COMSAE PHASE 2 – FORM 109 PRACTICE EXAM QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026/2027 Q&A | INSTANT DOWNLOAD PDF
1. A 45-year-old man presents with sudden severe chest pain radiating to his
back. BP is 90/60 mmHg. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Rationale: Sudden tearing chest pain radiating to the back with hypotension is
classic for aortic dissection.
2. A patient with type 1 diabetes presents with polyuria, polydipsia, and fruity
breath. Blood glucose is 480 mg/dL, pH 7.1. What is the first step in
management?
A. Start oral hypoglycemics
B. Administer subcutaneous insulin
C. IV fluids and insulin
D. Give potassium immediately
Rationale: Diabetic ketoacidosis requires IV fluids and insulin. Electrolytes are
corrected as needed.
3. Which of the following is a contraindication to thrombolytic therapy in
stroke?
A. Age > 80
B. Recent intracranial hemorrhage
C. Hypertension
D. Diabetes
Rationale: Recent intracranial bleeding is an absolute contraindication.
4. A 60-year-old man has progressive difficulty speaking, right-sided
weakness, and right facial droop. Imaging shows an infarct in the left
middle cerebral artery. Which deficit is expected?
A. Left-sided neglect
, B. Right-sided hemiplegia and aphasia
C. Bilateral visual loss
D. Left-sided hemiplegia
Rationale: Left MCA stroke causes right hemiplegia and, if dominant hemisphere,
aphasia.
5. Which of the following bacteria is most commonly associated with infective
endocarditis in IV drug users?
A. Streptococcus viridans
B. Staphylococcus aureus
C. Enterococcus faecalis
D. Pseudomonas aeruginosa
Rationale: IV drug users commonly get S. aureus right-sided endocarditis.
6. A 30-year-old woman presents with fatigue, pallor, and spoon-shaped nails.
Labs show microcytic hypochromic anemia. What is the most likely cause?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Folate deficiency
D. Aplastic anemia
Rationale: Microcytic anemia with pallor and spoon nails is classic for iron
deficiency.
7. A patient presents with sudden onset shortness of breath and pleuritic
chest pain. He has a history of DVT. Which test is most appropriate to
confirm the diagnosis?
A. Chest X-ray
B. ECG
C. CT pulmonary angiography
D. Echocardiogram
Rationale: CT pulmonary angiography is the gold standard for pulmonary
embolism diagnosis.
8. A 55-year-old man with hypertension presents with severe headache and
vomiting. BP is 220/120 mmHg. Fundoscopy shows papilledema. What is
, the immediate management?
A. IV antihypertensives (e.g., labetalol, nitroprusside)
B. Oral antihypertensives
C. Start diuretics
D. Observation
Rationale: Hypertensive emergency with end-organ damage requires IV
antihypertensives.
9. Which of the following is the first-line treatment for newly diagnosed
essential hypertension in a patient with diabetes?
A. Beta-blockers
B. ACE inhibitors or ARBs
C. Calcium channel blockers
D. Thiazide diuretics
Rationale: ACE inhibitors or ARBs protect kidneys and are preferred in diabetic
patients.
10.A patient presents with fever, cough, and rust-colored sputum. Chest X-ray
shows lobar consolidation. What is the most likely pathogen?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
C. Mycoplasma pneumoniae
D. Legionella pneumophila
Rationale: Lobar pneumonia with rust-colored sputum is classic for S.
pneumoniae.
11.A 24-year-old woman presents with fatigue, jaundice, and dark urine. Labs
show positive anti-smooth muscle antibodies. Most likely diagnosis?
A. Autoimmune hepatitis
B. Hepatitis B
C. Wilson’s disease
D. Hemochromatosis
Rationale: Positive anti-smooth muscle antibodies indicate autoimmune hepatitis.
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026/2027 Q&A | INSTANT DOWNLOAD PDF
1. A 45-year-old man presents with sudden severe chest pain radiating to his
back. BP is 90/60 mmHg. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Rationale: Sudden tearing chest pain radiating to the back with hypotension is
classic for aortic dissection.
2. A patient with type 1 diabetes presents with polyuria, polydipsia, and fruity
breath. Blood glucose is 480 mg/dL, pH 7.1. What is the first step in
management?
A. Start oral hypoglycemics
B. Administer subcutaneous insulin
C. IV fluids and insulin
D. Give potassium immediately
Rationale: Diabetic ketoacidosis requires IV fluids and insulin. Electrolytes are
corrected as needed.
3. Which of the following is a contraindication to thrombolytic therapy in
stroke?
A. Age > 80
B. Recent intracranial hemorrhage
C. Hypertension
D. Diabetes
Rationale: Recent intracranial bleeding is an absolute contraindication.
4. A 60-year-old man has progressive difficulty speaking, right-sided
weakness, and right facial droop. Imaging shows an infarct in the left
middle cerebral artery. Which deficit is expected?
A. Left-sided neglect
, B. Right-sided hemiplegia and aphasia
C. Bilateral visual loss
D. Left-sided hemiplegia
Rationale: Left MCA stroke causes right hemiplegia and, if dominant hemisphere,
aphasia.
5. Which of the following bacteria is most commonly associated with infective
endocarditis in IV drug users?
A. Streptococcus viridans
B. Staphylococcus aureus
C. Enterococcus faecalis
D. Pseudomonas aeruginosa
Rationale: IV drug users commonly get S. aureus right-sided endocarditis.
6. A 30-year-old woman presents with fatigue, pallor, and spoon-shaped nails.
Labs show microcytic hypochromic anemia. What is the most likely cause?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Folate deficiency
D. Aplastic anemia
Rationale: Microcytic anemia with pallor and spoon nails is classic for iron
deficiency.
7. A patient presents with sudden onset shortness of breath and pleuritic
chest pain. He has a history of DVT. Which test is most appropriate to
confirm the diagnosis?
A. Chest X-ray
B. ECG
C. CT pulmonary angiography
D. Echocardiogram
Rationale: CT pulmonary angiography is the gold standard for pulmonary
embolism diagnosis.
8. A 55-year-old man with hypertension presents with severe headache and
vomiting. BP is 220/120 mmHg. Fundoscopy shows papilledema. What is
, the immediate management?
A. IV antihypertensives (e.g., labetalol, nitroprusside)
B. Oral antihypertensives
C. Start diuretics
D. Observation
Rationale: Hypertensive emergency with end-organ damage requires IV
antihypertensives.
9. Which of the following is the first-line treatment for newly diagnosed
essential hypertension in a patient with diabetes?
A. Beta-blockers
B. ACE inhibitors or ARBs
C. Calcium channel blockers
D. Thiazide diuretics
Rationale: ACE inhibitors or ARBs protect kidneys and are preferred in diabetic
patients.
10.A patient presents with fever, cough, and rust-colored sputum. Chest X-ray
shows lobar consolidation. What is the most likely pathogen?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
C. Mycoplasma pneumoniae
D. Legionella pneumophila
Rationale: Lobar pneumonia with rust-colored sputum is classic for S.
pneumoniae.
11.A 24-year-old woman presents with fatigue, jaundice, and dark urine. Labs
show positive anti-smooth muscle antibodies. Most likely diagnosis?
A. Autoimmune hepatitis
B. Hepatitis B
C. Wilson’s disease
D. Hemochromatosis
Rationale: Positive anti-smooth muscle antibodies indicate autoimmune hepatitis.
