Ace the COMSAE Phase II: 150 High-
Yield Form 114 Practice Questions
with Step-by-Step Explanations
1. Community-acquired pneumonia is most commonly caused by which organism?
A. Haemophilus influenzae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Answer: C
Rationale: Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia (CAP) worldwide. Classic presentation includes acute fever,
productive cough with rust-colored sputum, and pleuritic chest pain.
2. A 24-year-old woman presents with acute lower abdominal pain and fever.
Pelvic exam reveals cervical motion tenderness. What is the most likely diagnosis?
A. Ruptured ovarian cyst
B. Appendicitis
C. Pelvic inflammatory disease (PID)
D. Ectopic pregnancy
Answer: C
Rationale: Lower abdominal pain, fever, and cervical motion tenderness ("chandelier
sign") are classic for PID, usually caused by ascending Neisseria
gonorrhoeae or Chlamydia trachomatis.
,3. A 65-year-old male with a 50-pack-year smoking history presents with painless
hematuria. What is the most likely diagnosis?
A. Nephrolithiasis
B. Bladder cancer (urothelial carcinoma)
C. Renal cell carcinoma
D. Benign prostatic hyperplasia
Answer: B
Rationale: Smoking is the strongest risk factor for bladder cancer. Painless gross
hematuria is the classic presenting sign of urothelial carcinoma.
4. A 25-year-old male presents with sudden severe chest pain radiating to the back
and unequal blood pressures in the arms. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: Acute aortic dissection classically presents with tearing chest pain radiating
to the back, often with pulse or blood pressure differentials between the upper
extremities. It is a surgical emergency.
5. Night blindness is associated with deficiency of which vitamin?
A. Vitamin B12
B. Vitamin A
,C. Vitamin C
D. Vitamin D
Answer: B
Rationale: Vitamin A is essential for the synthesis of rhodopsin (visual pigment in rod
cells). Deficiency leads to impaired dark adaptation and night blindness.
6. A patient presents with hematuria, hypertension, and edema 2 weeks after a
sore throat. What is the most likely diagnosis?
A. IgA nephropathy
B. Post-streptococcal glomerulonephritis
C. Minimal change disease
D. Focal segmental glomerulosclerosis
Answer: B
Rationale: Post-streptococcal glomerulonephritis typically occurs 1–3 weeks after a
group A beta-hemolytic streptococcal infection (e.g., pharyngitis). It presents with the
nephritic syndrome: hematuria, edema, and hypertension.
7. A 50-year-old with newly diagnosed hypertension has elevated BUN/creatinine
and mild hyperkalemia. Which antihypertensive class is preferred in this setting?
A. Hydrochlorothiazide
B. ACE inhibitor
C. Beta-blocker
D. Calcium channel blocker
Answer: B
Rationale: ACE inhibitors (or ARBs) are preferred in patients with chronic kidney disease
, and proteinuria due to their renoprotective effects. However, creatinine and potassium
must be monitored closely.
8. A 30-year-old presents with palpitations. ECG shows a narrow-complex
tachycardia at 180 bpm with an irregularly irregular rhythm. What is the next best
management step if hemodynamically stable?
A. Synchronized cardioversion
B. Intravenous adenosine
C. Oral metoprolol
D. Anticoagulation and rate control
Answer: D
Rationale: The ECG findings are classic for atrial fibrillation. In a stable patient, the
priority is rate control (beta-blocker or CCB) and anticoagulation if CHA₂DS₂-VASc score
indicates risk. Adenosine is for regular narrow-complex tachycardias (e.g., SVT).
9. An HIV-positive patient with a CD4 count of 120 cells/µL is Toxoplasma IgG
positive. What is the recommended prophylaxis?
A. TMP-SMX
B. Pyrimethamine
C. Repeat CD4 count
D. Observation
Answer: A
Rationale: For HIV patients with CD4 < 100 cells/µL and positive Toxoplasma IgG,
primary prophylaxis with TMP-SMX is indicated to prevent toxoplasmic encephalitis.
Yield Form 114 Practice Questions
with Step-by-Step Explanations
1. Community-acquired pneumonia is most commonly caused by which organism?
A. Haemophilus influenzae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Answer: C
Rationale: Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia (CAP) worldwide. Classic presentation includes acute fever,
productive cough with rust-colored sputum, and pleuritic chest pain.
2. A 24-year-old woman presents with acute lower abdominal pain and fever.
Pelvic exam reveals cervical motion tenderness. What is the most likely diagnosis?
A. Ruptured ovarian cyst
B. Appendicitis
C. Pelvic inflammatory disease (PID)
D. Ectopic pregnancy
Answer: C
Rationale: Lower abdominal pain, fever, and cervical motion tenderness ("chandelier
sign") are classic for PID, usually caused by ascending Neisseria
gonorrhoeae or Chlamydia trachomatis.
,3. A 65-year-old male with a 50-pack-year smoking history presents with painless
hematuria. What is the most likely diagnosis?
A. Nephrolithiasis
B. Bladder cancer (urothelial carcinoma)
C. Renal cell carcinoma
D. Benign prostatic hyperplasia
Answer: B
Rationale: Smoking is the strongest risk factor for bladder cancer. Painless gross
hematuria is the classic presenting sign of urothelial carcinoma.
4. A 25-year-old male presents with sudden severe chest pain radiating to the back
and unequal blood pressures in the arms. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: Acute aortic dissection classically presents with tearing chest pain radiating
to the back, often with pulse or blood pressure differentials between the upper
extremities. It is a surgical emergency.
5. Night blindness is associated with deficiency of which vitamin?
A. Vitamin B12
B. Vitamin A
,C. Vitamin C
D. Vitamin D
Answer: B
Rationale: Vitamin A is essential for the synthesis of rhodopsin (visual pigment in rod
cells). Deficiency leads to impaired dark adaptation and night blindness.
6. A patient presents with hematuria, hypertension, and edema 2 weeks after a
sore throat. What is the most likely diagnosis?
A. IgA nephropathy
B. Post-streptococcal glomerulonephritis
C. Minimal change disease
D. Focal segmental glomerulosclerosis
Answer: B
Rationale: Post-streptococcal glomerulonephritis typically occurs 1–3 weeks after a
group A beta-hemolytic streptococcal infection (e.g., pharyngitis). It presents with the
nephritic syndrome: hematuria, edema, and hypertension.
7. A 50-year-old with newly diagnosed hypertension has elevated BUN/creatinine
and mild hyperkalemia. Which antihypertensive class is preferred in this setting?
A. Hydrochlorothiazide
B. ACE inhibitor
C. Beta-blocker
D. Calcium channel blocker
Answer: B
Rationale: ACE inhibitors (or ARBs) are preferred in patients with chronic kidney disease
, and proteinuria due to their renoprotective effects. However, creatinine and potassium
must be monitored closely.
8. A 30-year-old presents with palpitations. ECG shows a narrow-complex
tachycardia at 180 bpm with an irregularly irregular rhythm. What is the next best
management step if hemodynamically stable?
A. Synchronized cardioversion
B. Intravenous adenosine
C. Oral metoprolol
D. Anticoagulation and rate control
Answer: D
Rationale: The ECG findings are classic for atrial fibrillation. In a stable patient, the
priority is rate control (beta-blocker or CCB) and anticoagulation if CHA₂DS₂-VASc score
indicates risk. Adenosine is for regular narrow-complex tachycardias (e.g., SVT).
9. An HIV-positive patient with a CD4 count of 120 cells/µL is Toxoplasma IgG
positive. What is the recommended prophylaxis?
A. TMP-SMX
B. Pyrimethamine
C. Repeat CD4 count
D. Observation
Answer: A
Rationale: For HIV patients with CD4 < 100 cells/µL and positive Toxoplasma IgG,
primary prophylaxis with TMP-SMX is indicated to prevent toxoplasmic encephalitis.
