COMSAE Phase 3 Form CSA 114 Advanced Clinical
Synthesis Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 68-year-old man with hypertension, type 2 diabetes mellitus,
chronic kidney disease stage 3, and heart failure with reduced
ejection fraction presents with progressive dyspnea, orthopnea,
and bilateral lower-extremity edema. Blood pressure is 148/88
mm Hg, pulse is 96/min, and oxygen saturation is 92% on room
air. Laboratory studies reveal BNP 1,250 pg/mL and creatinine 1.9
mg/dL. Chest radiograph demonstrates pulmonary vascular
congestion. Which of the following is the most appropriate initial
management?
A. Begin intravenous furosemide therapy
B. Initiate spironolactone immediately
C. Administer intravenous fluids
D. Begin dopamine infusion
E. Schedule outpatient echocardiography
Answer: A. Begin intravenous furosemide therapy
Rationale: Acute decompensated heart failure with volume overload
requires prompt diuresis. Intravenous loop diuretics reduce preload,
pulmonary congestion, and peripheral edema. Fluid administration
would worsen symptoms, while outpatient evaluation is inappropriate
in an unstable patient.
2. A 32-year-old woman presents 3 days postpartum with headache,
visual disturbances, and blood pressure of 172/110 mm Hg.
, Urinalysis demonstrates 3+ proteinuria. Which of the following is
the most appropriate next step?
A. Oral nifedipine alone
B. Immediate magnesium sulfate administration
C. Observation only
D. Oral hydrochlorothiazide
E. Repeat evaluation in 48 hours
Answer: B. Immediate magnesium sulfate administration
Rationale: Postpartum preeclampsia can occur after delivery and
carries a risk of eclamptic seizures. Magnesium sulfate is indicated for
seizure prophylaxis while blood pressure is controlled with
antihypertensive therapy.
3. A 54-year-old smoker presents with sudden onset chest pain
radiating to the back. Blood pressure is 190/100 mm Hg in the
right arm and 150/80 mm Hg in the left arm. Which diagnosis is
most likely?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Costochondritis
E. Stable angina
Answer: C. Aortic dissection
Rationale: Tearing chest pain radiating to the back with blood
pressure discrepancies strongly suggests aortic dissection. Immediate
blood pressure reduction and vascular imaging are required.
4. A 6-year-old boy presents with fever, strawberry tongue,
conjunctivitis, cervical lymphadenopathy, and desquamation of
, the fingers. Symptoms have persisted for 6 days. Which therapy
should be initiated?
A. Oral penicillin
B. Intravenous immunoglobulin and aspirin
C. Corticosteroids alone
D. Observation
E. Azithromycin
Answer: B. Intravenous immunoglobulin and aspirin
Rationale: Kawasaki disease is treated with IVIG and aspirin to reduce
the risk of coronary artery aneurysm formation. Early treatment is
critical.
5. A 72-year-old woman develops acute confusion, urinary
incontinence, and gait instability. MRI reveals enlarged ventricles
without cortical atrophy. What is the most likely diagnosis?
A. Alzheimer disease
B. Vascular dementia
C. Normal pressure hydrocephalus
D. Lewy body dementia
E. Frontotemporal dementia
Answer: C. Normal pressure hydrocephalus
Rationale: The classic triad consists of gait disturbance, urinary
incontinence, and cognitive impairment. Ventriculomegaly with
normal CSF pressure is characteristic.
6. A patient develops fever, hypotension, and diffuse rash after
prolonged tampon use. Which organism is the most likely cause?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
, C. Neisseria meningitidis
D. Escherichia coli
E. Pseudomonas aeruginosa
Answer: B. Staphylococcus aureus
Rationale: Toxic shock syndrome is caused by toxin-producing
Staphylococcus aureus, leading to fever, hypotension, diffuse rash,
and multiorgan involvement.
7. A 58-year-old man presents with tremor that improves with
alcohol consumption. Examination reveals bilateral action tremor
without rigidity or bradykinesia. Diagnosis?
A. Parkinson disease
B. Essential tremor
C. Wilson disease
D. Huntington disease
E. Cerebellar infarction
Answer: B. Essential tremor
Rationale: Essential tremor is characterized by action tremor, often
familial, and frequently improves temporarily with alcohol.
8. A hospitalized patient receiving unfractionated heparin develops
thrombocytopenia and a new lower-extremity DVT. What is the
best next step?
A. Continue heparin
B. Add aspirin
C. Switch to argatroban
D. Administer platelet transfusion
E. Observe
Answer: C. Switch to argatroban
Synthesis Exam Practice Questions & [Verified
Answers], Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A 68-year-old man with hypertension, type 2 diabetes mellitus,
chronic kidney disease stage 3, and heart failure with reduced
ejection fraction presents with progressive dyspnea, orthopnea,
and bilateral lower-extremity edema. Blood pressure is 148/88
mm Hg, pulse is 96/min, and oxygen saturation is 92% on room
air. Laboratory studies reveal BNP 1,250 pg/mL and creatinine 1.9
mg/dL. Chest radiograph demonstrates pulmonary vascular
congestion. Which of the following is the most appropriate initial
management?
A. Begin intravenous furosemide therapy
B. Initiate spironolactone immediately
C. Administer intravenous fluids
D. Begin dopamine infusion
E. Schedule outpatient echocardiography
Answer: A. Begin intravenous furosemide therapy
Rationale: Acute decompensated heart failure with volume overload
requires prompt diuresis. Intravenous loop diuretics reduce preload,
pulmonary congestion, and peripheral edema. Fluid administration
would worsen symptoms, while outpatient evaluation is inappropriate
in an unstable patient.
2. A 32-year-old woman presents 3 days postpartum with headache,
visual disturbances, and blood pressure of 172/110 mm Hg.
, Urinalysis demonstrates 3+ proteinuria. Which of the following is
the most appropriate next step?
A. Oral nifedipine alone
B. Immediate magnesium sulfate administration
C. Observation only
D. Oral hydrochlorothiazide
E. Repeat evaluation in 48 hours
Answer: B. Immediate magnesium sulfate administration
Rationale: Postpartum preeclampsia can occur after delivery and
carries a risk of eclamptic seizures. Magnesium sulfate is indicated for
seizure prophylaxis while blood pressure is controlled with
antihypertensive therapy.
3. A 54-year-old smoker presents with sudden onset chest pain
radiating to the back. Blood pressure is 190/100 mm Hg in the
right arm and 150/80 mm Hg in the left arm. Which diagnosis is
most likely?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Costochondritis
E. Stable angina
Answer: C. Aortic dissection
Rationale: Tearing chest pain radiating to the back with blood
pressure discrepancies strongly suggests aortic dissection. Immediate
blood pressure reduction and vascular imaging are required.
4. A 6-year-old boy presents with fever, strawberry tongue,
conjunctivitis, cervical lymphadenopathy, and desquamation of
, the fingers. Symptoms have persisted for 6 days. Which therapy
should be initiated?
A. Oral penicillin
B. Intravenous immunoglobulin and aspirin
C. Corticosteroids alone
D. Observation
E. Azithromycin
Answer: B. Intravenous immunoglobulin and aspirin
Rationale: Kawasaki disease is treated with IVIG and aspirin to reduce
the risk of coronary artery aneurysm formation. Early treatment is
critical.
5. A 72-year-old woman develops acute confusion, urinary
incontinence, and gait instability. MRI reveals enlarged ventricles
without cortical atrophy. What is the most likely diagnosis?
A. Alzheimer disease
B. Vascular dementia
C. Normal pressure hydrocephalus
D. Lewy body dementia
E. Frontotemporal dementia
Answer: C. Normal pressure hydrocephalus
Rationale: The classic triad consists of gait disturbance, urinary
incontinence, and cognitive impairment. Ventriculomegaly with
normal CSF pressure is characteristic.
6. A patient develops fever, hypotension, and diffuse rash after
prolonged tampon use. Which organism is the most likely cause?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
, C. Neisseria meningitidis
D. Escherichia coli
E. Pseudomonas aeruginosa
Answer: B. Staphylococcus aureus
Rationale: Toxic shock syndrome is caused by toxin-producing
Staphylococcus aureus, leading to fever, hypotension, diffuse rash,
and multiorgan involvement.
7. A 58-year-old man presents with tremor that improves with
alcohol consumption. Examination reveals bilateral action tremor
without rigidity or bradykinesia. Diagnosis?
A. Parkinson disease
B. Essential tremor
C. Wilson disease
D. Huntington disease
E. Cerebellar infarction
Answer: B. Essential tremor
Rationale: Essential tremor is characterized by action tremor, often
familial, and frequently improves temporarily with alcohol.
8. A hospitalized patient receiving unfractionated heparin develops
thrombocytopenia and a new lower-extremity DVT. What is the
best next step?
A. Continue heparin
B. Add aspirin
C. Switch to argatroban
D. Administer platelet transfusion
E. Observe
Answer: C. Switch to argatroban
