COMSAE Phase 2 Form BSA 114 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 45 minutes associated with diaphoresis and nausea. ECG
demonstrates ST-segment elevation in leads II, III, and aVF. Blood
pressure is 88/58 mmHg. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction produces ST elevation in
II, III, and aVF. The right coronary artery supplies the inferior wall in
most individuals. Associated hypotension may indicate right
ventricular involvement. Immediate reperfusion therapy is indicated.
2. A 24-year-old woman presents with fever, dysuria, flank pain, and
costovertebral angle tenderness. Urinalysis shows WBC casts and
positive nitrites. What is the most likely diagnosis?
,A. Acute cystitis
B. Acute pyelonephritis
C. Nephrolithiasis
D. Interstitial cystitis
E. Urethritis
Answer: B. Acute pyelonephritis
Rationale: Fever, flank pain, CVA tenderness, and WBC casts strongly
indicate renal parenchymal infection. WBC casts are highly suggestive
of pyelonephritis rather than lower urinary tract infection.
3. A 59-year-old man suddenly develops tearing chest pain radiating
to his back. Blood pressure is 190/110 mmHg in the right arm and
160/90 mmHg in the left arm. What is the next best diagnostic
test?
A. Exercise stress test
B. Coronary angiography
C. CT angiography of the chest
D. Chest radiograph only
E. Endoscopy
Answer: C. CT angiography of the chest
Rationale: Sudden tearing chest pain with unequal arm pressures
suggests aortic dissection. CT angiography is the preferred diagnostic
study in hemodynamically stable patients.
4. A 32-year-old pregnant woman at 34 weeks gestation develops
hypertension, proteinuria, headache, and visual changes. What is
the most appropriate next step?
A. Observation only
B. Methyldopa and discharge
,C. Immediate delivery after stabilization
D. Oral contraceptives
E. Indomethacin
Answer: C. Immediate delivery after stabilization
Rationale: Severe preeclampsia after fetal viability requires
stabilization with magnesium sulfate and antihypertensive therapy
followed by delivery because maternal complications can be life-
threatening.
5. A 7-year-old child develops fever, conjunctivitis, strawberry
tongue, and cervical lymphadenopathy for six days. What
complication is most feared?
A. Rheumatic fever
B. Coronary artery aneurysm
C. Endocarditis
D. Aortic stenosis
E. Mitral valve prolapse
Answer: B. Coronary artery aneurysm
Rationale: Kawasaki disease causes medium-vessel vasculitis and may
produce coronary artery aneurysms. Treatment with IVIG and aspirin
reduces this risk significantly.
6. A patient receiving heparin develops thrombocytopenia and a
painful swollen leg. What is the mechanism?
A. Direct platelet destruction
B. Autoimmune hemolysis
C. IgG antibodies against platelet factor 4-heparin complexes
D. Vitamin K deficiency
E. Fibrinolysis activation
, Answer: C. IgG antibodies against platelet factor 4-heparin complexes
Rationale: Heparin-induced thrombocytopenia is caused by antibodies
against PF4-heparin complexes, resulting paradoxically in thrombosis
despite low platelet counts.
7. A 62-year-old smoker presents with hematuria without pain. The
next best diagnostic step is:
A. Repeat urinalysis in six months
B. Urine culture only
C. Cystoscopy with imaging
D. Empiric antibiotics
E. PSA level
Answer: C. Cystoscopy with imaging
Rationale: Painless hematuria in an older smoker should be assumed
to be bladder cancer until proven otherwise. Cystoscopy is essential.
8. A patient with atrial fibrillation suddenly develops left-sided
weakness and aphasia. The most likely mechanism is:
A. Lipohyalinosis
B. Cardioembolism
C. Hypertensive hemorrhage
D. Vasculitis
E. Migraine
Answer: B. Cardioembolism
Rationale: Atrial fibrillation predisposes to left atrial thrombus
formation, which can embolize to cerebral arteries causing ischemic
stroke.
9. A patient develops hypotension immediately after penicillin
administration. The first medication to administer is:
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 45 minutes associated with diaphoresis and nausea. ECG
demonstrates ST-segment elevation in leads II, III, and aVF. Blood
pressure is 88/58 mmHg. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction produces ST elevation in
II, III, and aVF. The right coronary artery supplies the inferior wall in
most individuals. Associated hypotension may indicate right
ventricular involvement. Immediate reperfusion therapy is indicated.
2. A 24-year-old woman presents with fever, dysuria, flank pain, and
costovertebral angle tenderness. Urinalysis shows WBC casts and
positive nitrites. What is the most likely diagnosis?
,A. Acute cystitis
B. Acute pyelonephritis
C. Nephrolithiasis
D. Interstitial cystitis
E. Urethritis
Answer: B. Acute pyelonephritis
Rationale: Fever, flank pain, CVA tenderness, and WBC casts strongly
indicate renal parenchymal infection. WBC casts are highly suggestive
of pyelonephritis rather than lower urinary tract infection.
3. A 59-year-old man suddenly develops tearing chest pain radiating
to his back. Blood pressure is 190/110 mmHg in the right arm and
160/90 mmHg in the left arm. What is the next best diagnostic
test?
A. Exercise stress test
B. Coronary angiography
C. CT angiography of the chest
D. Chest radiograph only
E. Endoscopy
Answer: C. CT angiography of the chest
Rationale: Sudden tearing chest pain with unequal arm pressures
suggests aortic dissection. CT angiography is the preferred diagnostic
study in hemodynamically stable patients.
4. A 32-year-old pregnant woman at 34 weeks gestation develops
hypertension, proteinuria, headache, and visual changes. What is
the most appropriate next step?
A. Observation only
B. Methyldopa and discharge
,C. Immediate delivery after stabilization
D. Oral contraceptives
E. Indomethacin
Answer: C. Immediate delivery after stabilization
Rationale: Severe preeclampsia after fetal viability requires
stabilization with magnesium sulfate and antihypertensive therapy
followed by delivery because maternal complications can be life-
threatening.
5. A 7-year-old child develops fever, conjunctivitis, strawberry
tongue, and cervical lymphadenopathy for six days. What
complication is most feared?
A. Rheumatic fever
B. Coronary artery aneurysm
C. Endocarditis
D. Aortic stenosis
E. Mitral valve prolapse
Answer: B. Coronary artery aneurysm
Rationale: Kawasaki disease causes medium-vessel vasculitis and may
produce coronary artery aneurysms. Treatment with IVIG and aspirin
reduces this risk significantly.
6. A patient receiving heparin develops thrombocytopenia and a
painful swollen leg. What is the mechanism?
A. Direct platelet destruction
B. Autoimmune hemolysis
C. IgG antibodies against platelet factor 4-heparin complexes
D. Vitamin K deficiency
E. Fibrinolysis activation
, Answer: C. IgG antibodies against platelet factor 4-heparin complexes
Rationale: Heparin-induced thrombocytopenia is caused by antibodies
against PF4-heparin complexes, resulting paradoxically in thrombosis
despite low platelet counts.
7. A 62-year-old smoker presents with hematuria without pain. The
next best diagnostic step is:
A. Repeat urinalysis in six months
B. Urine culture only
C. Cystoscopy with imaging
D. Empiric antibiotics
E. PSA level
Answer: C. Cystoscopy with imaging
Rationale: Painless hematuria in an older smoker should be assumed
to be bladder cancer until proven otherwise. Cystoscopy is essential.
8. A patient with atrial fibrillation suddenly develops left-sided
weakness and aphasia. The most likely mechanism is:
A. Lipohyalinosis
B. Cardioembolism
C. Hypertensive hemorrhage
D. Vasculitis
E. Migraine
Answer: B. Cardioembolism
Rationale: Atrial fibrillation predisposes to left atrial thrombus
formation, which can embolize to cerebral arteries causing ischemic
stroke.
9. A patient develops hypotension immediately after penicillin
administration. The first medication to administer is:
