Expert Rationale:
DETAILED
COMSAE 114 EXAM 2026/2027 300 MOST
TESTED QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
(VERIFIEDSOLUTIONS) 2026 EDITION
|BEST DOCUMENT FOR EXAM-TESTBANK
A 58-year-old man with a history of chronic smoking presents with chronic cough,
dyspnea, and a barrel-shaped chest. Spirometry shows an FEV1/FVC ratio of 60%. Which
of the following is the most likely diagnosis?
a. Asthma
b. COPD
c. Pulmonary fibrosis
d. Bronchiectasis
✔️ Correct Answer: B
Rationale: COPD is characterized by irreversible airflow limitation, typically due to
chronic smoking, with a reduced FEV1/FVC ratio (<0.70). The barrel-shaped chest is a
classic sign of hyperinflation due to air trapping. Asthma is reversible, pulmonary fibrosis
is restrictive, and bronchiectasis involves abnormal airway dilation.
A newborn fails to pass meconium within 48 hours and has abdominal distension. Which
of the following conditions is most likely?
a. Hirschsprung disease
b. Pyloric stenosis
c. Meckel diverticulum
d. Intussusception
,Expert Rationale:
✔️ Correct Answer: A
Rationale: Hirschsprung disease is caused by failure of neural crest cell migration,
resulting in an aganglionic segment of the bowel, leading to obstruction and failure to
pass meconium. Pyloric stenosis presents with projectile vomiting, Meckel diverticulum
with painless bleeding, and intussusception with currant jelly stools.
A patient presents with sudden severe "worst headache of life" and neck stiffness. A CT
scan is negative. What is the next best step?
a. MRI brain
b. Lumbar puncture
c. EEG
d. Start antibiotics
✔️ Correct Answer: B
Rationale: Suspected subarachnoid hemorrhage with a negative CT scan requires a
lumbar puncture to detect xanthochromia (bilirubin in CSF). MRI is less sensitive in the
acute setting, EEG is for seizures, and antibiotics are for meningitis.
A patient presents with fever, cough, and atypical pneumonia. Cold agglutinins are
positive. Which organism is responsible?
a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Klebsiella pneumoniae
d. Legionella pneumophila
✔️ Correct Answer: B
Rationale: Mycoplasma pneumoniae causes atypical pneumonia and is associated with
cold agglutinin hemolytic anemia. S. pneumoniae causes lobar pneumonia, K.
pneumoniae causes necrotizing pneumonia, and Legionella causes severe pneumonia
with gastrointestinal symptoms.
,Expert Rationale:
A patient presents with sudden painless vision loss described as a "curtain falling."
Which diagnosis is most likely?
a. Retinal detachment
b. Acute glaucoma
c. Cataract
d. Optic neuritis
✔️ Correct Answer: A
Rationale: Retinal detachment causes sudden painless vision loss with a curtain-like
visual field defect. Acute glaucoma presents with pain and halos, cataracts are gradual,
and optic neuritis presents with painful vision loss.
A child presents with edema, proteinuria, and hypoalbuminemia after a viral illness.
Which condition is most likely?
a. Nephritic syndrome
b. Nephrotic syndrome
c. Pyelonephritis
d. UTI
✔️ Correct Answer: B
Rationale: Minimal change disease is the most common cause of nephrotic syndrome in
children, presenting with edema, heavy proteinuria, and hypoalbuminemia. Nephritic
syndrome presents with hematuria and RBC casts.
A patient presents with a tremor that improves with alcohol use. Which diagnosis is
most likely?
a. Parkinson disease
b. Essential tremor
c. Huntington disease
d. Wilson disease
, Expert Rationale:
✔️ Correct Answer: B
Rationale: Essential tremor is an action tremor that is improved by alcohol and worsened
with movement. Parkinson disease is a resting tremor, Huntington disease involves
chorea, and Wilson disease involves hepatic and neurologic symptoms.
A patient presents with chronic diarrhea and weight loss. Stool studies show steatorrhea.
Which enzyme deficiency is most likely?
a. Lactase deficiency
b. Pancreatic lipase deficiency
c. Amylase deficiency
d. Sucrase deficiency
✔️ Correct Answer: B
Rationale: Pancreatic insufficiency leads to fat malabsorption and steatorrhea due to
lipase deficiency. Lactase deficiency causes osmotic diarrhea, amylase deficiency affects
starch digestion, and sucrase deficiency affects sucrose digestion.
A patient presents with fever, rash, and joint pain after using a new medication. What is
the diagnosis?
a. Stevens-Johnson syndrome
b. Serum sickness
c. Toxic epidermal necrolysis
d. Contact dermatitis
✔️ Correct Answer: B
Rationale: Serum sickness is a Type III hypersensitivity reaction causing immune complex
deposition, leading to fever, rash, and arthralgia. Stevens-Johnson syndrome and toxic
epidermal necrolysis are severe skin reactions, and contact dermatitis is a Type IV
reaction.
DETAILED
COMSAE 114 EXAM 2026/2027 300 MOST
TESTED QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
(VERIFIEDSOLUTIONS) 2026 EDITION
|BEST DOCUMENT FOR EXAM-TESTBANK
A 58-year-old man with a history of chronic smoking presents with chronic cough,
dyspnea, and a barrel-shaped chest. Spirometry shows an FEV1/FVC ratio of 60%. Which
of the following is the most likely diagnosis?
a. Asthma
b. COPD
c. Pulmonary fibrosis
d. Bronchiectasis
✔️ Correct Answer: B
Rationale: COPD is characterized by irreversible airflow limitation, typically due to
chronic smoking, with a reduced FEV1/FVC ratio (<0.70). The barrel-shaped chest is a
classic sign of hyperinflation due to air trapping. Asthma is reversible, pulmonary fibrosis
is restrictive, and bronchiectasis involves abnormal airway dilation.
A newborn fails to pass meconium within 48 hours and has abdominal distension. Which
of the following conditions is most likely?
a. Hirschsprung disease
b. Pyloric stenosis
c. Meckel diverticulum
d. Intussusception
,Expert Rationale:
✔️ Correct Answer: A
Rationale: Hirschsprung disease is caused by failure of neural crest cell migration,
resulting in an aganglionic segment of the bowel, leading to obstruction and failure to
pass meconium. Pyloric stenosis presents with projectile vomiting, Meckel diverticulum
with painless bleeding, and intussusception with currant jelly stools.
A patient presents with sudden severe "worst headache of life" and neck stiffness. A CT
scan is negative. What is the next best step?
a. MRI brain
b. Lumbar puncture
c. EEG
d. Start antibiotics
✔️ Correct Answer: B
Rationale: Suspected subarachnoid hemorrhage with a negative CT scan requires a
lumbar puncture to detect xanthochromia (bilirubin in CSF). MRI is less sensitive in the
acute setting, EEG is for seizures, and antibiotics are for meningitis.
A patient presents with fever, cough, and atypical pneumonia. Cold agglutinins are
positive. Which organism is responsible?
a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Klebsiella pneumoniae
d. Legionella pneumophila
✔️ Correct Answer: B
Rationale: Mycoplasma pneumoniae causes atypical pneumonia and is associated with
cold agglutinin hemolytic anemia. S. pneumoniae causes lobar pneumonia, K.
pneumoniae causes necrotizing pneumonia, and Legionella causes severe pneumonia
with gastrointestinal symptoms.
,Expert Rationale:
A patient presents with sudden painless vision loss described as a "curtain falling."
Which diagnosis is most likely?
a. Retinal detachment
b. Acute glaucoma
c. Cataract
d. Optic neuritis
✔️ Correct Answer: A
Rationale: Retinal detachment causes sudden painless vision loss with a curtain-like
visual field defect. Acute glaucoma presents with pain and halos, cataracts are gradual,
and optic neuritis presents with painful vision loss.
A child presents with edema, proteinuria, and hypoalbuminemia after a viral illness.
Which condition is most likely?
a. Nephritic syndrome
b. Nephrotic syndrome
c. Pyelonephritis
d. UTI
✔️ Correct Answer: B
Rationale: Minimal change disease is the most common cause of nephrotic syndrome in
children, presenting with edema, heavy proteinuria, and hypoalbuminemia. Nephritic
syndrome presents with hematuria and RBC casts.
A patient presents with a tremor that improves with alcohol use. Which diagnosis is
most likely?
a. Parkinson disease
b. Essential tremor
c. Huntington disease
d. Wilson disease
, Expert Rationale:
✔️ Correct Answer: B
Rationale: Essential tremor is an action tremor that is improved by alcohol and worsened
with movement. Parkinson disease is a resting tremor, Huntington disease involves
chorea, and Wilson disease involves hepatic and neurologic symptoms.
A patient presents with chronic diarrhea and weight loss. Stool studies show steatorrhea.
Which enzyme deficiency is most likely?
a. Lactase deficiency
b. Pancreatic lipase deficiency
c. Amylase deficiency
d. Sucrase deficiency
✔️ Correct Answer: B
Rationale: Pancreatic insufficiency leads to fat malabsorption and steatorrhea due to
lipase deficiency. Lactase deficiency causes osmotic diarrhea, amylase deficiency affects
starch digestion, and sucrase deficiency affects sucrose digestion.
A patient presents with fever, rash, and joint pain after using a new medication. What is
the diagnosis?
a. Stevens-Johnson syndrome
b. Serum sickness
c. Toxic epidermal necrolysis
d. Contact dermatitis
✔️ Correct Answer: B
Rationale: Serum sickness is a Type III hypersensitivity reaction causing immune complex
deposition, leading to fever, rash, and arthralgia. Stevens-Johnson syndrome and toxic
epidermal necrolysis are severe skin reactions, and contact dermatitis is a Type IV
reaction.
