2026 Original COMSAE Phase 1 –
Assessment Series A Form 111i Style Practice
Exam | Verified Comprehensive Questions
with Detailed Rationales & Answers
Question 1
A 24-year-old woman presents with fatigue, salt craving, weight
loss, and hyperpigmentation of the palmar creases. Laboratory
testing demonstrates hyponatremia, hyperkalemia, and
hypoglycemia.
Which hormone is expected to be elevated?
A. Aldosterone
B. Cortisol
C. ACTH
D. Renin
Answer: C. ACTH
Rationale: Primary adrenal insufficiency destroys the adrenal
cortex, leading to decreased cortisol and aldosterone
production. Loss of cortisol removes negative feedback on the
,pituitary, increasing ACTH secretion. ACTH shares a precursor
(POMC) with MSH, explaining hyperpigmentation.
Question 2
A patient develops severe chest pain shortly after an anterior
wall myocardial infarction. Histology demonstrates coagulative
necrosis.
Which inflammatory cell predominates 24–48 hours after
infarction?
A. Macrophages
B. Neutrophils
C. Fibroblasts
D. Lymphocytes
Answer: B. Neutrophils
Rationale: Neutrophils infiltrate infarcted myocardium within
the first 1–3 days. Macrophages predominate after 3–7 days,
while fibroblasts appear during healing.
Question 3
,A 6-year-old boy experiences recurrent bacterial infections with
catalase-positive organisms. Neutrophils fail to produce
reactive oxygen species.
Which enzyme is deficient?
A. Myeloperoxidase
B. NADPH oxidase
C. Catalase
D. Superoxide dismutase
Answer: B. NADPH oxidase
Rationale: Chronic granulomatous disease results from NADPH
oxidase deficiency, preventing respiratory burst and impairing
intracellular killing.
Question 4
A patient with cirrhosis develops confusion and asterixis.
Ammonia is primarily detoxified by which organ?
A. Kidney
B. Liver
C. Pancreas
, D. Spleen
Answer: B. Liver
Rationale: Hepatocytes convert ammonia into urea through the
urea cycle. Liver dysfunction allows ammonia accumulation,
leading to hepatic encephalopathy.
Question 5
A patient has weakness when attempting to abduct the arm
from 15° to 90°.
Which muscle is dysfunctional?
A. Supraspinatus
B. Deltoid
C. Teres major
D. Latissimus dorsi
Answer: B. Deltoid
Rationale: Supraspinatus initiates the first 15° of abduction. The
deltoid performs abduction from 15° to approximately 90°.
Question 6
Assessment Series A Form 111i Style Practice
Exam | Verified Comprehensive Questions
with Detailed Rationales & Answers
Question 1
A 24-year-old woman presents with fatigue, salt craving, weight
loss, and hyperpigmentation of the palmar creases. Laboratory
testing demonstrates hyponatremia, hyperkalemia, and
hypoglycemia.
Which hormone is expected to be elevated?
A. Aldosterone
B. Cortisol
C. ACTH
D. Renin
Answer: C. ACTH
Rationale: Primary adrenal insufficiency destroys the adrenal
cortex, leading to decreased cortisol and aldosterone
production. Loss of cortisol removes negative feedback on the
,pituitary, increasing ACTH secretion. ACTH shares a precursor
(POMC) with MSH, explaining hyperpigmentation.
Question 2
A patient develops severe chest pain shortly after an anterior
wall myocardial infarction. Histology demonstrates coagulative
necrosis.
Which inflammatory cell predominates 24–48 hours after
infarction?
A. Macrophages
B. Neutrophils
C. Fibroblasts
D. Lymphocytes
Answer: B. Neutrophils
Rationale: Neutrophils infiltrate infarcted myocardium within
the first 1–3 days. Macrophages predominate after 3–7 days,
while fibroblasts appear during healing.
Question 3
,A 6-year-old boy experiences recurrent bacterial infections with
catalase-positive organisms. Neutrophils fail to produce
reactive oxygen species.
Which enzyme is deficient?
A. Myeloperoxidase
B. NADPH oxidase
C. Catalase
D. Superoxide dismutase
Answer: B. NADPH oxidase
Rationale: Chronic granulomatous disease results from NADPH
oxidase deficiency, preventing respiratory burst and impairing
intracellular killing.
Question 4
A patient with cirrhosis develops confusion and asterixis.
Ammonia is primarily detoxified by which organ?
A. Kidney
B. Liver
C. Pancreas
, D. Spleen
Answer: B. Liver
Rationale: Hepatocytes convert ammonia into urea through the
urea cycle. Liver dysfunction allows ammonia accumulation,
leading to hepatic encephalopathy.
Question 5
A patient has weakness when attempting to abduct the arm
from 15° to 90°.
Which muscle is dysfunctional?
A. Supraspinatus
B. Deltoid
C. Teres major
D. Latissimus dorsi
Answer: B. Deltoid
Rationale: Supraspinatus initiates the first 15° of abduction. The
deltoid performs abduction from 15° to approximately 90°.
Question 6
