[COMSAE FORM 113 FREQUENTLY TESTED EXAM] –
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 67-year-old man presents with crushing substernal chest pain radiating to the left arm
that began 45 minutes ago while mowing his lawn. ECG reveals ST-segment elevations in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Posterior descending artery
════════════════════
Correct Answer: C. Right coronary artery
Rationale:
Inferior wall myocardial infarctions involving leads II, III, and aVF are most commonly caused
by occlusion of the right coronary artery. The LAD typically causes anterior wall infarctions,
while the circumflex artery is more often associated with lateral wall involvement. Prompt
recognition is critical for immediate reperfusion therapy and exam-style cardiovascular risk
management scenarios.
════════════════════
2. A 24-year-old woman presents with heat intolerance, palpitations, weight loss, and
exophthalmos. Laboratory studies reveal suppressed TSH and elevated free T4 levels. Which
diagnosis is most likely?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
════════════════════
Correct Answer: B. Graves disease
Rationale:
,Graves disease is characterized by hyperthyroidism accompanied by ophthalmopathy such as
exophthalmos. Suppressed TSH with elevated free T4 confirms hyperthyroidism. Hashimoto
thyroiditis usually presents with hypothyroidism, while toxic multinodular goiter lacks the
autoimmune ophthalmic findings seen in Graves disease.
════════════════════
3. A hospitalized patient develops sudden shortness of breath, pleuritic chest pain, and
tachycardia 3 days after orthopedic surgery. Which diagnostic study is most appropriate
initially?
A. Chest radiograph
B. Ventilation-perfusion scan
C. CT pulmonary angiography
D. Echocardiography
════════════════════
Correct Answer: C. CT pulmonary angiography
Rationale:
CT pulmonary angiography is the preferred initial imaging study in a hemodynamically stable
patient with suspected pulmonary embolism. The clinical presentation following surgery
strongly suggests venous thromboembolism. Chest radiographs are often nonspecific, and
V/Q scanning is generally reserved for patients who cannot receive contrast.
════════════════════
4. A 6-year-old boy presents with periorbital edema and cola-colored urine two weeks after
recovering from streptococcal pharyngitis. Which condition is most likely responsible?
A. IgA nephropathy
B. Minimal change disease
C. Poststreptococcal glomerulonephritis
D. Membranous nephropathy
════════════════════
Correct Answer: C. Poststreptococcal glomerulonephritis
Rationale:
Poststreptococcal glomerulonephritis classically occurs 1–3 weeks after streptococcal infection
and presents with edema, hematuria, and hypertension. Cola-colored urine reflects
,glomerular bleeding. IgA nephropathy generally occurs concurrently with upper respiratory
infections rather than weeks later.
════════════════════
5. A 58-year-old smoker presents with hematuria and flank pain. Imaging reveals a renal
mass. Which paraneoplastic syndrome is most commonly associated with renal cell
carcinoma?
A. SIADH
B. Hypercalcemia
C. Hypoglycemia
D. Polyneuropathy
════════════════════
Correct Answer: B. Hypercalcemia
Rationale:
Renal cell carcinoma commonly produces paraneoplastic syndromes including hypercalcemia
due to ectopic production of parathyroid hormone-related peptide. Hematuria, flank pain,
and smoking history are classic clues. SIADH is more commonly associated with small cell lung
carcinoma.
════════════════════
6. A patient receiving mechanical ventilation suddenly becomes hypotensive with absent
breath sounds on the right side and tracheal deviation to the left. What is the most likely
diagnosis?
A. Pulmonary embolism
B. Massive pleural effusion
C. Cardiac tamponade
D. Tension pneumothorax
════════════════════
Correct Answer: D. Tension pneumothorax
Rationale:
Tension pneumothorax causes obstructive shock with hypotension, unilateral absent breath
sounds, and tracheal deviation away from the affected side. Mechanical ventilation increases
risk due to barotrauma. Immediate needle decompression is required before confirmatory
imaging.
, ════════════════════
7. A 42-year-old woman presents with fatigue and pruritus. Laboratory studies reveal elevated
alkaline phosphatase and positive antimitochondrial antibodies. Which diagnosis is most
likely?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune hepatitis
D. Acute viral hepatitis
════════════════════
Correct Answer: A. Primary biliary cholangitis
Rationale:
Primary biliary cholangitis is strongly associated with antimitochondrial antibodies and
cholestatic liver enzyme elevation. Middle-aged women commonly present with fatigue and
pruritus. Primary sclerosing cholangitis is more commonly associated with inflammatory
bowel disease and p-ANCA positivity.
════════════════════
8. A physician accidentally administers the wrong medication dosage but immediately reports
the mistake before patient harm occurs. Which ethical principle is best demonstrated?
A. Justice
B. Beneficence
C. Fidelity
D. Veracity
════════════════════
Correct Answer: D. Veracity
Rationale:
Veracity refers to honesty and truthfulness in professional practice. Prompt disclosure of
medical errors supports ethical patient care and professional accountability. Beneficence
involves acting in the patient’s best interest, but the scenario specifically highlights honesty in
communication.
════════════════════
9. A newborn presents with a harsh holosystolic murmur at the left lower sternal border.
Which congenital heart defect is most likely?
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 67-year-old man presents with crushing substernal chest pain radiating to the left arm
that began 45 minutes ago while mowing his lawn. ECG reveals ST-segment elevations in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Posterior descending artery
════════════════════
Correct Answer: C. Right coronary artery
Rationale:
Inferior wall myocardial infarctions involving leads II, III, and aVF are most commonly caused
by occlusion of the right coronary artery. The LAD typically causes anterior wall infarctions,
while the circumflex artery is more often associated with lateral wall involvement. Prompt
recognition is critical for immediate reperfusion therapy and exam-style cardiovascular risk
management scenarios.
════════════════════
2. A 24-year-old woman presents with heat intolerance, palpitations, weight loss, and
exophthalmos. Laboratory studies reveal suppressed TSH and elevated free T4 levels. Which
diagnosis is most likely?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
════════════════════
Correct Answer: B. Graves disease
Rationale:
,Graves disease is characterized by hyperthyroidism accompanied by ophthalmopathy such as
exophthalmos. Suppressed TSH with elevated free T4 confirms hyperthyroidism. Hashimoto
thyroiditis usually presents with hypothyroidism, while toxic multinodular goiter lacks the
autoimmune ophthalmic findings seen in Graves disease.
════════════════════
3. A hospitalized patient develops sudden shortness of breath, pleuritic chest pain, and
tachycardia 3 days after orthopedic surgery. Which diagnostic study is most appropriate
initially?
A. Chest radiograph
B. Ventilation-perfusion scan
C. CT pulmonary angiography
D. Echocardiography
════════════════════
Correct Answer: C. CT pulmonary angiography
Rationale:
CT pulmonary angiography is the preferred initial imaging study in a hemodynamically stable
patient with suspected pulmonary embolism. The clinical presentation following surgery
strongly suggests venous thromboembolism. Chest radiographs are often nonspecific, and
V/Q scanning is generally reserved for patients who cannot receive contrast.
════════════════════
4. A 6-year-old boy presents with periorbital edema and cola-colored urine two weeks after
recovering from streptococcal pharyngitis. Which condition is most likely responsible?
A. IgA nephropathy
B. Minimal change disease
C. Poststreptococcal glomerulonephritis
D. Membranous nephropathy
════════════════════
Correct Answer: C. Poststreptococcal glomerulonephritis
Rationale:
Poststreptococcal glomerulonephritis classically occurs 1–3 weeks after streptococcal infection
and presents with edema, hematuria, and hypertension. Cola-colored urine reflects
,glomerular bleeding. IgA nephropathy generally occurs concurrently with upper respiratory
infections rather than weeks later.
════════════════════
5. A 58-year-old smoker presents with hematuria and flank pain. Imaging reveals a renal
mass. Which paraneoplastic syndrome is most commonly associated with renal cell
carcinoma?
A. SIADH
B. Hypercalcemia
C. Hypoglycemia
D. Polyneuropathy
════════════════════
Correct Answer: B. Hypercalcemia
Rationale:
Renal cell carcinoma commonly produces paraneoplastic syndromes including hypercalcemia
due to ectopic production of parathyroid hormone-related peptide. Hematuria, flank pain,
and smoking history are classic clues. SIADH is more commonly associated with small cell lung
carcinoma.
════════════════════
6. A patient receiving mechanical ventilation suddenly becomes hypotensive with absent
breath sounds on the right side and tracheal deviation to the left. What is the most likely
diagnosis?
A. Pulmonary embolism
B. Massive pleural effusion
C. Cardiac tamponade
D. Tension pneumothorax
════════════════════
Correct Answer: D. Tension pneumothorax
Rationale:
Tension pneumothorax causes obstructive shock with hypotension, unilateral absent breath
sounds, and tracheal deviation away from the affected side. Mechanical ventilation increases
risk due to barotrauma. Immediate needle decompression is required before confirmatory
imaging.
, ════════════════════
7. A 42-year-old woman presents with fatigue and pruritus. Laboratory studies reveal elevated
alkaline phosphatase and positive antimitochondrial antibodies. Which diagnosis is most
likely?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune hepatitis
D. Acute viral hepatitis
════════════════════
Correct Answer: A. Primary biliary cholangitis
Rationale:
Primary biliary cholangitis is strongly associated with antimitochondrial antibodies and
cholestatic liver enzyme elevation. Middle-aged women commonly present with fatigue and
pruritus. Primary sclerosing cholangitis is more commonly associated with inflammatory
bowel disease and p-ANCA positivity.
════════════════════
8. A physician accidentally administers the wrong medication dosage but immediately reports
the mistake before patient harm occurs. Which ethical principle is best demonstrated?
A. Justice
B. Beneficence
C. Fidelity
D. Veracity
════════════════════
Correct Answer: D. Veracity
Rationale:
Veracity refers to honesty and truthfulness in professional practice. Prompt disclosure of
medical errors supports ethical patient care and professional accountability. Beneficence
involves acting in the patient’s best interest, but the scenario specifically highlights honesty in
communication.
════════════════════
9. A newborn presents with a harsh holosystolic murmur at the left lower sternal border.
Which congenital heart defect is most likely?
