COMSAE Phase 2 Form BSA 119 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 62-year-old man with a 40-pack-year smoking history presents
with progressive dyspnea, chronic productive cough, and
wheezing. Spirometry shows FEV1/FVC of 55% with minimal
reversibility after bronchodilator. What is the most appropriate
long-term management to reduce exacerbations?
A. Oral prednisone daily
B. Short-acting beta agonist only
C. Long-acting muscarinic antagonist (LAMA)
D. Theophylline monotherapy
Answer: C. Long-acting muscarinic antagonist (LAMA)
Rationale: COPD with FEV1/FVC < 70% and poor reversibility suggests
chronic obstructive pulmonary disease. LAMAs reduce exacerbations
and improve lung function better than SABA alone or systemic
steroids, which are not used long-term due to adverse effects.
2. A 28-year-old woman presents with palpitations, heat intolerance,
and weight loss. Labs show low TSH and elevated T3/T4. She has
exophthalmos. What is the first-line definitive therapy?
,A. Methimazole
B. Radioactive iodine
C. Propranolol only
D. Thyroidectomy immediately
Answer: A. Methimazole
Rationale: Graves disease is treated initially with antithyroid drugs
like methimazole (except in first trimester pregnancy). Radioactive
iodine is definitive but not first-line in symptomatic control or
ophthalmopathy.
3. A patient presents with crushing chest pain radiating to the left
arm. ECG shows ST-elevation in leads II, III, aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior wall MI (II, III, aVF) is most commonly due to right
coronary artery occlusion.
4. A 45-year-old man has epigastric pain relieved by eating.
Endoscopy shows duodenal ulcer. Most likely cause?
A. NSAID use
B. H. pylori infection
C. Gastric carcinoma
D. Zollinger-Ellison syndrome
,Answer: B. H. pylori infection
Rationale: Duodenal ulcers are most commonly associated with H.
pylori infection, which increases acid secretion and mucosal damage.
5. A newborn fails to pass meconium within 48 hours and has
abdominal distension. Biopsy shows absence of ganglion cells in
the distal colon. Diagnosis?
A. Meckel diverticulum
B. Hirschsprung disease
C. Pyloric stenosis
D. Intussusception
Answer: B. Hirschsprung disease
Rationale: Absence of ganglion cells in Meissner and Auerbach
plexuses causes functional obstruction of distal colon.
6. A diabetic patient presents with fruity breath odor, Kussmaul
respirations, glucose 520 mg/dL, and pH 7.1. First step in
management?
A. IV insulin only
B. IV fluids (normal saline)
C. Sodium bicarbonate
D. Subcutaneous insulin
Answer: B. IV fluids (normal saline)
Rationale: Initial management of DKA is fluid resuscitation to restore
perfusion before insulin therapy.
, 7. A 30-year-old woman presents with episodic hypertension,
headaches, and palpitations. Lab shows elevated metanephrines.
Diagnosis?
A. Cushing syndrome
B. Pheochromocytoma
C. Addison disease
D. Primary hyperaldosteronism
Answer: B. Pheochromocytoma
Rationale: Catecholamine-secreting tumor causes episodic
hypertension and elevated metanephrines.
8. A patient has right lower quadrant pain, fever, and leukocytosis.
Most appropriate next step?
A. CT abdomen
B. Immediate appendectomy
C. Colonoscopy
D. Barium enema
Answer: A. CT abdomen
Rationale: CT confirms appendicitis before surgery in adults unless
classic presentation in young patient.
9. A 55-year-old man has progressive dysphagia first to solids then
liquids. Most likely diagnosis?
A. Achalasia
B. Esophageal cancer
C. GERD
D. Diffuse esophageal spasm
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 62-year-old man with a 40-pack-year smoking history presents
with progressive dyspnea, chronic productive cough, and
wheezing. Spirometry shows FEV1/FVC of 55% with minimal
reversibility after bronchodilator. What is the most appropriate
long-term management to reduce exacerbations?
A. Oral prednisone daily
B. Short-acting beta agonist only
C. Long-acting muscarinic antagonist (LAMA)
D. Theophylline monotherapy
Answer: C. Long-acting muscarinic antagonist (LAMA)
Rationale: COPD with FEV1/FVC < 70% and poor reversibility suggests
chronic obstructive pulmonary disease. LAMAs reduce exacerbations
and improve lung function better than SABA alone or systemic
steroids, which are not used long-term due to adverse effects.
2. A 28-year-old woman presents with palpitations, heat intolerance,
and weight loss. Labs show low TSH and elevated T3/T4. She has
exophthalmos. What is the first-line definitive therapy?
,A. Methimazole
B. Radioactive iodine
C. Propranolol only
D. Thyroidectomy immediately
Answer: A. Methimazole
Rationale: Graves disease is treated initially with antithyroid drugs
like methimazole (except in first trimester pregnancy). Radioactive
iodine is definitive but not first-line in symptomatic control or
ophthalmopathy.
3. A patient presents with crushing chest pain radiating to the left
arm. ECG shows ST-elevation in leads II, III, aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior wall MI (II, III, aVF) is most commonly due to right
coronary artery occlusion.
4. A 45-year-old man has epigastric pain relieved by eating.
Endoscopy shows duodenal ulcer. Most likely cause?
A. NSAID use
B. H. pylori infection
C. Gastric carcinoma
D. Zollinger-Ellison syndrome
,Answer: B. H. pylori infection
Rationale: Duodenal ulcers are most commonly associated with H.
pylori infection, which increases acid secretion and mucosal damage.
5. A newborn fails to pass meconium within 48 hours and has
abdominal distension. Biopsy shows absence of ganglion cells in
the distal colon. Diagnosis?
A. Meckel diverticulum
B. Hirschsprung disease
C. Pyloric stenosis
D. Intussusception
Answer: B. Hirschsprung disease
Rationale: Absence of ganglion cells in Meissner and Auerbach
plexuses causes functional obstruction of distal colon.
6. A diabetic patient presents with fruity breath odor, Kussmaul
respirations, glucose 520 mg/dL, and pH 7.1. First step in
management?
A. IV insulin only
B. IV fluids (normal saline)
C. Sodium bicarbonate
D. Subcutaneous insulin
Answer: B. IV fluids (normal saline)
Rationale: Initial management of DKA is fluid resuscitation to restore
perfusion before insulin therapy.
, 7. A 30-year-old woman presents with episodic hypertension,
headaches, and palpitations. Lab shows elevated metanephrines.
Diagnosis?
A. Cushing syndrome
B. Pheochromocytoma
C. Addison disease
D. Primary hyperaldosteronism
Answer: B. Pheochromocytoma
Rationale: Catecholamine-secreting tumor causes episodic
hypertension and elevated metanephrines.
8. A patient has right lower quadrant pain, fever, and leukocytosis.
Most appropriate next step?
A. CT abdomen
B. Immediate appendectomy
C. Colonoscopy
D. Barium enema
Answer: A. CT abdomen
Rationale: CT confirms appendicitis before surgery in adults unless
classic presentation in young patient.
9. A 55-year-old man has progressive dysphagia first to solids then
liquids. Most likely diagnosis?
A. Achalasia
B. Esophageal cancer
C. GERD
D. Diffuse esophageal spasm
