COMSAE Phase 1 Form 111 Practice Exam
Questions And Correct Detailed Answers (100%
Verified Answers) Plus Rationales Newest Update
2025|2026 Q&A | Guaranteed Pass!!!
1. A 58-year-old with hypertension and new fatigue has a holosystolic murmur at the apex radiating to the
axilla. What is the most likely diagnosis?
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Ventricular septal defect
Answer: B
Chronic hypertension causes left ventricular dilation and functional mitral regurgitation; the murmur
radiates to the axilla.
2. A 32-year-old woman has episodic right upper quadrant pain after fatty meals. Ultrasound shows
gallbladder sludge but no stones. What is the next best step?
A) Cholecystectomy
B) HIDA scan with cholecystokinin
C) MRCP
D) Observation
Answer: B
Sludge with symptoms suggests biliary dyskinesia; HIDA scan calculates gallbladder ejection fraction to
confirm.
3. A 45-year-old with alcohol use disorder presents with ascites and spider angiomata. Paracentesis shows
SAAG >1.1. What is the most likely cause?
A) Malignant ascites
B) Tuberculous peritonitis
1|Page SUCCESS!!!
,C) Portal hypertension
D) Nephrotic syndrome
Answer: C
SAAG >1.1 indicates high-protein gradient ascites from portal hypertension, typically due to cirrhosis.
4. A 68-year-old with COPD on home oxygen becomes confused. ABG: pH 7.28, PaCO2 70, HCO3 28.
What is the acid-base disorder?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Acute on chronic respiratory acidosis
D) Metabolic alkalosis
Answer: C
Elevated PaCO2 with partially elevated HCO3 indicates chronic compensation with acute worsening.
5. A 23-year-old man has sudden severe unilateral testicular pain, nausea, and absent cremasteric reflex.
What is the next best step?
A) Scrotal ultrasound
B) Urinalysis
C) Emergency surgical exploration
D) Antibiotics
Answer: C
Absent cremasteric reflex with sudden pain is testicular torsion until proven otherwise; surgery saves the
testicle.
6. A 55-year-old with diabetes has a painless non-healing ulcer on the plantar foot with surrounding
callus. What is the most likely etiology?
A) Arterial insufficiency
B) Venous stasis
C) Neuropathic ulcer
D) Pressure ulcer
Answer: C
2|Page SUCCESS!!!
,Peripheral neuropathy from diabetes causes loss of protective sensation leading to repetitive pressure and
ulceration.
7. A 30-year-old woman with dysuria and frequency has urine dipstick positive for nitrites and leukocyte
esterase. What is the best initial treatment?
A) Ciprofloxacin 3 days
B) Nitrofurantoin monohydrate 5 days
C) Doxycycline 7 days
D) Ceftriaxone 1 dose
Answer: B
Nitrites indicate gram-negative bacteria; nitrofurantoin concentrates in urine and covers common
uropathogens.
8. A 72-year-old with BPH presents with acute urinary retention after taking diphenhydramine for
allergies. What is the mechanism?
A) Alpha-1 blockade
B) Beta-2 agonism
C) Anticholinergic effect
D) Calcium channel blockade
Answer: C
Diphenhydramine blocks M3 receptors on detrusor muscle, reducing bladder contraction and worsening
obstruction.
9. A 19-year-old college student has fever, headache, and petechial rash. CSF shows gram-negative
diplococci. What is the most likely organism?
A) Haemophilus influenzae
B) Streptococcus pneumoniae
C) Neisseria meningitidis
D) Listeria monocytogenes
Answer: C
Petechial rash with meningitis in a young adult is classic for meningococcus; rapid treatment with
ceftriaxone is critical.
3|Page SUCCESS!!!
, 10. A 40-year-old with HIV (CD4 120) has dyspnea, dry cough, and bilateral interstitial infiltrates. What
is the most likely diagnosis?
A) Bacterial pneumonia
B) Tuberculosis
C) Pneumocystis jirovecii pneumonia
D) CMV pneumonitis
Answer: C
CD4 <200 with subacute dyspnea, dry cough, and diffuse infiltrates is PJP; treat with TMP-SMX.
11. A 65-year-old smoker presents with new hoarseness and weight loss. Laryngoscopy shows a left vocal
cord polypoid lesion. What is the next best step?
A) CT neck
B) Empiric antibiotics
C) Biopsy under direct laryngoscopy
D) Voice rest
Answer: C
Hoarseness in a smoker with a lesion is malignancy until proven otherwise; biopsy determines histology.
12. A 28-year-old pregnant woman at 32 weeks has gestational hypertension and new proteinuria. What is
the most likely diagnosis?
A) Chronic hypertension
B) Preeclampsia
C) HELLP syndrome
D) Gestational diabetes
Answer: B
Hypertension after 20 weeks with new proteinuria defines preeclampsia; magnesium sulfate for seizure
prophylaxis if severe.
13. A 47-year-old has acute severe tearing chest pain radiating to the back. BP 100/60 in right arm, 70/40
in left arm. What is the next best imaging?
A) Chest X-ray
4|Page SUCCESS!!!
Questions And Correct Detailed Answers (100%
Verified Answers) Plus Rationales Newest Update
2025|2026 Q&A | Guaranteed Pass!!!
1. A 58-year-old with hypertension and new fatigue has a holosystolic murmur at the apex radiating to the
axilla. What is the most likely diagnosis?
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Ventricular septal defect
Answer: B
Chronic hypertension causes left ventricular dilation and functional mitral regurgitation; the murmur
radiates to the axilla.
2. A 32-year-old woman has episodic right upper quadrant pain after fatty meals. Ultrasound shows
gallbladder sludge but no stones. What is the next best step?
A) Cholecystectomy
B) HIDA scan with cholecystokinin
C) MRCP
D) Observation
Answer: B
Sludge with symptoms suggests biliary dyskinesia; HIDA scan calculates gallbladder ejection fraction to
confirm.
3. A 45-year-old with alcohol use disorder presents with ascites and spider angiomata. Paracentesis shows
SAAG >1.1. What is the most likely cause?
A) Malignant ascites
B) Tuberculous peritonitis
1|Page SUCCESS!!!
,C) Portal hypertension
D) Nephrotic syndrome
Answer: C
SAAG >1.1 indicates high-protein gradient ascites from portal hypertension, typically due to cirrhosis.
4. A 68-year-old with COPD on home oxygen becomes confused. ABG: pH 7.28, PaCO2 70, HCO3 28.
What is the acid-base disorder?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Acute on chronic respiratory acidosis
D) Metabolic alkalosis
Answer: C
Elevated PaCO2 with partially elevated HCO3 indicates chronic compensation with acute worsening.
5. A 23-year-old man has sudden severe unilateral testicular pain, nausea, and absent cremasteric reflex.
What is the next best step?
A) Scrotal ultrasound
B) Urinalysis
C) Emergency surgical exploration
D) Antibiotics
Answer: C
Absent cremasteric reflex with sudden pain is testicular torsion until proven otherwise; surgery saves the
testicle.
6. A 55-year-old with diabetes has a painless non-healing ulcer on the plantar foot with surrounding
callus. What is the most likely etiology?
A) Arterial insufficiency
B) Venous stasis
C) Neuropathic ulcer
D) Pressure ulcer
Answer: C
2|Page SUCCESS!!!
,Peripheral neuropathy from diabetes causes loss of protective sensation leading to repetitive pressure and
ulceration.
7. A 30-year-old woman with dysuria and frequency has urine dipstick positive for nitrites and leukocyte
esterase. What is the best initial treatment?
A) Ciprofloxacin 3 days
B) Nitrofurantoin monohydrate 5 days
C) Doxycycline 7 days
D) Ceftriaxone 1 dose
Answer: B
Nitrites indicate gram-negative bacteria; nitrofurantoin concentrates in urine and covers common
uropathogens.
8. A 72-year-old with BPH presents with acute urinary retention after taking diphenhydramine for
allergies. What is the mechanism?
A) Alpha-1 blockade
B) Beta-2 agonism
C) Anticholinergic effect
D) Calcium channel blockade
Answer: C
Diphenhydramine blocks M3 receptors on detrusor muscle, reducing bladder contraction and worsening
obstruction.
9. A 19-year-old college student has fever, headache, and petechial rash. CSF shows gram-negative
diplococci. What is the most likely organism?
A) Haemophilus influenzae
B) Streptococcus pneumoniae
C) Neisseria meningitidis
D) Listeria monocytogenes
Answer: C
Petechial rash with meningitis in a young adult is classic for meningococcus; rapid treatment with
ceftriaxone is critical.
3|Page SUCCESS!!!
, 10. A 40-year-old with HIV (CD4 120) has dyspnea, dry cough, and bilateral interstitial infiltrates. What
is the most likely diagnosis?
A) Bacterial pneumonia
B) Tuberculosis
C) Pneumocystis jirovecii pneumonia
D) CMV pneumonitis
Answer: C
CD4 <200 with subacute dyspnea, dry cough, and diffuse infiltrates is PJP; treat with TMP-SMX.
11. A 65-year-old smoker presents with new hoarseness and weight loss. Laryngoscopy shows a left vocal
cord polypoid lesion. What is the next best step?
A) CT neck
B) Empiric antibiotics
C) Biopsy under direct laryngoscopy
D) Voice rest
Answer: C
Hoarseness in a smoker with a lesion is malignancy until proven otherwise; biopsy determines histology.
12. A 28-year-old pregnant woman at 32 weeks has gestational hypertension and new proteinuria. What is
the most likely diagnosis?
A) Chronic hypertension
B) Preeclampsia
C) HELLP syndrome
D) Gestational diabetes
Answer: B
Hypertension after 20 weeks with new proteinuria defines preeclampsia; magnesium sulfate for seizure
prophylaxis if severe.
13. A 47-year-old has acute severe tearing chest pain radiating to the back. BP 100/60 in right arm, 70/40
in left arm. What is the next best imaging?
A) Chest X-ray
4|Page SUCCESS!!!
