COMSAE-1 2025 Simulated Exam: 100 High-Yield
USMLE/COMLEX-Style Questions with Answers and
Rationales – Basic Sciences, Clinical Medicine, and
Osteopathic Principles Review
Hyperimmunoglobulinemia E (Job syndrome)
An autosomal dominant condition characterized by the triad of eczema, eosinophilia, and
recurrent skin and pulmonary infections.
It is also associated with multiple connective tissue and skeletal abnormalities, including
scoliosis, hyperextensibility, pathologic fractures, retained primary dentition, craniosynostosis,
and vascular abnormalities
Small Cell Carcinoma of the Lung
Central lesion that's typically metastasized at the time of diagnosis. It's too small to be seen on
X-ray so it requires a *CT scan to make the diagnosis*. EBUS with Biopsy confirms the diagnosis.
The tumor should NOT be resected; it's exquisitely *sensitive to chemo*.
Because it's a *neuroendocrine tumor* it can produce ADH (SIADH) or ACTH (Cushing's).
*Eaton-Lambert paraneoplastic syndrome*.
It does not get large enough to cause obstructive pneumonias or hemoptysis.
Facial Nerve (CN VII)
Nerve of facial expression and the one affected during Bells Palsy. It is responsible for eye
closure, facial expression, partial taste, and salivation. It originates in the pons and exits the
skull via the internal auditory meatus, along with the vestibulocochlear nerve (CN VIII) where it
innervates areas of the face, tongue, and salivary glands. The facial nerve then courses through
the facial canal, exits through the stylomastoid foramen, and penetrates the parotid gland to
divide into its respective branches: temporal, zygomatic, buccal, mandibular, and cervical.
,Foramen Magnum
Contains spinal roots of the accessory nerve, the brainstem, and the vertebral arteries.
Foramen Ovale
Contains spinal roots of the accessory nerve, the brainstem, and the vertebral arteries.
Foramen Rotundum
contains the maxillary branch of the trigeminal nerve, which is involved in facial sensation, not
facial movement.
Jugular Foramen
contains the jugular vein and the glossopharyngeal, vagus, and accessory nerves.
Thalamus: Medial geniculate nucleus
It receives auditory input from the superior olive and inferior colliculus of tectum and directs
the information to the auditory cortex of the temporal lobe
Thalamus: Lateral Geniculate Nucleus
It receives visual input and sends information to the visual cortex of the occipital lobe.
Thalamus: lateral part of the ventral posterior nucleus
It functions in body sensation such as touch, pressure, vibration, and pain that is directed from
the dorsal columns of the spinal cord to the primary somatosensory cortex
Thalamus: medial part of the ventral posterior nucleus
It relays facial sensation supplied by the trigeminal nerve to the primary somatosensory cortex.
Thalamus: ventral anterior nucleus
It is involved in motor signals, mostly from the basal ganglia and cerebellum, and distributes
them to the motor cortex of the frontal lobe.
Epiglottitis
An acute inflammation of the supraglottic region of the oropharynx, specifically involving the
epiglottis, vallecula, arytenoids, and aryepiglottic folds. The presentation usually involves a
fever, sore throat, odynophagia/dysphagia, and a muffled voice (“hot potato voice”). Young
children classically present with respiratory distress, anxiety, and the characteristic “tripod”,
“sniffing”, "or catcher's stance" position. Leaning forward in a seated position, hyperextension
of the neck, and thrusting the jaw forward are positional accommodations for obstructed
, airways. The hallmarks of epiglottis in children consist of “the three D’s” which are dysphagia,
drooling, and distress. Children with epiglottitis generally lack hoarseness, cough, and stridor
until late in the disease process. Epiglottitis is a medical emergency. Swelling of the epiglottis on
lateral x-ray is known at the “thumb sign”. Stable patients may be placed on the appropriate
antibiotics and monitored in the intensive care unit. Unstable patients require immediate
restoration of the airway.
Antiarrhythmic drugs CI and adverse effects
Primary Hyperparathyroidism
most likely due to a parathyroid adenoma (causes 80-85%). Other causes include parathyroid
hyperplasia (15-20% of cases) or parathyroid carcinoma (<1% of cases). PTH acts primarily by
stimulating adenylate cyclase and generating cyclic adenosine monophosphate
(cAMP). Elevated cAMP promotes increased bone resorption of calcium and phosphate,
increased renal reabsorption of calcium (in ascending loop, distal tubule, and collecting tubule)
and decreased renal reabsorption of phosphate (in proximal tubule). Therefore, elevated
parathyroid hormone (PTH) levels with normal renal function results in hypercalcemia coupled
with hypophosphatemia in the setting of elevated serum alkaline phosphatase. Patients may
present with kidney stones, bone aches and pains, muscle pain, weakness, constipation, gout,
or psychological disturbances (depression, fatigue, anxiety)
PTH also stimulates 1a-hydroxylase in the kidneys to increase 1,25-(OH)2 vitamin D production,
which increases intestinal absorption and bone resorption of calcium and phosphate. PTH does
not act directly on the intestines.
Schizophreniform Disorder
It requires at least one-month history of two or more of the following symptoms: delusions,
hallucinations, disorganized speech, disorganized or catatonic behavior, and/or negative
symptoms (apathy, decreased speech output, diminished emotional expression, or minimal
desire for social interaction). However, to diagnosis, symptoms must not persist longer than six
months
Schizoaffective Disorder
It requires at least one-month history of two or more of the following symptoms: delusions,
hallucinations, disorganized speech, disorganized or catatonic behavior, and/or negative
symptoms (apathy, decreased speech output, diminished emotional expression, or minimal
desire for social interaction) PLUS full diagnostic criteria for either a manic or depressive
episode.
Heart Failure Cells
USMLE/COMLEX-Style Questions with Answers and
Rationales – Basic Sciences, Clinical Medicine, and
Osteopathic Principles Review
Hyperimmunoglobulinemia E (Job syndrome)
An autosomal dominant condition characterized by the triad of eczema, eosinophilia, and
recurrent skin and pulmonary infections.
It is also associated with multiple connective tissue and skeletal abnormalities, including
scoliosis, hyperextensibility, pathologic fractures, retained primary dentition, craniosynostosis,
and vascular abnormalities
Small Cell Carcinoma of the Lung
Central lesion that's typically metastasized at the time of diagnosis. It's too small to be seen on
X-ray so it requires a *CT scan to make the diagnosis*. EBUS with Biopsy confirms the diagnosis.
The tumor should NOT be resected; it's exquisitely *sensitive to chemo*.
Because it's a *neuroendocrine tumor* it can produce ADH (SIADH) or ACTH (Cushing's).
*Eaton-Lambert paraneoplastic syndrome*.
It does not get large enough to cause obstructive pneumonias or hemoptysis.
Facial Nerve (CN VII)
Nerve of facial expression and the one affected during Bells Palsy. It is responsible for eye
closure, facial expression, partial taste, and salivation. It originates in the pons and exits the
skull via the internal auditory meatus, along with the vestibulocochlear nerve (CN VIII) where it
innervates areas of the face, tongue, and salivary glands. The facial nerve then courses through
the facial canal, exits through the stylomastoid foramen, and penetrates the parotid gland to
divide into its respective branches: temporal, zygomatic, buccal, mandibular, and cervical.
,Foramen Magnum
Contains spinal roots of the accessory nerve, the brainstem, and the vertebral arteries.
Foramen Ovale
Contains spinal roots of the accessory nerve, the brainstem, and the vertebral arteries.
Foramen Rotundum
contains the maxillary branch of the trigeminal nerve, which is involved in facial sensation, not
facial movement.
Jugular Foramen
contains the jugular vein and the glossopharyngeal, vagus, and accessory nerves.
Thalamus: Medial geniculate nucleus
It receives auditory input from the superior olive and inferior colliculus of tectum and directs
the information to the auditory cortex of the temporal lobe
Thalamus: Lateral Geniculate Nucleus
It receives visual input and sends information to the visual cortex of the occipital lobe.
Thalamus: lateral part of the ventral posterior nucleus
It functions in body sensation such as touch, pressure, vibration, and pain that is directed from
the dorsal columns of the spinal cord to the primary somatosensory cortex
Thalamus: medial part of the ventral posterior nucleus
It relays facial sensation supplied by the trigeminal nerve to the primary somatosensory cortex.
Thalamus: ventral anterior nucleus
It is involved in motor signals, mostly from the basal ganglia and cerebellum, and distributes
them to the motor cortex of the frontal lobe.
Epiglottitis
An acute inflammation of the supraglottic region of the oropharynx, specifically involving the
epiglottis, vallecula, arytenoids, and aryepiglottic folds. The presentation usually involves a
fever, sore throat, odynophagia/dysphagia, and a muffled voice (“hot potato voice”). Young
children classically present with respiratory distress, anxiety, and the characteristic “tripod”,
“sniffing”, "or catcher's stance" position. Leaning forward in a seated position, hyperextension
of the neck, and thrusting the jaw forward are positional accommodations for obstructed
, airways. The hallmarks of epiglottis in children consist of “the three D’s” which are dysphagia,
drooling, and distress. Children with epiglottitis generally lack hoarseness, cough, and stridor
until late in the disease process. Epiglottitis is a medical emergency. Swelling of the epiglottis on
lateral x-ray is known at the “thumb sign”. Stable patients may be placed on the appropriate
antibiotics and monitored in the intensive care unit. Unstable patients require immediate
restoration of the airway.
Antiarrhythmic drugs CI and adverse effects
Primary Hyperparathyroidism
most likely due to a parathyroid adenoma (causes 80-85%). Other causes include parathyroid
hyperplasia (15-20% of cases) or parathyroid carcinoma (<1% of cases). PTH acts primarily by
stimulating adenylate cyclase and generating cyclic adenosine monophosphate
(cAMP). Elevated cAMP promotes increased bone resorption of calcium and phosphate,
increased renal reabsorption of calcium (in ascending loop, distal tubule, and collecting tubule)
and decreased renal reabsorption of phosphate (in proximal tubule). Therefore, elevated
parathyroid hormone (PTH) levels with normal renal function results in hypercalcemia coupled
with hypophosphatemia in the setting of elevated serum alkaline phosphatase. Patients may
present with kidney stones, bone aches and pains, muscle pain, weakness, constipation, gout,
or psychological disturbances (depression, fatigue, anxiety)
PTH also stimulates 1a-hydroxylase in the kidneys to increase 1,25-(OH)2 vitamin D production,
which increases intestinal absorption and bone resorption of calcium and phosphate. PTH does
not act directly on the intestines.
Schizophreniform Disorder
It requires at least one-month history of two or more of the following symptoms: delusions,
hallucinations, disorganized speech, disorganized or catatonic behavior, and/or negative
symptoms (apathy, decreased speech output, diminished emotional expression, or minimal
desire for social interaction). However, to diagnosis, symptoms must not persist longer than six
months
Schizoaffective Disorder
It requires at least one-month history of two or more of the following symptoms: delusions,
hallucinations, disorganized speech, disorganized or catatonic behavior, and/or negative
symptoms (apathy, decreased speech output, diminished emotional expression, or minimal
desire for social interaction) PLUS full diagnostic criteria for either a manic or depressive
episode.
Heart Failure Cells
