ALL THE COMSAE | ACTUAL EXAM 2025 LATEST UPDATED | COMPLETE
QUESTIONS WITH 100% RATED CORRECT ANSWERS PLUS WELL
DETAILED AND ELABORATE RATIONALES | GET IT A+
Question 1
A 78-year-old woman is brought to the clinic by her daughter due to progressive memory loss
and cognitive decline. The daughter reports her mother frequently gets lost, forgets recent
conversations, and struggles with daily tasks. A neurological workup suggests Alzheimer's
disease. This condition is most associated with a deficiency of which neurotransmitter and in
which key brain region?
A) Dopamine in the substantia nigra
B) Serotonin in the raphe nuclei
C) Acetylcholine in the basal nucleus of Meynert
D) GABA in the striatum
E) Norepinephrine in the locus coeruleus
Correct Answer: C) Acetylcholine in the basal nucleus of Meynert
Rationale: Alzheimer's disease is characterized by a marked decrease in acetylcholine levels,
primarily resulting from a deficiency of choline acetyltransferase. This deficiency is most
notable in the basal nucleus of Meynert and the hippocampus, two brain regions critically
involved in memory and cognition.
Question 2
A patient who recently underwent a total thyroidectomy presents with perioral numbness and
muscle cramps. During the physical exam, the physician inflates a blood pressure cuff on the
patient's arm and observes a carpal spasm. What is the name of this clinical sign?
A) Chvostek's sign
B) Trousseau's sign
C) Trousseau's syndrome
D) Homans' sign
E) Kernig's sign
,Correct Answer: B) Trousseau's sign
Rationale: Trousseau's sign is the induction of carpal spasm by inflating a blood pressure cuff
above systolic pressure for a few minutes. It indicates latent tetany and is a classic sign of
hypocalcemia, which can occur post-thyroidectomy due to iatrogenic hypoparathyroidism.
Question 3
A patient presents with a history of recurrent kidney stones and bone pain. Labs reveal
hypocalcemia and elevated PTH levels. Physical exam shows a short stature and
characteristically shortened 4th and 5th metacarpals. This constellation of findings is most
consistent with which condition?
A) Primary hyperparathyroidism
B) Hypoparathyroidism
C) Pseudohypoparathyroidism
D) Vitamin D deficiency
E) McCune-Albright Syndrome
Correct Answer: C) Pseudohypoparathyroidism
Rationale: This describes Albright's hereditary osteodystrophy, a feature of
pseudohypoparathyroidism. The condition is characterized by end-organ (kidney)
unresponsiveness to PTH, leading to hypocalcemia and hyperphosphatemia despite elevated
PTH levels. The physical deformities, like shortened digits, are classic.
Question 4
A 65-year-old male with a history of chronic pancreatitis presents with redness, tenderness, and
swelling in his left calf. Last month, he had similar symptoms in his right thigh that resolved
spontaneously. This presentation of a migratory thrombophlebitis is known as Trousseau's
syndrome and is strongly associated with what underlying condition?
A) Liver cirrhosis
B) A visceral malignancy
C) Systemic lupus erythematosus
, D) Factor V Leiden mutation
E) Congestive heart failure
Correct Answer: B) A visceral malignancy
Rationale: Trousseau's syndrome, or migratory thrombophlebitis, is a paraneoplastic
syndrome. It is most commonly associated with a visceral adenocarcinoma, particularly of the
pancreas, but also of the colon or lung. The malignancy creates a hypercoagulable state.
Question 5
A 55-year-old male, a heavy smoker and drinker, is hospitalized after presenting with high fever,
cough, confusion, and diarrhea. A chest X-ray shows a lobar pneumonia, and lab tests reveal
hyponatremia. A urinary antigen test is positive. What is the most appropriate antibiotic
treatment for this patient's condition?
A) Penicillin G
B) Trimethoprim-sulfamethoxazole
C) A respiratory fluoroquinolone
D) Vancomycin
E) Metronidazole
Correct Answer: C) A respiratory fluoroquinolone
Rationale: The combination of pneumonia, gastrointestinal symptoms (diarrhea), and
neurological symptoms (confusion) in a patient with exposure risk factors is classic for
Legionnaires' disease, caused by Legionella pneumophila. The treatment of choice is a
respiratory fluoroquinolone (e.g., levofloxacin) or a macrolide (e.g., azithromycin).
Question 6
A 9-year-old girl is evaluated for early onset of puberty. Physical exam reveals several large,
unilateral café-au-lait spots with irregular borders. A skeletal survey shows multiple unilateral
bone lesions consistent with polyostotic fibrous dysplasia. What is the most likely diagnosis?
A) Neurofibromatosis type 1
B) Tuberous sclerosis
C) Von Hippel-Lindau disease
QUESTIONS WITH 100% RATED CORRECT ANSWERS PLUS WELL
DETAILED AND ELABORATE RATIONALES | GET IT A+
Question 1
A 78-year-old woman is brought to the clinic by her daughter due to progressive memory loss
and cognitive decline. The daughter reports her mother frequently gets lost, forgets recent
conversations, and struggles with daily tasks. A neurological workup suggests Alzheimer's
disease. This condition is most associated with a deficiency of which neurotransmitter and in
which key brain region?
A) Dopamine in the substantia nigra
B) Serotonin in the raphe nuclei
C) Acetylcholine in the basal nucleus of Meynert
D) GABA in the striatum
E) Norepinephrine in the locus coeruleus
Correct Answer: C) Acetylcholine in the basal nucleus of Meynert
Rationale: Alzheimer's disease is characterized by a marked decrease in acetylcholine levels,
primarily resulting from a deficiency of choline acetyltransferase. This deficiency is most
notable in the basal nucleus of Meynert and the hippocampus, two brain regions critically
involved in memory and cognition.
Question 2
A patient who recently underwent a total thyroidectomy presents with perioral numbness and
muscle cramps. During the physical exam, the physician inflates a blood pressure cuff on the
patient's arm and observes a carpal spasm. What is the name of this clinical sign?
A) Chvostek's sign
B) Trousseau's sign
C) Trousseau's syndrome
D) Homans' sign
E) Kernig's sign
,Correct Answer: B) Trousseau's sign
Rationale: Trousseau's sign is the induction of carpal spasm by inflating a blood pressure cuff
above systolic pressure for a few minutes. It indicates latent tetany and is a classic sign of
hypocalcemia, which can occur post-thyroidectomy due to iatrogenic hypoparathyroidism.
Question 3
A patient presents with a history of recurrent kidney stones and bone pain. Labs reveal
hypocalcemia and elevated PTH levels. Physical exam shows a short stature and
characteristically shortened 4th and 5th metacarpals. This constellation of findings is most
consistent with which condition?
A) Primary hyperparathyroidism
B) Hypoparathyroidism
C) Pseudohypoparathyroidism
D) Vitamin D deficiency
E) McCune-Albright Syndrome
Correct Answer: C) Pseudohypoparathyroidism
Rationale: This describes Albright's hereditary osteodystrophy, a feature of
pseudohypoparathyroidism. The condition is characterized by end-organ (kidney)
unresponsiveness to PTH, leading to hypocalcemia and hyperphosphatemia despite elevated
PTH levels. The physical deformities, like shortened digits, are classic.
Question 4
A 65-year-old male with a history of chronic pancreatitis presents with redness, tenderness, and
swelling in his left calf. Last month, he had similar symptoms in his right thigh that resolved
spontaneously. This presentation of a migratory thrombophlebitis is known as Trousseau's
syndrome and is strongly associated with what underlying condition?
A) Liver cirrhosis
B) A visceral malignancy
C) Systemic lupus erythematosus
, D) Factor V Leiden mutation
E) Congestive heart failure
Correct Answer: B) A visceral malignancy
Rationale: Trousseau's syndrome, or migratory thrombophlebitis, is a paraneoplastic
syndrome. It is most commonly associated with a visceral adenocarcinoma, particularly of the
pancreas, but also of the colon or lung. The malignancy creates a hypercoagulable state.
Question 5
A 55-year-old male, a heavy smoker and drinker, is hospitalized after presenting with high fever,
cough, confusion, and diarrhea. A chest X-ray shows a lobar pneumonia, and lab tests reveal
hyponatremia. A urinary antigen test is positive. What is the most appropriate antibiotic
treatment for this patient's condition?
A) Penicillin G
B) Trimethoprim-sulfamethoxazole
C) A respiratory fluoroquinolone
D) Vancomycin
E) Metronidazole
Correct Answer: C) A respiratory fluoroquinolone
Rationale: The combination of pneumonia, gastrointestinal symptoms (diarrhea), and
neurological symptoms (confusion) in a patient with exposure risk factors is classic for
Legionnaires' disease, caused by Legionella pneumophila. The treatment of choice is a
respiratory fluoroquinolone (e.g., levofloxacin) or a macrolide (e.g., azithromycin).
Question 6
A 9-year-old girl is evaluated for early onset of puberty. Physical exam reveals several large,
unilateral café-au-lait spots with irregular borders. A skeletal survey shows multiple unilateral
bone lesions consistent with polyostotic fibrous dysplasia. What is the most likely diagnosis?
A) Neurofibromatosis type 1
B) Tuberous sclerosis
C) Von Hippel-Lindau disease
