COMSAE 115 Phase 1 (Level 1) Practice Exam 2026 –
Scenario-Based MCQs with Answers & Rationales | 3
Complete Versions | Updated Blueprint-Aligned
Review Guide | pdf
1. (Scenario)
A 65-year-old male presents with sudden-onset chest pain radiating to his left arm. ECG
shows ST-elevation in leads II, III, aVF. Which artery is most likely occluded?
A) Left anterior descending
B) Circumflex
C) Right coronary artery
D) Posterior descending artery
Answer: C
Inferior MI (leads II, III, aVF) usually involves the right coronary artery.
2. The most common cause of community-acquired pneumonia in adults is:
A) Haemophilus influenzae
B) Streptococcus pneumoniae
C) Mycoplasma pneumoniae
D) Legionella pneumophila
Answer: B
Streptococcus pneumoniae accounts for the majority of adult CAP cases.
3. (Scenario)
A 22-year-old college student presents with sudden fever, neck stiffness, and petechial
rash. What is the first-line empiric therapy?
A) Amoxicillin
B) Azithromycin
C) Ceftriaxone
D) Vancomycin
Answer: C
Suspected meningococcemia requires prompt IV ceftriaxone.
,4. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Labs:
TSH elevated, free T4 low. Most likely diagnosis?
A) Hyperthyroidism
B) Subclinical hypothyroidism
C) Primary hypothyroidism
D) Pituitary failure
Answer: C
Elevated TSH with low T4 indicates primary hypothyroidism.
5. (Scenario)
A 60-year-old man with atrial fibrillation presents with right-sided weakness and slurred
speech. Which is the most appropriate immediate management?
A) Administer IV alteplase if within window
B) Start aspirin only
C) Give beta-blocker
D) Initiate statin
Answer: A
Acute ischemic stroke in AF requires evaluation for thrombolysis within 4.5 hours.
6. Which type of shock is characterized by warm, flushed skin, hypotension, and high
cardiac output?
A) Hypovolemic
B) Cardiogenic
C) Obstructive
D) Distributive (e.g., septic)
Answer: D
Septic shock causes vasodilation, leading to warm extremities despite hypotension.
7. The drug of choice for status epilepticus is:
,A) Phenytoin
B) Carbamazepine
C) Lorazepam
D) Levetiracetam
Answer: C
Benzodiazepines are first-line for immediate seizure termination.
8. (Scenario)
A 28-year-old female presents with polyuria, polydipsia, and fasting glucose of 180 mg/dL.
Best initial therapy?
A) Insulin only
B) Metformin
C) Sulfonylurea
D) Lifestyle modification alone
Answer: B
Metformin is first-line for newly diagnosed type 2 diabetes in adults.
9. Which of the following is the hallmark of nephrotic syndrome?
A) Hematuria
B) Proteinuria >3.5 g/day
C) Hypertension
D) Oliguria
Answer: B
Nephrotic syndrome is defined by heavy proteinuria and hypoalbuminemia.
10. A patient presents with sudden painless vision loss in one eye. Fundoscopy:
cherry-red spot at the macula. Most likely diagnosis?
A) Retinal detachment
B) Central retinal vein occlusion
C) Central retinal artery occlusion
D) Acute glaucoma
, Answer: C
Cherry-red spot is classic for central retinal artery occlusion.
11. (Scenario)
A 32-year-old male presents with fatigue and sore throat. Labs show atypical lymphocytosis
and positive heterophile antibody. Diagnosis?
A) HIV infection
B) Cytomegalovirus infection
C) Infectious mononucleosis (EBV)
D) Streptococcal pharyngitis
Answer: C
Atypical lymphocytosis with heterophile positivity suggests EBV infection.
12. Which antibiotic is contraindicated in pregnancy due to teratogenicity?
A) Amoxicillin
B) Cephalexin
C) Tetracycline
D) Azithromycin
Answer: C
Tetracyclines cause permanent tooth discoloration and bone defects.
13. (Scenario)
A 55-year-old man presents with progressive dysphagia for solids, history of chronic GERD.
Most appropriate next step?
A) Barium swallow only
B) Endoscopy with biopsy
C) Start PPI therapy
D) Manometry
Answer: B
Chronic GERD with dysphagia warrants endoscopy to rule out Barrett’s esophagus or
cancer.
Scenario-Based MCQs with Answers & Rationales | 3
Complete Versions | Updated Blueprint-Aligned
Review Guide | pdf
1. (Scenario)
A 65-year-old male presents with sudden-onset chest pain radiating to his left arm. ECG
shows ST-elevation in leads II, III, aVF. Which artery is most likely occluded?
A) Left anterior descending
B) Circumflex
C) Right coronary artery
D) Posterior descending artery
Answer: C
Inferior MI (leads II, III, aVF) usually involves the right coronary artery.
2. The most common cause of community-acquired pneumonia in adults is:
A) Haemophilus influenzae
B) Streptococcus pneumoniae
C) Mycoplasma pneumoniae
D) Legionella pneumophila
Answer: B
Streptococcus pneumoniae accounts for the majority of adult CAP cases.
3. (Scenario)
A 22-year-old college student presents with sudden fever, neck stiffness, and petechial
rash. What is the first-line empiric therapy?
A) Amoxicillin
B) Azithromycin
C) Ceftriaxone
D) Vancomycin
Answer: C
Suspected meningococcemia requires prompt IV ceftriaxone.
,4. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Labs:
TSH elevated, free T4 low. Most likely diagnosis?
A) Hyperthyroidism
B) Subclinical hypothyroidism
C) Primary hypothyroidism
D) Pituitary failure
Answer: C
Elevated TSH with low T4 indicates primary hypothyroidism.
5. (Scenario)
A 60-year-old man with atrial fibrillation presents with right-sided weakness and slurred
speech. Which is the most appropriate immediate management?
A) Administer IV alteplase if within window
B) Start aspirin only
C) Give beta-blocker
D) Initiate statin
Answer: A
Acute ischemic stroke in AF requires evaluation for thrombolysis within 4.5 hours.
6. Which type of shock is characterized by warm, flushed skin, hypotension, and high
cardiac output?
A) Hypovolemic
B) Cardiogenic
C) Obstructive
D) Distributive (e.g., septic)
Answer: D
Septic shock causes vasodilation, leading to warm extremities despite hypotension.
7. The drug of choice for status epilepticus is:
,A) Phenytoin
B) Carbamazepine
C) Lorazepam
D) Levetiracetam
Answer: C
Benzodiazepines are first-line for immediate seizure termination.
8. (Scenario)
A 28-year-old female presents with polyuria, polydipsia, and fasting glucose of 180 mg/dL.
Best initial therapy?
A) Insulin only
B) Metformin
C) Sulfonylurea
D) Lifestyle modification alone
Answer: B
Metformin is first-line for newly diagnosed type 2 diabetes in adults.
9. Which of the following is the hallmark of nephrotic syndrome?
A) Hematuria
B) Proteinuria >3.5 g/day
C) Hypertension
D) Oliguria
Answer: B
Nephrotic syndrome is defined by heavy proteinuria and hypoalbuminemia.
10. A patient presents with sudden painless vision loss in one eye. Fundoscopy:
cherry-red spot at the macula. Most likely diagnosis?
A) Retinal detachment
B) Central retinal vein occlusion
C) Central retinal artery occlusion
D) Acute glaucoma
, Answer: C
Cherry-red spot is classic for central retinal artery occlusion.
11. (Scenario)
A 32-year-old male presents with fatigue and sore throat. Labs show atypical lymphocytosis
and positive heterophile antibody. Diagnosis?
A) HIV infection
B) Cytomegalovirus infection
C) Infectious mononucleosis (EBV)
D) Streptococcal pharyngitis
Answer: C
Atypical lymphocytosis with heterophile positivity suggests EBV infection.
12. Which antibiotic is contraindicated in pregnancy due to teratogenicity?
A) Amoxicillin
B) Cephalexin
C) Tetracycline
D) Azithromycin
Answer: C
Tetracyclines cause permanent tooth discoloration and bone defects.
13. (Scenario)
A 55-year-old man presents with progressive dysphagia for solids, history of chronic GERD.
Most appropriate next step?
A) Barium swallow only
B) Endoscopy with biopsy
C) Start PPI therapy
D) Manometry
Answer: B
Chronic GERD with dysphagia warrants endoscopy to rule out Barrett’s esophagus or
cancer.
