COMSAE 107 EXAM – EXAM-STYLE QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | 2026/27
LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A 52-year-old male with a 30-pack-year smoking history presents for a
routine physical. He reports no current symptoms. His blood pressure is 138/88
mmHg. A chest radiograph shows a 1.2 cm solitary pulmonary nodule in the
right upper lobe with slightly spiculated margins. What is the most appropriate
next step in the management of this patient?
A. Repeat chest radiograph in 6 months
B. Administer a course of oral antibiotics
C. Obtain a contrast-enhanced CT scan of the chest
D. Refer for immediate surgical resection
Correct Answer: C. Obtain a contrast-enhanced CT scan of the chest
Rationale: A solitary pulmonary nodule with spiculated margins in a patient with a
significant smoking history is suspicious for malignancy. The next appropriate step
is a detailed evaluation with a contrast-enhanced CT scan to better characterize the
nodule and assess for mediastinal lymphadenopathy, which guides further
management. Repeating a radiograph is insufficient and delays diagnosis.
Antibiotics are not indicated without evidence of infection. Surgical resection is
premature without further characterization and staging.
2. In the context of cardiovascular physiology, which of the following best
describes the primary mechanism by which the baroreceptor reflex responds to
an acute increase in systemic blood pressure?
,A. Increased sympathetic outflow to the heart and peripheral vasculature
B. Decreased parasympathetic activity leading to increased heart rate
C. Increased vagal tone and decreased sympathetic outflow
D. Direct relaxation of arteriolar smooth muscle via nitric oxide release
Correct Answer: C. Increased vagal tone and decreased sympathetic outflow
Rationale: The baroreceptor reflex is a negative feedback loop. An increase in blood
pressure stretches the carotid and aortic baroreceptors, increasing their firing rate.
This triggers a central response that increases parasympathetic (vagal) outflow to
the heart, decreasing heart rate, and decreases sympathetic outflow to the heart
and vasculature, reducing contractility and causing vasodilation. This leads to a
decrease in blood pressure. Option A describes the response to hypotension, not
hypertension. Option B is incorrect as parasympathetic activity increases. Option D
describes a direct vascular effect, not the primary reflex mechanism.
3. A 34-year-old female presents with a 3-week history of progressive fatigue,
exertional dyspnea, and a non-productive cough. She has no significant past
medical history. On examination, her jugular venous pressure is elevated, and
she has a loud S3 gallop. An echocardiogram reveals a left ventricular ejection
fraction of 25%. Which of the following is the most appropriate initial
pharmacologic therapy to reduce mortality in this patient?
A. Digoxin
B. Metoprolol succinate
C. Verapamil
D. Furosemide
Correct Answer: B. Metoprolol succinate
,Rationale: The patient presents with systolic heart failure (HFrEF). Beta-blockers,
specifically the controlled-release form of metoprolol (succinate), bisoprolol, and
carvedilol, are a cornerstone of therapy that have been shown to significantly
reduce mortality and morbidity in patients with HFrEF. Digoxin is used for symptom
control and rate control in atrial fibrillation but has no mortality benefit. Verapamil
is a calcium channel blocker that is generally avoided in HFrEF due to negative
inotropic effects. Furosemide is used for symptom management of fluid overload
but does not reduce mortality.
4. A 68-year-old male with a history of hypertension and type 2 diabetes
mellitus presents with sudden onset of severe, tearing chest pain that radiates
to his back. His blood pressure is 190/110 mmHg in the right arm and 130/80
mmHg in the left arm. Which of the following is the most likely diagnosis and
what is the single most critical immediate step in management?
A. Myocardial infarction; administer aspirin and nitroglycerin
B. Pulmonary embolism; obtain a CT pulmonary angiogram
C. Aortic dissection; initiate urgent blood pressure control
D. Acute pancreatitis; obtain serum lipase and amylase
Correct Answer: C. Aortic dissection; initiate urgent blood pressure control
Rationale: The classic presentation of sudden, severe, tearing chest pain radiating to
the back, combined with a significant blood pressure differential between arms, is
highly suggestive of an acute aortic dissection. The most critical immediate step is
to reduce the force of cardiac contraction (dP/dt) and blood pressure to prevent
propagation of the dissection. This is typically achieved with agents like beta-
blockers (e.g., esmolol, labetalol) followed by other antihypertensives. The other
, options represent other differentials but do not address the immediate life-
threatening pathophysiology or correct management of an aortic dissection.
5. According to the Centers for Disease Control and Prevention (CDC)
guidelines, which of the following is the recommended first-line treatment for
uncomplicated, community-acquired pneumonia in a previously healthy,
immunocompetent adult without significant comorbidities?
A. Azithromycin
B. Doxycycline
C. Levofloxacin
D. Amoxicillin
Correct Answer: D. Amoxicillin
Rationale: For an outpatient adult with no comorbidities or risk factors for drug-
resistant pathogens, the latest guidelines recommend amoxicillin as the first-line
agent. While macrolides (azithromycin) and doxycycline are alternatives,
amoxicillin is preferred due to its targeted coverage of Streptococcus pneumoniae,
its efficacy, and its role in antibiotic stewardship. Levofloxacin is a fluoroquinolone
and is reserved for patients with allergies, comorbidities, or treatment failure to
minimize resistance and side effects.
6. A patient with a known diagnosis of chronic obstructive pulmonary disease
(COPD) presents with a two-day history of increased sputum purulence and
volume. His oxygen saturation is 88% on room air. An arterial blood gas reveals
a pH of 7.32, PaCO2 of 60 mmHg, and PaO2 of 55 mmHg. Which of the
following best describes the acid-base status of this patient?
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | 2026/27
LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A 52-year-old male with a 30-pack-year smoking history presents for a
routine physical. He reports no current symptoms. His blood pressure is 138/88
mmHg. A chest radiograph shows a 1.2 cm solitary pulmonary nodule in the
right upper lobe with slightly spiculated margins. What is the most appropriate
next step in the management of this patient?
A. Repeat chest radiograph in 6 months
B. Administer a course of oral antibiotics
C. Obtain a contrast-enhanced CT scan of the chest
D. Refer for immediate surgical resection
Correct Answer: C. Obtain a contrast-enhanced CT scan of the chest
Rationale: A solitary pulmonary nodule with spiculated margins in a patient with a
significant smoking history is suspicious for malignancy. The next appropriate step
is a detailed evaluation with a contrast-enhanced CT scan to better characterize the
nodule and assess for mediastinal lymphadenopathy, which guides further
management. Repeating a radiograph is insufficient and delays diagnosis.
Antibiotics are not indicated without evidence of infection. Surgical resection is
premature without further characterization and staging.
2. In the context of cardiovascular physiology, which of the following best
describes the primary mechanism by which the baroreceptor reflex responds to
an acute increase in systemic blood pressure?
,A. Increased sympathetic outflow to the heart and peripheral vasculature
B. Decreased parasympathetic activity leading to increased heart rate
C. Increased vagal tone and decreased sympathetic outflow
D. Direct relaxation of arteriolar smooth muscle via nitric oxide release
Correct Answer: C. Increased vagal tone and decreased sympathetic outflow
Rationale: The baroreceptor reflex is a negative feedback loop. An increase in blood
pressure stretches the carotid and aortic baroreceptors, increasing their firing rate.
This triggers a central response that increases parasympathetic (vagal) outflow to
the heart, decreasing heart rate, and decreases sympathetic outflow to the heart
and vasculature, reducing contractility and causing vasodilation. This leads to a
decrease in blood pressure. Option A describes the response to hypotension, not
hypertension. Option B is incorrect as parasympathetic activity increases. Option D
describes a direct vascular effect, not the primary reflex mechanism.
3. A 34-year-old female presents with a 3-week history of progressive fatigue,
exertional dyspnea, and a non-productive cough. She has no significant past
medical history. On examination, her jugular venous pressure is elevated, and
she has a loud S3 gallop. An echocardiogram reveals a left ventricular ejection
fraction of 25%. Which of the following is the most appropriate initial
pharmacologic therapy to reduce mortality in this patient?
A. Digoxin
B. Metoprolol succinate
C. Verapamil
D. Furosemide
Correct Answer: B. Metoprolol succinate
,Rationale: The patient presents with systolic heart failure (HFrEF). Beta-blockers,
specifically the controlled-release form of metoprolol (succinate), bisoprolol, and
carvedilol, are a cornerstone of therapy that have been shown to significantly
reduce mortality and morbidity in patients with HFrEF. Digoxin is used for symptom
control and rate control in atrial fibrillation but has no mortality benefit. Verapamil
is a calcium channel blocker that is generally avoided in HFrEF due to negative
inotropic effects. Furosemide is used for symptom management of fluid overload
but does not reduce mortality.
4. A 68-year-old male with a history of hypertension and type 2 diabetes
mellitus presents with sudden onset of severe, tearing chest pain that radiates
to his back. His blood pressure is 190/110 mmHg in the right arm and 130/80
mmHg in the left arm. Which of the following is the most likely diagnosis and
what is the single most critical immediate step in management?
A. Myocardial infarction; administer aspirin and nitroglycerin
B. Pulmonary embolism; obtain a CT pulmonary angiogram
C. Aortic dissection; initiate urgent blood pressure control
D. Acute pancreatitis; obtain serum lipase and amylase
Correct Answer: C. Aortic dissection; initiate urgent blood pressure control
Rationale: The classic presentation of sudden, severe, tearing chest pain radiating to
the back, combined with a significant blood pressure differential between arms, is
highly suggestive of an acute aortic dissection. The most critical immediate step is
to reduce the force of cardiac contraction (dP/dt) and blood pressure to prevent
propagation of the dissection. This is typically achieved with agents like beta-
blockers (e.g., esmolol, labetalol) followed by other antihypertensives. The other
, options represent other differentials but do not address the immediate life-
threatening pathophysiology or correct management of an aortic dissection.
5. According to the Centers for Disease Control and Prevention (CDC)
guidelines, which of the following is the recommended first-line treatment for
uncomplicated, community-acquired pneumonia in a previously healthy,
immunocompetent adult without significant comorbidities?
A. Azithromycin
B. Doxycycline
C. Levofloxacin
D. Amoxicillin
Correct Answer: D. Amoxicillin
Rationale: For an outpatient adult with no comorbidities or risk factors for drug-
resistant pathogens, the latest guidelines recommend amoxicillin as the first-line
agent. While macrolides (azithromycin) and doxycycline are alternatives,
amoxicillin is preferred due to its targeted coverage of Streptococcus pneumoniae,
its efficacy, and its role in antibiotic stewardship. Levofloxacin is a fluoroquinolone
and is reserved for patients with allergies, comorbidities, or treatment failure to
minimize resistance and side effects.
6. A patient with a known diagnosis of chronic obstructive pulmonary disease
(COPD) presents with a two-day history of increased sputum purulence and
volume. His oxygen saturation is 88% on room air. An arterial blood gas reveals
a pH of 7.32, PaCO2 of 60 mmHg, and PaO2 of 55 mmHg. Which of the
following best describes the acid-base status of this patient?
