COMSAE PHASE 1 FORM 113 EXAM LATEST 2026/2027 PRACTICE
QUESTIONS AND A NEW UPDATED STUDY GUIDE ACCURATE
QUESTIONS WITH WELL ELABORATED ANSWERS AND RATIONALES
(100% CORRECT VERIFIED ANSWERS) LATEST UPDATED VERSION 2026
EDITION |ALREADY GRADED A+ (BRAND NEW!) FULL REVISED
COMSAE PHASE 1 FORM 113 APPROVED EXAM
A 28-year-old female presents with acute onset of right lower quadrant abdominal
pain, nausea, and vomiting. On examination, tenderness is noted at Burney’s point.
Which of the following is the most appropriate next step in management?
A. Computed tomography of the abdomen and pelvis
B. Surgical consultation CORRECT ANSWER
C. Oral antibiotics and outpatient follow-up
D. Pelvic ultrasound
Rationale: The presentation is classic for acute appendicitis. Immediate surgical
consultation is indicated for probable appendectomy. CT may be used but should
not delay surgical evaluation. Oral antibiotics are not first-line for acute
appendicitis. Pelvic ultrasound is more useful for gynecologic causes.
A 65-year-old male with a 40-pack-year smoking history presents with hemoptysis
and weight loss. Chest X-ray shows a right hilar mass. Which of the following is
the most specific tumor marker for small cell lung cancer?
A. Carcinoembryonic antigen (CEA)
B. CA 19-9
C. Neuron-specific enolase (NSE) CORRECT ANSWER
D. Alpha-fetoprotein (AFP)
,Rationale: NSE is a sensitive and specific marker for small cell lung cancer. CEA
is non-specific, elevated in various cancers. CA 19-9 is associated with pancreatic
cancer. AFP is for hepatocellular carcinoma or germ cell tumors.
During a well-child visit, a 4-month-old infant is noted to have poor head control
and persistent fisting of the hands. Which of the following primitive reflexes
should be absent by this age?
A. Moro reflex
B. Palmar grasp reflex
C. Asymmetric tonic neck reflex (ATNR) CORRECT ANSWER
D. Rooting reflex
Rationale: ATNR typically integrates by 4-6 months. Persistence beyond this age
suggests neurological impairment. Moro and rooting reflexes disappear by 3-4
months; palmar grasp by 4-6 months but may persist slightly longer. However,
ATNR is specifically assessed at 4 months.
A 45-year-old male with type 2 diabetes mellitus presents with a non-healing ulcer
on the plantar aspect of the left foot. The ulcer is surrounded by callus, and there is
no evidence of infection or ischemia. Which of the following is the most
appropriate initial management?
A. Systemic antibiotics
B. Surgical debridement
C. Offloading with a total contact cast CORRECT ANSWER
D. Hyperbaric oxygen therapy
Rationale: For a non-infected, non-ischemic neuropathic ulcer, offloading is key.
Total contact cast provides effective pressure redistribution. Antibiotics are not
indicated without infection. Debridement may be needed but offloading is primary.
Hyperbaric oxygen is reserved for refractory cases.
,A 72-year-old female with hypertension and osteoporosis presents with acute onset
of severe back pain after lifting a heavy box. She is unable to stand. On
examination, midline tenderness over the L1 vertebra is noted. Which of the
following is the most appropriate initial imaging study?
A. Magnetic resonance imaging (MRI) of the spine
B. Plain radiography of the lumbar spine CORRECT ANSWER
C. Computed tomography (CT) of the spine
D. Bone scan
Rationale: Plain radiography is first-line for suspected vertebral compression
fracture, which is likely given age, osteoporosis, and mechanism. MRI is indicated
if neurological deficit or suspected malignancy. CT provides more detail but higher
radiation. Bone scan is less specific and not initial.
A 22-year-old male presents with palpitations, diaphoresis, and headache. His
blood pressure is 180/110 mm Hg, heart rate 120 bpm. Laboratory studies show
elevated plasma metanephrines. Which of the following is the most appropriate
definitive treatment?
A. Beta-blockade
B. Calcium channel blocker
C. Surgical resection CORRECT ANSWER
D. Alpha-blockade
Rationale: The diagnosis is pheochromocytoma. Definitive treatment is surgical
resection after preoperative alpha-blockade (e.g., phenoxybenzamine) to prevent
hypertensive crisis. Beta-blockade alone can cause unopposed alpha stimulation.
Calcium channel blockers are adjunctive. Alpha-blockade is preoperative, not
definitive.
, A 34-year-old pregnant woman at 28 weeks’ gestation presents with painless
vaginal bleeding. Ultrasound reveals placenta Previa. Which of the following is the
most appropriate next step?
A. Digital cervical examination
B. Cesarean section at 36-37 weeks CORRECT ANSWER
C. Induction of labor
D. Administration of betamethasone
Rationale: In placenta Previa, delivery by cesarean section is planned at 36-37
weeks to avoid hemorrhage. Digital examination is contraindicated. Induction of
labor is dangerous. Betamethasone is for fetal lung maturation if preterm delivery
anticipated, but not the primary next step.
A 55-year-old male with a history of alcohol use disorder presents with confusion,
ataxia, and ophthalmoplegia. Which vitamin deficiency is most likely responsible?
A. Vitamin A
B. Vitamin B6
C. Thiamine (Vitamin B1) CORRECT ANSWER
D. Vitamin C
Rationale: The triad of confusion, ataxia, and ophthalmoplegia is Wernicke's
encephalopathy due to thiamine deficiency, common in alcohol use disorder.
Vitamin A deficiency causes night blindness. Vitamin B6 deficiency leads to
peripheral neuropathy. Vitamin C deficiency causes scurvy.
A 6-year-old child presents with a palpable, purpuric rash on the lower extremities,
arthralgia’s, and abdominal pain. Urinalysis shows hematuria and proteinuria.
Which of the following is the most likely diagnosis?
A. Henoch-Schönlein purpura (IgA vasculitis)
QUESTIONS AND A NEW UPDATED STUDY GUIDE ACCURATE
QUESTIONS WITH WELL ELABORATED ANSWERS AND RATIONALES
(100% CORRECT VERIFIED ANSWERS) LATEST UPDATED VERSION 2026
EDITION |ALREADY GRADED A+ (BRAND NEW!) FULL REVISED
COMSAE PHASE 1 FORM 113 APPROVED EXAM
A 28-year-old female presents with acute onset of right lower quadrant abdominal
pain, nausea, and vomiting. On examination, tenderness is noted at Burney’s point.
Which of the following is the most appropriate next step in management?
A. Computed tomography of the abdomen and pelvis
B. Surgical consultation CORRECT ANSWER
C. Oral antibiotics and outpatient follow-up
D. Pelvic ultrasound
Rationale: The presentation is classic for acute appendicitis. Immediate surgical
consultation is indicated for probable appendectomy. CT may be used but should
not delay surgical evaluation. Oral antibiotics are not first-line for acute
appendicitis. Pelvic ultrasound is more useful for gynecologic causes.
A 65-year-old male with a 40-pack-year smoking history presents with hemoptysis
and weight loss. Chest X-ray shows a right hilar mass. Which of the following is
the most specific tumor marker for small cell lung cancer?
A. Carcinoembryonic antigen (CEA)
B. CA 19-9
C. Neuron-specific enolase (NSE) CORRECT ANSWER
D. Alpha-fetoprotein (AFP)
,Rationale: NSE is a sensitive and specific marker for small cell lung cancer. CEA
is non-specific, elevated in various cancers. CA 19-9 is associated with pancreatic
cancer. AFP is for hepatocellular carcinoma or germ cell tumors.
During a well-child visit, a 4-month-old infant is noted to have poor head control
and persistent fisting of the hands. Which of the following primitive reflexes
should be absent by this age?
A. Moro reflex
B. Palmar grasp reflex
C. Asymmetric tonic neck reflex (ATNR) CORRECT ANSWER
D. Rooting reflex
Rationale: ATNR typically integrates by 4-6 months. Persistence beyond this age
suggests neurological impairment. Moro and rooting reflexes disappear by 3-4
months; palmar grasp by 4-6 months but may persist slightly longer. However,
ATNR is specifically assessed at 4 months.
A 45-year-old male with type 2 diabetes mellitus presents with a non-healing ulcer
on the plantar aspect of the left foot. The ulcer is surrounded by callus, and there is
no evidence of infection or ischemia. Which of the following is the most
appropriate initial management?
A. Systemic antibiotics
B. Surgical debridement
C. Offloading with a total contact cast CORRECT ANSWER
D. Hyperbaric oxygen therapy
Rationale: For a non-infected, non-ischemic neuropathic ulcer, offloading is key.
Total contact cast provides effective pressure redistribution. Antibiotics are not
indicated without infection. Debridement may be needed but offloading is primary.
Hyperbaric oxygen is reserved for refractory cases.
,A 72-year-old female with hypertension and osteoporosis presents with acute onset
of severe back pain after lifting a heavy box. She is unable to stand. On
examination, midline tenderness over the L1 vertebra is noted. Which of the
following is the most appropriate initial imaging study?
A. Magnetic resonance imaging (MRI) of the spine
B. Plain radiography of the lumbar spine CORRECT ANSWER
C. Computed tomography (CT) of the spine
D. Bone scan
Rationale: Plain radiography is first-line for suspected vertebral compression
fracture, which is likely given age, osteoporosis, and mechanism. MRI is indicated
if neurological deficit or suspected malignancy. CT provides more detail but higher
radiation. Bone scan is less specific and not initial.
A 22-year-old male presents with palpitations, diaphoresis, and headache. His
blood pressure is 180/110 mm Hg, heart rate 120 bpm. Laboratory studies show
elevated plasma metanephrines. Which of the following is the most appropriate
definitive treatment?
A. Beta-blockade
B. Calcium channel blocker
C. Surgical resection CORRECT ANSWER
D. Alpha-blockade
Rationale: The diagnosis is pheochromocytoma. Definitive treatment is surgical
resection after preoperative alpha-blockade (e.g., phenoxybenzamine) to prevent
hypertensive crisis. Beta-blockade alone can cause unopposed alpha stimulation.
Calcium channel blockers are adjunctive. Alpha-blockade is preoperative, not
definitive.
, A 34-year-old pregnant woman at 28 weeks’ gestation presents with painless
vaginal bleeding. Ultrasound reveals placenta Previa. Which of the following is the
most appropriate next step?
A. Digital cervical examination
B. Cesarean section at 36-37 weeks CORRECT ANSWER
C. Induction of labor
D. Administration of betamethasone
Rationale: In placenta Previa, delivery by cesarean section is planned at 36-37
weeks to avoid hemorrhage. Digital examination is contraindicated. Induction of
labor is dangerous. Betamethasone is for fetal lung maturation if preterm delivery
anticipated, but not the primary next step.
A 55-year-old male with a history of alcohol use disorder presents with confusion,
ataxia, and ophthalmoplegia. Which vitamin deficiency is most likely responsible?
A. Vitamin A
B. Vitamin B6
C. Thiamine (Vitamin B1) CORRECT ANSWER
D. Vitamin C
Rationale: The triad of confusion, ataxia, and ophthalmoplegia is Wernicke's
encephalopathy due to thiamine deficiency, common in alcohol use disorder.
Vitamin A deficiency causes night blindness. Vitamin B6 deficiency leads to
peripheral neuropathy. Vitamin C deficiency causes scurvy.
A 6-year-old child presents with a palpable, purpuric rash on the lower extremities,
arthralgia’s, and abdominal pain. Urinalysis shows hematuria and proteinuria.
Which of the following is the most likely diagnosis?
A. Henoch-Schönlein purpura (IgA vasculitis)
