INTERNAL MEDICINE COMAT EXAM /
ACTUAL COMAT INTERNAL MEDICINE
EXAM TEST BANK Practice Exam 2026|
Most Tested Questions Collection &
Verified Detailed Answers | Tutor Verified
Success Exam) Graded A+
1. A 67-year-old man has substernal chest pressure for 45
minutes with diaphoresis. ECG shows ST elevations in leads II,
III, and aVF. What is the most appropriate next step?
A. Exercise stress test
B. IV adenosine
C. Emergent coronary reperfusion
D. Observation and serial ECGs
E. Oral aspirin only
Answer: C. Emergent coronary reperfusion
ST elevation in II, III, and aVF indicates an acute inferior
STEMI. Immediate reperfusion with PCI is preferred when
available promptly.
2. A patient with an inferior STEMI becomes hypotensive. JVP
is elevated, but lungs are clear. Which complication is most
likely?
A. Left ventricular failure
B. Right ventricular infarction
C. Papillary muscle rupture
,D. Ventricular septal rupture
E. Pericarditis
Answer: B. Right ventricular infarction
Right ventricular infarction causes hypotension, elevated JVP,
and clear lungs. These patients are preload dependent.
3. A 72-year-old woman has dyspnea, orthopnea, pulmonary
crackles, and bilateral leg edema. BNP is elevated. Which
medication provides rapid symptomatic relief of pulmonary
congestion?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Spironolactone
E. Digoxin
Answer: A. Furosemide
Loop diuretics rapidly reduce volume overload and relieve
congestion in acute decompensated heart failure.
4. Which finding is most characteristic of aortic stenosis?
A. Holosystolic murmur at the apex
B. Early diastolic murmur
C. Harsh crescendo-decrescendo systolic murmur radiating to
the carotids
D. Continuous machinery murmur
E. Opening snap
Answer: C. Harsh crescendo-decrescendo systolic murmur
radiating to the carotids
,Aortic stenosis produces a systolic ejection murmur that
typically radiates to the carotid arteries.
5. A patient with atrial fibrillation has a ventricular rate of
160/min and BP 75/45 mm Hg. What is the immediate
treatment?
A. Oral metoprolol
B. IV heparin only
C. Synchronized cardioversion
D. Oral amiodarone
E. Vagal maneuvers
Answer: C. Synchronized cardioversion
Hemodynamic instability caused by atrial fibrillation requires
immediate synchronized cardioversion.
6. A patient with stable atrial fibrillation needs ventricular
rate control. Which medication is appropriate?
A. Adenosine
B. Metoprolol
C. Atropine
D. Lidocaine
E. Magnesium sulfate
Answer: B. Metoprolol
Beta blockers are commonly used for ventricular rate control
in stable atrial fibrillation.
7. A 60-year-old man has exertional chest pain relieved by
rest. ECG is normal at rest. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
, C. Acute pericarditis
D. Aortic dissection
E. Pulmonary embolism
Answer: B. Stable angina
Predictable exertional chest pain relieved by rest is
characteristic of stable angina.
8. Which ECG finding is most characteristic of hyperkalemia?
A. U waves
B. Prolonged QT interval
C. Peaked T waves
D. Delta waves
E. ST elevation
Answer: C. Peaked T waves
Early hyperkalemia commonly produces tall, peaked T waves.
9. A patient develops hypotension, muffled heart sounds,
and jugular venous distention after a penetrating chest
injury. What is the diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Pulmonary embolism
D. Myocardial infarction
E. Aortic dissection
Answer: B. Cardiac tamponade
Hypotension, JVD, and muffled heart sounds constitute Beck
triad of cardiac tamponade.
ACTUAL COMAT INTERNAL MEDICINE
EXAM TEST BANK Practice Exam 2026|
Most Tested Questions Collection &
Verified Detailed Answers | Tutor Verified
Success Exam) Graded A+
1. A 67-year-old man has substernal chest pressure for 45
minutes with diaphoresis. ECG shows ST elevations in leads II,
III, and aVF. What is the most appropriate next step?
A. Exercise stress test
B. IV adenosine
C. Emergent coronary reperfusion
D. Observation and serial ECGs
E. Oral aspirin only
Answer: C. Emergent coronary reperfusion
ST elevation in II, III, and aVF indicates an acute inferior
STEMI. Immediate reperfusion with PCI is preferred when
available promptly.
2. A patient with an inferior STEMI becomes hypotensive. JVP
is elevated, but lungs are clear. Which complication is most
likely?
A. Left ventricular failure
B. Right ventricular infarction
C. Papillary muscle rupture
,D. Ventricular septal rupture
E. Pericarditis
Answer: B. Right ventricular infarction
Right ventricular infarction causes hypotension, elevated JVP,
and clear lungs. These patients are preload dependent.
3. A 72-year-old woman has dyspnea, orthopnea, pulmonary
crackles, and bilateral leg edema. BNP is elevated. Which
medication provides rapid symptomatic relief of pulmonary
congestion?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Spironolactone
E. Digoxin
Answer: A. Furosemide
Loop diuretics rapidly reduce volume overload and relieve
congestion in acute decompensated heart failure.
4. Which finding is most characteristic of aortic stenosis?
A. Holosystolic murmur at the apex
B. Early diastolic murmur
C. Harsh crescendo-decrescendo systolic murmur radiating to
the carotids
D. Continuous machinery murmur
E. Opening snap
Answer: C. Harsh crescendo-decrescendo systolic murmur
radiating to the carotids
,Aortic stenosis produces a systolic ejection murmur that
typically radiates to the carotid arteries.
5. A patient with atrial fibrillation has a ventricular rate of
160/min and BP 75/45 mm Hg. What is the immediate
treatment?
A. Oral metoprolol
B. IV heparin only
C. Synchronized cardioversion
D. Oral amiodarone
E. Vagal maneuvers
Answer: C. Synchronized cardioversion
Hemodynamic instability caused by atrial fibrillation requires
immediate synchronized cardioversion.
6. A patient with stable atrial fibrillation needs ventricular
rate control. Which medication is appropriate?
A. Adenosine
B. Metoprolol
C. Atropine
D. Lidocaine
E. Magnesium sulfate
Answer: B. Metoprolol
Beta blockers are commonly used for ventricular rate control
in stable atrial fibrillation.
7. A 60-year-old man has exertional chest pain relieved by
rest. ECG is normal at rest. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
, C. Acute pericarditis
D. Aortic dissection
E. Pulmonary embolism
Answer: B. Stable angina
Predictable exertional chest pain relieved by rest is
characteristic of stable angina.
8. Which ECG finding is most characteristic of hyperkalemia?
A. U waves
B. Prolonged QT interval
C. Peaked T waves
D. Delta waves
E. ST elevation
Answer: C. Peaked T waves
Early hyperkalemia commonly produces tall, peaked T waves.
9. A patient develops hypotension, muffled heart sounds,
and jugular venous distention after a penetrating chest
injury. What is the diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Pulmonary embolism
D. Myocardial infarction
E. Aortic dissection
Answer: B. Cardiac tamponade
Hypotension, JVD, and muffled heart sounds constitute Beck
triad of cardiac tamponade.
