COMSAE PHASE 11 EXAM
2026 Edition Questions And
Verified Answers & Rationales
1.
A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffuse,
nontender goiter and bilateral exophthalmos. Laboratory
studies show elevated free T4 and suppressed TSH. Which
mechanism best explains her thyroid dysfunction?
A. Antibodies stimulating the TSH receptor
B. Antibodies destroying thyroid follicular cells
C. Excessive iodine inhibiting thyroid hormone synthesis
D. T-cell destruction of thyroid tissue
Answer: A. Antibodies stimulating the TSH receptor
The patient has Graves disease, caused by thyroid-stimulating
immunoglobulins that activate the TSH receptor and increase
thyroid hormone production.
2.
A 67-year-old man with a history of hypertension develops
sudden right-sided weakness and expressive aphasia. Imaging
,reveals an infarction involving the lateral frontal lobe. Which
artery is most likely occluded?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Answer: B. Middle cerebral artery
The dominant hemisphere's lateral frontal cortex is supplied
by the middle cerebral artery. Infarction causes contralateral
face and upper-extremity weakness with language deficits.
3.
A 19-year-old college student presents with fever, headache,
photophobia, and neck stiffness. Cerebrospinal fluid
demonstrates neutrophilic predominance, low glucose, and
elevated protein. Which organism is most likely responsible?
A. Cryptococcus neoformans
B. Neisseria meningitidis
C. Listeria monocytogenes
D. Herpes simplex virus
Answer: B. Neisseria meningitidis
Acute bacterial meningitis in a young adult is classically
caused by N. meningitidis. The CSF profile supports bacterial
infection.
,4.
A 45-year-old woman develops proximal muscle weakness
and difficulty climbing stairs. Laboratory studies reveal
elevated creatine kinase. Muscle biopsy shows perifascicular
atrophy. Which diagnosis is most likely?
A. Polymyositis
B. Dermatomyositis
C. Inclusion body myositis
D. Myasthenia gravis
Answer: B. Dermatomyositis
Perifascicular atrophy is characteristic of dermatomyositis,
which produces proximal muscle weakness and may be
associated with characteristic cutaneous findings.
5.
A 58-year-old man with a history of chronic alcohol use
presents with confusion, ophthalmoplegia, and gait
instability. Which treatment should be administered
immediately?
A. Intravenous glucose
B. Intravenous thiamine
C. Oral folate
D. Intramuscular vitamin B12
Answer: B. Intravenous thiamine
, The triad suggests Wernicke encephalopathy due to thiamine
deficiency. Thiamine should be given before glucose to
prevent worsening neurologic injury.
6.
A 32-year-old woman presents with episodic muscle
weakness after strenuous exercise. Laboratory testing reveals
hypokalemia during attacks. Which condition is most likely?
A. Hyperkalemic periodic paralysis
B. Hypokalemic periodic paralysis
C. Myotonic dystrophy
D. Lambert-Eaton syndrome
Answer: B. Hypokalemic periodic paralysis
This disorder causes transient weakness associated with
intracellular potassium shifts, often triggered by exercise or
carbohydrate-rich meals.
7.
A 72-year-old man presents with resting tremor, bradykinesia,
rigidity, and a shuffling gait. Degeneration of which structure
is primarily responsible?
A. Caudate nucleus
B. Substantia nigra pars compacta
C. Subthalamic nucleus
D. Globus pallidus externus
2026 Edition Questions And
Verified Answers & Rationales
1.
A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffuse,
nontender goiter and bilateral exophthalmos. Laboratory
studies show elevated free T4 and suppressed TSH. Which
mechanism best explains her thyroid dysfunction?
A. Antibodies stimulating the TSH receptor
B. Antibodies destroying thyroid follicular cells
C. Excessive iodine inhibiting thyroid hormone synthesis
D. T-cell destruction of thyroid tissue
Answer: A. Antibodies stimulating the TSH receptor
The patient has Graves disease, caused by thyroid-stimulating
immunoglobulins that activate the TSH receptor and increase
thyroid hormone production.
2.
A 67-year-old man with a history of hypertension develops
sudden right-sided weakness and expressive aphasia. Imaging
,reveals an infarction involving the lateral frontal lobe. Which
artery is most likely occluded?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Answer: B. Middle cerebral artery
The dominant hemisphere's lateral frontal cortex is supplied
by the middle cerebral artery. Infarction causes contralateral
face and upper-extremity weakness with language deficits.
3.
A 19-year-old college student presents with fever, headache,
photophobia, and neck stiffness. Cerebrospinal fluid
demonstrates neutrophilic predominance, low glucose, and
elevated protein. Which organism is most likely responsible?
A. Cryptococcus neoformans
B. Neisseria meningitidis
C. Listeria monocytogenes
D. Herpes simplex virus
Answer: B. Neisseria meningitidis
Acute bacterial meningitis in a young adult is classically
caused by N. meningitidis. The CSF profile supports bacterial
infection.
,4.
A 45-year-old woman develops proximal muscle weakness
and difficulty climbing stairs. Laboratory studies reveal
elevated creatine kinase. Muscle biopsy shows perifascicular
atrophy. Which diagnosis is most likely?
A. Polymyositis
B. Dermatomyositis
C. Inclusion body myositis
D. Myasthenia gravis
Answer: B. Dermatomyositis
Perifascicular atrophy is characteristic of dermatomyositis,
which produces proximal muscle weakness and may be
associated with characteristic cutaneous findings.
5.
A 58-year-old man with a history of chronic alcohol use
presents with confusion, ophthalmoplegia, and gait
instability. Which treatment should be administered
immediately?
A. Intravenous glucose
B. Intravenous thiamine
C. Oral folate
D. Intramuscular vitamin B12
Answer: B. Intravenous thiamine
, The triad suggests Wernicke encephalopathy due to thiamine
deficiency. Thiamine should be given before glucose to
prevent worsening neurologic injury.
6.
A 32-year-old woman presents with episodic muscle
weakness after strenuous exercise. Laboratory testing reveals
hypokalemia during attacks. Which condition is most likely?
A. Hyperkalemic periodic paralysis
B. Hypokalemic periodic paralysis
C. Myotonic dystrophy
D. Lambert-Eaton syndrome
Answer: B. Hypokalemic periodic paralysis
This disorder causes transient weakness associated with
intracellular potassium shifts, often triggered by exercise or
carbohydrate-rich meals.
7.
A 72-year-old man presents with resting tremor, bradykinesia,
rigidity, and a shuffling gait. Degeneration of which structure
is primarily responsible?
A. Caudate nucleus
B. Substantia nigra pars compacta
C. Subthalamic nucleus
D. Globus pallidus externus
