COMSAE PHASE 1 FORM 114 PRACTICE EXAM
LATEST 2026 UPDATE 100+ QUESTIONS AND
DETAILED VERIFIED ANSWERS FROM ACTUAL
EXAMS TEST GRADE A+
Question 1
A 28-year-old woman presents with fatigue, weight gain, cold intolerance, and
constipation. Labs show elevated TSH and low free T4. What is the most likely
diagnosis?
A) Hashimoto thyroiditis
B) Graves disease
C) Subacute thyroiditis
D) Euthyroid sick syndrome
Correct Answer: A
*Explanation: Hashimoto thyroiditis is the most common cause of hypothyroidism
in iodine-sufficient areas. The presentation includes fatigue, weight gain, cold
intolerance, and constipation. Elevated TSH with low free T4 confirms primary
hypothyroidism. Graves disease causes hyperthyroidism (low TSH, high T4).
Subacute thyroiditis often causes transient hyperthyroidism with pain. Euthyroid
sick syndrome shows low T3 with normal TSH.*
Question 2
A 55-year-old male with history of hypertension presents with sudden onset of
severe, tearing chest pain radiating to the back. Blood pressure is 160/90 in the
right arm and 100/70 in the left arm. What is the most appropriate next step?
A) ECG
B) Chest X-ray
C) CT angiography of the chest
D) Administer thrombolytics
,Correct Answer: C
Explanation: This presentation (tearing chest pain radiating to back, differential
blood pressures) is classic for aortic dissection. CT angiography is the most rapid
and sensitive imaging study to confirm dissection. ECG and chest X-ray may be
done but do not rule out dissection. Thrombolytics are contraindicated as they
increase bleeding risk.
Question 3
A 45-year-old woman presents with episodic headaches, palpitations, sweating,
and hypertension. Laboratory tests show elevated plasma metanephrines. Which
imaging study is best to localize the tumor?
A) Abdominal ultrasound
B) CT abdomen
C) MRI abdomen
D) MIBG scan
Correct Answer: D
Explanation: Elevated metanephrines indicate pheochromocytoma. While CT/MRI
can localize adrenal masses, MIBG (metaiodobenzylguanidine) scan is the most
specific for functional pheochromocytoma and can detect extra-adrenal tumors.
Ultrasound has lower sensitivity. MRI may be used but MIBG is preferred for
localization when biochemical diagnosis is confirmed.
Question 4
A 72-year-old man with COPD presents with worsening dyspnea and cough. On
exam, he has jugular venous distension and pedal edema. Which medication is
most likely to improve mortality in this patient?
A) Albuterol
B) Prednisone
C) Tiotropium
D) Long-term oxygen therapy
,Correct Answer: D
*Explanation: This patient has signs of cor pulmonale from severe COPD. Long-
term oxygen therapy (>15 hours/day) is the only intervention shown to reduce
mortality in hypoxemic COPD patients. Albuterol and tiotropium improve
symptoms but not mortality. Prednisone may help exacerbations but chronic use
does not improve survival.*
Question 5
A 30-year-old man presents with acute onset of testicular pain, nausea, and
vomiting. On exam, the testis is tender, elevated, and horizontal lie is noted. What
is the most appropriate next step?
A) Urinalysis
B) Doppler ultrasound
C) Surgical exploration
D) Antibiotics
Correct Answer: C
Explanation: This presentation (acute pain, horizontal lie of testis) is highly
suspicious for testicular torsion. Surgical exploration is emergent because
testicular viability diminishes after 6 hours. Doppler ultrasound may delay care; if
clinical suspicion is high, proceed directly to surgery. Antibiotics are for
epididymitis, which typically presents with gradual pain and pyuria.
Question 6
A 60-year-old woman with osteoporosis presents with acute back pain after lifting
a heavy box. X-ray shows vertebral compression fracture. Which medication is
first-line to prevent future fractures?
A) Calcium and vitamin D
B) Alendronate
C) Raloxifene
D) Teriparatide
, Correct Answer: B
Explanation: Alendronate (bisphosphonate) is first-line for osteoporosis to reduce
vertebral and hip fracture risk. Calcium/vitamin D are adjuncts, not monotherapy.
Raloxifene is for vertebral fractures but less effective. Teriparatide is used for
severe cases or bisphosphonate failure.
Question 7
A 25-year-old woman presents with palpitations, heat intolerance, weight loss,
and exophthalmos. TSH is suppressed, free T4 elevated. Which antibody is most
specific for this condition?
A) Anti-thyroglobulin antibody
B) Anti-TPO antibody
C) TSH receptor antibody
D) Anti-nuclear antibody
Correct Answer: C
Explanation: This is Graves disease. TSH receptor antibodies (TRAb) are
pathognomonic and cause hyperthyroidism by stimulating TSH receptors. Anti-
thyroglobulin and anti-TPO are seen in Hashimoto but not specific. ANA is for
autoimmune diseases like lupus.
Question 8
A 50-year-old male with chronic alcoholism presents with confusion, ataxia, and
nystagmus. What is the most appropriate immediate treatment?
A) Thiamine 100 mg IV
B) Glucose 50% IV
C) Folic acid 1 mg IM
D) Magnesium sulfate IV
Correct Answer: A
Explanation: This triad (confusion, ataxia, nystagmus) is Wernicke encephalopathy
LATEST 2026 UPDATE 100+ QUESTIONS AND
DETAILED VERIFIED ANSWERS FROM ACTUAL
EXAMS TEST GRADE A+
Question 1
A 28-year-old woman presents with fatigue, weight gain, cold intolerance, and
constipation. Labs show elevated TSH and low free T4. What is the most likely
diagnosis?
A) Hashimoto thyroiditis
B) Graves disease
C) Subacute thyroiditis
D) Euthyroid sick syndrome
Correct Answer: A
*Explanation: Hashimoto thyroiditis is the most common cause of hypothyroidism
in iodine-sufficient areas. The presentation includes fatigue, weight gain, cold
intolerance, and constipation. Elevated TSH with low free T4 confirms primary
hypothyroidism. Graves disease causes hyperthyroidism (low TSH, high T4).
Subacute thyroiditis often causes transient hyperthyroidism with pain. Euthyroid
sick syndrome shows low T3 with normal TSH.*
Question 2
A 55-year-old male with history of hypertension presents with sudden onset of
severe, tearing chest pain radiating to the back. Blood pressure is 160/90 in the
right arm and 100/70 in the left arm. What is the most appropriate next step?
A) ECG
B) Chest X-ray
C) CT angiography of the chest
D) Administer thrombolytics
,Correct Answer: C
Explanation: This presentation (tearing chest pain radiating to back, differential
blood pressures) is classic for aortic dissection. CT angiography is the most rapid
and sensitive imaging study to confirm dissection. ECG and chest X-ray may be
done but do not rule out dissection. Thrombolytics are contraindicated as they
increase bleeding risk.
Question 3
A 45-year-old woman presents with episodic headaches, palpitations, sweating,
and hypertension. Laboratory tests show elevated plasma metanephrines. Which
imaging study is best to localize the tumor?
A) Abdominal ultrasound
B) CT abdomen
C) MRI abdomen
D) MIBG scan
Correct Answer: D
Explanation: Elevated metanephrines indicate pheochromocytoma. While CT/MRI
can localize adrenal masses, MIBG (metaiodobenzylguanidine) scan is the most
specific for functional pheochromocytoma and can detect extra-adrenal tumors.
Ultrasound has lower sensitivity. MRI may be used but MIBG is preferred for
localization when biochemical diagnosis is confirmed.
Question 4
A 72-year-old man with COPD presents with worsening dyspnea and cough. On
exam, he has jugular venous distension and pedal edema. Which medication is
most likely to improve mortality in this patient?
A) Albuterol
B) Prednisone
C) Tiotropium
D) Long-term oxygen therapy
,Correct Answer: D
*Explanation: This patient has signs of cor pulmonale from severe COPD. Long-
term oxygen therapy (>15 hours/day) is the only intervention shown to reduce
mortality in hypoxemic COPD patients. Albuterol and tiotropium improve
symptoms but not mortality. Prednisone may help exacerbations but chronic use
does not improve survival.*
Question 5
A 30-year-old man presents with acute onset of testicular pain, nausea, and
vomiting. On exam, the testis is tender, elevated, and horizontal lie is noted. What
is the most appropriate next step?
A) Urinalysis
B) Doppler ultrasound
C) Surgical exploration
D) Antibiotics
Correct Answer: C
Explanation: This presentation (acute pain, horizontal lie of testis) is highly
suspicious for testicular torsion. Surgical exploration is emergent because
testicular viability diminishes after 6 hours. Doppler ultrasound may delay care; if
clinical suspicion is high, proceed directly to surgery. Antibiotics are for
epididymitis, which typically presents with gradual pain and pyuria.
Question 6
A 60-year-old woman with osteoporosis presents with acute back pain after lifting
a heavy box. X-ray shows vertebral compression fracture. Which medication is
first-line to prevent future fractures?
A) Calcium and vitamin D
B) Alendronate
C) Raloxifene
D) Teriparatide
, Correct Answer: B
Explanation: Alendronate (bisphosphonate) is first-line for osteoporosis to reduce
vertebral and hip fracture risk. Calcium/vitamin D are adjuncts, not monotherapy.
Raloxifene is for vertebral fractures but less effective. Teriparatide is used for
severe cases or bisphosphonate failure.
Question 7
A 25-year-old woman presents with palpitations, heat intolerance, weight loss,
and exophthalmos. TSH is suppressed, free T4 elevated. Which antibody is most
specific for this condition?
A) Anti-thyroglobulin antibody
B) Anti-TPO antibody
C) TSH receptor antibody
D) Anti-nuclear antibody
Correct Answer: C
Explanation: This is Graves disease. TSH receptor antibodies (TRAb) are
pathognomonic and cause hyperthyroidism by stimulating TSH receptors. Anti-
thyroglobulin and anti-TPO are seen in Hashimoto but not specific. ANA is for
autoimmune diseases like lupus.
Question 8
A 50-year-old male with chronic alcoholism presents with confusion, ataxia, and
nystagmus. What is the most appropriate immediate treatment?
A) Thiamine 100 mg IV
B) Glucose 50% IV
C) Folic acid 1 mg IM
D) Magnesium sulfate IV
Correct Answer: A
Explanation: This triad (confusion, ataxia, nystagmus) is Wernicke encephalopathy
