COMSAE Phase 2 – Form BSA 108 (Core
Diagnostic and Clinical Presentation Set) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
Question 1
A 65-year-old man presents with crushing substernal chest
pain radiating to his left arm for 45 minutes. ECG shows ST-
segment elevation 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. Left main coronary artery
E. Posterior descending artery
Answer: C. Right coronary artery
Inferior wall myocardial infarctions produce ST elevations in
leads II, III, and aVF. The right coronary artery is the most
common vessel involved.
Question 2
A 24-year-old woman presents with dysuria, urinary
frequency, and urgency. Urinalysis shows positive leukocyte
esterase and nitrites. What is the most likely organism?
,A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Enterococcus faecalis
D. Escherichia coli
E. Klebsiella pneumoniae
Answer: D. Escherichia coli
E. coli causes approximately 80–90% of uncomplicated
urinary tract infections due to its ability to adhere to
uroepithelial cells.
Question 3
A 72-year-old smoker presents with hematuria. Which
diagnosis should be considered first?
A. Nephrolithiasis
B. Pyelonephritis
C. Glomerulonephritis
D. Benign prostatic hyperplasia
E. Bladder cancer
Answer: E. Bladder cancer
Painless hematuria in an older smoker is classic for urothelial
carcinoma until proven otherwise.
Question 4
,A patient develops sudden unilateral facial weakness
involving the forehead and lower face. Which diagnosis is
most likely?
A. Ischemic stroke
B. Trigeminal neuralgia
C. Multiple sclerosis
D. Bell palsy
E. Temporal arteritis
Answer: D. Bell palsy
Bell palsy causes a lower motor neuron facial nerve lesion
involving the entire ipsilateral face, including the forehead.
Question 5
A 30-year-old woman presents with weight loss, heat
intolerance, tremor, and exophthalmos. What is the most
likely diagnosis?
A. Toxic multinodular goiter
B. Thyroiditis
C. Pituitary adenoma
D. Thyroid cancer
E. Graves disease
Answer: E. Graves disease
Graves disease is an autoimmune disorder characterized by
thyroid-stimulating immunoglobulins causing
hyperthyroidism and ophthalmopathy.
, Question 6
A patient presents with severe epigastric pain radiating to the
back. Lipase is markedly elevated. What is the diagnosis?
A. Cholecystitis
B. Gastritis
C. Peptic ulcer disease
D. Acute pancreatitis
E. Hepatitis
Answer: D. Acute pancreatitis
Elevated lipase with severe epigastric pain radiating to the
back is highly suggestive of acute pancreatitis.
Question 7
A 55-year-old woman presents with progressive fatigue and
microcytic anemia. Colonoscopy is recommended primarily to
evaluate for:
A. Hemorrhoids
B. Crohn disease
C. Diverticulosis
D. Ulcerative colitis
E. Colon cancer
Answer: E. Colon cancer
Iron deficiency anemia in older adults should prompt
evaluation for occult gastrointestinal malignancy.
Diagnostic and Clinical Presentation Set) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
Question 1
A 65-year-old man presents with crushing substernal chest
pain radiating to his left arm for 45 minutes. ECG shows ST-
segment elevation 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. Left main coronary artery
E. Posterior descending artery
Answer: C. Right coronary artery
Inferior wall myocardial infarctions produce ST elevations in
leads II, III, and aVF. The right coronary artery is the most
common vessel involved.
Question 2
A 24-year-old woman presents with dysuria, urinary
frequency, and urgency. Urinalysis shows positive leukocyte
esterase and nitrites. What is the most likely organism?
,A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Enterococcus faecalis
D. Escherichia coli
E. Klebsiella pneumoniae
Answer: D. Escherichia coli
E. coli causes approximately 80–90% of uncomplicated
urinary tract infections due to its ability to adhere to
uroepithelial cells.
Question 3
A 72-year-old smoker presents with hematuria. Which
diagnosis should be considered first?
A. Nephrolithiasis
B. Pyelonephritis
C. Glomerulonephritis
D. Benign prostatic hyperplasia
E. Bladder cancer
Answer: E. Bladder cancer
Painless hematuria in an older smoker is classic for urothelial
carcinoma until proven otherwise.
Question 4
,A patient develops sudden unilateral facial weakness
involving the forehead and lower face. Which diagnosis is
most likely?
A. Ischemic stroke
B. Trigeminal neuralgia
C. Multiple sclerosis
D. Bell palsy
E. Temporal arteritis
Answer: D. Bell palsy
Bell palsy causes a lower motor neuron facial nerve lesion
involving the entire ipsilateral face, including the forehead.
Question 5
A 30-year-old woman presents with weight loss, heat
intolerance, tremor, and exophthalmos. What is the most
likely diagnosis?
A. Toxic multinodular goiter
B. Thyroiditis
C. Pituitary adenoma
D. Thyroid cancer
E. Graves disease
Answer: E. Graves disease
Graves disease is an autoimmune disorder characterized by
thyroid-stimulating immunoglobulins causing
hyperthyroidism and ophthalmopathy.
, Question 6
A patient presents with severe epigastric pain radiating to the
back. Lipase is markedly elevated. What is the diagnosis?
A. Cholecystitis
B. Gastritis
C. Peptic ulcer disease
D. Acute pancreatitis
E. Hepatitis
Answer: D. Acute pancreatitis
Elevated lipase with severe epigastric pain radiating to the
back is highly suggestive of acute pancreatitis.
Question 7
A 55-year-old woman presents with progressive fatigue and
microcytic anemia. Colonoscopy is recommended primarily to
evaluate for:
A. Hemorrhoids
B. Crohn disease
C. Diverticulosis
D. Ulcerative colitis
E. Colon cancer
Answer: E. Colon cancer
Iron deficiency anemia in older adults should prompt
evaluation for occult gastrointestinal malignancy.
