COMSAE Phase 2 Form BSA 112 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with crushing substernal chest pain
radiating to his left arm for 90 minutes. ECG shows ST-segment
elevation in leads II, III, and aVF. Blood pressure is 84/58 mmHg.
Lungs are clear. Which medication should be avoided initially?
A. Aspirin
B. Clopidogrel
C. Nitroglycerin
D. Heparin
E. Atorvastatin
Answer: C. Nitroglycerin
Rationale: Inferior wall MI with hypotension suggests right ventricular
infarction. Nitroglycerin decreases preload and can precipitate
profound hypotension. Immediate treatment includes aspirin,
anticoagulation, reperfusion therapy, and cautious IV fluids to
maintain preload.
2. A 24-year-old woman presents with sudden right lower quadrant
pain, nausea, and vomiting. Pregnancy test is negative. Ultrasound
shows an enlarged ovary with absent Doppler blood flow. What is
the next best step?
,A. Oral contraceptives
B. Observation
C. Laparoscopic detorsion
D. Methotrexate
E. Hysterectomy
Answer: C. Laparoscopic detorsion
Rationale: Ovarian torsion is a surgical emergency. Preservation of
ovarian tissue requires prompt laparoscopic detorsion even when the
ovary appears ischemic.
3. A 58-year-old diabetic man has fever, flank pain, and
costovertebral angle tenderness. CT reveals gas within the renal
parenchyma. What is the diagnosis?
A. Renal abscess
B. Acute pyelonephritis
C. Emphysematous pyelonephritis
D. Papillary necrosis
E. Xanthogranulomatous pyelonephritis
Answer: C. Emphysematous pyelonephritis
Rationale: Gas-producing organisms in diabetic patients can cause
emphysematous pyelonephritis, a severe necrotizing infection
requiring aggressive antibiotics and often surgical intervention.
4. A 32-year-old pregnant woman at 34 weeks presents with
hypertension, headache, and visual changes. BP is 170/110
mmHg. Urinalysis reveals 4+ protein. Initial treatment?
A. Methyldopa only
B. Magnesium sulfate and delivery planning
C. Aspirin
,D. Bed rest
E. Hydrochlorothiazide
Answer: B. Magnesium sulfate and delivery planning
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and expedited delivery after maternal
stabilization.
5. A patient with COPD exacerbation has pH 7.28, PaCO2 65 mmHg,
and increasing respiratory distress. Best next step?
A. High-flow oxygen alone
B. Inhaled steroids
C. Noninvasive positive pressure ventilation
D. Immediate bronchoscopy
E. Antibiotics alone
Answer: C. Noninvasive positive pressure ventilation
Rationale: NIPPV reduces work of breathing, improves gas exchange,
and decreases mortality in COPD exacerbations with hypercapnic
respiratory failure.
6. A newborn has continuous machinery-like murmur and bounding
pulses. Most likely diagnosis?
A. VSD
B. ASD
C. Patent ductus arteriosus
D. Tetralogy of Fallot
E. Pulmonary stenosis
Answer: C. Patent ductus arteriosus
, Rationale: PDA produces a continuous machinery murmur with
widened pulse pressure and bounding peripheral pulses due to
persistent left-to-right shunting.
7. A patient develops fever, muscle rigidity, altered mental status,
and elevated CK after receiving haloperidol. Diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Malignant hyperthermia
D. Meningitis
E. Catatonia
Answer: B. Neuroleptic malignant syndrome
Rationale: NMS presents with hyperthermia, "lead-pipe" rigidity,
autonomic instability, and elevated CK following dopamine antagonist
exposure.
8. A 6-year-old child presents with palpable purpura, abdominal
pain, and hematuria after an upper respiratory infection.
Diagnosis?
A. ITP
B. TTP
C. Henoch-Schönlein purpura
D. Kawasaki disease
E. Scarlet fever
Answer: C. Henoch-Schönlein purpura
Rationale: IgA vasculitis classically presents with palpable purpura,
arthralgias, abdominal pain, and renal involvement.
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with crushing substernal chest pain
radiating to his left arm for 90 minutes. ECG shows ST-segment
elevation in leads II, III, and aVF. Blood pressure is 84/58 mmHg.
Lungs are clear. Which medication should be avoided initially?
A. Aspirin
B. Clopidogrel
C. Nitroglycerin
D. Heparin
E. Atorvastatin
Answer: C. Nitroglycerin
Rationale: Inferior wall MI with hypotension suggests right ventricular
infarction. Nitroglycerin decreases preload and can precipitate
profound hypotension. Immediate treatment includes aspirin,
anticoagulation, reperfusion therapy, and cautious IV fluids to
maintain preload.
2. A 24-year-old woman presents with sudden right lower quadrant
pain, nausea, and vomiting. Pregnancy test is negative. Ultrasound
shows an enlarged ovary with absent Doppler blood flow. What is
the next best step?
,A. Oral contraceptives
B. Observation
C. Laparoscopic detorsion
D. Methotrexate
E. Hysterectomy
Answer: C. Laparoscopic detorsion
Rationale: Ovarian torsion is a surgical emergency. Preservation of
ovarian tissue requires prompt laparoscopic detorsion even when the
ovary appears ischemic.
3. A 58-year-old diabetic man has fever, flank pain, and
costovertebral angle tenderness. CT reveals gas within the renal
parenchyma. What is the diagnosis?
A. Renal abscess
B. Acute pyelonephritis
C. Emphysematous pyelonephritis
D. Papillary necrosis
E. Xanthogranulomatous pyelonephritis
Answer: C. Emphysematous pyelonephritis
Rationale: Gas-producing organisms in diabetic patients can cause
emphysematous pyelonephritis, a severe necrotizing infection
requiring aggressive antibiotics and often surgical intervention.
4. A 32-year-old pregnant woman at 34 weeks presents with
hypertension, headache, and visual changes. BP is 170/110
mmHg. Urinalysis reveals 4+ protein. Initial treatment?
A. Methyldopa only
B. Magnesium sulfate and delivery planning
C. Aspirin
,D. Bed rest
E. Hydrochlorothiazide
Answer: B. Magnesium sulfate and delivery planning
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and expedited delivery after maternal
stabilization.
5. A patient with COPD exacerbation has pH 7.28, PaCO2 65 mmHg,
and increasing respiratory distress. Best next step?
A. High-flow oxygen alone
B. Inhaled steroids
C. Noninvasive positive pressure ventilation
D. Immediate bronchoscopy
E. Antibiotics alone
Answer: C. Noninvasive positive pressure ventilation
Rationale: NIPPV reduces work of breathing, improves gas exchange,
and decreases mortality in COPD exacerbations with hypercapnic
respiratory failure.
6. A newborn has continuous machinery-like murmur and bounding
pulses. Most likely diagnosis?
A. VSD
B. ASD
C. Patent ductus arteriosus
D. Tetralogy of Fallot
E. Pulmonary stenosis
Answer: C. Patent ductus arteriosus
, Rationale: PDA produces a continuous machinery murmur with
widened pulse pressure and bounding peripheral pulses due to
persistent left-to-right shunting.
7. A patient develops fever, muscle rigidity, altered mental status,
and elevated CK after receiving haloperidol. Diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Malignant hyperthermia
D. Meningitis
E. Catatonia
Answer: B. Neuroleptic malignant syndrome
Rationale: NMS presents with hyperthermia, "lead-pipe" rigidity,
autonomic instability, and elevated CK following dopamine antagonist
exposure.
8. A 6-year-old child presents with palpable purpura, abdominal
pain, and hematuria after an upper respiratory infection.
Diagnosis?
A. ITP
B. TTP
C. Henoch-Schönlein purpura
D. Kawasaki disease
E. Scarlet fever
Answer: C. Henoch-Schönlein purpura
Rationale: IgA vasculitis classically presents with palpable purpura,
arthralgias, abdominal pain, and renal involvement.
