Ultimate COMSAE Phase 1 Form 114 Practice Exam
2026: High-Yield Questions with Answers &
Rationales Complete Review of Cardiology,
Pulmonology, Neurology, OMM, Microbiology, and
Endocrinology | PDF
Cardiology
1. A 58-year-old man presents with crushing chest pain radiating to the jaw. ECG
shows ST elevations in leads V1–V4. Which coronary artery is most likely occluded?
A) Right coronary artery
B) Left circumflex
C) Left anterior descending
D) Posterior descending
Answer: C) Left anterior descending
Rationale: ST elevation in the anterior leads (V1–V4) indicates an anterior wall myocardial
infarction (MI). The left anterior descending (LAD) artery supplies the anterior wall of the left
ventricle, making it the most likely occluded vessel.
2. A patient with hypertension is started on an ACE inhibitor. Which of the following
changes is expected due to the medication's mechanism of action?
A) Increased aldosterone
B) Decreased bradykinin
C) Increased angiotensin II
D) Decreased aldosterone
Answer: D) Decreased aldosterone
, Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II. Lower
angiotensin II levels lead to decreased stimulation of aldosterone secretion from the adrenal
cortex, resulting in reduced blood pressure and sodium retention.
3. A 70-year-old patient with chronic atrial fibrillation is at highest risk for thrombus
formation in which location?
A) Right ventricle
B) Left atrial appendage
C) Pulmonary artery
D) Coronary sinus
Answer: B) Left atrial appendage
Rationale: In atrial fibrillation, ineffective atrial contraction leads to blood stasis. The left
atrial appendage (LAA) is a small, trabeculated pouch where blood tends to pool, making it
the most common site for thrombus formation. This is why LAA occlusion devices are used
for stroke prevention in some patients.
4. A patient with heart failure has an S3 gallop. What does this sound represent?
A) Turbulent flow across a stenotic aortic valve
B) Blood striking a dilated ventricle
C) Opening snap of a stenotic mitral valve
D) Ejection click from a bicuspid valve
Answer: B) Blood striking a dilated ventricle
*Rationale: An S3 heart sound ("ventricular gallop") occurs early in diastole during rapid
ventricular filling. It is caused by blood striking a non-compliant or volume-overloaded
ventricle. It is often a sign of heart failure or volume overload.*
5. A patient has blood pressure measurements of 160/70 mm Hg in the right arm and
130/80 mm Hg in the left leg. Which condition is most likely?
A) Aortic stenosis
B) Coarctation of the aorta
C) Aortic regurgitation
D) Atherosclerosis
2026: High-Yield Questions with Answers &
Rationales Complete Review of Cardiology,
Pulmonology, Neurology, OMM, Microbiology, and
Endocrinology | PDF
Cardiology
1. A 58-year-old man presents with crushing chest pain radiating to the jaw. ECG
shows ST elevations in leads V1–V4. Which coronary artery is most likely occluded?
A) Right coronary artery
B) Left circumflex
C) Left anterior descending
D) Posterior descending
Answer: C) Left anterior descending
Rationale: ST elevation in the anterior leads (V1–V4) indicates an anterior wall myocardial
infarction (MI). The left anterior descending (LAD) artery supplies the anterior wall of the left
ventricle, making it the most likely occluded vessel.
2. A patient with hypertension is started on an ACE inhibitor. Which of the following
changes is expected due to the medication's mechanism of action?
A) Increased aldosterone
B) Decreased bradykinin
C) Increased angiotensin II
D) Decreased aldosterone
Answer: D) Decreased aldosterone
, Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II. Lower
angiotensin II levels lead to decreased stimulation of aldosterone secretion from the adrenal
cortex, resulting in reduced blood pressure and sodium retention.
3. A 70-year-old patient with chronic atrial fibrillation is at highest risk for thrombus
formation in which location?
A) Right ventricle
B) Left atrial appendage
C) Pulmonary artery
D) Coronary sinus
Answer: B) Left atrial appendage
Rationale: In atrial fibrillation, ineffective atrial contraction leads to blood stasis. The left
atrial appendage (LAA) is a small, trabeculated pouch where blood tends to pool, making it
the most common site for thrombus formation. This is why LAA occlusion devices are used
for stroke prevention in some patients.
4. A patient with heart failure has an S3 gallop. What does this sound represent?
A) Turbulent flow across a stenotic aortic valve
B) Blood striking a dilated ventricle
C) Opening snap of a stenotic mitral valve
D) Ejection click from a bicuspid valve
Answer: B) Blood striking a dilated ventricle
*Rationale: An S3 heart sound ("ventricular gallop") occurs early in diastole during rapid
ventricular filling. It is caused by blood striking a non-compliant or volume-overloaded
ventricle. It is often a sign of heart failure or volume overload.*
5. A patient has blood pressure measurements of 160/70 mm Hg in the right arm and
130/80 mm Hg in the left leg. Which condition is most likely?
A) Aortic stenosis
B) Coarctation of the aorta
C) Aortic regurgitation
D) Atherosclerosis
