COMSAE Phase 2 – BSA 119 (2026 Update): Advanced
Practice Exam | High Yield COMLEX Level Question
2026/2027 WITH COMPLETE QUESTIONS AND CORRECT
ANSWERS RATED A+
Section I — Clinical Medicine, Diagnosis & Management
A 68-year-old man presents with crushing substernal chest pain and diaphoresis.
ECG shows ST-segment elevations in leads II, III, and aVF. He is hypotensive with
elevated jugular venous pressure and clear lung fields. Which complication is most
likely?
A) Acute left ventricular failure
B) Right ventricular infarction
C) Papillary muscle rupture
D) Ventricular septal rupture
✓✓ Correct Answer: B) Right ventricular infarction
Rationale:
An inferior myocardial infarction accompanied by hypotension, elevated JVP, and
clear lungs strongly suggests right ventricular involvement. The right coronary
artery commonly supplies the right ventricle. Loss of right ventricular contractility
decreases pulmonary blood flow and left-sided preload, producing hypotension
without pulmonary edema.
A 54-year-old woman presents with fatigue, constipation, and cold intolerance.
TSH is markedly elevated and free T4 is decreased. Which finding is most likely?
A) Hyperreflexia
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,B) Increased intestinal motility
C) Delayed relaxation of deep tendon reflexes
D) Increased basal metabolic rate
✓✓ Correct Answer: C) Delayed relaxation of deep tendon reflexes
Rationale:
Primary hypothyroidism produces decreased metabolic activity, constipation, cold
intolerance, bradycardia, and delayed relaxation of deep tendon reflexes. The
elevated TSH indicates primary thyroid failure. Hyperreflexia and increased
metabolic activity are more consistent with thyrotoxicosis.
A 23-year-old woman develops acute unilateral lower abdominal pain and vaginal
spotting. Pregnancy testing is positive. Transvaginal ultrasound shows no
intrauterine pregnancy and a complex adnexal mass. Which diagnosis is most
likely?
A) Ectopic pregnancy
B) Placenta previa
C) Ovarian torsion
D) Endometriosis
✓✓ Correct Answer: A) Ectopic pregnancy
Rationale:
A positive pregnancy test combined with abdominal pain, vaginal bleeding, and
absence of an intrauterine gestational sac when one should be visible raises
strong concern for ectopic pregnancy. Most ectopic pregnancies occur in the
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,fallopian tube. Hemodynamic instability or evidence of rupture requires urgent
intervention.
A 72-year-old man presents with fever, confusion, and hypotension. He has a
urinary source of infection and laboratory evidence of elevated serum lactate.
Which process best explains his hypotension?
A) Increased systemic vascular resistance
B) Widespread pathologic vasodilation
C) Increased oncotic pressure
D) Decreased capillary permeability
✓✓ Correct Answer: B) Widespread pathologic vasodilation
Rationale:
Septic shock involves profound inflammatory activation with systemic
vasodilation, endothelial dysfunction, and abnormal tissue perfusion. The
resulting decrease in systemic vascular resistance can produce severe hypotension
despite compensatory increases in cardiac output early in the course.
A 46-year-old man develops sudden severe dyspnea and pleuritic chest pain after
prolonged immobilization. Heart rate is 122/min and oxygen saturation is 88%.
Which finding would most strongly support pulmonary embolism?
A) Diffuse bilateral crackles
B) Pleuritic chest pain with unexplained tachycardia
C) Productive cough with purulent sputum
D) Slow respiratory rate
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, ✓✓ Correct Answer: B) Pleuritic chest pain with unexplained tachycardia
Rationale:
Pulmonary embolism often presents with acute dyspnea, tachycardia, pleuritic
chest pain, and hypoxemia. Prolonged immobilization increases venous
thromboembolism risk. Clinical probability assessment guides subsequent
diagnostic testing.
A 35-year-old woman has recurrent episodes of wheezing, cough, and chest
tightness that worsen at night and after exercise. Spirometry demonstrates
reversible airflow obstruction. Which diagnosis is most likely?
A) Asthma
B) Emphysema
C) Pulmonary fibrosis
D) Bronchiectasis
✓✓ Correct Answer: A) Asthma
Rationale:
Asthma is characterized by variable respiratory symptoms and reversible airflow
obstruction caused by airway inflammation and hyperresponsiveness. Symptoms
may be triggered by exercise, allergens, viral infections, or environmental
exposures. The reversibility distinguishes asthma from many fixed obstructive lung
disorders.
A 61-year-old woman develops sudden right-sided weakness and expressive
language difficulty. Which vascular territory is most likely affected?
A) Left middle cerebral artery
B) Right posterior cerebral artery
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Practice Exam | High Yield COMLEX Level Question
2026/2027 WITH COMPLETE QUESTIONS AND CORRECT
ANSWERS RATED A+
Section I — Clinical Medicine, Diagnosis & Management
A 68-year-old man presents with crushing substernal chest pain and diaphoresis.
ECG shows ST-segment elevations in leads II, III, and aVF. He is hypotensive with
elevated jugular venous pressure and clear lung fields. Which complication is most
likely?
A) Acute left ventricular failure
B) Right ventricular infarction
C) Papillary muscle rupture
D) Ventricular septal rupture
✓✓ Correct Answer: B) Right ventricular infarction
Rationale:
An inferior myocardial infarction accompanied by hypotension, elevated JVP, and
clear lungs strongly suggests right ventricular involvement. The right coronary
artery commonly supplies the right ventricle. Loss of right ventricular contractility
decreases pulmonary blood flow and left-sided preload, producing hypotension
without pulmonary edema.
A 54-year-old woman presents with fatigue, constipation, and cold intolerance.
TSH is markedly elevated and free T4 is decreased. Which finding is most likely?
A) Hyperreflexia
Page 1 of 142
,B) Increased intestinal motility
C) Delayed relaxation of deep tendon reflexes
D) Increased basal metabolic rate
✓✓ Correct Answer: C) Delayed relaxation of deep tendon reflexes
Rationale:
Primary hypothyroidism produces decreased metabolic activity, constipation, cold
intolerance, bradycardia, and delayed relaxation of deep tendon reflexes. The
elevated TSH indicates primary thyroid failure. Hyperreflexia and increased
metabolic activity are more consistent with thyrotoxicosis.
A 23-year-old woman develops acute unilateral lower abdominal pain and vaginal
spotting. Pregnancy testing is positive. Transvaginal ultrasound shows no
intrauterine pregnancy and a complex adnexal mass. Which diagnosis is most
likely?
A) Ectopic pregnancy
B) Placenta previa
C) Ovarian torsion
D) Endometriosis
✓✓ Correct Answer: A) Ectopic pregnancy
Rationale:
A positive pregnancy test combined with abdominal pain, vaginal bleeding, and
absence of an intrauterine gestational sac when one should be visible raises
strong concern for ectopic pregnancy. Most ectopic pregnancies occur in the
Page 2 of 142
,fallopian tube. Hemodynamic instability or evidence of rupture requires urgent
intervention.
A 72-year-old man presents with fever, confusion, and hypotension. He has a
urinary source of infection and laboratory evidence of elevated serum lactate.
Which process best explains his hypotension?
A) Increased systemic vascular resistance
B) Widespread pathologic vasodilation
C) Increased oncotic pressure
D) Decreased capillary permeability
✓✓ Correct Answer: B) Widespread pathologic vasodilation
Rationale:
Septic shock involves profound inflammatory activation with systemic
vasodilation, endothelial dysfunction, and abnormal tissue perfusion. The
resulting decrease in systemic vascular resistance can produce severe hypotension
despite compensatory increases in cardiac output early in the course.
A 46-year-old man develops sudden severe dyspnea and pleuritic chest pain after
prolonged immobilization. Heart rate is 122/min and oxygen saturation is 88%.
Which finding would most strongly support pulmonary embolism?
A) Diffuse bilateral crackles
B) Pleuritic chest pain with unexplained tachycardia
C) Productive cough with purulent sputum
D) Slow respiratory rate
Page 3 of 142
, ✓✓ Correct Answer: B) Pleuritic chest pain with unexplained tachycardia
Rationale:
Pulmonary embolism often presents with acute dyspnea, tachycardia, pleuritic
chest pain, and hypoxemia. Prolonged immobilization increases venous
thromboembolism risk. Clinical probability assessment guides subsequent
diagnostic testing.
A 35-year-old woman has recurrent episodes of wheezing, cough, and chest
tightness that worsen at night and after exercise. Spirometry demonstrates
reversible airflow obstruction. Which diagnosis is most likely?
A) Asthma
B) Emphysema
C) Pulmonary fibrosis
D) Bronchiectasis
✓✓ Correct Answer: A) Asthma
Rationale:
Asthma is characterized by variable respiratory symptoms and reversible airflow
obstruction caused by airway inflammation and hyperresponsiveness. Symptoms
may be triggered by exercise, allergens, viral infections, or environmental
exposures. The reversibility distinguishes asthma from many fixed obstructive lung
disorders.
A 61-year-old woman develops sudden right-sided weakness and expressive
language difficulty. Which vascular territory is most likely affected?
A) Left middle cerebral artery
B) Right posterior cerebral artery
Page 4 of 142
