COMSAE Phase 1 / COMLEX Level 1
Complete Exam Review | Master Study Guide
& Comprehensive Practice Question Bank |
Latest Update 2026
Question 1
A 58-year-old man presents with substernal chest pressure radiating to the left arm that
began 2 hours ago. ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Right coronary artery
B. Posterior descending artery (from LAD)
C. Left main coronary artery
D. Left anterior descending artery
E. Left circumflex artery
Answer: A
Rationale: ST elevation in the inferior leads (II, III, aVF) localizes the infarct to the
inferior wall, which is supplied by the right coronary artery in the majority of patients
(right-dominant circulation).
Question 2
A patient's ECG shows a sawtooth pattern of atrial activity at approximately 300 bpm
with a ventricular rate of 150 bpm. What is the most likely arrhythmia?
A. Ventricular tachycardia
B. Atrial flutter
C. Wolff-Parkinson-White syndrome
D. Multifocal atrial tachycardia
E. Atrial fibrillation
Answer: B
Rationale: Atrial flutter classically produces a "sawtooth" or "picket fence" pattern of
atrial activity (flutter waves) at ~300 bpm with a variable ventricular response, often 2:1
conduction producing a ventricular rate of ~150 bpm.
pg. 1
,Question 3
A 65-year-old woman with a history of hypertension develops progressive dyspnea on
exertion. Echocardiogram shows a thickened, poorly compliant left ventricle with
preserved ejection fraction. Which type of heart failure does this represent?
A. Right-sided heart failure
B. High-output heart failure
C. Cor pulmonale
D. Diastolic heart failure (HFpEF)
E. Systolic heart failure
Answer: D
Rationale: Preserved ejection fraction with impaired ventricular relaxation/filling due
to chronic hypertension-induced hypertrophy is the hallmark of diastolic heart failure
(HFpEF).
Question 4
Which crystal arthropathy shows positively birefringent, rhomboid-shaped crystals and
is associated with chondrocalcinosis on X-ray?
A. Septic arthritis
B. Osteoarthritis
C. Hydroxyapatite deposition disease
D. Gout
E. Calcium pyrophosphate deposition disease (pseudogout)
Answer: E
Rationale: Pseudogout is caused by calcium pyrophosphate dihydrate crystals, which
are rhomboid-shaped and positively birefringent, often visualized as chondrocalcinosis
on imaging.
Question 5
A patient presents with fever, productive cough, and chest X-ray showing consolidation
confined to a single lobe. Sputum Gram stain shows gram-positive diplococci. What is
the most likely causative organism?
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae
C. Klebsiella pneumoniae
D. Legionella pneumophila
E. Mycoplasma pneumoniae
pg. 2
,Answer: B
Rationale: Streptococcus pneumoniae is the most common cause of community-
acquired lobar pneumonia and classically appears as gram-positive, lancet-shaped
diplococci on Gram stain.
Question 6
A patient has recurrent, intrusive, unwanted thoughts causing anxiety, relieved
temporarily by repetitive behaviors such as handwashing. Diagnosis?
A. Body dysmorphic disorder
B. Specific phobia
C. Obsessive-compulsive disorder
D. Generalized anxiety disorder
E. Illness anxiety disorder
Answer: C
Rationale: OCD is characterized by obsessions (intrusive, distressing thoughts) and
compulsions (repetitive behaviors performed to reduce the anxiety from obsessions).
Question 7
A patient with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is responsible, and what condition may
develop if untreated?
A. Thiamine (B1) deficiency; Wernicke encephalopathy progressing to Korsakoff
syndrome
B. Folate deficiency; neural tube defects
C. Vitamin B6 deficiency; peripheral neuropathy
D. Niacin deficiency; pellagra
E. Vitamin B12 deficiency; subacute combined degeneration
Answer: A
Rationale: Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia) results
from thiamine deficiency, often in alcoholics; if untreated, it can progress to irreversible
Korsakoff syndrome with anterograde amnesia and confabulation.
Question 8
A newborn is found to be cyanotic immediately after birth. Echocardiography reveals
the aorta arising from the right ventricle and the pulmonary artery arising from the left
pg. 3
, ventricle. Which additional finding is necessary for postnatal survival?
A. Closure of the ductus arteriosus
B. Bicuspid aortic valve
C. A shunt allowing mixing of blood (e.g., PDA, ASD, or VSD)
D. Pulmonary valve stenosis
E. Ventricular septal defect closure
Answer: C
Rationale: Transposition of the great arteries creates two parallel circulations; survival
requires a mixing shunt (PDA, PFO/ASD, or VSD) to allow oxygenated blood to reach
the systemic circulation.
Question 9
A patient with a history of recurrent calcium oxalate kidney stones is found to have
hypercalciuria. Which class of medication is commonly used to reduce urinary calcium
excretion in this setting?
A. Alpha-blockers (e.g., tamsulosin)
B. Thiazide diuretics
C. ACE inhibitors
D. NSAIDs
E. Loop diuretics (e.g., furosemide)
Answer: B
Rationale: Thiazide diuretics reduce urinary calcium excretion by increasing distal
tubule calcium reabsorption, making them first-line medication for hypercalciuria-
related calcium oxalate stone prevention.
Question 10
A patient has a positive standing flexion test on the right, indicating restriction on which
side, and which structure does this test primarily assess?
A. Right innominate (iliosacral) dysfunction; assesses innominate motion relative to the
sacrum
B. Lumbar disc herniation; assesses neurologic function
C. Thoracic rib dysfunction; assesses rib cage motion
D. Cervical dysfunction; assesses atlanto-occipital motion
E. Left sacral dysfunction only; assesses sacral motion alone
Answer: A
pg. 4
Complete Exam Review | Master Study Guide
& Comprehensive Practice Question Bank |
Latest Update 2026
Question 1
A 58-year-old man presents with substernal chest pressure radiating to the left arm that
began 2 hours ago. ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Right coronary artery
B. Posterior descending artery (from LAD)
C. Left main coronary artery
D. Left anterior descending artery
E. Left circumflex artery
Answer: A
Rationale: ST elevation in the inferior leads (II, III, aVF) localizes the infarct to the
inferior wall, which is supplied by the right coronary artery in the majority of patients
(right-dominant circulation).
Question 2
A patient's ECG shows a sawtooth pattern of atrial activity at approximately 300 bpm
with a ventricular rate of 150 bpm. What is the most likely arrhythmia?
A. Ventricular tachycardia
B. Atrial flutter
C. Wolff-Parkinson-White syndrome
D. Multifocal atrial tachycardia
E. Atrial fibrillation
Answer: B
Rationale: Atrial flutter classically produces a "sawtooth" or "picket fence" pattern of
atrial activity (flutter waves) at ~300 bpm with a variable ventricular response, often 2:1
conduction producing a ventricular rate of ~150 bpm.
pg. 1
,Question 3
A 65-year-old woman with a history of hypertension develops progressive dyspnea on
exertion. Echocardiogram shows a thickened, poorly compliant left ventricle with
preserved ejection fraction. Which type of heart failure does this represent?
A. Right-sided heart failure
B. High-output heart failure
C. Cor pulmonale
D. Diastolic heart failure (HFpEF)
E. Systolic heart failure
Answer: D
Rationale: Preserved ejection fraction with impaired ventricular relaxation/filling due
to chronic hypertension-induced hypertrophy is the hallmark of diastolic heart failure
(HFpEF).
Question 4
Which crystal arthropathy shows positively birefringent, rhomboid-shaped crystals and
is associated with chondrocalcinosis on X-ray?
A. Septic arthritis
B. Osteoarthritis
C. Hydroxyapatite deposition disease
D. Gout
E. Calcium pyrophosphate deposition disease (pseudogout)
Answer: E
Rationale: Pseudogout is caused by calcium pyrophosphate dihydrate crystals, which
are rhomboid-shaped and positively birefringent, often visualized as chondrocalcinosis
on imaging.
Question 5
A patient presents with fever, productive cough, and chest X-ray showing consolidation
confined to a single lobe. Sputum Gram stain shows gram-positive diplococci. What is
the most likely causative organism?
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae
C. Klebsiella pneumoniae
D. Legionella pneumophila
E. Mycoplasma pneumoniae
pg. 2
,Answer: B
Rationale: Streptococcus pneumoniae is the most common cause of community-
acquired lobar pneumonia and classically appears as gram-positive, lancet-shaped
diplococci on Gram stain.
Question 6
A patient has recurrent, intrusive, unwanted thoughts causing anxiety, relieved
temporarily by repetitive behaviors such as handwashing. Diagnosis?
A. Body dysmorphic disorder
B. Specific phobia
C. Obsessive-compulsive disorder
D. Generalized anxiety disorder
E. Illness anxiety disorder
Answer: C
Rationale: OCD is characterized by obsessions (intrusive, distressing thoughts) and
compulsions (repetitive behaviors performed to reduce the anxiety from obsessions).
Question 7
A patient with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is responsible, and what condition may
develop if untreated?
A. Thiamine (B1) deficiency; Wernicke encephalopathy progressing to Korsakoff
syndrome
B. Folate deficiency; neural tube defects
C. Vitamin B6 deficiency; peripheral neuropathy
D. Niacin deficiency; pellagra
E. Vitamin B12 deficiency; subacute combined degeneration
Answer: A
Rationale: Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia) results
from thiamine deficiency, often in alcoholics; if untreated, it can progress to irreversible
Korsakoff syndrome with anterograde amnesia and confabulation.
Question 8
A newborn is found to be cyanotic immediately after birth. Echocardiography reveals
the aorta arising from the right ventricle and the pulmonary artery arising from the left
pg. 3
, ventricle. Which additional finding is necessary for postnatal survival?
A. Closure of the ductus arteriosus
B. Bicuspid aortic valve
C. A shunt allowing mixing of blood (e.g., PDA, ASD, or VSD)
D. Pulmonary valve stenosis
E. Ventricular septal defect closure
Answer: C
Rationale: Transposition of the great arteries creates two parallel circulations; survival
requires a mixing shunt (PDA, PFO/ASD, or VSD) to allow oxygenated blood to reach
the systemic circulation.
Question 9
A patient with a history of recurrent calcium oxalate kidney stones is found to have
hypercalciuria. Which class of medication is commonly used to reduce urinary calcium
excretion in this setting?
A. Alpha-blockers (e.g., tamsulosin)
B. Thiazide diuretics
C. ACE inhibitors
D. NSAIDs
E. Loop diuretics (e.g., furosemide)
Answer: B
Rationale: Thiazide diuretics reduce urinary calcium excretion by increasing distal
tubule calcium reabsorption, making them first-line medication for hypercalciuria-
related calcium oxalate stone prevention.
Question 10
A patient has a positive standing flexion test on the right, indicating restriction on which
side, and which structure does this test primarily assess?
A. Right innominate (iliosacral) dysfunction; assesses innominate motion relative to the
sacrum
B. Lumbar disc herniation; assesses neurologic function
C. Thoracic rib dysfunction; assesses rib cage motion
D. Cervical dysfunction; assesses atlanto-occipital motion
E. Left sacral dysfunction only; assesses sacral motion alone
Answer: A
pg. 4
