COMSAE Phase 2 – BSA 117 Exam
Preparation Guide (2026 Verified Edition):
Questions and Answers with Detailed
Rationales
Question 1
A 67-year-old man with chronic atrial fibrillation develops
sudden severe abdominal pain that is disproportionate to
physical examination findings. Laboratory evaluation reveals
metabolic acidosis and elevated serum lactate. CT
angiography demonstrates an embolic occlusion of the
superior mesenteric artery.
Which portion of the gastrointestinal tract is most vulnerable
to ischemic injury in this patient?
A. Rectum
B. Descending colon
C. Mid-jejunum
D. Distal sigmoid colon
Rationale: C is correct because the jejunum receives its blood
supply from branches of the superior mesenteric artery
(SMA), making it highly susceptible to embolic occlusion. The
rectum has dual collateral circulation from the inferior
mesenteric and internal iliac arteries. The descending colon
,and splenic flexure represent watershed areas more
commonly affected by systemic hypoperfusion than embolic
SMA occlusion.
Question 2
A 29-year-old woman with Graves disease is admitted with
fever, confusion, tachycardia, vomiting, and severe agitation
after discontinuing antithyroid medication. Initial
management includes propranolol.
Which medication should be administered immediately after
propylthiouracil?
A. Hydrocortisone
B. Potassium iodide
C. Cholestyramine
D. Methimazole
Rationale: B is correct. In thyroid storm, propylthiouracil first
blocks hormone synthesis and peripheral T4-to-T3 conversion.
Approximately one hour later, iodide is administered to inhibit
hormone release (Wolff-Chaikoff effect). Giving iodide before
PTU may paradoxically increase hormone synthesis.
Corticosteroids are also important but are not administered
immediately after PTU for this pharmacologic sequence.
Question 3
,A patient develops acute respiratory distress syndrome
following severe pancreatitis. Mechanical ventilation is
initiated.
Which ventilator strategy has been shown to improve
survival?
A. High tidal volume ventilation
B. Low tidal volume ventilation (6 mL/kg predicted body
weight)
C. Hyperventilation to normalize PaCO₂
D. Routine recruitment maneuvers every hour
Rationale: B is correct. Lung-protective ventilation with low
tidal volumes minimizes ventilator-induced lung injury by
reducing volutrauma and barotrauma. Permissive
hypercapnia is acceptable if necessary. High tidal volumes
significantly increase mortality in ARDS.
Question 4
A newborn develops persistent cyanosis shortly after birth.
Oxygen administration fails to improve arterial oxygen
saturation. Echocardiography demonstrates transposition of
the great arteries.
Which medication should be initiated immediately?
A. Indomethacin
B. Prostaglandin E1
C. Digoxin
, D. Furosemide
Rationale: B is correct. Prostaglandin E1 maintains ductus
arteriosus patency, allowing mixing of oxygenated and
deoxygenated blood until definitive surgical correction.
Closure of the ductus in transposition is life-threatening.
Question 5
A patient with nephrotic syndrome develops sudden flank
pain and gross hematuria. Imaging demonstrates renal vein
thrombosis.
Which urinary finding most likely preceded this complication?
A. White blood cell casts
B. Massive proteinuria
C. Red blood cell casts
D. Granular casts
Rationale: B is correct. Heavy urinary protein loss leads to
urinary depletion of antithrombin III and other anticoagulant
proteins, creating a hypercoagulable state that predisposes to
renal vein thrombosis.
Question 6
A 56-year-old smoker presents with hemoptysis, recurrent
pneumonia, and hypercalcemia. Chest imaging reveals a
centrally located hilar mass.
Preparation Guide (2026 Verified Edition):
Questions and Answers with Detailed
Rationales
Question 1
A 67-year-old man with chronic atrial fibrillation develops
sudden severe abdominal pain that is disproportionate to
physical examination findings. Laboratory evaluation reveals
metabolic acidosis and elevated serum lactate. CT
angiography demonstrates an embolic occlusion of the
superior mesenteric artery.
Which portion of the gastrointestinal tract is most vulnerable
to ischemic injury in this patient?
A. Rectum
B. Descending colon
C. Mid-jejunum
D. Distal sigmoid colon
Rationale: C is correct because the jejunum receives its blood
supply from branches of the superior mesenteric artery
(SMA), making it highly susceptible to embolic occlusion. The
rectum has dual collateral circulation from the inferior
mesenteric and internal iliac arteries. The descending colon
,and splenic flexure represent watershed areas more
commonly affected by systemic hypoperfusion than embolic
SMA occlusion.
Question 2
A 29-year-old woman with Graves disease is admitted with
fever, confusion, tachycardia, vomiting, and severe agitation
after discontinuing antithyroid medication. Initial
management includes propranolol.
Which medication should be administered immediately after
propylthiouracil?
A. Hydrocortisone
B. Potassium iodide
C. Cholestyramine
D. Methimazole
Rationale: B is correct. In thyroid storm, propylthiouracil first
blocks hormone synthesis and peripheral T4-to-T3 conversion.
Approximately one hour later, iodide is administered to inhibit
hormone release (Wolff-Chaikoff effect). Giving iodide before
PTU may paradoxically increase hormone synthesis.
Corticosteroids are also important but are not administered
immediately after PTU for this pharmacologic sequence.
Question 3
,A patient develops acute respiratory distress syndrome
following severe pancreatitis. Mechanical ventilation is
initiated.
Which ventilator strategy has been shown to improve
survival?
A. High tidal volume ventilation
B. Low tidal volume ventilation (6 mL/kg predicted body
weight)
C. Hyperventilation to normalize PaCO₂
D. Routine recruitment maneuvers every hour
Rationale: B is correct. Lung-protective ventilation with low
tidal volumes minimizes ventilator-induced lung injury by
reducing volutrauma and barotrauma. Permissive
hypercapnia is acceptable if necessary. High tidal volumes
significantly increase mortality in ARDS.
Question 4
A newborn develops persistent cyanosis shortly after birth.
Oxygen administration fails to improve arterial oxygen
saturation. Echocardiography demonstrates transposition of
the great arteries.
Which medication should be initiated immediately?
A. Indomethacin
B. Prostaglandin E1
C. Digoxin
, D. Furosemide
Rationale: B is correct. Prostaglandin E1 maintains ductus
arteriosus patency, allowing mixing of oxygenated and
deoxygenated blood until definitive surgical correction.
Closure of the ductus in transposition is life-threatening.
Question 5
A patient with nephrotic syndrome develops sudden flank
pain and gross hematuria. Imaging demonstrates renal vein
thrombosis.
Which urinary finding most likely preceded this complication?
A. White blood cell casts
B. Massive proteinuria
C. Red blood cell casts
D. Granular casts
Rationale: B is correct. Heavy urinary protein loss leads to
urinary depletion of antithrombin III and other anticoagulant
proteins, creating a hypercoagulable state that predisposes to
renal vein thrombosis.
Question 6
A 56-year-old smoker presents with hemoptysis, recurrent
pneumonia, and hypercalcemia. Chest imaging reveals a
centrally located hilar mass.
