COMSAE Phase 2 – Form 109 Actual Exam 2026-2028|
150 Questions with Answers & Rationales | INSTANT
PDF DOWNLOAD
Question 1
A 45-year-old man presents with sudden-onset chest pain radiating to his left
arm. He is diaphoretic and nauseated. ECG shows ST-segment elevation in
leads II, III, and aVF. Which is the most likely diagnosis?
A) Pulmonary embolism
B) Acute inferior myocardial infarction
C) Aortic dissection
D) Pericarditis
Answer: B
Rationale: 👀*** ST elevation in II, III, aVF indicates inferior MI. Symptoms of
chest pain radiating to the arm, diaphoresis, and nausea support this.
Question 2
A 32-year-old woman presents with fatigue, pallor, and heavy menstrual periods.
Labs reveal hemoglobin 9 g/dL and microcytic anemia. The most likely cause is:
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Hemolytic anemia
D) Aplastic anemia
Answer: B
Rationale: 👀*** Microcytic anemia with chronic blood loss (menorrhagia)
suggests iron deficiency.
,Question 3
A 60-year-old man with a history of hypertension presents with sudden severe
headache, neck stiffness, and photophobia. Which is the next best step?
A) MRI of the brain
B) Non-contrast CT of the head
C) Lumbar puncture immediately
D) Start empiric antibiotics
Answer: B
Rationale: 👀*** Sudden severe headache (“thunderclap”) suggests
subarachnoid hemorrhage; non-contrast CT is the initial test. LP is next if CT is
negative.
Question 4
A 28-year-old woman presents with fever, dysuria, and urgency. Urinalysis
shows positive nitrites and leukocyte esterase. The most appropriate initial
therapy is:
A) IV vancomycin
B) Oral trimethoprim-sulfamethoxazole
C) Oral ciprofloxacin
D) Observation only
Answer: B
Rationale: 👀*** Uncomplicated UTI in a non-pregnant woman is treated with
TMP-SMX for 3 days (or nitrofurantoin).
Question 5
A 50-year-old man presents with progressive difficulty swallowing solids more
than liquids, regurgitation of undigested food, and weight loss. Most likely
diagnosis:
,A) GERD
B) Esophageal cancer
C) Achalasia
D) Peptic ulcer disease
Answer: B
Rationale: 👀*** Progressive dysphagia for solids, weight loss, and
regurgitation suggest obstructive pathology like esophageal cancer.
Question 6
A 70-year-old woman presents with resting tremor, bradykinesia, and rigidity.
Which of the following is the most likely diagnosis?
A) Essential tremor
B) Huntington disease
C) Parkinson disease
D) Multiple sclerosis
Answer: C
Rationale: 👀*** Classic Parkinson triad: resting tremor, rigidity, bradykinesia.
Question 7
A 25-year-old male presents with sudden right knee swelling after playing
soccer. Examination shows a large effusion, positive Lachman test, and limited
range of motion. Most likely injury:
A) Meniscal tear
B) Patellar dislocation
C) Anterior cruciate ligament (ACL) tear
D) Medial collateral ligament injury
, Answer: C
Rationale: 👀*** Acute knee injury with effusion and positive Lachman
suggests ACL tear.
Question 8
A 38-year-old woman presents with heat intolerance, palpitations, and weight
loss. Examination reveals tachycardia, tremor, and exophthalmos. Labs show
low TSH and elevated free T4. Most likely diagnosis:
A) Hypothyroidism
B) Graves disease
C) Subacute thyroiditis
D) Hashimoto thyroiditis
Answer: B
Rationale: 👀*** Hyperthyroidism with ophthalmopathy is characteristic of
Graves disease.
Question 9
A 55-year-old man presents with sudden-onset left-sided weakness and slurred
speech. CT shows no hemorrhage. Which is the most appropriate next step?
A) Start aspirin immediately
B) Assess for thrombolytic therapy eligibility
C) MRI of the spine
D) Lumbar puncture
Answer: B
Rationale: 👀*** Acute ischemic stroke without hemorrhage should be
evaluated for tPA within 4.5 hours of onset.
150 Questions with Answers & Rationales | INSTANT
PDF DOWNLOAD
Question 1
A 45-year-old man presents with sudden-onset chest pain radiating to his left
arm. He is diaphoretic and nauseated. ECG shows ST-segment elevation in
leads II, III, and aVF. Which is the most likely diagnosis?
A) Pulmonary embolism
B) Acute inferior myocardial infarction
C) Aortic dissection
D) Pericarditis
Answer: B
Rationale: 👀*** ST elevation in II, III, aVF indicates inferior MI. Symptoms of
chest pain radiating to the arm, diaphoresis, and nausea support this.
Question 2
A 32-year-old woman presents with fatigue, pallor, and heavy menstrual periods.
Labs reveal hemoglobin 9 g/dL and microcytic anemia. The most likely cause is:
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Hemolytic anemia
D) Aplastic anemia
Answer: B
Rationale: 👀*** Microcytic anemia with chronic blood loss (menorrhagia)
suggests iron deficiency.
,Question 3
A 60-year-old man with a history of hypertension presents with sudden severe
headache, neck stiffness, and photophobia. Which is the next best step?
A) MRI of the brain
B) Non-contrast CT of the head
C) Lumbar puncture immediately
D) Start empiric antibiotics
Answer: B
Rationale: 👀*** Sudden severe headache (“thunderclap”) suggests
subarachnoid hemorrhage; non-contrast CT is the initial test. LP is next if CT is
negative.
Question 4
A 28-year-old woman presents with fever, dysuria, and urgency. Urinalysis
shows positive nitrites and leukocyte esterase. The most appropriate initial
therapy is:
A) IV vancomycin
B) Oral trimethoprim-sulfamethoxazole
C) Oral ciprofloxacin
D) Observation only
Answer: B
Rationale: 👀*** Uncomplicated UTI in a non-pregnant woman is treated with
TMP-SMX for 3 days (or nitrofurantoin).
Question 5
A 50-year-old man presents with progressive difficulty swallowing solids more
than liquids, regurgitation of undigested food, and weight loss. Most likely
diagnosis:
,A) GERD
B) Esophageal cancer
C) Achalasia
D) Peptic ulcer disease
Answer: B
Rationale: 👀*** Progressive dysphagia for solids, weight loss, and
regurgitation suggest obstructive pathology like esophageal cancer.
Question 6
A 70-year-old woman presents with resting tremor, bradykinesia, and rigidity.
Which of the following is the most likely diagnosis?
A) Essential tremor
B) Huntington disease
C) Parkinson disease
D) Multiple sclerosis
Answer: C
Rationale: 👀*** Classic Parkinson triad: resting tremor, rigidity, bradykinesia.
Question 7
A 25-year-old male presents with sudden right knee swelling after playing
soccer. Examination shows a large effusion, positive Lachman test, and limited
range of motion. Most likely injury:
A) Meniscal tear
B) Patellar dislocation
C) Anterior cruciate ligament (ACL) tear
D) Medial collateral ligament injury
, Answer: C
Rationale: 👀*** Acute knee injury with effusion and positive Lachman
suggests ACL tear.
Question 8
A 38-year-old woman presents with heat intolerance, palpitations, and weight
loss. Examination reveals tachycardia, tremor, and exophthalmos. Labs show
low TSH and elevated free T4. Most likely diagnosis:
A) Hypothyroidism
B) Graves disease
C) Subacute thyroiditis
D) Hashimoto thyroiditis
Answer: B
Rationale: 👀*** Hyperthyroidism with ophthalmopathy is characteristic of
Graves disease.
Question 9
A 55-year-old man presents with sudden-onset left-sided weakness and slurred
speech. CT shows no hemorrhage. Which is the most appropriate next step?
A) Start aspirin immediately
B) Assess for thrombolytic therapy eligibility
C) MRI of the spine
D) Lumbar puncture
Answer: B
Rationale: 👀*** Acute ischemic stroke without hemorrhage should be
evaluated for tPA within 4.5 hours of onset.
