COMSAE Institutional Readiness Assessment
Form IRA 101 Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 22-year-old medical student presents with intermittent
episodes of wheezing, chest tightness, and cough that worsen at
night and after exposure to cats. Pulmonary function testing
demonstrates an FEV1/FVC ratio of 65% with significant
reversibility after bronchodilator administration. Which of the
following is the most likely underlying pathophysiologic
mechanism?
A. Destruction of alveolar septa due to elastase activity
B. Airway hyperresponsiveness with eosinophilic inflammation
C. Fibrotic thickening of alveolar walls
D. Decreased chest wall compliance
Answer: B. Airway hyperresponsiveness with eosinophilic
inflammation
Rationale: Asthma is characterized by chronic airway inflammation,
bronchial hyperreactivity, and reversible airflow obstruction.
Eosinophils, mast cells, and Th2 lymphocytes play major roles. The
reversibility on spirometry strongly supports asthma.
2. A 67-year-old man presents with crushing substernal chest pain
radiating to his 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. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction produces ST elevation in
leads II, III, and aVF and is most commonly due to occlusion of the
right coronary artery.
3. A patient presents with polyuria, polydipsia, fasting glucose of 310
mg/dL, and positive anti-GAD antibodies. Which is the most likely
diagnosis?
A. Type 2 diabetes mellitus
B. Type 1 diabetes mellitus
C. MODY
D. Gestational diabetes
Answer: B. Type 1 diabetes mellitus
Rationale: Autoantibodies against glutamic acid decarboxylase
indicate autoimmune destruction of pancreatic beta cells
characteristic of Type 1 diabetes.
4. Which acid-base disorder is expected in a patient with prolonged
vomiting?
,A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: C. Metabolic alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid, leading to
increased serum bicarbonate and metabolic alkalosis.
5. A 58-year-old smoker develops hematuria without pain. Urinalysis
reveals numerous RBCs but no casts. Which diagnosis is most
concerning?
A. Pyelonephritis
B. Renal artery stenosis
C. Bladder carcinoma
D. Nephrotic syndrome
Answer: C. Bladder carcinoma
Rationale: Painless hematuria in an older smoker is classic for
urothelial carcinoma of the bladder and requires prompt evaluation.
6. A patient with hyperthyroidism is most likely to exhibit which
physical finding?
A. Bradycardia
B. Weight gain
C. Cold intolerance
D. Fine tremor
Answer: D. Fine tremor
, Rationale: Increased adrenergic activity in hyperthyroidism causes
tremor, tachycardia, anxiety, and heat intolerance.
7. A patient presents with severe epigastric pain radiating to the
back and elevated serum lipase. Which diagnosis is most likely?
A. Cholecystitis
B. Acute pancreatitis
C. Gastritis
D. Appendicitis
Answer: B. Acute pancreatitis
Rationale: Acute pancreatitis classically presents with epigastric pain
radiating to the back and elevated lipase levels.
8. Which nephron segment reabsorbs the largest percentage of
filtered sodium?
A. Distal convoluted tubule
B. Collecting duct
C. Proximal convoluted tubule
D. Thin descending limb
Answer: C. Proximal convoluted tubule
Rationale: Approximately 65% of filtered sodium is reabsorbed in the
proximal convoluted tubule along with water and nutrients.
9. A patient develops fever, neck stiffness, and photophobia. CSF
analysis reveals elevated neutrophils, low glucose, and high
protein. The most likely diagnosis is:
Form IRA 101 Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 22-year-old medical student presents with intermittent
episodes of wheezing, chest tightness, and cough that worsen at
night and after exposure to cats. Pulmonary function testing
demonstrates an FEV1/FVC ratio of 65% with significant
reversibility after bronchodilator administration. Which of the
following is the most likely underlying pathophysiologic
mechanism?
A. Destruction of alveolar septa due to elastase activity
B. Airway hyperresponsiveness with eosinophilic inflammation
C. Fibrotic thickening of alveolar walls
D. Decreased chest wall compliance
Answer: B. Airway hyperresponsiveness with eosinophilic
inflammation
Rationale: Asthma is characterized by chronic airway inflammation,
bronchial hyperreactivity, and reversible airflow obstruction.
Eosinophils, mast cells, and Th2 lymphocytes play major roles. The
reversibility on spirometry strongly supports asthma.
2. A 67-year-old man presents with crushing substernal chest pain
radiating to his 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. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction produces ST elevation in
leads II, III, and aVF and is most commonly due to occlusion of the
right coronary artery.
3. A patient presents with polyuria, polydipsia, fasting glucose of 310
mg/dL, and positive anti-GAD antibodies. Which is the most likely
diagnosis?
A. Type 2 diabetes mellitus
B. Type 1 diabetes mellitus
C. MODY
D. Gestational diabetes
Answer: B. Type 1 diabetes mellitus
Rationale: Autoantibodies against glutamic acid decarboxylase
indicate autoimmune destruction of pancreatic beta cells
characteristic of Type 1 diabetes.
4. Which acid-base disorder is expected in a patient with prolonged
vomiting?
,A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: C. Metabolic alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid, leading to
increased serum bicarbonate and metabolic alkalosis.
5. A 58-year-old smoker develops hematuria without pain. Urinalysis
reveals numerous RBCs but no casts. Which diagnosis is most
concerning?
A. Pyelonephritis
B. Renal artery stenosis
C. Bladder carcinoma
D. Nephrotic syndrome
Answer: C. Bladder carcinoma
Rationale: Painless hematuria in an older smoker is classic for
urothelial carcinoma of the bladder and requires prompt evaluation.
6. A patient with hyperthyroidism is most likely to exhibit which
physical finding?
A. Bradycardia
B. Weight gain
C. Cold intolerance
D. Fine tremor
Answer: D. Fine tremor
, Rationale: Increased adrenergic activity in hyperthyroidism causes
tremor, tachycardia, anxiety, and heat intolerance.
7. A patient presents with severe epigastric pain radiating to the
back and elevated serum lipase. Which diagnosis is most likely?
A. Cholecystitis
B. Acute pancreatitis
C. Gastritis
D. Appendicitis
Answer: B. Acute pancreatitis
Rationale: Acute pancreatitis classically presents with epigastric pain
radiating to the back and elevated lipase levels.
8. Which nephron segment reabsorbs the largest percentage of
filtered sodium?
A. Distal convoluted tubule
B. Collecting duct
C. Proximal convoluted tubule
D. Thin descending limb
Answer: C. Proximal convoluted tubule
Rationale: Approximately 65% of filtered sodium is reabsorbed in the
proximal convoluted tubule along with water and nutrients.
9. A patient develops fever, neck stiffness, and photophobia. CSF
analysis reveals elevated neutrophils, low glucose, and high
protein. The most likely diagnosis is:
