COMSAE Phase 2 Form BSA 105 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man presents with crushing substernal chest pain
for 2 hours. ECG shows ST-segment elevation in leads II, III, and
aVF. Blood pressure is 88/56 mmHg, and the lungs are clear.
Which additional finding is most likely?
A. Pulmonary edema
B. Bradycardia with elevated jugular venous pressure
C. Hyperdynamic pulses
D. Wide pulse pressure
Answer: B. Bradycardia with elevated jugular venous pressure
Rationale: Inferior myocardial infarction is usually due to right coronary
artery occlusion. Right ventricular involvement causes hypotension,
elevated JVP, and clear lungs. Bradycardia is common because the RCA
supplies the SA and AV nodes.
2. A 24-year-old woman presents with fever, pleuritic chest pain,
malar rash, and proteinuria. ANA is positive. Which antibody is
most specific for her condition?
A. Anti-histone
B. Anti-RNP
,C. Anti-dsDNA
D. Anti-centromere
Answer: C. Anti-dsDNA
Rationale: Anti-dsDNA is highly specific for systemic lupus
erythematosus and correlates with lupus nephritis activity.
3. A 4-year-old child develops fever, conjunctivitis, strawberry
tongue, and cervical lymphadenopathy lasting 7 days. Which
treatment prevents coronary artery aneurysm?
A. Penicillin
B. Corticosteroids only
C. Aspirin and IVIG
D. Ceftriaxone
Answer: C. Aspirin and IVIG
Rationale: Kawasaki disease is treated with intravenous
immunoglobulin and aspirin to reduce coronary artery complications.
4. A 72-year-old man with smoking history develops painless
hematuria. Which diagnosis is most likely?
A. Renal stone
B. Pyelonephritis
C. Transitional cell carcinoma
D. Glomerulonephritis
Answer: C. Transitional cell carcinoma
Rationale: Painless hematuria in an older smoker strongly suggests
bladder cancer, most commonly transitional cell carcinoma.
, 5. A patient presents with sudden tearing chest pain radiating to the
back. Blood pressure differs between the two arms. Which
diagnosis is most likely?
A. Pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Stable angina
Answer: C. Aortic dissection
Rationale: The classic presentation is abrupt tearing chest pain
radiating to the back with pulse or blood pressure asymmetry.
6. A 30-year-old woman develops tremor, heat intolerance, and
weight loss. TSH is suppressed and free T4 is elevated. Which is
the most likely diagnosis?
A. Toxic adenoma
B. Graves disease
C. Hashimoto thyroiditis
D. Subacute thyroiditis
Answer: B. Graves disease
Rationale: Graves disease is the most common cause of
hyperthyroidism and presents with elevated thyroid hormone and low
TSH.
7. A 65-year-old alcoholic presents with confusion, ataxia, and
horizontal nystagmus. Which vitamin deficiency is responsible?
A. B12
B. B6
C. Thiamine
D. Folate
, Answer: C. Thiamine
Rationale: Wernicke encephalopathy is caused by thiamine deficiency
and manifests as confusion, ataxia, and ophthalmoplegia.
8. A patient presents with prolonged PTT that does not correct with
mixing studies and recurrent miscarriages. Which diagnosis is
most likely?
A. Hemophilia A
B. Antiphospholipid syndrome
C. von Willebrand disease
D. Factor V deficiency
Answer: B. Antiphospholipid syndrome
Rationale: Antiphospholipid antibodies paradoxically prolong PTT while
causing thrombosis and pregnancy loss.
9. A 19-year-old male presents with fever, sore throat, and posterior
cervical adenopathy. Which complication should he avoid?
A. Swimming
B. Contact sports
C. Weight loss
D. Dairy products
Answer: B. Contact sports
Rationale: Splenomegaly from infectious mononucleosis increases the
risk of splenic rupture.
10. A 6-year-old boy presents with hemarthrosis and prolonged
PTT with normal PT. Which disorder is most likely?
A. Hemophilia A
B. ITP
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man presents with crushing substernal chest pain
for 2 hours. ECG shows ST-segment elevation in leads II, III, and
aVF. Blood pressure is 88/56 mmHg, and the lungs are clear.
Which additional finding is most likely?
A. Pulmonary edema
B. Bradycardia with elevated jugular venous pressure
C. Hyperdynamic pulses
D. Wide pulse pressure
Answer: B. Bradycardia with elevated jugular venous pressure
Rationale: Inferior myocardial infarction is usually due to right coronary
artery occlusion. Right ventricular involvement causes hypotension,
elevated JVP, and clear lungs. Bradycardia is common because the RCA
supplies the SA and AV nodes.
2. A 24-year-old woman presents with fever, pleuritic chest pain,
malar rash, and proteinuria. ANA is positive. Which antibody is
most specific for her condition?
A. Anti-histone
B. Anti-RNP
,C. Anti-dsDNA
D. Anti-centromere
Answer: C. Anti-dsDNA
Rationale: Anti-dsDNA is highly specific for systemic lupus
erythematosus and correlates with lupus nephritis activity.
3. A 4-year-old child develops fever, conjunctivitis, strawberry
tongue, and cervical lymphadenopathy lasting 7 days. Which
treatment prevents coronary artery aneurysm?
A. Penicillin
B. Corticosteroids only
C. Aspirin and IVIG
D. Ceftriaxone
Answer: C. Aspirin and IVIG
Rationale: Kawasaki disease is treated with intravenous
immunoglobulin and aspirin to reduce coronary artery complications.
4. A 72-year-old man with smoking history develops painless
hematuria. Which diagnosis is most likely?
A. Renal stone
B. Pyelonephritis
C. Transitional cell carcinoma
D. Glomerulonephritis
Answer: C. Transitional cell carcinoma
Rationale: Painless hematuria in an older smoker strongly suggests
bladder cancer, most commonly transitional cell carcinoma.
, 5. A patient presents with sudden tearing chest pain radiating to the
back. Blood pressure differs between the two arms. Which
diagnosis is most likely?
A. Pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Stable angina
Answer: C. Aortic dissection
Rationale: The classic presentation is abrupt tearing chest pain
radiating to the back with pulse or blood pressure asymmetry.
6. A 30-year-old woman develops tremor, heat intolerance, and
weight loss. TSH is suppressed and free T4 is elevated. Which is
the most likely diagnosis?
A. Toxic adenoma
B. Graves disease
C. Hashimoto thyroiditis
D. Subacute thyroiditis
Answer: B. Graves disease
Rationale: Graves disease is the most common cause of
hyperthyroidism and presents with elevated thyroid hormone and low
TSH.
7. A 65-year-old alcoholic presents with confusion, ataxia, and
horizontal nystagmus. Which vitamin deficiency is responsible?
A. B12
B. B6
C. Thiamine
D. Folate
, Answer: C. Thiamine
Rationale: Wernicke encephalopathy is caused by thiamine deficiency
and manifests as confusion, ataxia, and ophthalmoplegia.
8. A patient presents with prolonged PTT that does not correct with
mixing studies and recurrent miscarriages. Which diagnosis is
most likely?
A. Hemophilia A
B. Antiphospholipid syndrome
C. von Willebrand disease
D. Factor V deficiency
Answer: B. Antiphospholipid syndrome
Rationale: Antiphospholipid antibodies paradoxically prolong PTT while
causing thrombosis and pregnancy loss.
9. A 19-year-old male presents with fever, sore throat, and posterior
cervical adenopathy. Which complication should he avoid?
A. Swimming
B. Contact sports
C. Weight loss
D. Dairy products
Answer: B. Contact sports
Rationale: Splenomegaly from infectious mononucleosis increases the
risk of splenic rupture.
10. A 6-year-old boy presents with hemarthrosis and prolonged
PTT with normal PT. Which disorder is most likely?
A. Hemophilia A
B. ITP
