COMSAE Form 107b: High-Yield Practice
Questions with Answers & Clinical
Rationales
,CARDIOLOGY
1. A 62-year-old man with hypertension presents with sudden severe chest pain radiating to the
back. BP is 180/100 mmHg in the right arm and 150/90 mmHg in the left arm. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
,Rationale: Sudden tearing chest pain radiating to the back combined with a blood pressure
differential between arms is classic for aortic dissection, often involving the ascending aorta and
affecting branch vessel flow .
2. A 67-year-old man presents with crushing substernal chest pain radiating to the left arm. ECG
shows ST-segment elevations in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
, Rationale: The inferior wall of the heart is typically supplied by the right coronary artery. ST-
segment elevation in leads II, III, and aVF indicates an inferior myocardial infarction .
3. A patient presents with chest pain relieved by nitroglycerin. Which mechanism explains this?
A. Increased preload
B. Decreased preload
C. Increased afterload
D. Increased contractility
Answer: B. Decreased preload
Rationale: Nitroglycerin dilates veins, reducing venous return and myocardial oxygen demand,
which relieves anginal chest pain.
Questions with Answers & Clinical
Rationales
,CARDIOLOGY
1. A 62-year-old man with hypertension presents with sudden severe chest pain radiating to the
back. BP is 180/100 mmHg in the right arm and 150/90 mmHg in the left arm. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
,Rationale: Sudden tearing chest pain radiating to the back combined with a blood pressure
differential between arms is classic for aortic dissection, often involving the ascending aorta and
affecting branch vessel flow .
2. A 67-year-old man presents with crushing substernal chest pain radiating to the left arm. ECG
shows ST-segment elevations in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
, Rationale: The inferior wall of the heart is typically supplied by the right coronary artery. ST-
segment elevation in leads II, III, and aVF indicates an inferior myocardial infarction .
3. A patient presents with chest pain relieved by nitroglycerin. Which mechanism explains this?
A. Increased preload
B. Decreased preload
C. Increased afterload
D. Increased contractility
Answer: B. Decreased preload
Rationale: Nitroglycerin dilates veins, reducing venous return and myocardial oxygen demand,
which relieves anginal chest pain.
