COMSAE Phase 3 Form CSA 125 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 sudden tearing chest pain
radiating to his back. Blood pressure is 180/95 mmHg in the right
arm and 150/85 mmHg in the left arm. Chest radiograph shows
widened mediastinum. Which is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Acute tearing chest pain with pulse/BP differences and
widened mediastinum strongly suggests aortic dissection. The initial
diagnostic test in stable patients is CT angiography, while
management involves urgent blood pressure control and surgical
evaluation depending on location.
2. A 54-year-old woman with diabetes presents with fever, flank
pain, and dysuria. Urinalysis shows leukocyte esterase and
nitrites. She is hypotensive despite fluids. Which organism is most
likely responsible?
,A. Enterococcus faecalis
B. Escherichia coli
C. Candida albicans
D. Staphylococcus saprophyticus
Answer: B. Escherichia coli
Rationale: E. coli is the most common cause of complicated urinary
tract infections and pyelonephritis. Septic shock from urinary infection
requires rapid antibiotics and hemodynamic support.
3. A patient with chronic atrial fibrillation develops sudden right-
sided weakness and aphasia. CT head shows no hemorrhage.
What is the best next step?
A. Aspirin only
B. IV thrombolytic therapy if eligible
C. Warfarin initiation
D. Carotid endarterectomy
Answer: B. IV thrombolytic therapy if eligible
Rationale: Acute ischemic stroke within the treatment window may be
treated with thrombolysis after excluding hemorrhage. Atrial
fibrillation increases risk of embolic stroke.
4. A 35-year-old woman has fatigue, weight gain, constipation, and
cold intolerance. Labs show elevated TSH and low free T4. What is
the diagnosis?
A. Hyperthyroidism
B. Hashimoto thyroiditis
,C. Graves disease
D. Subacute thyroiditis
Answer: B. Hashimoto thyroiditis
Rationale: Primary hypothyroidism presents with elevated TSH and
low thyroid hormone levels. Hashimoto thyroiditis is the most
common cause in iodine-sufficient regions.
5. A 72-year-old man develops confusion and weakness after
starting hydrochlorothiazide. Sodium is 118 mEq/L. Which finding
is expected?
A. Hyperreflexia
B. Seizures
C. Polyuria
D. Severe hypertension
Answer: B. Seizures
Rationale: Severe hyponatremia causes cerebral edema and
neurologic symptoms including confusion, seizures, and altered
mental status.
6. A 25-year-old woman presents with fever, neck stiffness, and
photophobia. Lumbar puncture shows neutrophilic predominance
and low glucose. Most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Subarachnoid hemorrhage
D. Brain tumor
, Answer: B. Bacterial meningitis
Rationale: Bacterial meningitis classically causes neutrophils, elevated
protein, and decreased CSF glucose. Immediate empiric antibiotics are
required.
7. A 60-year-old smoker has hematuria. Urine cytology shows
malignant cells. What is the most likely diagnosis?
A. Renal cell carcinoma
B. Transitional cell carcinoma
C. Prostate cancer
D. Bladder infection
Answer: B. Transitional cell carcinoma
Rationale: Painless hematuria in an older smoker is classic for
urothelial carcinoma of the bladder. Smoking is the major risk factor.
8. A patient with COPD has worsening dyspnea and increased
sputum production. Which medication provides rapid
bronchodilation?
A. Inhaled corticosteroid
B. Long-acting beta agonist
C. Short-acting beta agonist
D. Leukotriene inhibitor
Answer: C. Short-acting beta agonist
Rationale: Short-acting beta agonists such as albuterol are rescue
medications used for acute COPD symptom relief.
Clinical Synthesis Exam Practice Questions
& [Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with sudden tearing chest pain
radiating to his back. Blood pressure is 180/95 mmHg in the right
arm and 150/85 mmHg in the left arm. Chest radiograph shows
widened mediastinum. Which is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Acute tearing chest pain with pulse/BP differences and
widened mediastinum strongly suggests aortic dissection. The initial
diagnostic test in stable patients is CT angiography, while
management involves urgent blood pressure control and surgical
evaluation depending on location.
2. A 54-year-old woman with diabetes presents with fever, flank
pain, and dysuria. Urinalysis shows leukocyte esterase and
nitrites. She is hypotensive despite fluids. Which organism is most
likely responsible?
,A. Enterococcus faecalis
B. Escherichia coli
C. Candida albicans
D. Staphylococcus saprophyticus
Answer: B. Escherichia coli
Rationale: E. coli is the most common cause of complicated urinary
tract infections and pyelonephritis. Septic shock from urinary infection
requires rapid antibiotics and hemodynamic support.
3. A patient with chronic atrial fibrillation develops sudden right-
sided weakness and aphasia. CT head shows no hemorrhage.
What is the best next step?
A. Aspirin only
B. IV thrombolytic therapy if eligible
C. Warfarin initiation
D. Carotid endarterectomy
Answer: B. IV thrombolytic therapy if eligible
Rationale: Acute ischemic stroke within the treatment window may be
treated with thrombolysis after excluding hemorrhage. Atrial
fibrillation increases risk of embolic stroke.
4. A 35-year-old woman has fatigue, weight gain, constipation, and
cold intolerance. Labs show elevated TSH and low free T4. What is
the diagnosis?
A. Hyperthyroidism
B. Hashimoto thyroiditis
,C. Graves disease
D. Subacute thyroiditis
Answer: B. Hashimoto thyroiditis
Rationale: Primary hypothyroidism presents with elevated TSH and
low thyroid hormone levels. Hashimoto thyroiditis is the most
common cause in iodine-sufficient regions.
5. A 72-year-old man develops confusion and weakness after
starting hydrochlorothiazide. Sodium is 118 mEq/L. Which finding
is expected?
A. Hyperreflexia
B. Seizures
C. Polyuria
D. Severe hypertension
Answer: B. Seizures
Rationale: Severe hyponatremia causes cerebral edema and
neurologic symptoms including confusion, seizures, and altered
mental status.
6. A 25-year-old woman presents with fever, neck stiffness, and
photophobia. Lumbar puncture shows neutrophilic predominance
and low glucose. Most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Subarachnoid hemorrhage
D. Brain tumor
, Answer: B. Bacterial meningitis
Rationale: Bacterial meningitis classically causes neutrophils, elevated
protein, and decreased CSF glucose. Immediate empiric antibiotics are
required.
7. A 60-year-old smoker has hematuria. Urine cytology shows
malignant cells. What is the most likely diagnosis?
A. Renal cell carcinoma
B. Transitional cell carcinoma
C. Prostate cancer
D. Bladder infection
Answer: B. Transitional cell carcinoma
Rationale: Painless hematuria in an older smoker is classic for
urothelial carcinoma of the bladder. Smoking is the major risk factor.
8. A patient with COPD has worsening dyspnea and increased
sputum production. Which medication provides rapid
bronchodilation?
A. Inhaled corticosteroid
B. Long-acting beta agonist
C. Short-acting beta agonist
D. Leukotriene inhibitor
Answer: C. Short-acting beta agonist
Rationale: Short-acting beta agonists such as albuterol are rescue
medications used for acute COPD symptom relief.
