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COMSAE Phase 2 – BSA 119 Practice Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+ Brand New Version!!
1. A 72-year-old male with a 40-pack-year smoking history presents
with a three-month history of progressive hoarseness and a sensation
of a lump in his throat. Flexible laryngoscopy reveals a lesion on the
right true vocal cord. A biopsy is performed. Which of the following
histopathological findings is most characteristic of the most common
type of malignancy in this location?
A. Verrucous surface with keratin pearls
B. Sheets of small cells with scant cytoplasm and nuclear molding
C. Glandular formation with mucin production
D. Spindle-shaped cells in a storiform pattern
Answer: A. Squamous cell carcinoma is the most common malignancy of
the larynx. Histologically, it is characterized by invasive nests of
squamous epithelial cells with keratin pearl formation and intercellular
bridges. The verrucous subtype is a well-differentiated variant. Small
cell carcinoma (B) is a neuroendocrine tumor more common in the lung.
Adenocarcinoma (C) is rare in the larynx. Spindle cell sarcoma (D) is a
mesenchymal tumor.
Rationale: The patient's age, smoking history, and vocal cord location
strongly predict squamous cell carcinoma. Keratin pearls represent
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mature squamous differentiation and are a hallmark of well-
differentiated SCC.
2. A 45-year-old woman with systemic lupus erythematosus presents
with acute onset of pleuritic chest pain and shortness of breath. A CT
pulmonary angiogram is negative for pulmonary embolism but shows a
small left pleural effusion. Which of the following findings on urinalysis
would most strongly suggest that this effusion is a manifestation of
lupus serositis rather than a concurrent infection?
A. Red blood cell casts
B. White blood cell casts
C. Proteinuria greater than 3.5 grams per day
D. Positive anti-double-stranded DNA antibody titer
Answer: D. Serositis in SLE is a clinical manifestation that correlates with
disease activity, often reflected by elevated anti-dsDNA antibodies and
low complement levels. While urinary casts (A, B) suggest lupus
nephritis, they do not specifically diagnose serositis. Nephrotic-range
proteinuria (C) points to glomerular disease, not pleural inflammation.
The presence of anti-dsDNA in the setting of pleuritic pain and effusion
supports active SLE serositis.
Rationale: Pleural effusion in SLE is exudative and responds to
corticosteroids. Anti-dsDNA titers are a biomarker for disease flare,
including serositis, in the appropriate clinical context.
3. A 28-year-old male who injects heroin presents with a high fever,
chills, and a new harsh holosystolic murmur at the left lower sternal
border. Blood cultures are positive for methicillin-susceptible
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Staphylococcus aureus. Transesophageal echocardiography reveals a
1.2-cm vegetation on the tricuspid valve. Which of the following is the
most appropriate initial antibiotic regimen?
A. Vancomycin and gentamicin
B. Nafcillin and gentamicin
C. Ceftriaxone and doxycycline
D. Ampicillin-sulbactam
Answer: B. For methicillin-susceptible Staphylococcus aureus native
valve infective endocarditis, nafcillin or oxacillin is the drug of choice.
The addition of low-dose gentamicin for the first 3-5 days is
recommended for synergy in prosthetic valves or complicated cases, but
it is also commonly used initially for native valve MSSA endocarditis
until clinical response is documented. Vancomycin (A) is reserved for
MRSA. Ceftriaxone and doxycycline (C) are not first-line for MSSA.
Ampicillin-sulbactam (D) is not the standard for MSSA endocarditis.
Rationale: The tricuspid valve is the most common site for right-sided
endocarditis in injection drug users. MSSA is highly susceptible to beta-
lactam penicillins; nafcillin is preferred over vancomycin to avoid
resistance induction and improve outcomes.
4. A 6-year-old boy is brought to the clinic by his mother because of a
two-day history of a barking cough that worsens at night, inspiratory
stridor, and low-grade fever. He is fully vaccinated. On examination, he
has mild suprasternal retractions. Which of the following is the most
appropriate next step in management?
A. Nebulized racemic epinephrine and dexamethasone
B. Direct laryngoscopy and bronchoscopy
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C. Chest radiograph
D. Oral amoxicillin
Answer: A. This presentation is classic for croup
(laryngotracheobronchitis), most commonly caused by parainfluenza
virus. Mild to moderate croup with stridor at rest and retractions
warrants treatment with nebulized racemic epinephrine for rapid
symptom relief and a single dose of dexamethasone to reduce airway
inflammation. Direct laryngoscopy (B) is reserved for suspected foreign
body or bacterial tracheitis. A chest radiograph (C) is not routinely
needed for classic croup. Antibiotics (D) are not effective for viral croup.
Rationale: Dexamethasone reduces the severity and duration of
symptoms, while racemic epinephrine acts as a vasoconstrictor to
decrease mucosal edema acutely.
5. A 58-year-old female with a history of hypertension and type 2
diabetes mellitus is found to have an elevated serum creatinine of 2.1
mg/dL during a routine checkup. Her baseline creatinine was 1.0 mg/dL
one year ago. Urinalysis shows 3+ protein and no red blood cells. A
renal ultrasound reveals normal-sized kidneys without hydronephrosis.
Which of the following is the most likely diagnosis?
A. Diabetic nephropathy
B. Acute tubular necrosis
C. Hypertensive nephrosclerosis
D. Polycystic kidney disease
Answer: A. Diabetic nephropathy is a progressive microvascular
complication of diabetes characterized by gradually increasing
proteinuria and declining glomerular filtration rate. The absence of
COMSAE Phase 2 – BSA 119 Practice Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+ Brand New Version!!
1. A 72-year-old male with a 40-pack-year smoking history presents
with a three-month history of progressive hoarseness and a sensation
of a lump in his throat. Flexible laryngoscopy reveals a lesion on the
right true vocal cord. A biopsy is performed. Which of the following
histopathological findings is most characteristic of the most common
type of malignancy in this location?
A. Verrucous surface with keratin pearls
B. Sheets of small cells with scant cytoplasm and nuclear molding
C. Glandular formation with mucin production
D. Spindle-shaped cells in a storiform pattern
Answer: A. Squamous cell carcinoma is the most common malignancy of
the larynx. Histologically, it is characterized by invasive nests of
squamous epithelial cells with keratin pearl formation and intercellular
bridges. The verrucous subtype is a well-differentiated variant. Small
cell carcinoma (B) is a neuroendocrine tumor more common in the lung.
Adenocarcinoma (C) is rare in the larynx. Spindle cell sarcoma (D) is a
mesenchymal tumor.
Rationale: The patient's age, smoking history, and vocal cord location
strongly predict squamous cell carcinoma. Keratin pearls represent
,2|Page
mature squamous differentiation and are a hallmark of well-
differentiated SCC.
2. A 45-year-old woman with systemic lupus erythematosus presents
with acute onset of pleuritic chest pain and shortness of breath. A CT
pulmonary angiogram is negative for pulmonary embolism but shows a
small left pleural effusion. Which of the following findings on urinalysis
would most strongly suggest that this effusion is a manifestation of
lupus serositis rather than a concurrent infection?
A. Red blood cell casts
B. White blood cell casts
C. Proteinuria greater than 3.5 grams per day
D. Positive anti-double-stranded DNA antibody titer
Answer: D. Serositis in SLE is a clinical manifestation that correlates with
disease activity, often reflected by elevated anti-dsDNA antibodies and
low complement levels. While urinary casts (A, B) suggest lupus
nephritis, they do not specifically diagnose serositis. Nephrotic-range
proteinuria (C) points to glomerular disease, not pleural inflammation.
The presence of anti-dsDNA in the setting of pleuritic pain and effusion
supports active SLE serositis.
Rationale: Pleural effusion in SLE is exudative and responds to
corticosteroids. Anti-dsDNA titers are a biomarker for disease flare,
including serositis, in the appropriate clinical context.
3. A 28-year-old male who injects heroin presents with a high fever,
chills, and a new harsh holosystolic murmur at the left lower sternal
border. Blood cultures are positive for methicillin-susceptible
,3|Page
Staphylococcus aureus. Transesophageal echocardiography reveals a
1.2-cm vegetation on the tricuspid valve. Which of the following is the
most appropriate initial antibiotic regimen?
A. Vancomycin and gentamicin
B. Nafcillin and gentamicin
C. Ceftriaxone and doxycycline
D. Ampicillin-sulbactam
Answer: B. For methicillin-susceptible Staphylococcus aureus native
valve infective endocarditis, nafcillin or oxacillin is the drug of choice.
The addition of low-dose gentamicin for the first 3-5 days is
recommended for synergy in prosthetic valves or complicated cases, but
it is also commonly used initially for native valve MSSA endocarditis
until clinical response is documented. Vancomycin (A) is reserved for
MRSA. Ceftriaxone and doxycycline (C) are not first-line for MSSA.
Ampicillin-sulbactam (D) is not the standard for MSSA endocarditis.
Rationale: The tricuspid valve is the most common site for right-sided
endocarditis in injection drug users. MSSA is highly susceptible to beta-
lactam penicillins; nafcillin is preferred over vancomycin to avoid
resistance induction and improve outcomes.
4. A 6-year-old boy is brought to the clinic by his mother because of a
two-day history of a barking cough that worsens at night, inspiratory
stridor, and low-grade fever. He is fully vaccinated. On examination, he
has mild suprasternal retractions. Which of the following is the most
appropriate next step in management?
A. Nebulized racemic epinephrine and dexamethasone
B. Direct laryngoscopy and bronchoscopy
, 4|Page
C. Chest radiograph
D. Oral amoxicillin
Answer: A. This presentation is classic for croup
(laryngotracheobronchitis), most commonly caused by parainfluenza
virus. Mild to moderate croup with stridor at rest and retractions
warrants treatment with nebulized racemic epinephrine for rapid
symptom relief and a single dose of dexamethasone to reduce airway
inflammation. Direct laryngoscopy (B) is reserved for suspected foreign
body or bacterial tracheitis. A chest radiograph (C) is not routinely
needed for classic croup. Antibiotics (D) are not effective for viral croup.
Rationale: Dexamethasone reduces the severity and duration of
symptoms, while racemic epinephrine acts as a vasoconstrictor to
decrease mucosal edema acutely.
5. A 58-year-old female with a history of hypertension and type 2
diabetes mellitus is found to have an elevated serum creatinine of 2.1
mg/dL during a routine checkup. Her baseline creatinine was 1.0 mg/dL
one year ago. Urinalysis shows 3+ protein and no red blood cells. A
renal ultrasound reveals normal-sized kidneys without hydronephrosis.
Which of the following is the most likely diagnosis?
A. Diabetic nephropathy
B. Acute tubular necrosis
C. Hypertensive nephrosclerosis
D. Polycystic kidney disease
Answer: A. Diabetic nephropathy is a progressive microvascular
complication of diabetes characterized by gradually increasing
proteinuria and declining glomerular filtration rate. The absence of
