COMSAE Comprehensive Midterm Assessment
Form CMA 108 Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 24-year-old woman presents with fatigue, jaundice, and dark
urine that developed over several days. Laboratory testing reveals
Hb 8.2 g/dL, elevated LDH, decreased haptoglobin, and a positive
direct Coombs test. Which of the following is the most likely
diagnosis?
A. Hereditary spherocytosis
B. Autoimmune hemolytic anemia
C. Sickle cell disease
D. G6PD deficiency
E. Iron deficiency anemia
Answer: B. Autoimmune hemolytic anemia
Rationale: A positive direct Coombs test demonstrates antibodies
attached to erythrocytes, confirming autoimmune hemolytic anemia
(AIHA). Elevated LDH, decreased haptoglobin, reticulocytosis, and
indirect hyperbilirubinemia are classic findings. Hereditary spherocytosis
presents with Coombs-negative hemolysis, while G6PD deficiency is
associated with oxidative stress and bite cells.
2. A 65-year-old man with a smoking history presents with
hematuria and flank pain. CT reveals a renal mass extending into
, the renal vein. Which paraneoplastic syndrome is most commonly
associated with this malignancy?
A. Hypercalcemia from PTHrP
B. SIADH
C. Polycythemia from erythropoietin production
D. Cushing syndrome
E. Carcinoid syndrome
Answer: C. Polycythemia from erythropoietin production
Rationale: Renal cell carcinoma commonly invades the renal vein and is
associated with erythropoietin production leading to polycythemia.
Other paraneoplastic syndromes include hypercalcemia, hypertension,
and ACTH production.
3. A 70-year-old woman develops sudden painless loss of vision in
one eye. Fundoscopy reveals a cherry-red spot and retinal pallor.
The diagnosis is:
A. Acute angle closure glaucoma
B. Central retinal artery occlusion
C. Retinal detachment
D. Optic neuritis
E. Diabetic retinopathy
Answer: B. Central retinal artery occlusion
Rationale: Central retinal artery occlusion presents with acute painless
monocular blindness and a cherry-red spot on fundoscopy. The retina
becomes pale because of ischemia while the macula retains its red
coloration.
, 4. A patient with chronic alcohol abuse develops confusion, ataxia,
and ophthalmoplegia. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Pyridoxine
C. Niacin
D. Thiamine
E. Folate
Answer: D. Thiamine
Rationale: The triad of confusion, ophthalmoplegia, and ataxia defines
Wernicke encephalopathy due to thiamine deficiency. Untreated
disease can progress to Korsakoff syndrome characterized by
confabulation and amnesia.
5. A neonate develops bilious vomiting within the first day of life.
Abdominal radiography demonstrates a double-bubble sign. The
diagnosis is:
A. Hirschsprung disease
B. Meconium ileus
C. Duodenal atresia
D. Pyloric stenosis
E. Intussusception
Answer: C. Duodenal atresia
Rationale: Duodenal atresia presents with early bilious vomiting and
the classic double-bubble sign representing dilation of the stomach and
proximal duodenum. It is strongly associated with trisomy 21.
, 6. A patient taking warfarin develops severe bleeding. Which
treatment provides the most rapid reversal?
A. Fresh frozen plasma alone
B. Vitamin K orally
C. Protamine sulfate
D. Four-factor prothrombin complex concentrate plus vitamin K
E. Platelet transfusion
Answer: D. Four-factor prothrombin complex concentrate plus
vitamin K
Rationale: PCC provides immediate replacement of vitamin K-
dependent clotting factors II, VII, IX, and X, producing rapid reversal.
Vitamin K restores hepatic synthesis but requires several hours.
7. Which glomerular disease is characterized by nephrotic syndrome
in children and diffuse foot process effacement on electron
microscopy?
A. FSGS
B. Minimal change disease
C. Membranous nephropathy
D. IgA nephropathy
E. RPGN
Answer: B. Minimal change disease
Rationale: Minimal change disease is the most common nephrotic
syndrome in children and demonstrates normal glomeruli on light
microscopy with podocyte foot process effacement on electron
microscopy.
Form CMA 108 Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 24-year-old woman presents with fatigue, jaundice, and dark
urine that developed over several days. Laboratory testing reveals
Hb 8.2 g/dL, elevated LDH, decreased haptoglobin, and a positive
direct Coombs test. Which of the following is the most likely
diagnosis?
A. Hereditary spherocytosis
B. Autoimmune hemolytic anemia
C. Sickle cell disease
D. G6PD deficiency
E. Iron deficiency anemia
Answer: B. Autoimmune hemolytic anemia
Rationale: A positive direct Coombs test demonstrates antibodies
attached to erythrocytes, confirming autoimmune hemolytic anemia
(AIHA). Elevated LDH, decreased haptoglobin, reticulocytosis, and
indirect hyperbilirubinemia are classic findings. Hereditary spherocytosis
presents with Coombs-negative hemolysis, while G6PD deficiency is
associated with oxidative stress and bite cells.
2. A 65-year-old man with a smoking history presents with
hematuria and flank pain. CT reveals a renal mass extending into
, the renal vein. Which paraneoplastic syndrome is most commonly
associated with this malignancy?
A. Hypercalcemia from PTHrP
B. SIADH
C. Polycythemia from erythropoietin production
D. Cushing syndrome
E. Carcinoid syndrome
Answer: C. Polycythemia from erythropoietin production
Rationale: Renal cell carcinoma commonly invades the renal vein and is
associated with erythropoietin production leading to polycythemia.
Other paraneoplastic syndromes include hypercalcemia, hypertension,
and ACTH production.
3. A 70-year-old woman develops sudden painless loss of vision in
one eye. Fundoscopy reveals a cherry-red spot and retinal pallor.
The diagnosis is:
A. Acute angle closure glaucoma
B. Central retinal artery occlusion
C. Retinal detachment
D. Optic neuritis
E. Diabetic retinopathy
Answer: B. Central retinal artery occlusion
Rationale: Central retinal artery occlusion presents with acute painless
monocular blindness and a cherry-red spot on fundoscopy. The retina
becomes pale because of ischemia while the macula retains its red
coloration.
, 4. A patient with chronic alcohol abuse develops confusion, ataxia,
and ophthalmoplegia. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Pyridoxine
C. Niacin
D. Thiamine
E. Folate
Answer: D. Thiamine
Rationale: The triad of confusion, ophthalmoplegia, and ataxia defines
Wernicke encephalopathy due to thiamine deficiency. Untreated
disease can progress to Korsakoff syndrome characterized by
confabulation and amnesia.
5. A neonate develops bilious vomiting within the first day of life.
Abdominal radiography demonstrates a double-bubble sign. The
diagnosis is:
A. Hirschsprung disease
B. Meconium ileus
C. Duodenal atresia
D. Pyloric stenosis
E. Intussusception
Answer: C. Duodenal atresia
Rationale: Duodenal atresia presents with early bilious vomiting and
the classic double-bubble sign representing dilation of the stomach and
proximal duodenum. It is strongly associated with trisomy 21.
, 6. A patient taking warfarin develops severe bleeding. Which
treatment provides the most rapid reversal?
A. Fresh frozen plasma alone
B. Vitamin K orally
C. Protamine sulfate
D. Four-factor prothrombin complex concentrate plus vitamin K
E. Platelet transfusion
Answer: D. Four-factor prothrombin complex concentrate plus
vitamin K
Rationale: PCC provides immediate replacement of vitamin K-
dependent clotting factors II, VII, IX, and X, producing rapid reversal.
Vitamin K restores hepatic synthesis but requires several hours.
7. Which glomerular disease is characterized by nephrotic syndrome
in children and diffuse foot process effacement on electron
microscopy?
A. FSGS
B. Minimal change disease
C. Membranous nephropathy
D. IgA nephropathy
E. RPGN
Answer: B. Minimal change disease
Rationale: Minimal change disease is the most common nephrotic
syndrome in children and demonstrates normal glomeruli on light
microscopy with podocyte foot process effacement on electron
microscopy.
