COMSAE Phase 2 – Form 116 (current)
Questions With Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
Download Pdf.
Course
COMSAE Phase 2 – Form 116 (current)
1. A 64-year-old man presents with sudden onset right-sided weakness
and expressive aphasia that began 90 minutes ago. CT of the head
shows no hemorrhage. Which treatment is most appropriate if there
are no contraindications?
A. Aspirin only
B. IV thrombolytic therapy
C. Heparin infusion
D. Warfarin
Answer: B. IV thrombolytic therapy
Rationale: An eligible patient with an acute ischemic stroke presenting
within the appropriate treatment window should receive IV thrombolytic
therapy after intracranial hemorrhage has been excluded. Rapid assessment
for large-vessel occlusion and mechanical thrombectomy eligibility is also
important.
2. A 27-year-old woman has episodic palpitations, diaphoresis, headache,
and severe hypertension. A pheochromocytoma is suspected. Which
biochemical test is most appropriate initially?
A. Serum cortisol
B. Plasma free metanephrines
C. Serum aldosterone
D. TSH
Answer: B. Plasma free metanephrines
Rationale: Plasma free metanephrines are highly sensitive for detecting
catecholamine excess from pheochromocytoma. The clinical combination of
episodic hypertension, headache, sweating, and palpitations should raise
suspicion.
, 3. A 22-year-old man develops fever, hypotension, diffuse erythematous
rash, and multiorgan dysfunction after several days of using tampons.
Which organism is most likely responsible?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Escherichia coli
D. Neisseria meningitidis
Answer: B. Staphylococcus aureus
Rationale: Toxic shock syndrome associated with tampon use is classically
caused by toxin-producing S. aureus. It can produce fever, hypotension,
diffuse rash, and involvement of multiple organ systems.
4. A 58-year-old woman has progressive difficulty swallowing that initially
involved solid foods and now includes liquids. Which condition should
be suspected?
A. Achalasia
B. GERD only
C. Peptic ulcer disease
D. Acute pancreatitis
Answer: A. Achalasia
Rationale: Progressive dysphagia to both solids and liquids suggests a
motility disorder such as achalasia. Mechanical obstruction typically causes
dysphagia to solids first and may later affect liquids.
5. A 19-year-old college student develops fever, headache, photophobia,
and neck stiffness. CSF demonstrates neutrophilic pleocytosis,
elevated protein, and decreased glucose. Which diagnosis is most
likely?
A. Viral meningitis
B. Bacterial meningitis
C. Multiple sclerosis
D. Migraine
Answer: B. Bacterial meningitis
Rationale: Acute bacterial meningitis classically produces neutrophil-
predominant CSF, elevated protein, and decreased glucose. Prompt empiric
antimicrobial therapy is essential when bacterial meningitis is suspected.
, 6. A patient with asthma develops acute wheezing and dyspnea after
exposure to a known allergen. Which medication provides rapid
bronchodilation?
A. Montelukast
B. Albuterol
C. Fluticasone
D. Tiotropium
Answer: B. Albuterol
Rationale: Albuterol is a short-acting beta2-adrenergic agonist that rapidly
relaxes bronchial smooth muscle. Inhaled corticosteroids are controller
medications and do not provide immediate bronchodilation.
7. A 72-year-old woman presents with a new unilateral temporal
headache, jaw pain while chewing, and visual blurring. ESR and CRP
are elevated. What is the most appropriate immediate treatment?
A. Ibuprofen
B. High-dose glucocorticoids
C. Sumatriptan
D. Observation
Answer: B. High-dose glucocorticoids
Rationale: Giant cell arteritis can cause irreversible blindness from ischemic
optic neuropathy. Treatment with high-dose glucocorticoids should begin
promptly when clinical suspicion is high, even before definitive biopsy results
are available.
8. A 34-year-old woman has fatigue, weight gain, constipation, dry skin,
and cold intolerance. Laboratory testing reveals elevated TSH and low
free T4. Which diagnosis is most likely?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Cushing syndrome
Answer: A. Primary hypothyroidism
Rationale: Primary hypothyroidism results from thyroid gland dysfunction.
Low thyroid hormone causes increased pituitary TSH secretion, producing the
characteristic combination of high TSH and low free T4.
, 9. A 46-year-old man has severe epigastric pain radiating to the back and
vomiting. Serum lipase is markedly elevated. Which diagnosis is most
likely?
A. Acute pancreatitis
B. Acute appendicitis
C. Cholecystitis
D. Diverticulitis
Answer: A. Acute pancreatitis
Rationale: Severe epigastric pain radiating to the back combined with
elevated lipase is highly characteristic of acute pancreatitis. Common causes
include gallstones and alcohol use.
10. A patient with cirrhosis becomes confused and develops
asterixis. Which medication is commonly used to reduce intestinal
ammonia absorption?
A. Lactulose
B. Omeprazole
C. Metformin
D. Furosemide
Answer: A. Lactulose
Rationale: Lactulose acidifies the colonic contents and promotes conversion
of ammonia to ammonium, reducing systemic ammonia absorption. It is
commonly used to treat hepatic encephalopathy.
11. A 60-year-old smoker presents with painless hematuria. Which
diagnosis must be considered particularly strongly?
A. Bladder cancer
B. Nephrotic syndrome
C. Acute pyelonephritis
D. Renal tubular acidosis
Answer: A. Bladder cancer
Rationale: Painless gross hematuria is a classic presenting feature of
urothelial malignancy, particularly in older adults with significant tobacco
exposure.
12. A patient with nephrotic syndrome develops generalized edema.
Which laboratory abnormality is expected?
Questions With Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
Download Pdf.
Course
COMSAE Phase 2 – Form 116 (current)
1. A 64-year-old man presents with sudden onset right-sided weakness
and expressive aphasia that began 90 minutes ago. CT of the head
shows no hemorrhage. Which treatment is most appropriate if there
are no contraindications?
A. Aspirin only
B. IV thrombolytic therapy
C. Heparin infusion
D. Warfarin
Answer: B. IV thrombolytic therapy
Rationale: An eligible patient with an acute ischemic stroke presenting
within the appropriate treatment window should receive IV thrombolytic
therapy after intracranial hemorrhage has been excluded. Rapid assessment
for large-vessel occlusion and mechanical thrombectomy eligibility is also
important.
2. A 27-year-old woman has episodic palpitations, diaphoresis, headache,
and severe hypertension. A pheochromocytoma is suspected. Which
biochemical test is most appropriate initially?
A. Serum cortisol
B. Plasma free metanephrines
C. Serum aldosterone
D. TSH
Answer: B. Plasma free metanephrines
Rationale: Plasma free metanephrines are highly sensitive for detecting
catecholamine excess from pheochromocytoma. The clinical combination of
episodic hypertension, headache, sweating, and palpitations should raise
suspicion.
, 3. A 22-year-old man develops fever, hypotension, diffuse erythematous
rash, and multiorgan dysfunction after several days of using tampons.
Which organism is most likely responsible?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Escherichia coli
D. Neisseria meningitidis
Answer: B. Staphylococcus aureus
Rationale: Toxic shock syndrome associated with tampon use is classically
caused by toxin-producing S. aureus. It can produce fever, hypotension,
diffuse rash, and involvement of multiple organ systems.
4. A 58-year-old woman has progressive difficulty swallowing that initially
involved solid foods and now includes liquids. Which condition should
be suspected?
A. Achalasia
B. GERD only
C. Peptic ulcer disease
D. Acute pancreatitis
Answer: A. Achalasia
Rationale: Progressive dysphagia to both solids and liquids suggests a
motility disorder such as achalasia. Mechanical obstruction typically causes
dysphagia to solids first and may later affect liquids.
5. A 19-year-old college student develops fever, headache, photophobia,
and neck stiffness. CSF demonstrates neutrophilic pleocytosis,
elevated protein, and decreased glucose. Which diagnosis is most
likely?
A. Viral meningitis
B. Bacterial meningitis
C. Multiple sclerosis
D. Migraine
Answer: B. Bacterial meningitis
Rationale: Acute bacterial meningitis classically produces neutrophil-
predominant CSF, elevated protein, and decreased glucose. Prompt empiric
antimicrobial therapy is essential when bacterial meningitis is suspected.
, 6. A patient with asthma develops acute wheezing and dyspnea after
exposure to a known allergen. Which medication provides rapid
bronchodilation?
A. Montelukast
B. Albuterol
C. Fluticasone
D. Tiotropium
Answer: B. Albuterol
Rationale: Albuterol is a short-acting beta2-adrenergic agonist that rapidly
relaxes bronchial smooth muscle. Inhaled corticosteroids are controller
medications and do not provide immediate bronchodilation.
7. A 72-year-old woman presents with a new unilateral temporal
headache, jaw pain while chewing, and visual blurring. ESR and CRP
are elevated. What is the most appropriate immediate treatment?
A. Ibuprofen
B. High-dose glucocorticoids
C. Sumatriptan
D. Observation
Answer: B. High-dose glucocorticoids
Rationale: Giant cell arteritis can cause irreversible blindness from ischemic
optic neuropathy. Treatment with high-dose glucocorticoids should begin
promptly when clinical suspicion is high, even before definitive biopsy results
are available.
8. A 34-year-old woman has fatigue, weight gain, constipation, dry skin,
and cold intolerance. Laboratory testing reveals elevated TSH and low
free T4. Which diagnosis is most likely?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Cushing syndrome
Answer: A. Primary hypothyroidism
Rationale: Primary hypothyroidism results from thyroid gland dysfunction.
Low thyroid hormone causes increased pituitary TSH secretion, producing the
characteristic combination of high TSH and low free T4.
, 9. A 46-year-old man has severe epigastric pain radiating to the back and
vomiting. Serum lipase is markedly elevated. Which diagnosis is most
likely?
A. Acute pancreatitis
B. Acute appendicitis
C. Cholecystitis
D. Diverticulitis
Answer: A. Acute pancreatitis
Rationale: Severe epigastric pain radiating to the back combined with
elevated lipase is highly characteristic of acute pancreatitis. Common causes
include gallstones and alcohol use.
10. A patient with cirrhosis becomes confused and develops
asterixis. Which medication is commonly used to reduce intestinal
ammonia absorption?
A. Lactulose
B. Omeprazole
C. Metformin
D. Furosemide
Answer: A. Lactulose
Rationale: Lactulose acidifies the colonic contents and promotes conversion
of ammonia to ammonium, reducing systemic ammonia absorption. It is
commonly used to treat hepatic encephalopathy.
11. A 60-year-old smoker presents with painless hematuria. Which
diagnosis must be considered particularly strongly?
A. Bladder cancer
B. Nephrotic syndrome
C. Acute pyelonephritis
D. Renal tubular acidosis
Answer: A. Bladder cancer
Rationale: Painless gross hematuria is a classic presenting feature of
urothelial malignancy, particularly in older adults with significant tobacco
exposure.
12. A patient with nephrotic syndrome develops generalized edema.
Which laboratory abnormality is expected?
