COMSAE PHASE 1 FORM 114 EXAM 2026 |
PRACTICE QUESTIONS, ANSWERS &
DETAILED RATIONALES
COMSAE PHASE 1 FORM 114 EXAM 2026 | PRACTICE QUESTIONS, ANSWERS &
DETAILED RATIONALES
• This comprehensive practice exam contains 200 carefully curated multiple-choice
questions designed to simulate the COMSAE Phase 1 Form 114 examination,
featuring detailed rationales for every question to reinforce clinical knowledge and
test-taking strategy.
• Study this material by working through questions systematically, reviewing
rationales thoroughly regardless of whether you answer correctly, timing yourself
to build speed and accuracy, and identifying weak areas to focus your remaining
study time.
1. A 45-year-old male presents with chest pain radiating to the left arm and
dyspnea. His ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
E) Diagonal branch of the left anterior descending artery
Correct Answer: C) Right coronary artery
Rationale: ST-segment elevation in the inferior leads (II, III, aVF) indicates an inferior
wall myocardial infarction. The right coronary artery supplies the inferior wall of the
left ventricle in approximately 80% of the population. The LAD supplies the anterior
and anteroseptal regions, the left circumflex supplies the lateral wall and
posterolateral regions, and the left main coronary artery is the common trunk
before bifurcation.
,2. A 3-year-old child presents with severe abdominal pain, bloody stools, and a
palpable abdominal mass. Physical examination reveals a sausage-shaped
mass in the right upper quadrant. Which is the most likely diagnosis?
A) Appendicitis
B) Meckel's diverticulum
C) Intussusception
D) Hirschsprung's disease
E) Malrotation with midgut volvulus
Correct Answer: C) Intussusception
Rationale: Intussusception is the most common cause of intestinal obstruction in
children between 6 months and 3 years of age. The classic triad includes colicky
abdominal pain, bloody (currant jelly) stools, and a palpable sausage-shaped mass,
typically in the right upper quadrant where the intussusceptum enters the colon.
The diagnosis is confirmed with ultrasound or air/contrast enema, which may also
be therapeutic.
3. A 28-year-old woman at 32 weeks of gestation presents with sudden onset
of severe headache, visual disturbances, and right upper quadrant pain. Her
blood pressure is 165/110 mmHg, and proteinuria is 3+ on urinalysis. What is
the most appropriate next step?
A) Reassure the patient and schedule an office visit in 1 week
B) Administer aspirin 325 mg orally
C) Hospitalize for delivery and initiate seizure prophylaxis with magnesium sulfate
D) Prescribe nifedipine XL 30 mg daily
E) Order an MRI of the brain
Correct Answer: C) Hospitalize for delivery and initiate seizure prophylaxis
with magnesium sulfate
,Rationale: This patient presents with preeclampsia with severe features (severe
hypertension, symptoms of severe preeclampsia including headache and RUQ pain,
significant proteinuria). At 32 weeks of gestation, delivery is indicated for severe
preeclampsia. Magnesium sulfate is the standard of care for seizure prophylaxis in
preeclampsia with severe features and should be initiated immediately. The patient
requires hospitalization for close monitoring and expedited delivery.
4. A 62-year-old man with a 40-year smoking history presents with a 3-month
history of progressive dyspnea, cough productive of blood-tinged sputum, and
10-pound weight loss. Chest X-ray reveals a cavitary lesion in the right upper
lobe. Which organism is most likely responsible?
A) Streptococcus pneumoniae
B) Mycobacterium tuberculosis
C) Histoplasma capsulatum
D) Aspergillus fumigatus
E) Klebsiella pneumoniae
Correct Answer: B) Mycobacterium tuberculosis
Rationale: The presentation of cavitary pulmonary disease in the upper lobes, along
with constitutional symptoms (weight loss) and hemoptysis, is classic for pulmonary
tuberculosis. TB has a predilection for the apical and posterior segments of the
upper lobes due to higher oxygen tension. Smoking and chronic exposure further
increase risk. While other organisms can cause cavitary lesions, the clinical
presentation, radiographic findings, and patient risk factors strongly suggest TB.
5. A 35-year-old woman presents with episodic severe headaches, profuse
diaphoresis, palpitations, and tremor lasting 30-60 minutes. Her blood
pressure during an episode is 180/120 mmHg. Between episodes, she is
normotensive. Which is the most likely diagnosis?
A) Generalized anxiety disorder
, B) Hyperthyroidism
C) Pheochromocytoma
D) Panic disorder with agoraphobia
E) Atrial fibrillation with rapid ventricular response
Correct Answer: C) Pheochromocytoma
Rationale: Pheochromocytoma presents with episodic symptoms including severe
hypertension, headache, diaphoresis, palpitations, and tremor. The classic triad is
severe hypertension, headache, and diaphoresis. The episodic nature with normal
blood pressure between episodes is characteristic of pheochromocytoma. The
diagnosis is confirmed with elevated plasma free metanephrines or 24-hour urine
metanephrines, followed by imaging to localize the tumor.
6. A 7-year-old boy is brought to the clinic with a productive cough for 2
weeks, low-grade fever, and wheezing. On examination, the child has bilateral
wheezing and hyperinflation on chest X-ray. Which medication should be
administered first?
A) Intravenous antibiotics
B) Oral corticosteroids
C) Inhaled beta-2 agonist
D) Chest physiotherapy
E) Nebulized ipratropium
Correct Answer: C) Inhaled beta-2 agonist
Rationale: In acute asthma exacerbation, inhaled beta-2 agonists (albuterol) are the
first-line treatment. They provide rapid bronchodilation and relief of
bronchoconstriction. While corticosteroids are important, they require time to
work. Antibiotics are not indicated unless there is evidence of bacterial infection.
This child's presentation is consistent with acute asthma, and rapid relief of airway
obstruction is the priority.
PRACTICE QUESTIONS, ANSWERS &
DETAILED RATIONALES
COMSAE PHASE 1 FORM 114 EXAM 2026 | PRACTICE QUESTIONS, ANSWERS &
DETAILED RATIONALES
• This comprehensive practice exam contains 200 carefully curated multiple-choice
questions designed to simulate the COMSAE Phase 1 Form 114 examination,
featuring detailed rationales for every question to reinforce clinical knowledge and
test-taking strategy.
• Study this material by working through questions systematically, reviewing
rationales thoroughly regardless of whether you answer correctly, timing yourself
to build speed and accuracy, and identifying weak areas to focus your remaining
study time.
1. A 45-year-old male presents with chest pain radiating to the left arm and
dyspnea. His ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
E) Diagonal branch of the left anterior descending artery
Correct Answer: C) Right coronary artery
Rationale: ST-segment elevation in the inferior leads (II, III, aVF) indicates an inferior
wall myocardial infarction. The right coronary artery supplies the inferior wall of the
left ventricle in approximately 80% of the population. The LAD supplies the anterior
and anteroseptal regions, the left circumflex supplies the lateral wall and
posterolateral regions, and the left main coronary artery is the common trunk
before bifurcation.
,2. A 3-year-old child presents with severe abdominal pain, bloody stools, and a
palpable abdominal mass. Physical examination reveals a sausage-shaped
mass in the right upper quadrant. Which is the most likely diagnosis?
A) Appendicitis
B) Meckel's diverticulum
C) Intussusception
D) Hirschsprung's disease
E) Malrotation with midgut volvulus
Correct Answer: C) Intussusception
Rationale: Intussusception is the most common cause of intestinal obstruction in
children between 6 months and 3 years of age. The classic triad includes colicky
abdominal pain, bloody (currant jelly) stools, and a palpable sausage-shaped mass,
typically in the right upper quadrant where the intussusceptum enters the colon.
The diagnosis is confirmed with ultrasound or air/contrast enema, which may also
be therapeutic.
3. A 28-year-old woman at 32 weeks of gestation presents with sudden onset
of severe headache, visual disturbances, and right upper quadrant pain. Her
blood pressure is 165/110 mmHg, and proteinuria is 3+ on urinalysis. What is
the most appropriate next step?
A) Reassure the patient and schedule an office visit in 1 week
B) Administer aspirin 325 mg orally
C) Hospitalize for delivery and initiate seizure prophylaxis with magnesium sulfate
D) Prescribe nifedipine XL 30 mg daily
E) Order an MRI of the brain
Correct Answer: C) Hospitalize for delivery and initiate seizure prophylaxis
with magnesium sulfate
,Rationale: This patient presents with preeclampsia with severe features (severe
hypertension, symptoms of severe preeclampsia including headache and RUQ pain,
significant proteinuria). At 32 weeks of gestation, delivery is indicated for severe
preeclampsia. Magnesium sulfate is the standard of care for seizure prophylaxis in
preeclampsia with severe features and should be initiated immediately. The patient
requires hospitalization for close monitoring and expedited delivery.
4. A 62-year-old man with a 40-year smoking history presents with a 3-month
history of progressive dyspnea, cough productive of blood-tinged sputum, and
10-pound weight loss. Chest X-ray reveals a cavitary lesion in the right upper
lobe. Which organism is most likely responsible?
A) Streptococcus pneumoniae
B) Mycobacterium tuberculosis
C) Histoplasma capsulatum
D) Aspergillus fumigatus
E) Klebsiella pneumoniae
Correct Answer: B) Mycobacterium tuberculosis
Rationale: The presentation of cavitary pulmonary disease in the upper lobes, along
with constitutional symptoms (weight loss) and hemoptysis, is classic for pulmonary
tuberculosis. TB has a predilection for the apical and posterior segments of the
upper lobes due to higher oxygen tension. Smoking and chronic exposure further
increase risk. While other organisms can cause cavitary lesions, the clinical
presentation, radiographic findings, and patient risk factors strongly suggest TB.
5. A 35-year-old woman presents with episodic severe headaches, profuse
diaphoresis, palpitations, and tremor lasting 30-60 minutes. Her blood
pressure during an episode is 180/120 mmHg. Between episodes, she is
normotensive. Which is the most likely diagnosis?
A) Generalized anxiety disorder
, B) Hyperthyroidism
C) Pheochromocytoma
D) Panic disorder with agoraphobia
E) Atrial fibrillation with rapid ventricular response
Correct Answer: C) Pheochromocytoma
Rationale: Pheochromocytoma presents with episodic symptoms including severe
hypertension, headache, diaphoresis, palpitations, and tremor. The classic triad is
severe hypertension, headache, and diaphoresis. The episodic nature with normal
blood pressure between episodes is characteristic of pheochromocytoma. The
diagnosis is confirmed with elevated plasma free metanephrines or 24-hour urine
metanephrines, followed by imaging to localize the tumor.
6. A 7-year-old boy is brought to the clinic with a productive cough for 2
weeks, low-grade fever, and wheezing. On examination, the child has bilateral
wheezing and hyperinflation on chest X-ray. Which medication should be
administered first?
A) Intravenous antibiotics
B) Oral corticosteroids
C) Inhaled beta-2 agonist
D) Chest physiotherapy
E) Nebulized ipratropium
Correct Answer: C) Inhaled beta-2 agonist
Rationale: In acute asthma exacerbation, inhaled beta-2 agonists (albuterol) are the
first-line treatment. They provide rapid bronchodilation and relief of
bronchoconstriction. While corticosteroids are important, they require time to
work. Antibiotics are not indicated unless there is evidence of bacterial infection.
This child's presentation is consistent with acute asthma, and rapid relief of airway
obstruction is the priority.
