COMSAE PHASE 2 – FORM 109 PRACTICE EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2025/2026 Q&A | INSTANT DOWNLOAD PDF
– QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
• Internal Medicine
• Pediatrics
• Obstetrics and Gynecology
• Surgery and Surgical Subspecialties
• Psychiatry and Behavioral Health
• Emergency Medicine and Acute Care
• Preventive Medicine and Public Health
• Medical Ethics and Jurisprudence
• Pharmacology and Therapeutics
• Biostatistics and Clinical Epidemiology
Introduction
This comprehensive examination is designed to assess the clinical knowledge, diagnostic acumen, and
decision-making skills expected of a second-year medical student preparing for the COMSAE Phase 2.
The assessment covers a broad spectrum of core medical disciplines, integrating foundational theory
with applied clinical practice. Questions are presented in a multiple-choice format, incorporating both
direct knowledge-based inquiries and complex scenario-based problems that mirror real-world
patient encounters. Emphasis is placed on the application of evidence-based medicine, interpretation
of clinical data, understanding of regulatory and legal frameworks, and the demonstration of
professional and ethical standards. Successful completion of this exam indicates readiness for the
clinical clerkship environment and the ability to synthesize information to provide safe, effective
patient care.
SECTION ONE: QUESTIONS 1 – 100
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes mellitus presents to the
emergency department with sudden onset of severe, tearing chest pain that radiates to his back.
His blood pressure is 180/110 mmHg in the right arm and 150/90 mmHg in the left arm. Which of
the following is the most appropriate initial imaging study to confirm the suspected diagnosis?
A. Transthoracic echocardiogram
B. Computed tomography angiography of the chest
C. Magnetic resonance imaging of the chest
D. Standard chest radiograph
🟢 B. Computed tomography angiography of the chest
🔴 Explanation: The presentation of sudden, severe tearing chest pain radiating to the back with a
blood pressure differential between arms is classic for an acute aortic dissection. Computed
tomography angiography (CTA) of the chest is the initial imaging modality of choice due to its high
,sensitivity and specificity, rapid acquisition, and widespread availability. It accurately delineates the
extent of the dissection and involvement of branch vessels, which is crucial for surgical planning.
Question 2
A 45-year-old female with a history of systemic lupus erythematosus presents with progressive
shortness of breath and a non-productive cough over the past two months. A chest radiograph
shows bilateral interstitial infiltrates. Pulmonary function tests reveal a restrictive pattern with a
reduced diffusion capacity for carbon monoxide (DLCO). Which of the following is the most likely
underlying pulmonary pathology?
A. Pulmonary embolism
B. Diffuse alveolar hemorrhage
C. Interstitial lung disease
D. Pulmonary hypertension
🟢 C. Interstitial lung disease
🔴 Explanation: Systemic lupus erythematosus can affect the lungs in various ways, but the
combination of progressive dyspnea, a non-productive cough, bilateral interstitial infiltrates on
chest radiograph, and a restrictive pattern with reduced DLCO on pulmonary function tests is most
consistent with interstitial lung disease (ILD). ILD is a known pulmonary manifestation of SLE,
characterized by inflammation and fibrosis of the lung interstitium.
Question 3
A 32-year-old male is brought to the emergency department after being found unresponsive at
home. His friends report he was using heroin earlier in the evening. On examination, he has a
respiratory rate of 4 breaths per minute and pinpoint pupils. Which of the following is the most
appropriate immediate pharmacological intervention?
A. Naloxone
B. Flumazenil
C. Activated charcoal
D. N-acetylcysteine
🟢 A. Naloxone
🔴 Explanation: The patient's presentation of unresponsiveness, severe respiratory depression, and
pinpoint pupils following heroin use is indicative of an opioid overdose. Naloxone is a specific
opioid antagonist that rapidly reverses these effects and is the first-line treatment. It should be
administered immediately to restore adequate ventilation.
Question 4
A 60-year-old female with a 30-pack-year smoking history presents with a hoarse voice that has
been progressive over the last three months. She denies any cold or flu symptoms. Laryngoscopy
reveals a lesion on the left vocal cord. A biopsy is performed. Which of the following cell types is
most commonly associated with the likely diagnosis?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Small cell carcinoma
D. Large cell carcinoma
,🟢 A. Squamous cell carcinoma
🔴 Explanation: The patient's risk factors (smoking history) and presentation with progressive
hoarseness point to laryngeal cancer. The most common histological type of laryngeal cancer is
squamous cell carcinoma, which typically arises from the squamous epithelial lining of the vocal
cords.
Question 5
A 55-year-old male with a history of chronic alcohol abuse presents with confusion, ataxia, and
ophthalmoplegia. Which of the following vitamin deficiencies is most likely responsible for his
symptoms?
A. Vitamin B12
B. Vitamin B1 (Thiamine)
C. Vitamin B6 (Pyridoxine)
D. Vitamin C
🟢 B. Vitamin B1 (Thiamine)
🔴 Explanation: The classic triad of confusion, ataxia, and ophthalmoplegia in a patient with chronic
alcohol abuse is Wernicke's encephalopathy, caused by a severe deficiency of thiamine (Vitamin
B1). Thiamine is an essential cofactor for several enzymes involved in glucose metabolism, and its
deficiency leads to neuronal damage in specific brain regions.
Question 6
A 72-year-old male with a history of benign prostatic hyperplasia presents with acute urinary
retention. A post-void residual volume of 600 mL is measured. Which of the following is the most
appropriate initial management step?
A. Place an indwelling Foley catheter
B. Prescribe an alpha-blocker
C. Schedule a transurethral resection of the prostate (TURP)
D. Perform a suprapubic cystostomy
🟢 A. Place an indwelling Foley catheter
🔴 Explanation: Acute urinary retention with a large post-void residual requires immediate bladder
decompression. The initial step is to place an indwelling Foley catheter to relieve the obstruction
and prevent complications like hydronephrosis or renal failure. Alpha-blockers can be used later to
help with voiding, but they are not the immediate management for acute retention.
Question 7
A 28-year-old female presents with a sudden onset of sharp, stabbing chest pain that worsens with
inspiration. She is breathing rapidly. On auscultation, breath sounds are diminished on the left side,
and there is hyper-resonance to percussion. Which of the following is the most likely diagnosis?
A. Acute pericarditis
B. Spontaneous pneumothorax
C. Pulmonary embolism
D. Myocardial infarction
🟢 B. Spontaneous pneumothorax
, 🔴 Explanation: The acute onset of unilateral sharp chest pain that is pleuritic (worsens with
inspiration), combined with diminished breath sounds and hyper-resonance on the affected side, is
classic for a spontaneous pneumothorax. This occurs when air enters the pleural space, collapsing
the lung.
Question 8
A 50-year-old female is prescribed a new medication for her hypertension. She is also taking
warfarin for atrial fibrillation. Which of the following classes of antihypertensives would most
significantly increase the risk of bleeding in this patient?
A. ACE inhibitors
B. Calcium channel blockers
C. Beta-blockers
D. Thiazide diuretics
🟢 B. Calcium channel blockers
🔴 Explanation: Certain calcium channel blockers, particularly diltiazem and verapamil, can inhibit
the metabolism of warfarin, leading to increased international normalized ratio (INR) and a
significantly elevated risk of bleeding. While other classes may have some effects, the interaction
with calcium channel blockers is a well-established and clinically significant drug-drug interaction.
Question 9
A 6-year-old boy is brought to the clinic by his mother due to a fever, sore throat, and a fine,
erythematous, sandpaper-like rash on his trunk. His tongue appears strawberry-red. Which of the
following is the most likely causative organism?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Streptococcus pneumoniae
D. Haemophilus influenzae
🟢 A. Streptococcus pyogenes
🔴 Explanation: The combination of fever, sore throat, and a sandpaper-like rash followed by a
strawberry-red tongue is the classic presentation of scarlet fever, which is caused by an exotoxin
produced by group A Streptococcus pyogenes. This is a complication of pharyngitis.
Question 10
A 34-year-old male with a history of Crohn's disease presents with a painful, erythematous nodule
on his shin. He also reports a new onset of arthralgias. Which of the following dermatologic
findings is most consistent with this presentation?
A. Erythema nodosum
B. Pyoderma gangrenosum
C. Erythema multiforme
D. Stevens-Johnson syndrome
🟢 A. Erythema nodosum
🔴 Explanation: Erythema nodosum is the most common cutaneous manifestation of inflammatory
bowel disease, particularly Crohn's disease. It typically presents as tender, erythematous nodules on
(VERIFIED ANSWERS) PLUS RATIONALES 2025/2026 Q&A | INSTANT DOWNLOAD PDF
– QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
• Internal Medicine
• Pediatrics
• Obstetrics and Gynecology
• Surgery and Surgical Subspecialties
• Psychiatry and Behavioral Health
• Emergency Medicine and Acute Care
• Preventive Medicine and Public Health
• Medical Ethics and Jurisprudence
• Pharmacology and Therapeutics
• Biostatistics and Clinical Epidemiology
Introduction
This comprehensive examination is designed to assess the clinical knowledge, diagnostic acumen, and
decision-making skills expected of a second-year medical student preparing for the COMSAE Phase 2.
The assessment covers a broad spectrum of core medical disciplines, integrating foundational theory
with applied clinical practice. Questions are presented in a multiple-choice format, incorporating both
direct knowledge-based inquiries and complex scenario-based problems that mirror real-world
patient encounters. Emphasis is placed on the application of evidence-based medicine, interpretation
of clinical data, understanding of regulatory and legal frameworks, and the demonstration of
professional and ethical standards. Successful completion of this exam indicates readiness for the
clinical clerkship environment and the ability to synthesize information to provide safe, effective
patient care.
SECTION ONE: QUESTIONS 1 – 100
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes mellitus presents to the
emergency department with sudden onset of severe, tearing chest pain that radiates to his back.
His blood pressure is 180/110 mmHg in the right arm and 150/90 mmHg in the left arm. Which of
the following is the most appropriate initial imaging study to confirm the suspected diagnosis?
A. Transthoracic echocardiogram
B. Computed tomography angiography of the chest
C. Magnetic resonance imaging of the chest
D. Standard chest radiograph
🟢 B. Computed tomography angiography of the chest
🔴 Explanation: The presentation of sudden, severe tearing chest pain radiating to the back with a
blood pressure differential between arms is classic for an acute aortic dissection. Computed
tomography angiography (CTA) of the chest is the initial imaging modality of choice due to its high
,sensitivity and specificity, rapid acquisition, and widespread availability. It accurately delineates the
extent of the dissection and involvement of branch vessels, which is crucial for surgical planning.
Question 2
A 45-year-old female with a history of systemic lupus erythematosus presents with progressive
shortness of breath and a non-productive cough over the past two months. A chest radiograph
shows bilateral interstitial infiltrates. Pulmonary function tests reveal a restrictive pattern with a
reduced diffusion capacity for carbon monoxide (DLCO). Which of the following is the most likely
underlying pulmonary pathology?
A. Pulmonary embolism
B. Diffuse alveolar hemorrhage
C. Interstitial lung disease
D. Pulmonary hypertension
🟢 C. Interstitial lung disease
🔴 Explanation: Systemic lupus erythematosus can affect the lungs in various ways, but the
combination of progressive dyspnea, a non-productive cough, bilateral interstitial infiltrates on
chest radiograph, and a restrictive pattern with reduced DLCO on pulmonary function tests is most
consistent with interstitial lung disease (ILD). ILD is a known pulmonary manifestation of SLE,
characterized by inflammation and fibrosis of the lung interstitium.
Question 3
A 32-year-old male is brought to the emergency department after being found unresponsive at
home. His friends report he was using heroin earlier in the evening. On examination, he has a
respiratory rate of 4 breaths per minute and pinpoint pupils. Which of the following is the most
appropriate immediate pharmacological intervention?
A. Naloxone
B. Flumazenil
C. Activated charcoal
D. N-acetylcysteine
🟢 A. Naloxone
🔴 Explanation: The patient's presentation of unresponsiveness, severe respiratory depression, and
pinpoint pupils following heroin use is indicative of an opioid overdose. Naloxone is a specific
opioid antagonist that rapidly reverses these effects and is the first-line treatment. It should be
administered immediately to restore adequate ventilation.
Question 4
A 60-year-old female with a 30-pack-year smoking history presents with a hoarse voice that has
been progressive over the last three months. She denies any cold or flu symptoms. Laryngoscopy
reveals a lesion on the left vocal cord. A biopsy is performed. Which of the following cell types is
most commonly associated with the likely diagnosis?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Small cell carcinoma
D. Large cell carcinoma
,🟢 A. Squamous cell carcinoma
🔴 Explanation: The patient's risk factors (smoking history) and presentation with progressive
hoarseness point to laryngeal cancer. The most common histological type of laryngeal cancer is
squamous cell carcinoma, which typically arises from the squamous epithelial lining of the vocal
cords.
Question 5
A 55-year-old male with a history of chronic alcohol abuse presents with confusion, ataxia, and
ophthalmoplegia. Which of the following vitamin deficiencies is most likely responsible for his
symptoms?
A. Vitamin B12
B. Vitamin B1 (Thiamine)
C. Vitamin B6 (Pyridoxine)
D. Vitamin C
🟢 B. Vitamin B1 (Thiamine)
🔴 Explanation: The classic triad of confusion, ataxia, and ophthalmoplegia in a patient with chronic
alcohol abuse is Wernicke's encephalopathy, caused by a severe deficiency of thiamine (Vitamin
B1). Thiamine is an essential cofactor for several enzymes involved in glucose metabolism, and its
deficiency leads to neuronal damage in specific brain regions.
Question 6
A 72-year-old male with a history of benign prostatic hyperplasia presents with acute urinary
retention. A post-void residual volume of 600 mL is measured. Which of the following is the most
appropriate initial management step?
A. Place an indwelling Foley catheter
B. Prescribe an alpha-blocker
C. Schedule a transurethral resection of the prostate (TURP)
D. Perform a suprapubic cystostomy
🟢 A. Place an indwelling Foley catheter
🔴 Explanation: Acute urinary retention with a large post-void residual requires immediate bladder
decompression. The initial step is to place an indwelling Foley catheter to relieve the obstruction
and prevent complications like hydronephrosis or renal failure. Alpha-blockers can be used later to
help with voiding, but they are not the immediate management for acute retention.
Question 7
A 28-year-old female presents with a sudden onset of sharp, stabbing chest pain that worsens with
inspiration. She is breathing rapidly. On auscultation, breath sounds are diminished on the left side,
and there is hyper-resonance to percussion. Which of the following is the most likely diagnosis?
A. Acute pericarditis
B. Spontaneous pneumothorax
C. Pulmonary embolism
D. Myocardial infarction
🟢 B. Spontaneous pneumothorax
, 🔴 Explanation: The acute onset of unilateral sharp chest pain that is pleuritic (worsens with
inspiration), combined with diminished breath sounds and hyper-resonance on the affected side, is
classic for a spontaneous pneumothorax. This occurs when air enters the pleural space, collapsing
the lung.
Question 8
A 50-year-old female is prescribed a new medication for her hypertension. She is also taking
warfarin for atrial fibrillation. Which of the following classes of antihypertensives would most
significantly increase the risk of bleeding in this patient?
A. ACE inhibitors
B. Calcium channel blockers
C. Beta-blockers
D. Thiazide diuretics
🟢 B. Calcium channel blockers
🔴 Explanation: Certain calcium channel blockers, particularly diltiazem and verapamil, can inhibit
the metabolism of warfarin, leading to increased international normalized ratio (INR) and a
significantly elevated risk of bleeding. While other classes may have some effects, the interaction
with calcium channel blockers is a well-established and clinically significant drug-drug interaction.
Question 9
A 6-year-old boy is brought to the clinic by his mother due to a fever, sore throat, and a fine,
erythematous, sandpaper-like rash on his trunk. His tongue appears strawberry-red. Which of the
following is the most likely causative organism?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Streptococcus pneumoniae
D. Haemophilus influenzae
🟢 A. Streptococcus pyogenes
🔴 Explanation: The combination of fever, sore throat, and a sandpaper-like rash followed by a
strawberry-red tongue is the classic presentation of scarlet fever, which is caused by an exotoxin
produced by group A Streptococcus pyogenes. This is a complication of pharyngitis.
Question 10
A 34-year-old male with a history of Crohn's disease presents with a painful, erythematous nodule
on his shin. He also reports a new onset of arthralgias. Which of the following dermatologic
findings is most consistent with this presentation?
A. Erythema nodosum
B. Pyoderma gangrenosum
C. Erythema multiforme
D. Stevens-Johnson syndrome
🟢 A. Erythema nodosum
🔴 Explanation: Erythema nodosum is the most common cutaneous manifestation of inflammatory
bowel disease, particularly Crohn's disease. It typically presents as tender, erythematous nodules on
