COMSAE Phase 2 – BSA 118 Exam
Preparation Guide (2026 Verified Edition):
Questions and Answers with Detailed
Rationales
Question 1
A 67-year-old man with chronic atrial fibrillation suddenly
develops severe abdominal pain that is disproportionate to
the physical examination findings. Laboratory studies reveal
metabolic acidosis with elevated lactate. Which diagnosis is
most likely?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Diverticulitis
D. Small bowel obstruction
Rationale: Acute mesenteric ischemia commonly results from
embolization of the superior mesenteric artery in patients
with atrial fibrillation. The hallmark is severe abdominal pain
out of proportion to physical findings, accompanied by
metabolic acidosis due to bowel hypoperfusion. Delay in
diagnosis markedly increases mortality.
Question 2
,A patient with septic shock remains hypotensive despite
receiving 30 mL/kg of isotonic crystalloid. Which vasopressor
is recommended as first-line therapy?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
Rationale: Norepinephrine is the preferred first-line
vasopressor because it provides potent α-adrenergic
vasoconstriction with modest β1 activity, improving vascular
tone while minimizing arrhythmias compared with dopamine.
Question 3
A newborn develops persistent cyanosis immediately after
birth. Oxygen administration fails to improve oxygen
saturation. Which congenital heart defect is most likely?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Transposition of the great arteries
D. Coarctation of the aorta
Rationale: Transposition of the great arteries causes parallel
systemic and pulmonary circulations. Oxygen therapy alone is
ineffective because mixing of oxygenated and deoxygenated
blood is inadequate unless a PDA, ASD, or VSD exists.
Prostaglandin E1 is initiated to maintain ductal patency.
,Question 4
A woman presents with progressive proximal muscle
weakness and a heliotrope rash. Laboratory testing shows
elevated creatine kinase. Which antibody is most associated
with this condition?
A. Anti-centromere
B. Anti-dsDNA
C. Anti-Jo-1
D. Anti-Scl-70
Rationale: Anti-Jo-1 antibodies are strongly associated with
polymyositis and dermatomyositis, particularly cases
complicated by interstitial lung disease. The heliotrope rash
specifically supports dermatomyositis.
Question 5
Which electrolyte abnormality is most likely to prolong the
QT interval and predispose to torsades de pointes?
A. Hypercalcemia
B. Hyperkalemia
C. Hypomagnesemia
D. Hypernatremia
Rationale: Hypomagnesemia prolongs ventricular
repolarization, increasing susceptibility to torsades de
, pointes. Magnesium sulfate is the treatment even when
serum magnesium appears normal.
Question 6
A patient presents with unilateral headache, lacrimation,
rhinorrhea, and ipsilateral ptosis lasting approximately 45
minutes. Which diagnosis is most likely?
A. Migraine
B. Temporal arteritis
C. Cluster headache
D. Tension headache
Rationale: Cluster headaches are characterized by severe
unilateral orbital pain accompanied by autonomic symptoms.
Acute treatment includes 100% oxygen and subcutaneous
sumatriptan, while verapamil is the preferred preventive
therapy.
Question 7
Which glomerular disease is classically associated with
hearing loss and ocular abnormalities?
A. Minimal change disease
B. Membranous nephropathy
C. Alport syndrome
D. IgA nephropathy
Preparation Guide (2026 Verified Edition):
Questions and Answers with Detailed
Rationales
Question 1
A 67-year-old man with chronic atrial fibrillation suddenly
develops severe abdominal pain that is disproportionate to
the physical examination findings. Laboratory studies reveal
metabolic acidosis with elevated lactate. Which diagnosis is
most likely?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Diverticulitis
D. Small bowel obstruction
Rationale: Acute mesenteric ischemia commonly results from
embolization of the superior mesenteric artery in patients
with atrial fibrillation. The hallmark is severe abdominal pain
out of proportion to physical findings, accompanied by
metabolic acidosis due to bowel hypoperfusion. Delay in
diagnosis markedly increases mortality.
Question 2
,A patient with septic shock remains hypotensive despite
receiving 30 mL/kg of isotonic crystalloid. Which vasopressor
is recommended as first-line therapy?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
Rationale: Norepinephrine is the preferred first-line
vasopressor because it provides potent α-adrenergic
vasoconstriction with modest β1 activity, improving vascular
tone while minimizing arrhythmias compared with dopamine.
Question 3
A newborn develops persistent cyanosis immediately after
birth. Oxygen administration fails to improve oxygen
saturation. Which congenital heart defect is most likely?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Transposition of the great arteries
D. Coarctation of the aorta
Rationale: Transposition of the great arteries causes parallel
systemic and pulmonary circulations. Oxygen therapy alone is
ineffective because mixing of oxygenated and deoxygenated
blood is inadequate unless a PDA, ASD, or VSD exists.
Prostaglandin E1 is initiated to maintain ductal patency.
,Question 4
A woman presents with progressive proximal muscle
weakness and a heliotrope rash. Laboratory testing shows
elevated creatine kinase. Which antibody is most associated
with this condition?
A. Anti-centromere
B. Anti-dsDNA
C. Anti-Jo-1
D. Anti-Scl-70
Rationale: Anti-Jo-1 antibodies are strongly associated with
polymyositis and dermatomyositis, particularly cases
complicated by interstitial lung disease. The heliotrope rash
specifically supports dermatomyositis.
Question 5
Which electrolyte abnormality is most likely to prolong the
QT interval and predispose to torsades de pointes?
A. Hypercalcemia
B. Hyperkalemia
C. Hypomagnesemia
D. Hypernatremia
Rationale: Hypomagnesemia prolongs ventricular
repolarization, increasing susceptibility to torsades de
, pointes. Magnesium sulfate is the treatment even when
serum magnesium appears normal.
Question 6
A patient presents with unilateral headache, lacrimation,
rhinorrhea, and ipsilateral ptosis lasting approximately 45
minutes. Which diagnosis is most likely?
A. Migraine
B. Temporal arteritis
C. Cluster headache
D. Tension headache
Rationale: Cluster headaches are characterized by severe
unilateral orbital pain accompanied by autonomic symptoms.
Acute treatment includes 100% oxygen and subcutaneous
sumatriptan, while verapamil is the preferred preventive
therapy.
Question 7
Which glomerular disease is classically associated with
hearing loss and ocular abnormalities?
A. Minimal change disease
B. Membranous nephropathy
C. Alport syndrome
D. IgA nephropathy
