COMSAE PHASE 2 FORM 103 PRACTICE EXAM COMPLETE TEST BANK QUESTIONS
AND ANSWERS | VERIFIED SOLUTIONS | UPDATED 2026/2027 STUDY GUIDE
Examiner/Administrator: Philippine Medical Specialty Board – COMSAE Committee
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
COMSAE PHASE 2 FORM 103 PRACTICE EXAM
2026/2027 EDITION
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
COMPLETE PRACTICE EXAM
100 MULTIPLE-CHOICE QUESTIONS
EXACT OFFICIAL COUNT: 100 QUESTIONS || PASSING SCORE: 70% || TESTING TIME:
180 MINUTES || PHILIPPINE MEDICAL SPECIALTY BOARD || ALIGNED WITH CURRENT
LICENSING BLUEPRINTS || PROFESSIONAL STUDY GUIDE || 100% VERIFIED | GRADED
A+ || COMPREHENSIVE EXAM PREPARATION || PREPARED FOR LICENSING &
CERTIFICATION || PROFESSIONAL EXAMINATION USE
Pharmacology & Therapeutics (Q1–Q10)
Q1. A 55-year-old patient with hypertension is prescribed an ACE inhibitor but
develops persistent cough. Which mediator is responsible for this side effect?
A. Histamine
B. Bradykinin
C. Dopamine
D. Acetylcholine
Correct Answer: 🔴 B. Bradykinin
Explanation: 🔹 ACE inhibitors reduce bradykinin breakdown, leading to accumulation
and cough. Histamine is related to allergic reactions, dopamine is not involved, and
acetylcholine does not mediate this effect.
,Q2. A patient develops ototoxicity and nephrotoxicity after antibiotic therapy. Which
class is most likely responsible?
A. Aminoglycosides
B. Penicillins
C. Cephalosporins
D. Macrolides
Correct Answer: 🔴 A. Aminoglycosides
Explanation: 🔹 Aminoglycosides can accumulate in renal tubules and inner ear, causing
nephrotoxicity and ototoxicity. Penicillins, cephalosporins, and macrolides are not
primarily associated with these toxicities.
Q3. Which drug is a direct oral factor Xa inhibitor used for atrial fibrillation?
A. Warfarin
B. Heparin
C. Rivaroxaban
D. Aspirin
Correct Answer: 🔴 C. Rivaroxaban
Explanation: 🔹 Rivaroxaban directly inhibits factor Xa. Warfarin is a vitamin K
antagonist, heparin acts indirectly via antithrombin, and aspirin is an antiplatelet.
Q4. A patient on chronic corticosteroids develops osteoporosis. What is the primary
mechanism?
A. Increased osteoblast activity
B. Enhanced calcium absorption
C. Increased bone resorption and decreased formation
D. Excess collagen synthesis
Correct Answer: 🔴 C. Increased bone resorption and decreased formation
Explanation: 🔹 Glucocorticoids impair osteoblasts, increase osteoclast activity, and
reduce calcium absorption, leading to osteoporosis.
Q5. Which antidote is used for opioid-induced respiratory depression?
,A. Flumazenil
B. Naloxone
C. Physostigmine
D. Atropine
Correct Answer: 🔴 B. Naloxone
Explanation: 🔹 Naloxone competitively blocks opioid receptors, rapidly reversing
respiratory depression. Flumazenil reverses benzodiazepines.
Q6. A patient develops hypotension despite fluids in septic shock. Which vasopressor
is first-line?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Dobutamine
Correct Answer: 🔴 C. Norepinephrine
Explanation: 🔹 Norepinephrine increases vascular resistance with relatively preserved
cardiac output, making it first-line in septic shock.
Q7. A patient develops fatigue, weight loss, and hypoglycemia after long-term insulin
use. What is the mechanism?
A. Insulin overdose
B. Counter-regulatory hormone deficiency
C. Increased hepatic glucose production
D. Reduced insulin sensitivity
Correct Answer: 🔴 A. Insulin overdose
Explanation: 🔹 Excess insulin reduces blood glucose, causing hypoglycemia. Counter-
regulatory hormone deficiency worsens but is not the primary cause.
Q8. Which drug class is associated with gingival hyperplasia and hirsutism?
A. Calcium channel blockers
B. Beta blockers
, C. ACE inhibitors
D. Diuretics
Correct Answer: 🔴 A. Calcium channel blockers
Explanation: 🔹 Drugs like nifedipine can cause gingival hyperplasia and hirsutism. Beta
blockers, ACE inhibitors, and diuretics do not.
Q9. Which medication is used in myasthenia gravis to improve neuromuscular
transmission?
A. Neostigmine
B. Atropine
C. Succinylcholine
D. Baclofen
Correct Answer: 🔴 A. Neostigmine
Explanation: 🔹 Neostigmine inhibits acetylcholinesterase, increasing acetylcholine at
the neuromuscular junction, improving muscle strength.
Q10. Which antibiotic is contraindicated in pregnancy due to teratogenic effects?
A. Penicillin
B. Tetracycline
C. Cephalexin
D. Azithromycin
Correct Answer: 🔴 B. Tetracycline
Explanation: 🔹 Tetracyclines bind fetal bone and teeth, causing discoloration and
growth inhibition. Penicillin, cephalexin, and azithromycin are safer alternatives.
Cardiology & Critical Care (Q11–Q30)
Q11. A 68-year-old man with hypertension presents with tearing chest pain radiating
to the back. BP is higher in the right arm than the left. Likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
AND ANSWERS | VERIFIED SOLUTIONS | UPDATED 2026/2027 STUDY GUIDE
Examiner/Administrator: Philippine Medical Specialty Board – COMSAE Committee
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
COMSAE PHASE 2 FORM 103 PRACTICE EXAM
2026/2027 EDITION
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
COMPLETE PRACTICE EXAM
100 MULTIPLE-CHOICE QUESTIONS
EXACT OFFICIAL COUNT: 100 QUESTIONS || PASSING SCORE: 70% || TESTING TIME:
180 MINUTES || PHILIPPINE MEDICAL SPECIALTY BOARD || ALIGNED WITH CURRENT
LICENSING BLUEPRINTS || PROFESSIONAL STUDY GUIDE || 100% VERIFIED | GRADED
A+ || COMPREHENSIVE EXAM PREPARATION || PREPARED FOR LICENSING &
CERTIFICATION || PROFESSIONAL EXAMINATION USE
Pharmacology & Therapeutics (Q1–Q10)
Q1. A 55-year-old patient with hypertension is prescribed an ACE inhibitor but
develops persistent cough. Which mediator is responsible for this side effect?
A. Histamine
B. Bradykinin
C. Dopamine
D. Acetylcholine
Correct Answer: 🔴 B. Bradykinin
Explanation: 🔹 ACE inhibitors reduce bradykinin breakdown, leading to accumulation
and cough. Histamine is related to allergic reactions, dopamine is not involved, and
acetylcholine does not mediate this effect.
,Q2. A patient develops ototoxicity and nephrotoxicity after antibiotic therapy. Which
class is most likely responsible?
A. Aminoglycosides
B. Penicillins
C. Cephalosporins
D. Macrolides
Correct Answer: 🔴 A. Aminoglycosides
Explanation: 🔹 Aminoglycosides can accumulate in renal tubules and inner ear, causing
nephrotoxicity and ototoxicity. Penicillins, cephalosporins, and macrolides are not
primarily associated with these toxicities.
Q3. Which drug is a direct oral factor Xa inhibitor used for atrial fibrillation?
A. Warfarin
B. Heparin
C. Rivaroxaban
D. Aspirin
Correct Answer: 🔴 C. Rivaroxaban
Explanation: 🔹 Rivaroxaban directly inhibits factor Xa. Warfarin is a vitamin K
antagonist, heparin acts indirectly via antithrombin, and aspirin is an antiplatelet.
Q4. A patient on chronic corticosteroids develops osteoporosis. What is the primary
mechanism?
A. Increased osteoblast activity
B. Enhanced calcium absorption
C. Increased bone resorption and decreased formation
D. Excess collagen synthesis
Correct Answer: 🔴 C. Increased bone resorption and decreased formation
Explanation: 🔹 Glucocorticoids impair osteoblasts, increase osteoclast activity, and
reduce calcium absorption, leading to osteoporosis.
Q5. Which antidote is used for opioid-induced respiratory depression?
,A. Flumazenil
B. Naloxone
C. Physostigmine
D. Atropine
Correct Answer: 🔴 B. Naloxone
Explanation: 🔹 Naloxone competitively blocks opioid receptors, rapidly reversing
respiratory depression. Flumazenil reverses benzodiazepines.
Q6. A patient develops hypotension despite fluids in septic shock. Which vasopressor
is first-line?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Dobutamine
Correct Answer: 🔴 C. Norepinephrine
Explanation: 🔹 Norepinephrine increases vascular resistance with relatively preserved
cardiac output, making it first-line in septic shock.
Q7. A patient develops fatigue, weight loss, and hypoglycemia after long-term insulin
use. What is the mechanism?
A. Insulin overdose
B. Counter-regulatory hormone deficiency
C. Increased hepatic glucose production
D. Reduced insulin sensitivity
Correct Answer: 🔴 A. Insulin overdose
Explanation: 🔹 Excess insulin reduces blood glucose, causing hypoglycemia. Counter-
regulatory hormone deficiency worsens but is not the primary cause.
Q8. Which drug class is associated with gingival hyperplasia and hirsutism?
A. Calcium channel blockers
B. Beta blockers
, C. ACE inhibitors
D. Diuretics
Correct Answer: 🔴 A. Calcium channel blockers
Explanation: 🔹 Drugs like nifedipine can cause gingival hyperplasia and hirsutism. Beta
blockers, ACE inhibitors, and diuretics do not.
Q9. Which medication is used in myasthenia gravis to improve neuromuscular
transmission?
A. Neostigmine
B. Atropine
C. Succinylcholine
D. Baclofen
Correct Answer: 🔴 A. Neostigmine
Explanation: 🔹 Neostigmine inhibits acetylcholinesterase, increasing acetylcholine at
the neuromuscular junction, improving muscle strength.
Q10. Which antibiotic is contraindicated in pregnancy due to teratogenic effects?
A. Penicillin
B. Tetracycline
C. Cephalexin
D. Azithromycin
Correct Answer: 🔴 B. Tetracycline
Explanation: 🔹 Tetracyclines bind fetal bone and teeth, causing discoloration and
growth inhibition. Penicillin, cephalexin, and azithromycin are safer alternatives.
Cardiology & Critical Care (Q11–Q30)
Q11. A 68-year-old man with hypertension presents with tearing chest pain radiating
to the back. BP is higher in the right arm than the left. Likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
