COMSAE Comprehensive Midterm
Assessment Form CMA 107 Exam Practice
Questions & [Verified Answers], Plus
Explained Rationales|2026 Latest Update|
Instant Download PDF
1. A 24-year-old woman presents with fatigue, pallor, and
paresthesias of the feet. She follows a strict vegan diet.
Laboratory studies show hemoglobin 8.9 g/dL, MCV 115 fL,
elevated methylmalonic acid, and hypersegmented neutrophils.
Which of the following is the most likely cause of her anemia?
A. Iron deficiency
B. Folate deficiency
C. Vitamin B12 deficiency
D. Sideroblastic anemia
E. Anemia of chronic disease
Answer: C. Vitamin B12 deficiency
Rationale: Vitamin B12 deficiency causes megaloblastic anemia
characterized by macrocytosis, hypersegmented neutrophils, elevated
methylmalonic acid, and neurologic symptoms such as paresthesias.
Folate deficiency causes megaloblastic anemia but does not elevate
methylmalonic acid or produce neurologic deficits.
2. A 68-year-old man suddenly develops right-sided weakness and
aphasia. CT scan shows no hemorrhage. Symptoms began 90
minutes ago. Blood pressure is 160/90 mmHg. What is the most
appropriate management?
,A. Aspirin only
B. Intravenous heparin
C. Tissue plasminogen activator
D. Warfarin
E. Carotid endarterectomy
Answer: C. Tissue plasminogen activator
Rationale: The patient has an acute ischemic stroke within the
treatment window for thrombolysis. In the absence of contraindications,
intravenous tPA is indicated within 4.5 hours of symptom onset to
restore cerebral perfusion.
3. A newborn develops vomiting, lethargy, hepatomegaly, and
jaundice after initiation of breastfeeding. Urine is positive for
reducing substances. Which enzyme deficiency is most likely?
A. Galactokinase
B. Galactose-1-phosphate uridyltransferase
C. Fructokinase
D. Aldolase B
E. Pyruvate kinase
Answer: B. Galactose-1-phosphate uridyltransferase
Rationale: Classic galactosemia results from deficiency of galactose-1-
phosphate uridyltransferase. Infants develop vomiting, jaundice,
hepatomegaly, cataracts, and failure to thrive after ingesting milk
products.
4. A patient with peptic ulcer disease is treated with a drug that
irreversibly inhibits H+/K+ ATPase in gastric parietal cells. Which
drug was prescribed?
,A. Famotidine
B. Omeprazole
C. Sucralfate
D. Calcium carbonate
E. Misoprostol
Answer: B. Omeprazole
Rationale: Proton pump inhibitors irreversibly inhibit the H+/K+ ATPase
proton pump, producing profound suppression of gastric acid secretion
and promoting ulcer healing.
5. A 32-year-old woman presents with tremor, heat intolerance,
weight loss, and exophthalmos. Which antibody is responsible for
her condition?
A. Anti-thyroglobulin
B. Anti-thyroid peroxidase
C. TSH receptor stimulating antibody
D. Anti-mitochondrial antibody
E. Anti-centromere antibody
Answer: C. TSH receptor stimulating antibody
Rationale: Graves disease is caused by IgG antibodies that stimulate
TSH receptors, resulting in increased thyroid hormone production and
diffuse thyroid enlargement.
6. A patient develops nephrotic syndrome. Electron microscopy
demonstrates diffuse effacement of podocyte foot processes
without immune deposits. Which disease is most likely?
A. Membranous nephropathy
B. Focal segmental glomerulosclerosis
C. Minimal change disease
, D. Diabetic nephropathy
E. IgA nephropathy
Answer: C. Minimal change disease
Rationale: Minimal change disease is characterized by selective
albuminuria and diffuse podocyte foot process effacement visible on
electron microscopy with normal light microscopy findings.
7. A 56-year-old alcoholic develops confusion, ophthalmoplegia, and
ataxia. Which vitamin deficiency is responsible?
A. Vitamin A
B. Thiamine
C. Niacin
D. Riboflavin
E. Vitamin K
Answer: B. Thiamine
Rationale: Wernicke encephalopathy results from thiamine deficiency
and presents with the classic triad of confusion, ophthalmoplegia, and
ataxia. Immediate thiamine administration is required.
8. A patient develops fever and a new holosystolic murmur after
intravenous drug use. Echocardiography reveals tricuspid
vegetations. Which organism is most likely?
A. Viridans streptococci
B. Enterococcus faecalis
C. Staphylococcus aureus
D. Streptococcus bovis
E. HACEK organisms
Answer: C. Staphylococcus aureus
Assessment Form CMA 107 Exam Practice
Questions & [Verified Answers], Plus
Explained Rationales|2026 Latest Update|
Instant Download PDF
1. A 24-year-old woman presents with fatigue, pallor, and
paresthesias of the feet. She follows a strict vegan diet.
Laboratory studies show hemoglobin 8.9 g/dL, MCV 115 fL,
elevated methylmalonic acid, and hypersegmented neutrophils.
Which of the following is the most likely cause of her anemia?
A. Iron deficiency
B. Folate deficiency
C. Vitamin B12 deficiency
D. Sideroblastic anemia
E. Anemia of chronic disease
Answer: C. Vitamin B12 deficiency
Rationale: Vitamin B12 deficiency causes megaloblastic anemia
characterized by macrocytosis, hypersegmented neutrophils, elevated
methylmalonic acid, and neurologic symptoms such as paresthesias.
Folate deficiency causes megaloblastic anemia but does not elevate
methylmalonic acid or produce neurologic deficits.
2. A 68-year-old man suddenly develops right-sided weakness and
aphasia. CT scan shows no hemorrhage. Symptoms began 90
minutes ago. Blood pressure is 160/90 mmHg. What is the most
appropriate management?
,A. Aspirin only
B. Intravenous heparin
C. Tissue plasminogen activator
D. Warfarin
E. Carotid endarterectomy
Answer: C. Tissue plasminogen activator
Rationale: The patient has an acute ischemic stroke within the
treatment window for thrombolysis. In the absence of contraindications,
intravenous tPA is indicated within 4.5 hours of symptom onset to
restore cerebral perfusion.
3. A newborn develops vomiting, lethargy, hepatomegaly, and
jaundice after initiation of breastfeeding. Urine is positive for
reducing substances. Which enzyme deficiency is most likely?
A. Galactokinase
B. Galactose-1-phosphate uridyltransferase
C. Fructokinase
D. Aldolase B
E. Pyruvate kinase
Answer: B. Galactose-1-phosphate uridyltransferase
Rationale: Classic galactosemia results from deficiency of galactose-1-
phosphate uridyltransferase. Infants develop vomiting, jaundice,
hepatomegaly, cataracts, and failure to thrive after ingesting milk
products.
4. A patient with peptic ulcer disease is treated with a drug that
irreversibly inhibits H+/K+ ATPase in gastric parietal cells. Which
drug was prescribed?
,A. Famotidine
B. Omeprazole
C. Sucralfate
D. Calcium carbonate
E. Misoprostol
Answer: B. Omeprazole
Rationale: Proton pump inhibitors irreversibly inhibit the H+/K+ ATPase
proton pump, producing profound suppression of gastric acid secretion
and promoting ulcer healing.
5. A 32-year-old woman presents with tremor, heat intolerance,
weight loss, and exophthalmos. Which antibody is responsible for
her condition?
A. Anti-thyroglobulin
B. Anti-thyroid peroxidase
C. TSH receptor stimulating antibody
D. Anti-mitochondrial antibody
E. Anti-centromere antibody
Answer: C. TSH receptor stimulating antibody
Rationale: Graves disease is caused by IgG antibodies that stimulate
TSH receptors, resulting in increased thyroid hormone production and
diffuse thyroid enlargement.
6. A patient develops nephrotic syndrome. Electron microscopy
demonstrates diffuse effacement of podocyte foot processes
without immune deposits. Which disease is most likely?
A. Membranous nephropathy
B. Focal segmental glomerulosclerosis
C. Minimal change disease
, D. Diabetic nephropathy
E. IgA nephropathy
Answer: C. Minimal change disease
Rationale: Minimal change disease is characterized by selective
albuminuria and diffuse podocyte foot process effacement visible on
electron microscopy with normal light microscopy findings.
7. A 56-year-old alcoholic develops confusion, ophthalmoplegia, and
ataxia. Which vitamin deficiency is responsible?
A. Vitamin A
B. Thiamine
C. Niacin
D. Riboflavin
E. Vitamin K
Answer: B. Thiamine
Rationale: Wernicke encephalopathy results from thiamine deficiency
and presents with the classic triad of confusion, ophthalmoplegia, and
ataxia. Immediate thiamine administration is required.
8. A patient develops fever and a new holosystolic murmur after
intravenous drug use. Echocardiography reveals tricuspid
vegetations. Which organism is most likely?
A. Viridans streptococci
B. Enterococcus faecalis
C. Staphylococcus aureus
D. Streptococcus bovis
E. HACEK organisms
Answer: C. Staphylococcus aureus
