COMSAE Phase 2 – Form BSA 117 (2026):
Clinical Review Practice Exam with Multiple-
Choice Questions, Answers, and Detailed
Rationales
1. A 62-year-old man with hypertension presents with
sudden, severe tearing chest pain radiating to the back. BP
is 180/100 in right arm and 150/90 in left arm. What is the
most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Rationale: The classic presentation of tearing chest pain
radiating to the back plus blood pressure differential between
arms strongly suggests aortic dissection. Hypertension is a
major risk factor.
2. A 24-year-old woman presents with fatigue, weight gain,
and cold intolerance. TSH is elevated and free T4 is low.
What is the most likely diagnosis?
A. Graves disease
B. Thyroid cancer
,C. Hashimoto thyroiditis
D. Subacute thyroiditis
Rationale: Primary hypothyroidism with elevated TSH and low
T4 is consistent with Hashimoto thyroiditis, the most common
cause of hypothyroidism in iodine-sufficient regions.
3. A patient presents with severe chest pain and ST
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior wall MI (II, III, aVF) is most commonly due
to right coronary artery occlusion.
4. A newborn has cyanosis that improves with oxygen. A
harsh systolic murmur is heard at the left upper sternal
border. Diagnosis?
A. Truncus arteriosus
B. Transposition of great vessels
C. Ventricular septal defect
D. Tetralogy of Fallot
Rationale: Tetralogy of Fallot causes cyanotic spells and a
harsh systolic murmur due to pulmonary stenosis.
,5. A 30-year-old man has recurrent nosebleeds,
telangiectasias on lips, and AV malformations. Diagnosis?
A. Hemophilia A
B. Von Willebrand disease
C. Hereditary hemorrhagic telangiectasia
D. ITP
Rationale: Osler-Weber-Rendu syndrome causes
mucocutaneous telangiectasias and AV malformations
leading to recurrent epistaxis.
6. A patient develops wheezing and hypotension after
receiving IV antibiotics. First step in management?
A. IV corticosteroids
B. Antihistamines
C. Intramuscular epinephrine
D. Oxygen only
Rationale: Anaphylaxis requires immediate IM epinephrine as
first-line treatment.
7. A 45-year-old alcoholic presents with confusion,
ophthalmoplegia, and ataxia. Treatment?
A. Thiamine
B. Vitamin B12
C. Folate
D. Thiamine before glucose
, Rationale: Wernicke encephalopathy is treated with thiamine
prior to glucose to prevent worsening neurologic injury.
8. A child has barking cough and inspiratory stridor. Most
likely diagnosis?
A. Epiglottitis
B. Asthma
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
Rationale: Croup presents with barking cough and stridor due
to viral upper airway inflammation.
9. A patient has painless hematuria and a mass in the
bladder on imaging. Most likely risk factor?
A. Smoking
B. High protein diet
C. Aromatic amine exposure
D. Alcohol use
Rationale: Bladder cancer is strongly associated with smoking
and aromatic amines in industrial exposure.
10. A woman presents with exophthalmos, heat intolerance,
and weight loss. Diagnosis?
A. Hashimoto thyroiditis
B. Thyroid storm
Clinical Review Practice Exam with Multiple-
Choice Questions, Answers, and Detailed
Rationales
1. A 62-year-old man with hypertension presents with
sudden, severe tearing chest pain radiating to the back. BP
is 180/100 in right arm and 150/90 in left arm. What is the
most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Rationale: The classic presentation of tearing chest pain
radiating to the back plus blood pressure differential between
arms strongly suggests aortic dissection. Hypertension is a
major risk factor.
2. A 24-year-old woman presents with fatigue, weight gain,
and cold intolerance. TSH is elevated and free T4 is low.
What is the most likely diagnosis?
A. Graves disease
B. Thyroid cancer
,C. Hashimoto thyroiditis
D. Subacute thyroiditis
Rationale: Primary hypothyroidism with elevated TSH and low
T4 is consistent with Hashimoto thyroiditis, the most common
cause of hypothyroidism in iodine-sufficient regions.
3. A patient presents with severe chest pain and ST
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior wall MI (II, III, aVF) is most commonly due
to right coronary artery occlusion.
4. A newborn has cyanosis that improves with oxygen. A
harsh systolic murmur is heard at the left upper sternal
border. Diagnosis?
A. Truncus arteriosus
B. Transposition of great vessels
C. Ventricular septal defect
D. Tetralogy of Fallot
Rationale: Tetralogy of Fallot causes cyanotic spells and a
harsh systolic murmur due to pulmonary stenosis.
,5. A 30-year-old man has recurrent nosebleeds,
telangiectasias on lips, and AV malformations. Diagnosis?
A. Hemophilia A
B. Von Willebrand disease
C. Hereditary hemorrhagic telangiectasia
D. ITP
Rationale: Osler-Weber-Rendu syndrome causes
mucocutaneous telangiectasias and AV malformations
leading to recurrent epistaxis.
6. A patient develops wheezing and hypotension after
receiving IV antibiotics. First step in management?
A. IV corticosteroids
B. Antihistamines
C. Intramuscular epinephrine
D. Oxygen only
Rationale: Anaphylaxis requires immediate IM epinephrine as
first-line treatment.
7. A 45-year-old alcoholic presents with confusion,
ophthalmoplegia, and ataxia. Treatment?
A. Thiamine
B. Vitamin B12
C. Folate
D. Thiamine before glucose
, Rationale: Wernicke encephalopathy is treated with thiamine
prior to glucose to prevent worsening neurologic injury.
8. A child has barking cough and inspiratory stridor. Most
likely diagnosis?
A. Epiglottitis
B. Asthma
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
Rationale: Croup presents with barking cough and stridor due
to viral upper airway inflammation.
9. A patient has painless hematuria and a mass in the
bladder on imaging. Most likely risk factor?
A. Smoking
B. High protein diet
C. Aromatic amine exposure
D. Alcohol use
Rationale: Bladder cancer is strongly associated with smoking
and aromatic amines in industrial exposure.
10. A woman presents with exophthalmos, heat intolerance,
and weight loss. Diagnosis?
A. Hashimoto thyroiditis
B. Thyroid storm
