COMSAE PHASE 1 (FORM 114) PRACTICE DRILLS: 200
BOARD-STYLE QUESTIONS COVERING OMM, MICRO,
PHARM & HIGH-YIELD SYSTEMS
1. A 28-year-old female presents with fatigue, arthralgias, and a
photosensitive malar rash. Laboratory evaluation reveals positive
antinuclear antibodies (ANA) and positive anti-double-stranded DNA
(anti-dsDNA) antibodies. Which renal pathology is most commonly
associated with this systemic disease?
A) Membranous nephropathy (Class V lupus nephritis)
B) Minimal change disease
C) Focal segmental glomerulosclerosis
D) Diffuse proliferative lupus nephritis (Class IV lupus nephritis)
Answer: D
Rationale: This patient has systemic lupus erythematosus (SLE). Diffuse
proliferative glomerulonephritis (Class IV lupus nephritis) is the most
common and severe form of renal involvement in SLE. It is characterized
by subendothelial immune complex deposits, which appear as "wire-
loop" lesions on histology, leading to proliferation and capillary wall
thickening .
2. A 48-year-old male with a history of heavy alcohol use presents
with acute onset of confusion, ophthalmoplegia (lateral rectus palsy),
and a wide-based ataxia. This neurological syndrome is caused by a
deficiency of which of the following vitamins?
,A) Vitamin B3 (Niacin)
B) Vitamin B1 (Thiamine)
C) Vitamin B12 (Cobalamin)
D) Vitamin C (Ascorbic acid)
Answer: B
Rationale: Wernicke encephalopathy is classically characterized by the
triad of confusion, ophthalmoplegia, and ataxia. It is caused by a
deficiency in vitamin B1 (thiamine), which is frequently seen in chronic
alcoholism. Thiamine is an essential coenzyme for several enzymes,
including pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase,
and transketolase .
3. A 4-year-old boy presents with a "barking" cough and inspiratory
stridor. A neck X-ray shows subglottic narrowing, the "Steeple sign".
What is the most likely causative agent?
A) Bordetella pertussis
B) Parainfluenza virus
C) Respiratory syncytial virus (RSV)
D) Mycoplasma pneumoniae
Answer: B
Rationale: The clinical presentation of a barking cough and inspiratory
stridor in a young child is classic for laryngotracheobronchitis (croup).
The most common viral cause of croup is the parainfluenza virus. The
characteristic "Steeple sign" on an X-ray is due to subglottic edema and
airway narrowing .
4. A patient with long-standing rheumatoid arthritis is undergoing
elective surgery. Which of the following must be evaluated
,preoperatively to prevent neurological injury during intubation?
A) Lumbar spine
B) Cervical spine (C1-C2)
C) Temporomandibular joint
D) Sacroiliac joints
Answer: B
Rationale: Rheumatoid arthritis can cause atlantoaxial subluxation,
which is instability at the C1-C2 joint. During intubation, neck extension
can lead to spinal cord compression if this subluxation is present and
unrecognized. Preoperative evaluation of cervical spine stability is
therefore critical .
5. A 65-year-old male with a history of hypertension and smoking
presents with sudden-onset tearing chest pain radiating to his back.
His blood pressure is 180/100 mmHg in the right arm and 140/90
mmHg in the left arm. What is the most important histological
precursor in the media of the aorta found on autopsy?
A) Granulomatous inflammation of the vasa vasorum
B) Cystic medial degeneration (necrosis)
C) Atheromatous plaque ulceration
D) Syphilitic endarteritis obliterans
Answer: B
Rationale: The clinical scenario is classic for an aortic dissection. The
most common underlying histological abnormality predisposing to
aortic dissection is cystic medial degeneration (also known as cystic
medial necrosis). This condition is characterized by the fragmentation of
elastic fibers and the deposition of basophilic ground substance in the
media of the aortic wall .
, 6. A 30-year-old male presents with acute onset of colicky right upper
quadrant pain radiating to the right shoulder, nausea, and vomiting
following a fatty meal. Physical examination reveals tenderness upon
deep palpation of the right upper quadrant during inspiration, causing
inspiratory arrest (positive Murphy's sign). Ultrasonography confirms
gallstones and gallbladder wall thickening. What is the most likely
diagnosis?
A) Acute cholecystitis
B) Ascending cholangitis
C) Choledocholithiasis
D) Acute pancreatitis
Answer: A
Rationale: Acute cholecystitis is caused by cystic duct obstruction, often
by a gallstone, leading to secondary inflammation of the gallbladder
wall. The presentation includes right upper quadrant pain, fever,
leukocytosis, and a positive Murphy's sign (inspiratory arrest during
palpation). Cholangitis features Charcot's triad (fever, jaundice, right
upper quadrant pain), while choledocholithiasis refers to common bile
duct stones .
7. A 45-year-old male with type 2 diabetes presents with a creatinine
of 2.5 mg/dL and a urine albumin-to-creatinine ratio (UACR) of 400
mg/g. What is the most likely diagnosis?
A) Minimal change disease
B) Diabetic nephropathy
C) Rapidly progressive glomerulonephritis
D) Post-streptococcal glomerulonephritis
Answer: B
BOARD-STYLE QUESTIONS COVERING OMM, MICRO,
PHARM & HIGH-YIELD SYSTEMS
1. A 28-year-old female presents with fatigue, arthralgias, and a
photosensitive malar rash. Laboratory evaluation reveals positive
antinuclear antibodies (ANA) and positive anti-double-stranded DNA
(anti-dsDNA) antibodies. Which renal pathology is most commonly
associated with this systemic disease?
A) Membranous nephropathy (Class V lupus nephritis)
B) Minimal change disease
C) Focal segmental glomerulosclerosis
D) Diffuse proliferative lupus nephritis (Class IV lupus nephritis)
Answer: D
Rationale: This patient has systemic lupus erythematosus (SLE). Diffuse
proliferative glomerulonephritis (Class IV lupus nephritis) is the most
common and severe form of renal involvement in SLE. It is characterized
by subendothelial immune complex deposits, which appear as "wire-
loop" lesions on histology, leading to proliferation and capillary wall
thickening .
2. A 48-year-old male with a history of heavy alcohol use presents
with acute onset of confusion, ophthalmoplegia (lateral rectus palsy),
and a wide-based ataxia. This neurological syndrome is caused by a
deficiency of which of the following vitamins?
,A) Vitamin B3 (Niacin)
B) Vitamin B1 (Thiamine)
C) Vitamin B12 (Cobalamin)
D) Vitamin C (Ascorbic acid)
Answer: B
Rationale: Wernicke encephalopathy is classically characterized by the
triad of confusion, ophthalmoplegia, and ataxia. It is caused by a
deficiency in vitamin B1 (thiamine), which is frequently seen in chronic
alcoholism. Thiamine is an essential coenzyme for several enzymes,
including pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase,
and transketolase .
3. A 4-year-old boy presents with a "barking" cough and inspiratory
stridor. A neck X-ray shows subglottic narrowing, the "Steeple sign".
What is the most likely causative agent?
A) Bordetella pertussis
B) Parainfluenza virus
C) Respiratory syncytial virus (RSV)
D) Mycoplasma pneumoniae
Answer: B
Rationale: The clinical presentation of a barking cough and inspiratory
stridor in a young child is classic for laryngotracheobronchitis (croup).
The most common viral cause of croup is the parainfluenza virus. The
characteristic "Steeple sign" on an X-ray is due to subglottic edema and
airway narrowing .
4. A patient with long-standing rheumatoid arthritis is undergoing
elective surgery. Which of the following must be evaluated
,preoperatively to prevent neurological injury during intubation?
A) Lumbar spine
B) Cervical spine (C1-C2)
C) Temporomandibular joint
D) Sacroiliac joints
Answer: B
Rationale: Rheumatoid arthritis can cause atlantoaxial subluxation,
which is instability at the C1-C2 joint. During intubation, neck extension
can lead to spinal cord compression if this subluxation is present and
unrecognized. Preoperative evaluation of cervical spine stability is
therefore critical .
5. A 65-year-old male with a history of hypertension and smoking
presents with sudden-onset tearing chest pain radiating to his back.
His blood pressure is 180/100 mmHg in the right arm and 140/90
mmHg in the left arm. What is the most important histological
precursor in the media of the aorta found on autopsy?
A) Granulomatous inflammation of the vasa vasorum
B) Cystic medial degeneration (necrosis)
C) Atheromatous plaque ulceration
D) Syphilitic endarteritis obliterans
Answer: B
Rationale: The clinical scenario is classic for an aortic dissection. The
most common underlying histological abnormality predisposing to
aortic dissection is cystic medial degeneration (also known as cystic
medial necrosis). This condition is characterized by the fragmentation of
elastic fibers and the deposition of basophilic ground substance in the
media of the aortic wall .
, 6. A 30-year-old male presents with acute onset of colicky right upper
quadrant pain radiating to the right shoulder, nausea, and vomiting
following a fatty meal. Physical examination reveals tenderness upon
deep palpation of the right upper quadrant during inspiration, causing
inspiratory arrest (positive Murphy's sign). Ultrasonography confirms
gallstones and gallbladder wall thickening. What is the most likely
diagnosis?
A) Acute cholecystitis
B) Ascending cholangitis
C) Choledocholithiasis
D) Acute pancreatitis
Answer: A
Rationale: Acute cholecystitis is caused by cystic duct obstruction, often
by a gallstone, leading to secondary inflammation of the gallbladder
wall. The presentation includes right upper quadrant pain, fever,
leukocytosis, and a positive Murphy's sign (inspiratory arrest during
palpation). Cholangitis features Charcot's triad (fever, jaundice, right
upper quadrant pain), while choledocholithiasis refers to common bile
duct stones .
7. A 45-year-old male with type 2 diabetes presents with a creatinine
of 2.5 mg/dL and a urine albumin-to-creatinine ratio (UACR) of 400
mg/g. What is the most likely diagnosis?
A) Minimal change disease
B) Diabetic nephropathy
C) Rapidly progressive glomerulonephritis
D) Post-streptococcal glomerulonephritis
Answer: B
