COMSAE 115 EXAM 2026/2027
COMPLETE ACCURATE TEST EXAM
ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED SOLUTIONS) 2026 EDITION
|BEST DOCUMENT FOR EXAM
QUESTION
What causes a subarachnoid hemorrhage (SAH)?
a. Trauma to the skull
b. Rupture of a berry (saccular) aneurysm
c. Arteriovenous malformation
d. Anticoagulation therapy
✔️ Correct Answer: B
Rationale: Subarachnoid hemorrhage most commonly results from rupture of a berry
(saccular) aneurysm, typically located at branch points of the Circle of Willis. These
aneurysms are congenital weak points in the arterial wall that can rupture spontaneously
,or after sudden increases in intracranial pressure, leading to bleeding into the
subarachnoid space. The presence of blood in the subarachnoid space irritates the
meninges, producing a sudden severe "thunderclap" headache, neck stiffness,
photophobia, and possible loss of consciousness. Non-contrast CT is the initial diagnostic
test, and lumbar puncture may show xanthochromia if CT is negative.
What are the characteristic signs of a basilar skull fracture?
a. Scalp hematoma and concussion
b. Raccoon eyes, CSF otorrhea, and Battle's sign
c. Epidural hematoma and subdural hematoma
d. Diplopia and facial numbness
✔️ Correct Answer: B
Rationale: Basilar skull fractures involve fractures of the skull base and are associated with
tearing of the meninges and dural venous sinuses. Raccoon eyes (periorbital ecchymosis)
occur due to anterior cranial fossa fractures, where blood tracks into the periorbital tissues.
Battle's sign (postauricular/mastoid ecchymosis) suggests a middle or posterior cranial
fossa fracture. CSF otorrhea or rhinorrhea results from dural tear with communication
between the subarachnoid space and the ear or nasal cavity. These findings are clinically
important because basilar skull fractures carry risks of meningitis due to open
communication between sterile intracranial spaces and the external environment.
How is G6PD deficiency identified?
a. Spherocytes on blood smear
b. Bite cells and Heinz bodies on blood smear; hemolytic anemia after fava bean ingestion
,c. Elevated reticulocyte count and low haptoglobin
d. Positive Coombs test
✔️ Correct Answer: B
Rationale: G6PD deficiency impairs the pentose phosphate pathway, reducing NADPH
production. This decreases the regeneration of reduced glutathione, leaving red blood
cells vulnerable to oxidative stress. When exposed to oxidative triggers such as fava beans,
sulfa drugs, or infections, hemoglobin denatures and precipitates within RBCs, forming
Heinz bodies. These damaged cells are partially removed by splenic macrophages,
producing "bite cells" on peripheral smear. Clinically, patients develop episodic hemolytic
anemia characterized by fatigue, jaundice, dark urine, and elevated LDH with low
haptoglobin.
What is a thyroid storm?
a. A chronic hypothyroid state
b. A life-threatening exacerbation of hyperthyroidism with fever, tachycardia, confusion,
and vomiting, often triggered by surgery
c. A benign enlargement of the thyroid gland
d. An autoimmune destruction of thyroid tissue
✔️ Correct Answer: B
Rationale: Thyroid storm is an acute, life-threatening decompensation of severe
hyperthyroidism characterized by a sudden surge in thyroid hormone activity and
heightened tissue sensitivity to catecholamines. It is most often triggered by stressors such
as infection, surgery, trauma, or discontinuation of antithyroid medication in a patient with
underlying Graves disease or toxic multinodular goiter. Excess thyroid hormone leads to a
hypermetabolic state with increased oxygen consumption, heat production, and
, adrenergic stimulation, resulting in high fever, marked tachycardia, altered mental status,
and gastrointestinal symptoms.
What is the main concern with elevated AFP in a pregnant woman?
a. Chromosomal abnormality such as Down syndrome
b. Neural tube defect (e.g., spina bifida)
c. Multiple gestation
d. Fetal growth restriction
✔️ Correct Answer: B
Rationale: An elevated maternal serum alpha-fetoprotein (AFP) is most concerning for
open fetal defects, particularly neural tube defects (NTDs) such as spina bifida or
anencephaly. These defects expose fetal tissues to the amniotic fluid, allowing increased
leakage of AFP into the amniotic cavity and subsequently into maternal blood. Other
causes include abdominal wall defects (e.g., gastroschisis), incorrect gestational dating, or
multiple gestation. The key diagnostic follow-up is targeted fetal ultrasound, which can
confirm structural anomalies and assess gestational age.
How is hereditary spherocytosis diagnosed?
a. Heinz bodies on blood smear and positive Coombs test
b. Spherocytes on blood smear, increased osmotic fragility, and negative Coombs test
c. Bite cells on blood smear and decreased osmotic fragility
d. Elevated reticulocyte count and positive Coombs test
COMPLETE ACCURATE TEST EXAM
ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED SOLUTIONS) 2026 EDITION
|BEST DOCUMENT FOR EXAM
QUESTION
What causes a subarachnoid hemorrhage (SAH)?
a. Trauma to the skull
b. Rupture of a berry (saccular) aneurysm
c. Arteriovenous malformation
d. Anticoagulation therapy
✔️ Correct Answer: B
Rationale: Subarachnoid hemorrhage most commonly results from rupture of a berry
(saccular) aneurysm, typically located at branch points of the Circle of Willis. These
aneurysms are congenital weak points in the arterial wall that can rupture spontaneously
,or after sudden increases in intracranial pressure, leading to bleeding into the
subarachnoid space. The presence of blood in the subarachnoid space irritates the
meninges, producing a sudden severe "thunderclap" headache, neck stiffness,
photophobia, and possible loss of consciousness. Non-contrast CT is the initial diagnostic
test, and lumbar puncture may show xanthochromia if CT is negative.
What are the characteristic signs of a basilar skull fracture?
a. Scalp hematoma and concussion
b. Raccoon eyes, CSF otorrhea, and Battle's sign
c. Epidural hematoma and subdural hematoma
d. Diplopia and facial numbness
✔️ Correct Answer: B
Rationale: Basilar skull fractures involve fractures of the skull base and are associated with
tearing of the meninges and dural venous sinuses. Raccoon eyes (periorbital ecchymosis)
occur due to anterior cranial fossa fractures, where blood tracks into the periorbital tissues.
Battle's sign (postauricular/mastoid ecchymosis) suggests a middle or posterior cranial
fossa fracture. CSF otorrhea or rhinorrhea results from dural tear with communication
between the subarachnoid space and the ear or nasal cavity. These findings are clinically
important because basilar skull fractures carry risks of meningitis due to open
communication between sterile intracranial spaces and the external environment.
How is G6PD deficiency identified?
a. Spherocytes on blood smear
b. Bite cells and Heinz bodies on blood smear; hemolytic anemia after fava bean ingestion
,c. Elevated reticulocyte count and low haptoglobin
d. Positive Coombs test
✔️ Correct Answer: B
Rationale: G6PD deficiency impairs the pentose phosphate pathway, reducing NADPH
production. This decreases the regeneration of reduced glutathione, leaving red blood
cells vulnerable to oxidative stress. When exposed to oxidative triggers such as fava beans,
sulfa drugs, or infections, hemoglobin denatures and precipitates within RBCs, forming
Heinz bodies. These damaged cells are partially removed by splenic macrophages,
producing "bite cells" on peripheral smear. Clinically, patients develop episodic hemolytic
anemia characterized by fatigue, jaundice, dark urine, and elevated LDH with low
haptoglobin.
What is a thyroid storm?
a. A chronic hypothyroid state
b. A life-threatening exacerbation of hyperthyroidism with fever, tachycardia, confusion,
and vomiting, often triggered by surgery
c. A benign enlargement of the thyroid gland
d. An autoimmune destruction of thyroid tissue
✔️ Correct Answer: B
Rationale: Thyroid storm is an acute, life-threatening decompensation of severe
hyperthyroidism characterized by a sudden surge in thyroid hormone activity and
heightened tissue sensitivity to catecholamines. It is most often triggered by stressors such
as infection, surgery, trauma, or discontinuation of antithyroid medication in a patient with
underlying Graves disease or toxic multinodular goiter. Excess thyroid hormone leads to a
hypermetabolic state with increased oxygen consumption, heat production, and
, adrenergic stimulation, resulting in high fever, marked tachycardia, altered mental status,
and gastrointestinal symptoms.
What is the main concern with elevated AFP in a pregnant woman?
a. Chromosomal abnormality such as Down syndrome
b. Neural tube defect (e.g., spina bifida)
c. Multiple gestation
d. Fetal growth restriction
✔️ Correct Answer: B
Rationale: An elevated maternal serum alpha-fetoprotein (AFP) is most concerning for
open fetal defects, particularly neural tube defects (NTDs) such as spina bifida or
anencephaly. These defects expose fetal tissues to the amniotic fluid, allowing increased
leakage of AFP into the amniotic cavity and subsequently into maternal blood. Other
causes include abdominal wall defects (e.g., gastroschisis), incorrect gestational dating, or
multiple gestation. The key diagnostic follow-up is targeted fetal ultrasound, which can
confirm structural anomalies and assess gestational age.
How is hereditary spherocytosis diagnosed?
a. Heinz bodies on blood smear and positive Coombs test
b. Spherocytes on blood smear, increased osmotic fragility, and negative Coombs test
c. Bite cells on blood smear and decreased osmotic fragility
d. Elevated reticulocyte count and positive Coombs test
