COMSAE Phase 2 – Form BSA 107 (Advanced
Clinical Data Synthesis Bank) (2026 Edition):
Comprehensive Multiple-Choice Questions,
Answers, and Detailed Rationales
Question 1
A 68-year-old man presents with progressive dyspnea and
fatigue. Echocardiography shows a left ventricular ejection
fraction of 30%. Which medication has been shown to reduce
mortality in heart failure with reduced ejection fraction?
A. Verapamil
B. Digoxin
C. Lisinopril
D. Diltiazem
E. Furosemide
Answer: C. Lisinopril
ACE inhibitors reduce mortality and hospitalizations in
patients with HFrEF by decreasing afterload and limiting
adverse cardiac remodeling. Digoxin and diuretics improve
symptoms but do not provide the same mortality benefit.
Question 2
A 24-year-old woman presents with dysuria and urinary
frequency. Urinalysis demonstrates positive leukocyte
,esterase and nitrites. What is the most likely causative
organism?
A. Staphylococcus saprophyticus
B. Enterococcus faecalis
C. Escherichia coli
D. Proteus vulgaris
E. Candida albicans
Answer: C. Escherichia coli
E. coli is responsible for the majority of uncomplicated
urinary tract infections. Nitrite positivity suggests infection
with nitrate-reducing gram-negative bacteria, most
commonly E. coli.
Question 3
A patient develops sudden chest pain and dyspnea 3 days
after hip replacement surgery. Which diagnostic test is most
appropriate initially in a hemodynamically stable patient with
suspected pulmonary embolism?
A. Chest radiograph
B. Echocardiogram
C. Ventilation-perfusion scan in all patients
D. CT pulmonary angiography
E. Bronchoscopy
Answer: D. CT pulmonary angiography
,CT pulmonary angiography is the preferred diagnostic test for
stable patients with suspected pulmonary embolism. It
directly visualizes thrombi within pulmonary arteries.
Question 4
A 57-year-old woman presents with tremor, heat intolerance,
and weight loss. Laboratory studies reveal suppressed TSH
and elevated free T4. Which diagnosis is most likely?
A. Hashimoto thyroiditis
B. Subacute thyroiditis
C. Pituitary adenoma
D. Euthyroid sick syndrome
E. Graves disease
Answer: E. Graves disease
Graves disease is the most common cause of
hyperthyroidism and presents with low TSH and elevated
thyroid hormone levels. Autoantibodies stimulate the TSH
receptor.
Question 5
A patient with chronic alcoholism develops confusion,
ophthalmoplegia, and ataxia. What is the most likely
diagnosis?
A. Korsakoff syndrome
B. Hepatic encephalopathy
C. Delirium tremens
, D. Wernicke encephalopathy
E. Creutzfeldt-Jakob disease
Answer: D. Wernicke encephalopathy
The classic triad of confusion, ophthalmoplegia, and ataxia is
caused by thiamine deficiency. Immediate thiamine
administration is required before glucose.
Question 6
A 45-year-old woman presents with fatigue and pruritus.
Laboratory testing reveals elevated alkaline phosphatase and
positive antimitochondrial antibodies. What is the diagnosis?
A. Primary sclerosing cholangitis
B. Autoimmune hepatitis
C. Viral hepatitis B
D. Hemochromatosis
E. Primary biliary cholangitis
Answer: E. Primary biliary cholangitis
Primary biliary cholangitis is characterized by autoimmune
destruction of intrahepatic bile ducts, elevated alkaline
phosphatase, and antimitochondrial antibodies.
Question 7
A diabetic patient presents with fever, flank pain, and
costovertebral angle tenderness. Which diagnosis is most
likely?
Clinical Data Synthesis Bank) (2026 Edition):
Comprehensive Multiple-Choice Questions,
Answers, and Detailed Rationales
Question 1
A 68-year-old man presents with progressive dyspnea and
fatigue. Echocardiography shows a left ventricular ejection
fraction of 30%. Which medication has been shown to reduce
mortality in heart failure with reduced ejection fraction?
A. Verapamil
B. Digoxin
C. Lisinopril
D. Diltiazem
E. Furosemide
Answer: C. Lisinopril
ACE inhibitors reduce mortality and hospitalizations in
patients with HFrEF by decreasing afterload and limiting
adverse cardiac remodeling. Digoxin and diuretics improve
symptoms but do not provide the same mortality benefit.
Question 2
A 24-year-old woman presents with dysuria and urinary
frequency. Urinalysis demonstrates positive leukocyte
,esterase and nitrites. What is the most likely causative
organism?
A. Staphylococcus saprophyticus
B. Enterococcus faecalis
C. Escherichia coli
D. Proteus vulgaris
E. Candida albicans
Answer: C. Escherichia coli
E. coli is responsible for the majority of uncomplicated
urinary tract infections. Nitrite positivity suggests infection
with nitrate-reducing gram-negative bacteria, most
commonly E. coli.
Question 3
A patient develops sudden chest pain and dyspnea 3 days
after hip replacement surgery. Which diagnostic test is most
appropriate initially in a hemodynamically stable patient with
suspected pulmonary embolism?
A. Chest radiograph
B. Echocardiogram
C. Ventilation-perfusion scan in all patients
D. CT pulmonary angiography
E. Bronchoscopy
Answer: D. CT pulmonary angiography
,CT pulmonary angiography is the preferred diagnostic test for
stable patients with suspected pulmonary embolism. It
directly visualizes thrombi within pulmonary arteries.
Question 4
A 57-year-old woman presents with tremor, heat intolerance,
and weight loss. Laboratory studies reveal suppressed TSH
and elevated free T4. Which diagnosis is most likely?
A. Hashimoto thyroiditis
B. Subacute thyroiditis
C. Pituitary adenoma
D. Euthyroid sick syndrome
E. Graves disease
Answer: E. Graves disease
Graves disease is the most common cause of
hyperthyroidism and presents with low TSH and elevated
thyroid hormone levels. Autoantibodies stimulate the TSH
receptor.
Question 5
A patient with chronic alcoholism develops confusion,
ophthalmoplegia, and ataxia. What is the most likely
diagnosis?
A. Korsakoff syndrome
B. Hepatic encephalopathy
C. Delirium tremens
, D. Wernicke encephalopathy
E. Creutzfeldt-Jakob disease
Answer: D. Wernicke encephalopathy
The classic triad of confusion, ophthalmoplegia, and ataxia is
caused by thiamine deficiency. Immediate thiamine
administration is required before glucose.
Question 6
A 45-year-old woman presents with fatigue and pruritus.
Laboratory testing reveals elevated alkaline phosphatase and
positive antimitochondrial antibodies. What is the diagnosis?
A. Primary sclerosing cholangitis
B. Autoimmune hepatitis
C. Viral hepatitis B
D. Hemochromatosis
E. Primary biliary cholangitis
Answer: E. Primary biliary cholangitis
Primary biliary cholangitis is characterized by autoimmune
destruction of intrahepatic bile ducts, elevated alkaline
phosphatase, and antimitochondrial antibodies.
Question 7
A diabetic patient presents with fever, flank pain, and
costovertebral angle tenderness. Which diagnosis is most
likely?
