 years per guidelines.
3. Mechanism of action of heparin?
Answer: Potentiates antithrombin III, inhibiting thrombin and Xa
Rationale: Heparin enhances antithrombin activity, inhibiting factor Xa
and thrombin directly.
4. Which cranial nerve controls lateral rectus muscle?
,Answer: Abducens (VI)
Rationale: Abducens nerve innervates the lateral rectus muscle,
abduction of the eye.
5. A 30-year-old with new-onset hypertension and hearing loss. Suspect
diagnosis?
Answer: Coarctation of the aorta
Rationale: Adult coarctation can present with hypertension and head
murmurs/hearing issues due to collateral flow.
6. Best initial test for suspected hyperthyroidism?
Answer: TSH level
Rationale: TSH is first-line screening: low in primary hyperthyroidism
and evaluates pituitary function.
7. A patient has hemoglobin A1c of 8.2%. Diabetes is managed with metformin.
Next step?
Answer: Add a second oral agent or insulin
Rationale: A1c >7% on monotherapy indicates need for an additional
agent or insulin.
8. Pathogen commonly causing osteomyelitis in sickle cell patients?
Answer: Salmonella
Rationale: Salmonella species are more common causes of osteomyelitis
in sickle cell disease than Staphylococcus.
,9. Initial imaging for suspected pulmonary embolism?
Answer: CT pulmonary angiography
Rationale: CT pulmonary angiogram is preferred for stable patients with
suspected PE.
10. A 50-year-old with sharp, tearing chest pain radiating to the back. Suspected
diagnosis?
Answer: Aortic dissection
Rationale: Classic presentation: tearing chest/back pain—urgent
imaging and management indicated.
11. Drug that directly inhibits platelet aggregation?
Answer: Clopidogrel
Rationale: Clopidogrel inhibits P2Y₁₂ receptor on platelets, blocking ADP-
mediated aggregation.
12. First-line treatment for acute asthma exacerbation?
Answer: Inhaled short-acting β₂-agonist (albuterol)
Rationale: SABAs are first-line for quick relief in acute
bronchoconstriction.
13. 35-year-old with polyuria, polydipsia, normal glucose. Next best test?
Answer: Serum sodium and osmolality
Rationale: To distinguish diabetes insipidus from primary polydipsia and
underlying etiologies.
, 14. Diagnostic test for rheumatoid arthritis?
Answer: Anti-CCP antibody
Rationale: Anti-CCP has high specificity for RA; RF is more sensitive but
less specific.
15. Poisoning treated with atropine and pralidoxime?
Answer: Organophosphate poisoning
Rationale: Organophosphates inhibit acetylcholinesterase—treated
with atropine and oximes.
16. A 70-year-old with new-onset focal neurologic deficit. Most sensitive early
stroke imaging?
Answer: Diffusion-weighted MRI
Rationale: DWI MRI is most sensitive for early ischemic stroke detection.
17. Mechanism of loop diuretics?
Answer: Inhibit Na-K-2Cl in thick ascending loop
Rationale: They block NKCC in LOH, causing increased sodium, chloride,
and water excretion.
18. Broad-spectrum antibiotic safe in pregnancy for UTIs?
Answer: Nitrofurantoin
Rationale: Safe in pregnancy for lower UTIs, except near term due to
risk of neonatal hemolysis.
19. Best initial diagnostic test for suspected Cushing’s syndrome?
