COMSAE Phase 2 Form BSA 104 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man is brought to the emergency department
because of acute shortness of breath, crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea for 45
minutes. He has hypertension, type 2 diabetes mellitus, and
hyperlipidemia. ECG shows ST-segment elevations in leads II, III,
and aVF. Blood pressure is 88/54 mm Hg, pulse is 118/min, and
oxygen saturation is 90%. Which complication is most likely
responsible for his hypotension?
A. Papillary muscle rupture
B. Right ventricular infarction
C. Atrial septal defect
D. Ventricular aneurysm
E. Dressler syndrome
Answer: B. Right ventricular infarction
Rationale: Inferior wall myocardial infarctions involving the right
coronary artery frequently extend to the right ventricle. Right
ventricular infarction reduces preload to the left ventricle, causing
hypotension, elevated jugular venous pressure, and clear lungs.
Papillary muscle rupture causes acute mitral regurgitation with
pulmonary edema. Ventricular aneurysm and Dressler syndrome occur
later.
, 2. A 24-year-old woman presents with fever, migratory joint pain,
hematuria, pleuritic chest pain, and a malar rash. Urinalysis shows
proteinuria and red blood cell casts. Which autoantibody is most
closely associated with her renal disease?
A. Anti-centromere antibody
B. Anti-Scl-70 antibody
C. Anti-dsDNA antibody
D. Anti-Jo-1 antibody
E. Anti-mitochondrial antibody
Answer: C. Anti-dsDNA antibody
Rationale: Anti-double stranded DNA antibodies correlate strongly
with lupus nephritis activity. Anti-Smith is highly specific but does not
correlate with disease activity as closely as anti-dsDNA.
3. A 58-year-old man with alcoholism presents with confusion,
ophthalmoplegia, and gait instability. MRI demonstrates
mammillary body atrophy. Which vitamin deficiency is
responsible?
A. Riboflavin
B. Pyridoxine
C. Thiamine
D. Niacin
E. Cobalamin
Answer: C. Thiamine
Rationale: Wernicke encephalopathy is characterized by confusion,
ophthalmoplegia, and ataxia caused by thiamine deficiency.
Untreated cases may progress to Korsakoff syndrome with
confabulation and irreversible memory impairment.
, 4. A neonate develops bilious vomiting and abdominal distension
shortly after birth. Abdominal radiograph reveals a double-bubble
sign. The infant also has Down syndrome. Which condition is most
likely?
A. Hirschsprung disease
B. Meconium ileus
C. Duodenal atresia
D. Pyloric stenosis
E. Intussusception
Answer: C. Duodenal atresia
Rationale: Duodenal atresia presents with bilious vomiting, minimal
abdominal distension, and the classic double-bubble sign. It is strongly
associated with trisomy 21.
5. A patient develops fever, hypotension, diffuse erythematous rash,
vomiting, and multiorgan dysfunction after prolonged tampon
use. Which toxin is responsible?
A. Exfoliative toxin A
B. TSST-1
C. Alpha toxin
D. Enterotoxin B
E. Streptolysin O
Answer: B. TSST-1
Rationale: Toxic shock syndrome results from toxic shock syndrome
toxin-1 produced by Staphylococcus aureus. It acts as a superantigen,
activating massive T-cell cytokine release causing shock and
multisystem failure.
, 6. A 73-year-old woman presents with resting tremor, bradykinesia,
cogwheel rigidity, and shuffling gait. Degeneration of which brain
structure is responsible?
A. Caudate nucleus
B. Subthalamic nucleus
C. Substantia nigra pars compacta
D. Globus pallidus externus
E. Red nucleus
Answer: C. Substantia nigra pars compacta
Rationale: Parkinson disease results from degeneration of
dopaminergic neurons in the substantia nigra pars compacta,
reducing dopamine input to the striatum and impairing movement
initiation.
7. A patient with COPD is given high-flow oxygen and becomes
increasingly somnolent. Arterial blood gas shows worsening
hypercapnia. What is the primary mechanism?
A. Increased bicarbonate production
B. Hypoxic respiratory drive suppression
C. Reduced renal excretion of CO2
D. Increased surfactant production
E. Increased dead space ventilation
Answer: B. Hypoxic respiratory drive suppression
Rationale: In patients with severe chronic hypercapnia, oxygen
administration can suppress hypoxic respiratory drive and worsen CO2
retention. Additional mechanisms include worsening ventilation-
perfusion mismatch.
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man is brought to the emergency department
because of acute shortness of breath, crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea for 45
minutes. He has hypertension, type 2 diabetes mellitus, and
hyperlipidemia. ECG shows ST-segment elevations in leads II, III,
and aVF. Blood pressure is 88/54 mm Hg, pulse is 118/min, and
oxygen saturation is 90%. Which complication is most likely
responsible for his hypotension?
A. Papillary muscle rupture
B. Right ventricular infarction
C. Atrial septal defect
D. Ventricular aneurysm
E. Dressler syndrome
Answer: B. Right ventricular infarction
Rationale: Inferior wall myocardial infarctions involving the right
coronary artery frequently extend to the right ventricle. Right
ventricular infarction reduces preload to the left ventricle, causing
hypotension, elevated jugular venous pressure, and clear lungs.
Papillary muscle rupture causes acute mitral regurgitation with
pulmonary edema. Ventricular aneurysm and Dressler syndrome occur
later.
, 2. A 24-year-old woman presents with fever, migratory joint pain,
hematuria, pleuritic chest pain, and a malar rash. Urinalysis shows
proteinuria and red blood cell casts. Which autoantibody is most
closely associated with her renal disease?
A. Anti-centromere antibody
B. Anti-Scl-70 antibody
C. Anti-dsDNA antibody
D. Anti-Jo-1 antibody
E. Anti-mitochondrial antibody
Answer: C. Anti-dsDNA antibody
Rationale: Anti-double stranded DNA antibodies correlate strongly
with lupus nephritis activity. Anti-Smith is highly specific but does not
correlate with disease activity as closely as anti-dsDNA.
3. A 58-year-old man with alcoholism presents with confusion,
ophthalmoplegia, and gait instability. MRI demonstrates
mammillary body atrophy. Which vitamin deficiency is
responsible?
A. Riboflavin
B. Pyridoxine
C. Thiamine
D. Niacin
E. Cobalamin
Answer: C. Thiamine
Rationale: Wernicke encephalopathy is characterized by confusion,
ophthalmoplegia, and ataxia caused by thiamine deficiency.
Untreated cases may progress to Korsakoff syndrome with
confabulation and irreversible memory impairment.
, 4. A neonate develops bilious vomiting and abdominal distension
shortly after birth. Abdominal radiograph reveals a double-bubble
sign. The infant also has Down syndrome. Which condition is most
likely?
A. Hirschsprung disease
B. Meconium ileus
C. Duodenal atresia
D. Pyloric stenosis
E. Intussusception
Answer: C. Duodenal atresia
Rationale: Duodenal atresia presents with bilious vomiting, minimal
abdominal distension, and the classic double-bubble sign. It is strongly
associated with trisomy 21.
5. A patient develops fever, hypotension, diffuse erythematous rash,
vomiting, and multiorgan dysfunction after prolonged tampon
use. Which toxin is responsible?
A. Exfoliative toxin A
B. TSST-1
C. Alpha toxin
D. Enterotoxin B
E. Streptolysin O
Answer: B. TSST-1
Rationale: Toxic shock syndrome results from toxic shock syndrome
toxin-1 produced by Staphylococcus aureus. It acts as a superantigen,
activating massive T-cell cytokine release causing shock and
multisystem failure.
, 6. A 73-year-old woman presents with resting tremor, bradykinesia,
cogwheel rigidity, and shuffling gait. Degeneration of which brain
structure is responsible?
A. Caudate nucleus
B. Subthalamic nucleus
C. Substantia nigra pars compacta
D. Globus pallidus externus
E. Red nucleus
Answer: C. Substantia nigra pars compacta
Rationale: Parkinson disease results from degeneration of
dopaminergic neurons in the substantia nigra pars compacta,
reducing dopamine input to the striatum and impairing movement
initiation.
7. A patient with COPD is given high-flow oxygen and becomes
increasingly somnolent. Arterial blood gas shows worsening
hypercapnia. What is the primary mechanism?
A. Increased bicarbonate production
B. Hypoxic respiratory drive suppression
C. Reduced renal excretion of CO2
D. Increased surfactant production
E. Increased dead space ventilation
Answer: B. Hypoxic respiratory drive suppression
Rationale: In patients with severe chronic hypercapnia, oxygen
administration can suppress hypoxic respiratory drive and worsen CO2
retention. Additional mechanisms include worsening ventilation-
perfusion mismatch.
