ALL COMSAE ACTUAL EXAM 150 QUESTIONS AND
CORRECT ANSWERS WITH EXPLANATIONS 2025-
2026 LATEST MOST QUESTIONS COVERED
GRADED A+
✅ A 22-year-old woman presents to the office for evaluation of malaise and
easy bruising. She also reports increased menses over the past 2 months.
Review of records reveals a hospital admission 6 months ago secondary to
viral pneumonia. Physical examination findings are normal. Laboratory study
results are normal except for a platelet count of 45 × 103/mcL (reference range:
150-450 × 103/mcL). The most likely diagnosis is
A. factor VII deficiency
B. IgA vasculitis (Henoch-Schönlein purpura)
C. idiopathic thrombocytopenic purpura
D. thrombotic thrombocytopenic purpura
E. von Willebrand disease
C. IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)
An acquired form of a low platelet count secondary to antibody formation against
GpIIb/IIIa on platelets, without any perturbation of the structure or function of WBCs,
RBCs, or coagulation factors (i.e., isolated thrombocytopenia). It is a diagnosis of
exclusion without specific clinical or laboratory parameters
.
✅ A 21-year-old woman presents to the office with a 6-month history of
increasing low back pain. She reports that she competes as a figure skater,
and the pain began following a bad landing. She describes the pain as achy
and localized to the lumbosacral junction. A radiograph of the spine taken 1
month ago reveals the findings shown in the exhibit. Neurologic examination
findings are normal, with no focal motor deficits. Structural examination
reveals increased tone in the lumbar paravertebral muscles with midline
tenderness in the lumbosacral area. Which of the following injuries did this
patient most likely sustain?
A. acute L3 flexion somatic dysfunction
B .acute right unilateral sacral flexion
C. fracture of the L5 pars interarticularis
D. L5 vertebral compression fracture
E. muscle strain of the quadratus lumborum
C. FRACTURE OF THE L5 PARS INTERARTICULARIS
✅ A male neonate is evaluated in the labor and delivery room immediately
after delivery for tachypnea and room air hypoxia. The patient was delivered
via cesarean section due to fetal tachycardia and non-reassuring fetal heart
tones. The mother had limited prenatal care. Vital signs reveal a respiratory
rate of 80-100/min. Physical examination reveals intercostal and subcostal
retractions and nasal flaring. The abdomen appears scaphoid. Chest
auscultation reveals decreased lung sounds on the left and a right shift of
,heart sounds. The most appropriate diagnostic test is
A. arterial blood gas analysis
B. chest radiography
C. echocardiography
D. fluoroscopy
E. oxygen challenge test
B. CHEST RADIOGRAPHY
The clinical scenario describes a neonate w/respiratory distress immediately after
birth, w/ signs including tachypnea, nasal flaring, intercostal and subcostal
retractions, decreased lung sounds on the left, and a rightward shift of the heart
sounds. The scaphoid abdomen is particularly concerning for congenital
diaphragmatic hernia (CDH), a condition where abdominal contents herniate into
the chest, leading to lung hypoplasia and displacement of
the heart and mediastinum.
Chest radiography is the most appropriate diagnostic test to confirm the diagnosis by
visualizing the herniated abdominal organs within the chest cavity. Other options,
such as arterial blood gas analysis or echocardiography, do not provide the
immediate anatomical information needed in this scenario.
A 53-year-old man is brought to the office by a staff member from the group
home where he has resided for the past 4 years. The staff member reports that
the patient has a 1-year history of gradually worsening mouth and tongue
movements. The movements are not apparent when he is sleeping. Past
medical history reveals chronic schizophrenia, which has been treated with
long-acting injectable antipsychotics for approximately 25 years. He has no
other known neurologic history. His only current medication is fluphenazine
decanoate. Physical examination reveals thrusting movements of the tongue
to the left and frequent grimacing that can be partially controlled by the patient
but is exacerbated when he is distracted. The most appropriate treatment is to
slowly taper fluphenazine and start
A. carbidopa-levodopa
B. clozapine
C. dantrolene
D. phenytoin
E. tizanidine
B. CLOZAPINE
An atypical antipsychotic mainly used for treatment-resistant schizophrenia that
has a ↓ risk of extrapyramidal symptoms compared to typical antipsychotics. Its most
dangerous adverse effect is life-threatening agranulocytosis; as a result, frequent
blood testing is required after initiating treatment.
A 28-year-old man presents to the office with a 14-day history of sore throat,
foul taste in his mouth, and heartburn. Past medical history reveals hemophilia
and a transfusion reaction 15 years ago. The patient's temperature is 36.9°C
(98.4°F). Physical examination reveals cervical lymphadenopathy and thick
white exudate on the oropharynx and tongue. Scraping of the exudate causes
punctate mucosal bleeding. This patient's pharyngeal exudate is most likely
,due to
A. bacterial pharyngitis
B. oral and esophageal candidiasis
C. premalignant oral leukoplakia
D. squamous cell carcinoma of the pharynx
E. viral pharyngitis
B. oral & esophageal candidiasis
The patient presents with a sore throat, foul taste in the mouth, and heartburn,
accompanied by cervical lymphadenopathy and thick white exudate on the
oropharynx and tongue. The exudate causes punctate mucosal bleeding when
scraped, which is highly suggestive of oral candidiasis (thrush), particularly in an
immunocompromised individual or someone with a disrupted oral environment, such
as after antibiotic use or with chronic disease.
Oral candidiasis is a fungal infection caused by Candida species, most commonly
Candida albicans. The key features include the white patches that can be scraped
off, often leaving a raw, bleeding surface beneath. The association with the patient's
symptoms and clinical findings makes candidiasis the most likely diagnosis.
A 22-year-old primigravid woman at 13 weeks' gestation presents to the office
for her first prenatal examination. She reports experiencing vaginal discharge
for the past 3 days. On questioning, she says that she has had 3 different
sexual partners in the past month. She reports no history of sexually
transmitted infections. Pelvic examination reveals a uterus compatible with
dates, slight tenderness to palpation, and no adnexal masses. Further
examination reveals thin, white, malodorous discharge, which is found to have
a pH of 5.5. Microscopic examination reveals epithelial cells covered with short
coccobacillus-type bacteria. What is this patient at the greatest risk of
developing?
a. abruptio placentae
b. future ectopic pregnancy
c. gestational diabetes
d. gestational hypertension
e. preterm labor
E. preterm labor
The patient described has findings consistent with bacterial vaginosis (BV), as
indicated by the thin, white, malodorous discharge, a vaginal pH of 5.5, and the
presence of clue cells (epithelial cells covered with coccobacillus-type bacteria) on
microscopy. Bacterial vaginosis during pregnancy is associated with an increased
risk of preterm labor and delivery. Therefore, the patient is at the greatest risk of
developing preterm labor.
Gestational diabetes (option C) is not directly associated with BV, making preterm
labor the more appropriate choice.
An 18-year-old man is brought to the emergency department by EMS after he
was involved in a high-speed motor vehicle collision, during which he struck
his chest on the steering wheel. He is now experiencing shortness of breath.
, On arrival, he is awake and reports severe chest pain. He appears to be in
significant distress.
Vital signs reveal:
BP= 86/50 mmHg, HR= 130/min, RR= 30/min, Oxygen saturation= 80% on room
air
P.E. reveals:
- Distended neck veins
- Midline trachea
- Bruising on the left chest wall with pain on palpation but no obvious
crepitation
- Hyperresonance of the left chest on percussion
- Normal lung sounds on the right
- Significantly diminished lung sounds on the left
- Significant left upper quadrant abdominal tenderness
Which of the following is the most appropriate initial intervention?
a. endotracheal intubation
b. needle decompression
c. normal saline bolus
d. pericardiocentesis
e. thoracotomy
B. NEEDLE DECOMPRESSION
This patient presents with signs and symptoms indicative of a tension
pneumothorax, which is a medical emergency. The findings of distended neck
veins, hyperresonance on the left side of the chest, diminished lung sounds on the
left, and severe respiratory distress with hypotension are all classic
signs. Immediate needle decompression is the correct initial intervention to relieve
the pressure in the pleural space, allowing the lung to re-expand and improving the
patient's hemodynamics and respiratory status.
A 48y.o. woman presents to ED w/a 12-hour hx of upper abdominal pain that
began suddenly. She reports nausea & vomiting for past 4 hrs. She describes
the pain as sharp, achy, constant, & worsening. She says pain is worse when
she moves or takes a deep breath. Past med hx reveals peptic ulcer dz, for
which she takes famotidine.
Temp= 37.3°C (99.2°F), BP= 150/90 mmHg, HR= 110/min, RR= 20/min, O2 sat=
98% room air
P.E. reveals distended abdomen w/marked diffuse tenderness, hypoactive
bowel sounds, & no organomegaly. A radiograph of chest & abdomen is
obtained, as shown in the exhibit. The most appropriate next step for this pt is
to
A. administer a 2-L bolus of crystalloid solution
B. order a CT scan of the abdomen & pelvis with contrast
C. obtain an immediate surgical consultation & prepare pt for surgery
D. order a type and crossmatch for 6 units of packed red blood cells
E. order an emergency upper & lower endoscopy
C. obtain an immediate surgical consultation & prepare pt for surgery
The patient's history of sudden onset upper abdominal pain, nausea, vomiting, and
worsening symptoms, along with physical examination findings of a distended
abdomen, diffuse tenderness, hypoactive bowel sounds, and absence of
CORRECT ANSWERS WITH EXPLANATIONS 2025-
2026 LATEST MOST QUESTIONS COVERED
GRADED A+
✅ A 22-year-old woman presents to the office for evaluation of malaise and
easy bruising. She also reports increased menses over the past 2 months.
Review of records reveals a hospital admission 6 months ago secondary to
viral pneumonia. Physical examination findings are normal. Laboratory study
results are normal except for a platelet count of 45 × 103/mcL (reference range:
150-450 × 103/mcL). The most likely diagnosis is
A. factor VII deficiency
B. IgA vasculitis (Henoch-Schönlein purpura)
C. idiopathic thrombocytopenic purpura
D. thrombotic thrombocytopenic purpura
E. von Willebrand disease
C. IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)
An acquired form of a low platelet count secondary to antibody formation against
GpIIb/IIIa on platelets, without any perturbation of the structure or function of WBCs,
RBCs, or coagulation factors (i.e., isolated thrombocytopenia). It is a diagnosis of
exclusion without specific clinical or laboratory parameters
.
✅ A 21-year-old woman presents to the office with a 6-month history of
increasing low back pain. She reports that she competes as a figure skater,
and the pain began following a bad landing. She describes the pain as achy
and localized to the lumbosacral junction. A radiograph of the spine taken 1
month ago reveals the findings shown in the exhibit. Neurologic examination
findings are normal, with no focal motor deficits. Structural examination
reveals increased tone in the lumbar paravertebral muscles with midline
tenderness in the lumbosacral area. Which of the following injuries did this
patient most likely sustain?
A. acute L3 flexion somatic dysfunction
B .acute right unilateral sacral flexion
C. fracture of the L5 pars interarticularis
D. L5 vertebral compression fracture
E. muscle strain of the quadratus lumborum
C. FRACTURE OF THE L5 PARS INTERARTICULARIS
✅ A male neonate is evaluated in the labor and delivery room immediately
after delivery for tachypnea and room air hypoxia. The patient was delivered
via cesarean section due to fetal tachycardia and non-reassuring fetal heart
tones. The mother had limited prenatal care. Vital signs reveal a respiratory
rate of 80-100/min. Physical examination reveals intercostal and subcostal
retractions and nasal flaring. The abdomen appears scaphoid. Chest
auscultation reveals decreased lung sounds on the left and a right shift of
,heart sounds. The most appropriate diagnostic test is
A. arterial blood gas analysis
B. chest radiography
C. echocardiography
D. fluoroscopy
E. oxygen challenge test
B. CHEST RADIOGRAPHY
The clinical scenario describes a neonate w/respiratory distress immediately after
birth, w/ signs including tachypnea, nasal flaring, intercostal and subcostal
retractions, decreased lung sounds on the left, and a rightward shift of the heart
sounds. The scaphoid abdomen is particularly concerning for congenital
diaphragmatic hernia (CDH), a condition where abdominal contents herniate into
the chest, leading to lung hypoplasia and displacement of
the heart and mediastinum.
Chest radiography is the most appropriate diagnostic test to confirm the diagnosis by
visualizing the herniated abdominal organs within the chest cavity. Other options,
such as arterial blood gas analysis or echocardiography, do not provide the
immediate anatomical information needed in this scenario.
A 53-year-old man is brought to the office by a staff member from the group
home where he has resided for the past 4 years. The staff member reports that
the patient has a 1-year history of gradually worsening mouth and tongue
movements. The movements are not apparent when he is sleeping. Past
medical history reveals chronic schizophrenia, which has been treated with
long-acting injectable antipsychotics for approximately 25 years. He has no
other known neurologic history. His only current medication is fluphenazine
decanoate. Physical examination reveals thrusting movements of the tongue
to the left and frequent grimacing that can be partially controlled by the patient
but is exacerbated when he is distracted. The most appropriate treatment is to
slowly taper fluphenazine and start
A. carbidopa-levodopa
B. clozapine
C. dantrolene
D. phenytoin
E. tizanidine
B. CLOZAPINE
An atypical antipsychotic mainly used for treatment-resistant schizophrenia that
has a ↓ risk of extrapyramidal symptoms compared to typical antipsychotics. Its most
dangerous adverse effect is life-threatening agranulocytosis; as a result, frequent
blood testing is required after initiating treatment.
A 28-year-old man presents to the office with a 14-day history of sore throat,
foul taste in his mouth, and heartburn. Past medical history reveals hemophilia
and a transfusion reaction 15 years ago. The patient's temperature is 36.9°C
(98.4°F). Physical examination reveals cervical lymphadenopathy and thick
white exudate on the oropharynx and tongue. Scraping of the exudate causes
punctate mucosal bleeding. This patient's pharyngeal exudate is most likely
,due to
A. bacterial pharyngitis
B. oral and esophageal candidiasis
C. premalignant oral leukoplakia
D. squamous cell carcinoma of the pharynx
E. viral pharyngitis
B. oral & esophageal candidiasis
The patient presents with a sore throat, foul taste in the mouth, and heartburn,
accompanied by cervical lymphadenopathy and thick white exudate on the
oropharynx and tongue. The exudate causes punctate mucosal bleeding when
scraped, which is highly suggestive of oral candidiasis (thrush), particularly in an
immunocompromised individual or someone with a disrupted oral environment, such
as after antibiotic use or with chronic disease.
Oral candidiasis is a fungal infection caused by Candida species, most commonly
Candida albicans. The key features include the white patches that can be scraped
off, often leaving a raw, bleeding surface beneath. The association with the patient's
symptoms and clinical findings makes candidiasis the most likely diagnosis.
A 22-year-old primigravid woman at 13 weeks' gestation presents to the office
for her first prenatal examination. She reports experiencing vaginal discharge
for the past 3 days. On questioning, she says that she has had 3 different
sexual partners in the past month. She reports no history of sexually
transmitted infections. Pelvic examination reveals a uterus compatible with
dates, slight tenderness to palpation, and no adnexal masses. Further
examination reveals thin, white, malodorous discharge, which is found to have
a pH of 5.5. Microscopic examination reveals epithelial cells covered with short
coccobacillus-type bacteria. What is this patient at the greatest risk of
developing?
a. abruptio placentae
b. future ectopic pregnancy
c. gestational diabetes
d. gestational hypertension
e. preterm labor
E. preterm labor
The patient described has findings consistent with bacterial vaginosis (BV), as
indicated by the thin, white, malodorous discharge, a vaginal pH of 5.5, and the
presence of clue cells (epithelial cells covered with coccobacillus-type bacteria) on
microscopy. Bacterial vaginosis during pregnancy is associated with an increased
risk of preterm labor and delivery. Therefore, the patient is at the greatest risk of
developing preterm labor.
Gestational diabetes (option C) is not directly associated with BV, making preterm
labor the more appropriate choice.
An 18-year-old man is brought to the emergency department by EMS after he
was involved in a high-speed motor vehicle collision, during which he struck
his chest on the steering wheel. He is now experiencing shortness of breath.
, On arrival, he is awake and reports severe chest pain. He appears to be in
significant distress.
Vital signs reveal:
BP= 86/50 mmHg, HR= 130/min, RR= 30/min, Oxygen saturation= 80% on room
air
P.E. reveals:
- Distended neck veins
- Midline trachea
- Bruising on the left chest wall with pain on palpation but no obvious
crepitation
- Hyperresonance of the left chest on percussion
- Normal lung sounds on the right
- Significantly diminished lung sounds on the left
- Significant left upper quadrant abdominal tenderness
Which of the following is the most appropriate initial intervention?
a. endotracheal intubation
b. needle decompression
c. normal saline bolus
d. pericardiocentesis
e. thoracotomy
B. NEEDLE DECOMPRESSION
This patient presents with signs and symptoms indicative of a tension
pneumothorax, which is a medical emergency. The findings of distended neck
veins, hyperresonance on the left side of the chest, diminished lung sounds on the
left, and severe respiratory distress with hypotension are all classic
signs. Immediate needle decompression is the correct initial intervention to relieve
the pressure in the pleural space, allowing the lung to re-expand and improving the
patient's hemodynamics and respiratory status.
A 48y.o. woman presents to ED w/a 12-hour hx of upper abdominal pain that
began suddenly. She reports nausea & vomiting for past 4 hrs. She describes
the pain as sharp, achy, constant, & worsening. She says pain is worse when
she moves or takes a deep breath. Past med hx reveals peptic ulcer dz, for
which she takes famotidine.
Temp= 37.3°C (99.2°F), BP= 150/90 mmHg, HR= 110/min, RR= 20/min, O2 sat=
98% room air
P.E. reveals distended abdomen w/marked diffuse tenderness, hypoactive
bowel sounds, & no organomegaly. A radiograph of chest & abdomen is
obtained, as shown in the exhibit. The most appropriate next step for this pt is
to
A. administer a 2-L bolus of crystalloid solution
B. order a CT scan of the abdomen & pelvis with contrast
C. obtain an immediate surgical consultation & prepare pt for surgery
D. order a type and crossmatch for 6 units of packed red blood cells
E. order an emergency upper & lower endoscopy
C. obtain an immediate surgical consultation & prepare pt for surgery
The patient's history of sudden onset upper abdominal pain, nausea, vomiting, and
worsening symptoms, along with physical examination findings of a distended
abdomen, diffuse tenderness, hypoactive bowel sounds, and absence of
