COMSAE Institutional Readiness Assessment Form
IRA 103 Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 67-year-old man presents with progressive fatigue, exertional
dyspnea, and intermittent chest discomfort. Physical examination
reveals conjunctival pallor and spoon-shaped nails. Laboratory
studies show hemoglobin 8.2 g/dL, MCV 68 fL, ferritin 8 ng/mL,
serum iron low, and TIBC elevated. Which of the following is the
most appropriate next step in management?
A. Begin folate supplementation only
B. Administer vitamin B12 injections
C. Evaluate for occult gastrointestinal blood loss
D. Start erythropoietin therapy
E. Order bone marrow biopsy
Answer: C. Evaluate for occult gastrointestinal blood loss
Rationale: Iron deficiency anemia in an elderly male should be
presumed secondary to chronic blood loss until proven otherwise.
Gastrointestinal malignancy, polyps, peptic ulcer disease, and
angiodysplasia must be excluded. Low ferritin is highly specific for iron
deficiency. Bone marrow biopsy is unnecessary initially.
2. A 28-year-old woman develops palpitations, tremor, weight loss
despite increased appetite, and heat intolerance. Examination
shows a diffuse goiter and lid lag. Laboratory testing reveals
suppressed TSH and elevated free T4. Which mechanism best
explains her disease?
,A. Autoantibodies destroying thyroid follicles
B. Autoantibodies stimulating TSH receptors
C. Defective thyroglobulin synthesis
D. Excess calcitonin secretion
E. Iodine deficiency
Answer: B. Autoantibodies stimulating TSH receptors
Rationale: Graves disease results from IgG autoantibodies stimulating
TSH receptors, leading to increased thyroid hormone synthesis and
gland hyperplasia. The disease also causes ophthalmopathy and
pretibial myxedema due to fibroblast activation.
3. A 54-year-old diabetic patient presents with crushing substernal
chest pain radiating to the left arm for 2 hours. ECG demonstrates
ST elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior myocardial infarctions involving leads II, III, and
aVF are most commonly caused by right coronary artery occlusion.
Associated findings may include bradycardia and AV nodal block
because the RCA supplies the AV node in most individuals.
4. A 24-year-old man suddenly develops pleuritic chest pain and
dyspnea while playing basketball. He is tall and thin. Breath
sounds are absent on the right and percussion is hyperresonant.
What is the most likely diagnosis?
,A. Pulmonary embolism
B. Tension pneumothorax
C. Community-acquired pneumonia
D. Pleural effusion
E. Acute bronchitis
Answer: B. Tension pneumothorax
Rationale: Primary spontaneous pneumothorax classically occurs in
tall, thin young males due to rupture of apical blebs. Hyperresonance
and absent breath sounds are characteristic findings. Tension
physiology may cause hypotension and tracheal deviation.
5. A patient with long-standing hypertension develops headache,
visual disturbances, and blood pressure of 230/135 mmHg with
papilledema. What is the diagnosis?
A. Essential hypertension
B. White coat hypertension
C. Hypertensive emergency
D. Resistant hypertension
E. Secondary hypotension
Answer: C. Hypertensive emergency
Rationale: Hypertensive emergency is defined as severe hypertension
accompanied by evidence of acute end-organ damage, including
papilledema, encephalopathy, renal failure, myocardial ischemia, or
retinal hemorrhage. Immediate blood pressure reduction with IV
antihypertensives is required.
6. A 34-year-old woman presents with proximal muscle weakness,
heliotrope rash, and violaceous papules over the knuckles. Which
diagnosis is most likely?
, A. Rheumatoid arthritis
B. Dermatomyositis
C. Psoriatic arthritis
D. Systemic sclerosis
E. Polymyalgia rheumatica
Answer: B. Dermatomyositis
Rationale: Dermatomyositis is characterized by proximal muscle
weakness with characteristic skin findings including heliotrope rash
and Gottron papules. Elevated CK levels and inflammatory infiltrates
are commonly present. Adult cases may be associated with
malignancy.
7. A patient with alcohol use disorder develops confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is
responsible?
A. Riboflavin
B. Pyridoxine
C. Thiamine
D. Folate
E. Niacin
Answer: C. Thiamine
Rationale: Wernicke encephalopathy results from thiamine deficiency
and presents with the triad of confusion, ophthalmoplegia, and
ataxia. Immediate thiamine administration before glucose is essential
to prevent worsening neurologic injury.
8. A patient presents with fever, productive cough, and rust-colored
sputum. Chest radiograph shows lobar consolidation. Which
organism is the most likely cause?
IRA 103 Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 67-year-old man presents with progressive fatigue, exertional
dyspnea, and intermittent chest discomfort. Physical examination
reveals conjunctival pallor and spoon-shaped nails. Laboratory
studies show hemoglobin 8.2 g/dL, MCV 68 fL, ferritin 8 ng/mL,
serum iron low, and TIBC elevated. Which of the following is the
most appropriate next step in management?
A. Begin folate supplementation only
B. Administer vitamin B12 injections
C. Evaluate for occult gastrointestinal blood loss
D. Start erythropoietin therapy
E. Order bone marrow biopsy
Answer: C. Evaluate for occult gastrointestinal blood loss
Rationale: Iron deficiency anemia in an elderly male should be
presumed secondary to chronic blood loss until proven otherwise.
Gastrointestinal malignancy, polyps, peptic ulcer disease, and
angiodysplasia must be excluded. Low ferritin is highly specific for iron
deficiency. Bone marrow biopsy is unnecessary initially.
2. A 28-year-old woman develops palpitations, tremor, weight loss
despite increased appetite, and heat intolerance. Examination
shows a diffuse goiter and lid lag. Laboratory testing reveals
suppressed TSH and elevated free T4. Which mechanism best
explains her disease?
,A. Autoantibodies destroying thyroid follicles
B. Autoantibodies stimulating TSH receptors
C. Defective thyroglobulin synthesis
D. Excess calcitonin secretion
E. Iodine deficiency
Answer: B. Autoantibodies stimulating TSH receptors
Rationale: Graves disease results from IgG autoantibodies stimulating
TSH receptors, leading to increased thyroid hormone synthesis and
gland hyperplasia. The disease also causes ophthalmopathy and
pretibial myxedema due to fibroblast activation.
3. A 54-year-old diabetic patient presents with crushing substernal
chest pain radiating to the left arm for 2 hours. ECG demonstrates
ST elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior myocardial infarctions involving leads II, III, and
aVF are most commonly caused by right coronary artery occlusion.
Associated findings may include bradycardia and AV nodal block
because the RCA supplies the AV node in most individuals.
4. A 24-year-old man suddenly develops pleuritic chest pain and
dyspnea while playing basketball. He is tall and thin. Breath
sounds are absent on the right and percussion is hyperresonant.
What is the most likely diagnosis?
,A. Pulmonary embolism
B. Tension pneumothorax
C. Community-acquired pneumonia
D. Pleural effusion
E. Acute bronchitis
Answer: B. Tension pneumothorax
Rationale: Primary spontaneous pneumothorax classically occurs in
tall, thin young males due to rupture of apical blebs. Hyperresonance
and absent breath sounds are characteristic findings. Tension
physiology may cause hypotension and tracheal deviation.
5. A patient with long-standing hypertension develops headache,
visual disturbances, and blood pressure of 230/135 mmHg with
papilledema. What is the diagnosis?
A. Essential hypertension
B. White coat hypertension
C. Hypertensive emergency
D. Resistant hypertension
E. Secondary hypotension
Answer: C. Hypertensive emergency
Rationale: Hypertensive emergency is defined as severe hypertension
accompanied by evidence of acute end-organ damage, including
papilledema, encephalopathy, renal failure, myocardial ischemia, or
retinal hemorrhage. Immediate blood pressure reduction with IV
antihypertensives is required.
6. A 34-year-old woman presents with proximal muscle weakness,
heliotrope rash, and violaceous papules over the knuckles. Which
diagnosis is most likely?
, A. Rheumatoid arthritis
B. Dermatomyositis
C. Psoriatic arthritis
D. Systemic sclerosis
E. Polymyalgia rheumatica
Answer: B. Dermatomyositis
Rationale: Dermatomyositis is characterized by proximal muscle
weakness with characteristic skin findings including heliotrope rash
and Gottron papules. Elevated CK levels and inflammatory infiltrates
are commonly present. Adult cases may be associated with
malignancy.
7. A patient with alcohol use disorder develops confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is
responsible?
A. Riboflavin
B. Pyridoxine
C. Thiamine
D. Folate
E. Niacin
Answer: C. Thiamine
Rationale: Wernicke encephalopathy results from thiamine deficiency
and presents with the triad of confusion, ophthalmoplegia, and
ataxia. Immediate thiamine administration before glucose is essential
to prevent worsening neurologic injury.
8. A patient presents with fever, productive cough, and rust-colored
sputum. Chest radiograph shows lobar consolidation. Which
organism is the most likely cause?
