COMSAE Comprehensive Midterm
Assessment Form CMA 109 Exam Practice
Questions & [Verified Answers], Plus
Explained Rationales|2026 Latest Update|
Instant Download PDF
1. A 24-year-old woman presents with fatigue, palpitations, and
exertional dyspnea. Laboratory studies show hemoglobin 8.4
g/dL, MCV 68 fL, ferritin 8 ng/mL, and elevated total iron-binding
capacity. Which of the following is the most likely mechanism
responsible for her anemia?
A. Reduced heme synthesis due to iron deficiency
B. Autoimmune destruction of erythrocytes
C. Defective globin chain synthesis due to β-globin mutation
D. Bone marrow replacement by fibrosis
E. Decreased erythropoietin production
Answer: A. Reduced heme synthesis due to iron deficiency
Rationale: Iron deficiency anemia causes impaired heme synthesis,
leading to microcytic hypochromic anemia. Low ferritin reflects
depleted iron stores, while elevated TIBC reflects increased transferrin
production. Autoimmune hemolysis causes normocytic anemia with
elevated reticulocytes. Thalassemia is associated with normal or
elevated iron stores.
2. A 68-year-old man presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG reveals ST-segment
, 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. Obtuse marginal artery
E. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior myocardial infarctions produce ST elevations in II,
III, and aVF. The right coronary artery supplies the inferior wall in
most individuals. LAD occlusion causes anterior wall infarction with
V1-V4 elevations.
3. A 32-year-old man presents with tremor, weight loss, heat
intolerance, and palpitations. Physical examination reveals
exophthalmos and diffuse goiter. Which antibody is responsible
for this disorder?
A. Anti-thyroglobulin antibody
B. Anti-thyroid peroxidase antibody
C. Thyroid-stimulating immunoglobulin
D. Anti-TSH antibody
E. Anti-microsomal antibody
Answer: C. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from IgG autoantibodies that
stimulate TSH receptors, causing hyperthyroidism and
ophthalmopathy. Anti-TPO antibodies are more characteristic of
Hashimoto thyroiditis.
, 4. A patient with chronic alcoholism develops confusion,
ophthalmoplegia, and gait ataxia. Which vitamin deficiency is
responsible?
A. Vitamin B6
B. Vitamin B12
C. Vitamin C
D. Thiamine
E. Niacin
Answer: D. Thiamine
Rationale: Wernicke encephalopathy is characterized by the triad of
confusion, ophthalmoplegia, and ataxia caused by thiamine
deficiency. Untreated patients may develop Korsakoff syndrome with
irreversible memory deficits.
5. A 5-year-old boy presents with recurrent catalase-positive
bacterial infections and granuloma formation. Neutrophils fail the
nitroblue tetrazolium test. What enzyme is deficient?
A. Myeloperoxidase
B. NADPH oxidase
C. Glucose-6-phosphatase
D. Superoxide dismutase
E. Catalase
Answer: B. NADPH oxidase
Rationale: Chronic granulomatous disease results from NADPH
oxidase deficiency, preventing respiratory burst and killing of
catalase-positive organisms such as Staphylococcus aureus, Serratia,
Aspergillus, and Burkholderia cepacia.
, 6. A 60-year-old smoker develops hematuria and painless urinary
bleeding. Cystoscopy demonstrates a bladder mass. What is the
strongest environmental risk factor?
A. Alcohol consumption
B. Ultraviolet radiation
C. Aromatic amines exposure
D. High-fat diet
E. Helicobacter pylori infection
Answer: C. Aromatic amines exposure
Rationale: Transitional cell carcinoma of the bladder is strongly
associated with cigarette smoking and exposure to aromatic amines
found in dye and rubber industries.
7. A newborn develops cyanosis shortly after birth.
Echocardiography reveals transposition of the great arteries.
Which embryologic structure failed to develop properly?
A. Septum primum
B. Endocardial cushions
C. Aorticopulmonary septum
D. Sinus venosus
E. Bulbus cordis
Answer: C. Aorticopulmonary septum
Rationale: Transposition of the great arteries results from failure of
the aorticopulmonary septum to spiral, producing parallel circulations
incompatible with life unless shunting exists.
8. A patient develops nephrotic syndrome with diffuse foot process
effacement on electron microscopy but normal light microscopy.
Which diagnosis is most likely?
Assessment Form CMA 109 Exam Practice
Questions & [Verified Answers], Plus
Explained Rationales|2026 Latest Update|
Instant Download PDF
1. A 24-year-old woman presents with fatigue, palpitations, and
exertional dyspnea. Laboratory studies show hemoglobin 8.4
g/dL, MCV 68 fL, ferritin 8 ng/mL, and elevated total iron-binding
capacity. Which of the following is the most likely mechanism
responsible for her anemia?
A. Reduced heme synthesis due to iron deficiency
B. Autoimmune destruction of erythrocytes
C. Defective globin chain synthesis due to β-globin mutation
D. Bone marrow replacement by fibrosis
E. Decreased erythropoietin production
Answer: A. Reduced heme synthesis due to iron deficiency
Rationale: Iron deficiency anemia causes impaired heme synthesis,
leading to microcytic hypochromic anemia. Low ferritin reflects
depleted iron stores, while elevated TIBC reflects increased transferrin
production. Autoimmune hemolysis causes normocytic anemia with
elevated reticulocytes. Thalassemia is associated with normal or
elevated iron stores.
2. A 68-year-old man presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG reveals ST-segment
, 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. Obtuse marginal artery
E. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior myocardial infarctions produce ST elevations in II,
III, and aVF. The right coronary artery supplies the inferior wall in
most individuals. LAD occlusion causes anterior wall infarction with
V1-V4 elevations.
3. A 32-year-old man presents with tremor, weight loss, heat
intolerance, and palpitations. Physical examination reveals
exophthalmos and diffuse goiter. Which antibody is responsible
for this disorder?
A. Anti-thyroglobulin antibody
B. Anti-thyroid peroxidase antibody
C. Thyroid-stimulating immunoglobulin
D. Anti-TSH antibody
E. Anti-microsomal antibody
Answer: C. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from IgG autoantibodies that
stimulate TSH receptors, causing hyperthyroidism and
ophthalmopathy. Anti-TPO antibodies are more characteristic of
Hashimoto thyroiditis.
, 4. A patient with chronic alcoholism develops confusion,
ophthalmoplegia, and gait ataxia. Which vitamin deficiency is
responsible?
A. Vitamin B6
B. Vitamin B12
C. Vitamin C
D. Thiamine
E. Niacin
Answer: D. Thiamine
Rationale: Wernicke encephalopathy is characterized by the triad of
confusion, ophthalmoplegia, and ataxia caused by thiamine
deficiency. Untreated patients may develop Korsakoff syndrome with
irreversible memory deficits.
5. A 5-year-old boy presents with recurrent catalase-positive
bacterial infections and granuloma formation. Neutrophils fail the
nitroblue tetrazolium test. What enzyme is deficient?
A. Myeloperoxidase
B. NADPH oxidase
C. Glucose-6-phosphatase
D. Superoxide dismutase
E. Catalase
Answer: B. NADPH oxidase
Rationale: Chronic granulomatous disease results from NADPH
oxidase deficiency, preventing respiratory burst and killing of
catalase-positive organisms such as Staphylococcus aureus, Serratia,
Aspergillus, and Burkholderia cepacia.
, 6. A 60-year-old smoker develops hematuria and painless urinary
bleeding. Cystoscopy demonstrates a bladder mass. What is the
strongest environmental risk factor?
A. Alcohol consumption
B. Ultraviolet radiation
C. Aromatic amines exposure
D. High-fat diet
E. Helicobacter pylori infection
Answer: C. Aromatic amines exposure
Rationale: Transitional cell carcinoma of the bladder is strongly
associated with cigarette smoking and exposure to aromatic amines
found in dye and rubber industries.
7. A newborn develops cyanosis shortly after birth.
Echocardiography reveals transposition of the great arteries.
Which embryologic structure failed to develop properly?
A. Septum primum
B. Endocardial cushions
C. Aorticopulmonary septum
D. Sinus venosus
E. Bulbus cordis
Answer: C. Aorticopulmonary septum
Rationale: Transposition of the great arteries results from failure of
the aorticopulmonary septum to spiral, producing parallel circulations
incompatible with life unless shunting exists.
8. A patient develops nephrotic syndrome with diffuse foot process
effacement on electron microscopy but normal light microscopy.
Which diagnosis is most likely?
