COMSAE 108b 2025/2026 Complete Prep Guide: Questions
with Verified Answers, Rationales, and High Yield Tips |
Pathophysiology, Pharmacology, Microbiology, Pediatrics &
Therapeutics
Section 1: Internal Medicine — Questions 1–20
1.
A 58-year-old male with a 40-pack-year smoking history presents with progressive
dyspnea on exertion, chronic productive cough, and wheezing. Spirometry shows
FEV1/FVC ratio of 0.62. What is the most likely diagnosis?
A. Asthma
B. COPD
C. Bronchiectasis
D. Interstitial lung disease
Correct Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio <0.70 confirms obstructive lung
disease. In a patient with significant smoking history and chronic symptoms, COPD is the
most likely diagnosis.
High-Yield Takeaway: FEV1/FVC <0.70 = obstructive; smoking history + chronic
symptoms = COPD.
2.
A 65-year-old female with atrial fibrillation has a CHA2DS2-VASc score of 4. What is the
most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Warfarin with INR goal 2–3
,C. Clopidogrel 75 mg daily
D. No anticoagulation
Correct Answer: B
Rationale: CHA2DS2-VASc ≥2 in women or ≥1 in men warrants anticoagulation.
Warfarin or a DOAC is recommended. Aspirin is insufficient for stroke prevention in AF.
High-Yield Takeaway: CHA2DS2-VASc ≥2 = anticoagulate with warfarin or DOAC.
3.
A 55-year-old male presents with crushing chest pain radiating to the left arm and
diaphoresis. ECG shows ST elevation in leads V1–V4. Which coronary artery is most likely
occluded?
A. Right coronary artery
B. Left circumflex artery
C. Left anterior descending artery
D. Left main coronary artery
Correct Answer: C
Rationale: Leads V1–V4 are anterior precordial leads. The left anterior descending (LAD)
artery supplies the anterior wall of the left ventricle.
High-Yield Takeaway: V1–V4 = anterior MI = LAD.
4.
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is elevated, free T4 is low. What is the most common cause of this
condition in the United States?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Iodine deficiency
D. Pituitary adenoma
,Correct Answer: B
Rationale: Hashimoto's thyroiditis (chronic autoimmune thyroiditis) is the most
common cause of primary hypothyroidism in the US.
High-Yield Takeaway: Primary hypothyroidism #1 cause = Hashimoto's thyroiditis.
5.
A 60-year-old male with type 2 diabetes has an eGFR of 38 mL/min. Which oral
antidiabetic medication should be avoided?
A. Glipizide
B. Metformin
C. Pioglitazone
D. Sitagliptin
Correct Answer: B
Rationale: Metformin is contraindicated when eGFR <30 mL/min and should be used
with caution when eGFR is 30–45 due to the risk of lactic acidosis.
High-Yield Takeaway: Metformin contraindicated if eGFR <30.
6.
A 70-year-old male presents with sudden onset of severe tearing chest pain radiating to
the back. BP is 190/100 mmHg. CT angiography confirms the diagnosis. What is the
most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Sudden severe tearing chest pain radiating to the back with severe
hypertension is classic for aortic dissection. CT angiography is the gold standard for
, diagnosis.
High-Yield Takeaway: Tearing chest pain + unequal BP = aortic dissection.
7.
A 55-year-old male with cirrhosis presents with confusion, asterixis, and fetor hepaticus.
What is the most likely diagnosis?
A. Hepatic encephalopathy
B. Wernicke's encephalopathy
C. Delirium tremens
D. Subdural hematoma
Correct Answer: A
Rationale: Hepatic encephalopathy presents with confusion, asterixis (flapping tremor),
and fetor hepaticus (musty breath) due to ammonia accumulation.
High-Yield Takeaway: Cirrhosis + confusion + asterixis = hepatic encephalopathy.
8.
A 30-year-old female presents with a butterfly rash on her face, arthralgias, and fatigue.
Which autoantibody is most specific for this condition?
A. Anti-CCP
B. Anti-dsDNA
C. Rheumatoid factor
D. Anti-SSA
Correct Answer: B
Rationale: Anti-double-stranded DNA (anti-dsDNA) is highly specific for systemic lupus
erythematosus (SLE) and correlates with disease activity.
High-Yield Takeaway: Anti-dsDNA = specific for SLE.
with Verified Answers, Rationales, and High Yield Tips |
Pathophysiology, Pharmacology, Microbiology, Pediatrics &
Therapeutics
Section 1: Internal Medicine — Questions 1–20
1.
A 58-year-old male with a 40-pack-year smoking history presents with progressive
dyspnea on exertion, chronic productive cough, and wheezing. Spirometry shows
FEV1/FVC ratio of 0.62. What is the most likely diagnosis?
A. Asthma
B. COPD
C. Bronchiectasis
D. Interstitial lung disease
Correct Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio <0.70 confirms obstructive lung
disease. In a patient with significant smoking history and chronic symptoms, COPD is the
most likely diagnosis.
High-Yield Takeaway: FEV1/FVC <0.70 = obstructive; smoking history + chronic
symptoms = COPD.
2.
A 65-year-old female with atrial fibrillation has a CHA2DS2-VASc score of 4. What is the
most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Warfarin with INR goal 2–3
,C. Clopidogrel 75 mg daily
D. No anticoagulation
Correct Answer: B
Rationale: CHA2DS2-VASc ≥2 in women or ≥1 in men warrants anticoagulation.
Warfarin or a DOAC is recommended. Aspirin is insufficient for stroke prevention in AF.
High-Yield Takeaway: CHA2DS2-VASc ≥2 = anticoagulate with warfarin or DOAC.
3.
A 55-year-old male presents with crushing chest pain radiating to the left arm and
diaphoresis. ECG shows ST elevation in leads V1–V4. Which coronary artery is most likely
occluded?
A. Right coronary artery
B. Left circumflex artery
C. Left anterior descending artery
D. Left main coronary artery
Correct Answer: C
Rationale: Leads V1–V4 are anterior precordial leads. The left anterior descending (LAD)
artery supplies the anterior wall of the left ventricle.
High-Yield Takeaway: V1–V4 = anterior MI = LAD.
4.
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is elevated, free T4 is low. What is the most common cause of this
condition in the United States?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Iodine deficiency
D. Pituitary adenoma
,Correct Answer: B
Rationale: Hashimoto's thyroiditis (chronic autoimmune thyroiditis) is the most
common cause of primary hypothyroidism in the US.
High-Yield Takeaway: Primary hypothyroidism #1 cause = Hashimoto's thyroiditis.
5.
A 60-year-old male with type 2 diabetes has an eGFR of 38 mL/min. Which oral
antidiabetic medication should be avoided?
A. Glipizide
B. Metformin
C. Pioglitazone
D. Sitagliptin
Correct Answer: B
Rationale: Metformin is contraindicated when eGFR <30 mL/min and should be used
with caution when eGFR is 30–45 due to the risk of lactic acidosis.
High-Yield Takeaway: Metformin contraindicated if eGFR <30.
6.
A 70-year-old male presents with sudden onset of severe tearing chest pain radiating to
the back. BP is 190/100 mmHg. CT angiography confirms the diagnosis. What is the
most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Sudden severe tearing chest pain radiating to the back with severe
hypertension is classic for aortic dissection. CT angiography is the gold standard for
, diagnosis.
High-Yield Takeaway: Tearing chest pain + unequal BP = aortic dissection.
7.
A 55-year-old male with cirrhosis presents with confusion, asterixis, and fetor hepaticus.
What is the most likely diagnosis?
A. Hepatic encephalopathy
B. Wernicke's encephalopathy
C. Delirium tremens
D. Subdural hematoma
Correct Answer: A
Rationale: Hepatic encephalopathy presents with confusion, asterixis (flapping tremor),
and fetor hepaticus (musty breath) due to ammonia accumulation.
High-Yield Takeaway: Cirrhosis + confusion + asterixis = hepatic encephalopathy.
8.
A 30-year-old female presents with a butterfly rash on her face, arthralgias, and fatigue.
Which autoantibody is most specific for this condition?
A. Anti-CCP
B. Anti-dsDNA
C. Rheumatoid factor
D. Anti-SSA
Correct Answer: B
Rationale: Anti-double-stranded DNA (anti-dsDNA) is highly specific for systemic lupus
erythematosus (SLE) and correlates with disease activity.
High-Yield Takeaway: Anti-dsDNA = specific for SLE.
