COMSAE Phase 2 – Form BSA 115i (Secure
Browser Testing Standard; Video-Enhanced
Format) (2026 Edition): Comprehensive Multiple-
Choice Questions, Answers, and Detailed
Rationales
1.
A 65-year-old man with COPD presents with worsening
dyspnea and increased sputum purulence. ABG shows pH
7.32, PaCO₂ 60 mmHg. What is the best next step?
A. High-dose IV steroids only
B. Noninvasive positive pressure ventilation (BiPAP)
C. Immediate intubation
D. Diuretics
E. Opioids for dyspnea
Rationale: The patient has acute hypercapnic respiratory
failure from COPD exacerbation. BiPAP is first-line if no
contraindications, improving ventilation and reducing CO₂
retention. Intubation is reserved for failure of noninvasive
support.
2.
,A 22-year-old woman has heat intolerance, weight loss, and
tremor. Labs show low TSH and elevated free T4. What is the
most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Thyroid cancer
E. Iodine deficiency
Rationale: Suppressed TSH with elevated T4 plus hyperthyroid
symptoms strongly indicates Graves disease, especially in
young women.
3.
A 60-year-old man has crushing chest pain for 1 hour. ECG
shows ST elevation in leads II, III, and aVF. Which artery is
most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main coronary artery
E. Posterior descending artery only
Rationale: Inferior MI (II, III, aVF) is most commonly due to
right coronary artery occlusion.
4.
,A child presents with barking cough and inspiratory stridor.
Symptoms improve with cool air exposure. Diagnosis?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Foreign body aspiration
D. Asthma
E. Bronchiolitis
Rationale: Croup presents with barking cough and stridor,
often improving with cold air or humidified oxygen.
5.
A patient presents with sudden severe flank pain radiating to
groin. Urinalysis shows hematuria. Most likely diagnosis?
A. Pyelonephritis
B. Nephrolithiasis (ureteral stone)
C. Appendicitis
D. Ovarian torsion
E. Cystitis
Rationale: Acute colicky flank pain with hematuria is classic
for kidney stones.
6.
A 45-year-old woman has fatigue, dry skin, and constipation.
Labs show high TSH and low T4. Diagnosis?
, A. Graves disease
B. Primary hypothyroidism (Hashimoto thyroiditis)
C. Secondary hypothyroidism
D. Thyroid storm
E. Subacute thyroiditis
Rationale: High TSH with low T4 indicates primary
hypothyroidism, commonly Hashimoto.
7.
A man presents with fever, dysuria, and perineal pain. Tender
prostate on exam. Diagnosis?
A. BPH
B. Epididymitis
C. Acute bacterial prostatitis
D. Urethritis
E. Prostate cancer
Rationale: Fever and tender prostate indicate acute bacterial
prostatitis.
8.
A newborn has failure to pass meconium within 48 hours.
Imaging shows transition zone in colon. Diagnosis?
A. Necrotizing enterocolitis
B. Hirschsprung disease
C. Pyloric stenosis
Browser Testing Standard; Video-Enhanced
Format) (2026 Edition): Comprehensive Multiple-
Choice Questions, Answers, and Detailed
Rationales
1.
A 65-year-old man with COPD presents with worsening
dyspnea and increased sputum purulence. ABG shows pH
7.32, PaCO₂ 60 mmHg. What is the best next step?
A. High-dose IV steroids only
B. Noninvasive positive pressure ventilation (BiPAP)
C. Immediate intubation
D. Diuretics
E. Opioids for dyspnea
Rationale: The patient has acute hypercapnic respiratory
failure from COPD exacerbation. BiPAP is first-line if no
contraindications, improving ventilation and reducing CO₂
retention. Intubation is reserved for failure of noninvasive
support.
2.
,A 22-year-old woman has heat intolerance, weight loss, and
tremor. Labs show low TSH and elevated free T4. What is the
most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Thyroid cancer
E. Iodine deficiency
Rationale: Suppressed TSH with elevated T4 plus hyperthyroid
symptoms strongly indicates Graves disease, especially in
young women.
3.
A 60-year-old man has crushing chest pain for 1 hour. ECG
shows ST elevation in leads II, III, and aVF. Which artery is
most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main coronary artery
E. Posterior descending artery only
Rationale: Inferior MI (II, III, aVF) is most commonly due to
right coronary artery occlusion.
4.
,A child presents with barking cough and inspiratory stridor.
Symptoms improve with cool air exposure. Diagnosis?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Foreign body aspiration
D. Asthma
E. Bronchiolitis
Rationale: Croup presents with barking cough and stridor,
often improving with cold air or humidified oxygen.
5.
A patient presents with sudden severe flank pain radiating to
groin. Urinalysis shows hematuria. Most likely diagnosis?
A. Pyelonephritis
B. Nephrolithiasis (ureteral stone)
C. Appendicitis
D. Ovarian torsion
E. Cystitis
Rationale: Acute colicky flank pain with hematuria is classic
for kidney stones.
6.
A 45-year-old woman has fatigue, dry skin, and constipation.
Labs show high TSH and low T4. Diagnosis?
, A. Graves disease
B. Primary hypothyroidism (Hashimoto thyroiditis)
C. Secondary hypothyroidism
D. Thyroid storm
E. Subacute thyroiditis
Rationale: High TSH with low T4 indicates primary
hypothyroidism, commonly Hashimoto.
7.
A man presents with fever, dysuria, and perineal pain. Tender
prostate on exam. Diagnosis?
A. BPH
B. Epididymitis
C. Acute bacterial prostatitis
D. Urethritis
E. Prostate cancer
Rationale: Fever and tender prostate indicate acute bacterial
prostatitis.
8.
A newborn has failure to pass meconium within 48 hours.
Imaging shows transition zone in colon. Diagnosis?
A. Necrotizing enterocolitis
B. Hirschsprung disease
C. Pyloric stenosis
