COMSAE Phase 3 Form CSA 124 Advanced
Clinical Synthesis 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
for 45 minutes. ECG shows ST elevation in leads II, III, and aVF.
Blood pressure is 88/60 mmHg. Which additional finding is most
likely?
A. Bradycardia due to vagal stimulation
B. Elevated pulmonary capillary wedge pressure
C. Left ventricular hypertrophy
D. Pulmonary edema with bilateral crackles
E. Wide pulse pressure
Answer: A. Bradycardia due to vagal stimulation
Rationale: Inferior myocardial infarctions involving the right coronary
artery can stimulate vagal tone, causing bradycardia and
hypotension. Right ventricular infarction may also occur, requiring
careful fluid management.
2. A 54-year-old woman with diabetes presents with fever, flank
pain, and dysuria. Urinalysis shows WBC casts. Which diagnosis is
most likely?
,A. Acute cystitis
B. Nephrolithiasis
C. Acute pyelonephritis
D. Interstitial nephritis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Fever, flank pain, and WBC casts indicate infection
involving the renal parenchyma rather than the bladder.
3. A 35-year-old man develops sudden dyspnea after a long airplane
flight. Heart rate is 120/min, oxygen saturation is 88%, and
examination reveals unilateral leg swelling. Most appropriate next
step?
A. Bronchoscopy
B. CT pulmonary angiography
C. Echocardiography only
D. Chest MRI
E. Pulmonary function testing
Answer: B. CT pulmonary angiography
Rationale: The presentation strongly suggests pulmonary embolism.
CT pulmonary angiography is the preferred diagnostic imaging test in
a hemodynamically stable patient.
4. A patient taking warfarin develops an INR of 8 without bleeding.
Best management?
A. Stop warfarin and give vitamin K
B. Continue current dose
,C. Give heparin
D. Platelet transfusion
E. Aspirin therapy
Answer: A. Stop warfarin and give vitamin K
Rationale: Excess anticoagulation without active bleeding is managed
by holding warfarin and administering vitamin K depending on INR
severity.
5. A 72-year-old smoker presents with painless gross hematuria.
Most likely diagnosis?
A. Kidney stone
B. Bladder urothelial carcinoma
C. Pyelonephritis
D. Benign prostatic hyperplasia
E. Glomerulonephritis
Answer: B. Bladder urothelial carcinoma
Rationale: Painless hematuria in an older smoker is a classic
presentation of bladder cancer.
6. A 23-year-old woman has fatigue, weight gain, constipation, and
cold intolerance. TSH is elevated and free T4 is low. Diagnosis?
A. Graves disease
B. Secondary hypothyroidism
C. Primary hypothyroidism
D. Thyroid storm
E. Euthyroid sick syndrome
, Answer: C. Primary hypothyroidism
Rationale: Elevated TSH with decreased free T4 indicates failure of the
thyroid gland itself.
7. A 65-year-old patient develops confusion, tremor, and diarrhea
after increasing levothyroxine dosage. Diagnosis?
A. Myxedema coma
B. Thyroid storm
C. Hypoglycemia
D. Adrenal crisis
E. Serotonin syndrome
Answer: B. Thyroid storm
Rationale: Excess thyroid hormone can cause severe hypermetabolic
symptoms including neurologic and gastrointestinal abnormalities.
8. A 45-year-old woman has episodic headaches, sweating,
palpitations, and hypertension. Best initial biochemical test?
A. Serum cortisol
B. Plasma free metanephrines
C. TSH
D. Aldosterone level
E. Insulin level
Answer: B. Plasma free metanephrines
Rationale: Pheochromocytoma screening begins with measurement of
catecholamine metabolites.
Clinical Synthesis 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
for 45 minutes. ECG shows ST elevation in leads II, III, and aVF.
Blood pressure is 88/60 mmHg. Which additional finding is most
likely?
A. Bradycardia due to vagal stimulation
B. Elevated pulmonary capillary wedge pressure
C. Left ventricular hypertrophy
D. Pulmonary edema with bilateral crackles
E. Wide pulse pressure
Answer: A. Bradycardia due to vagal stimulation
Rationale: Inferior myocardial infarctions involving the right coronary
artery can stimulate vagal tone, causing bradycardia and
hypotension. Right ventricular infarction may also occur, requiring
careful fluid management.
2. A 54-year-old woman with diabetes presents with fever, flank
pain, and dysuria. Urinalysis shows WBC casts. Which diagnosis is
most likely?
,A. Acute cystitis
B. Nephrolithiasis
C. Acute pyelonephritis
D. Interstitial nephritis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Fever, flank pain, and WBC casts indicate infection
involving the renal parenchyma rather than the bladder.
3. A 35-year-old man develops sudden dyspnea after a long airplane
flight. Heart rate is 120/min, oxygen saturation is 88%, and
examination reveals unilateral leg swelling. Most appropriate next
step?
A. Bronchoscopy
B. CT pulmonary angiography
C. Echocardiography only
D. Chest MRI
E. Pulmonary function testing
Answer: B. CT pulmonary angiography
Rationale: The presentation strongly suggests pulmonary embolism.
CT pulmonary angiography is the preferred diagnostic imaging test in
a hemodynamically stable patient.
4. A patient taking warfarin develops an INR of 8 without bleeding.
Best management?
A. Stop warfarin and give vitamin K
B. Continue current dose
,C. Give heparin
D. Platelet transfusion
E. Aspirin therapy
Answer: A. Stop warfarin and give vitamin K
Rationale: Excess anticoagulation without active bleeding is managed
by holding warfarin and administering vitamin K depending on INR
severity.
5. A 72-year-old smoker presents with painless gross hematuria.
Most likely diagnosis?
A. Kidney stone
B. Bladder urothelial carcinoma
C. Pyelonephritis
D. Benign prostatic hyperplasia
E. Glomerulonephritis
Answer: B. Bladder urothelial carcinoma
Rationale: Painless hematuria in an older smoker is a classic
presentation of bladder cancer.
6. A 23-year-old woman has fatigue, weight gain, constipation, and
cold intolerance. TSH is elevated and free T4 is low. Diagnosis?
A. Graves disease
B. Secondary hypothyroidism
C. Primary hypothyroidism
D. Thyroid storm
E. Euthyroid sick syndrome
, Answer: C. Primary hypothyroidism
Rationale: Elevated TSH with decreased free T4 indicates failure of the
thyroid gland itself.
7. A 65-year-old patient develops confusion, tremor, and diarrhea
after increasing levothyroxine dosage. Diagnosis?
A. Myxedema coma
B. Thyroid storm
C. Hypoglycemia
D. Adrenal crisis
E. Serotonin syndrome
Answer: B. Thyroid storm
Rationale: Excess thyroid hormone can cause severe hypermetabolic
symptoms including neurologic and gastrointestinal abnormalities.
8. A 45-year-old woman has episodic headaches, sweating,
palpitations, and hypertension. Best initial biochemical test?
A. Serum cortisol
B. Plasma free metanephrines
C. TSH
D. Aldosterone level
E. Insulin level
Answer: B. Plasma free metanephrines
Rationale: Pheochromocytoma screening begins with measurement of
catecholamine metabolites.
