COMSAE Phase 1 Form 114 Practice Exam
Questions And Correct Answers (100% Verified
Answers) Plus Rationales Latest 2025| 2026 Q&A
BRAND NEW!!!
1. A 58-year-old man with hypertension presents with sudden tearing chest pain radiating to the back.
BP is 160/90 in the right arm and 100/70 in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Blood pressure differential and tearing pain suggest aortic dissection involving the
subclavian artery.
2. A 23-year-old woman has recurrent sinusitis, bronchiectasis, and situs inversus on chest X-ray.
Which genetic defect is most likely?
A) CFTR mutation
B) Dynein arm defect
C) Alpha-1 antitrypsin deficiency
D) FBN1 mutation
Answer: B
Rationale: Kartagener syndrome (primary ciliary dyskinesia) causes immotile cilia due to dynein arm
defect.
3. A patient on warfarin has an INR of 9.0 with minor gum bleeding. What is the best immediate
therapy?
A) Fresh frozen plasma
Page 1 of 82 GOOD LUCK!!!
,B) Vitamin K (phytonadione)
C) Protamine sulfate
D) Platelet transfusion
Answer: B
Rationale: For elevated INR with minor bleeding, vitamin K reverses warfarin; FFP reserved for life-
threatening hemorrhage.
4. A 45-year-old with acute pancreatitis develops hypocalcemia and tetany 48 hours after admission.
What is the mechanism?
A) Hypoalbuminemia
B) Saponification of calcium in necrotic fat
C) Secondary hyperparathyroidism
D) Magnesium toxicity
Answer: B
Rationale: Pancreatic lipases release fatty acids that bind calcium, causing symptomatic hypocalcemia.
5. A 72-year-old man has painless hematuria and a palpable right flank mass. What is the most likely
diagnosis?
A) Nephrolithiasis
B) Renal cell carcinoma
C) Bladder cancer
D) Pyelonephritis
Answer: B
Rationale: Classic triad of hematuria, flank pain, and mass is late but highly suggestive of renal cell
carcinoma.
6. A 28-year-old woman on isotretinoin for acne reports headache, nausea, and blurred vision.
Fundoscopy shows papilledema. What is the next best step?
A) Lumbar puncture
B) CT angiogram
Page 2 of 82 GOOD LUCK!!!
,C) Discontinue isotretinoin and start acetazolamide
D) Start prednisone
Answer: C
Rationale: Isotretinoin can cause pseudotumor cerebri; stop drug and reduce intracranial pressure.
7. A 60-year-old with COPD on home oxygen is found confused with asterixis. ABG: pH 7.30, PaCO2 70,
PaO2 55. What is the most likely cause of confusion?
A) Hypoglycemia
B) Carbon dioxide narcosis
C) Oxygen toxicity
D) Meningitis
Answer: B
Rationale: High PaCO2 depresses CNS; oxygen therapy in COPD may worsen hypercapnia by reducing
hypoxic drive.
8. A 35-year-old with sickle cell disease has sudden chest pain, hypoxia, and a new lung infiltrate.
What is the initial treatment of choice?
A) IV fluids and oxygen
B) Exchange transfusion
C) Bronchodilators
D) Antibiotics alone
Answer: B
Rationale: Acute chest syndrome requires exchange transfusion to lower HbS percentage and improve
oxygenation.
9. A child with fever and petechial rash becomes hypotensive with DIC and adrenal hemorrhage. What
is the most likely organism?
A) Streptococcus pneumoniae
B) Neisseria meningitidis
C) Haemophilus influenzae
Page 3 of 82 GOOD LUCK!!!
, D) Staphylococcus aureus
Answer: B
Rationale: Meningococcemia causes Waterhouse-Friderichsen syndrome, DIC, and purpura fulminans.
10. A 50-year-old alcoholic presents with painful erythematous swelling of the right hand after a cat
bite. What is the most likely organism?
A) Bartonella henselae
B) Pasteurella multocida
C) Capnocytophaga canimorsus
D) Eikenella corrodens
Answer: B
Rationale: Cat bites often introduce Pasteurella, causing rapidly spreading cellulitis.
11. A 65-year-old woman with osteoporosis takes calcium carbonate and develops confusion,
polyuria, and constipation. Serum calcium is 12.5 mg/dL. What is the most likely cause?
A) Primary hyperparathyroidism
B) Milk-alkali syndrome
C) Vitamin D toxicity
D) Malignancy
Answer: B
Rationale: Excess calcium and absorbable alkali cause hypercalcemia, metabolic alkalosis, and renal
insufficiency.
12. A 30-year-old with HIV and CD4 count 50 has a seizure. MRI shows a ring-enhancing lesion in the
basal ganglia. What is the most likely pathogen?
A) Cryptococcus neoformans
B) Toxoplasma gondii
C) JC virus
D) Cytomegalovirus
Answer: B
Page 4 of 82 GOOD LUCK!!!
Questions And Correct Answers (100% Verified
Answers) Plus Rationales Latest 2025| 2026 Q&A
BRAND NEW!!!
1. A 58-year-old man with hypertension presents with sudden tearing chest pain radiating to the back.
BP is 160/90 in the right arm and 100/70 in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Blood pressure differential and tearing pain suggest aortic dissection involving the
subclavian artery.
2. A 23-year-old woman has recurrent sinusitis, bronchiectasis, and situs inversus on chest X-ray.
Which genetic defect is most likely?
A) CFTR mutation
B) Dynein arm defect
C) Alpha-1 antitrypsin deficiency
D) FBN1 mutation
Answer: B
Rationale: Kartagener syndrome (primary ciliary dyskinesia) causes immotile cilia due to dynein arm
defect.
3. A patient on warfarin has an INR of 9.0 with minor gum bleeding. What is the best immediate
therapy?
A) Fresh frozen plasma
Page 1 of 82 GOOD LUCK!!!
,B) Vitamin K (phytonadione)
C) Protamine sulfate
D) Platelet transfusion
Answer: B
Rationale: For elevated INR with minor bleeding, vitamin K reverses warfarin; FFP reserved for life-
threatening hemorrhage.
4. A 45-year-old with acute pancreatitis develops hypocalcemia and tetany 48 hours after admission.
What is the mechanism?
A) Hypoalbuminemia
B) Saponification of calcium in necrotic fat
C) Secondary hyperparathyroidism
D) Magnesium toxicity
Answer: B
Rationale: Pancreatic lipases release fatty acids that bind calcium, causing symptomatic hypocalcemia.
5. A 72-year-old man has painless hematuria and a palpable right flank mass. What is the most likely
diagnosis?
A) Nephrolithiasis
B) Renal cell carcinoma
C) Bladder cancer
D) Pyelonephritis
Answer: B
Rationale: Classic triad of hematuria, flank pain, and mass is late but highly suggestive of renal cell
carcinoma.
6. A 28-year-old woman on isotretinoin for acne reports headache, nausea, and blurred vision.
Fundoscopy shows papilledema. What is the next best step?
A) Lumbar puncture
B) CT angiogram
Page 2 of 82 GOOD LUCK!!!
,C) Discontinue isotretinoin and start acetazolamide
D) Start prednisone
Answer: C
Rationale: Isotretinoin can cause pseudotumor cerebri; stop drug and reduce intracranial pressure.
7. A 60-year-old with COPD on home oxygen is found confused with asterixis. ABG: pH 7.30, PaCO2 70,
PaO2 55. What is the most likely cause of confusion?
A) Hypoglycemia
B) Carbon dioxide narcosis
C) Oxygen toxicity
D) Meningitis
Answer: B
Rationale: High PaCO2 depresses CNS; oxygen therapy in COPD may worsen hypercapnia by reducing
hypoxic drive.
8. A 35-year-old with sickle cell disease has sudden chest pain, hypoxia, and a new lung infiltrate.
What is the initial treatment of choice?
A) IV fluids and oxygen
B) Exchange transfusion
C) Bronchodilators
D) Antibiotics alone
Answer: B
Rationale: Acute chest syndrome requires exchange transfusion to lower HbS percentage and improve
oxygenation.
9. A child with fever and petechial rash becomes hypotensive with DIC and adrenal hemorrhage. What
is the most likely organism?
A) Streptococcus pneumoniae
B) Neisseria meningitidis
C) Haemophilus influenzae
Page 3 of 82 GOOD LUCK!!!
, D) Staphylococcus aureus
Answer: B
Rationale: Meningococcemia causes Waterhouse-Friderichsen syndrome, DIC, and purpura fulminans.
10. A 50-year-old alcoholic presents with painful erythematous swelling of the right hand after a cat
bite. What is the most likely organism?
A) Bartonella henselae
B) Pasteurella multocida
C) Capnocytophaga canimorsus
D) Eikenella corrodens
Answer: B
Rationale: Cat bites often introduce Pasteurella, causing rapidly spreading cellulitis.
11. A 65-year-old woman with osteoporosis takes calcium carbonate and develops confusion,
polyuria, and constipation. Serum calcium is 12.5 mg/dL. What is the most likely cause?
A) Primary hyperparathyroidism
B) Milk-alkali syndrome
C) Vitamin D toxicity
D) Malignancy
Answer: B
Rationale: Excess calcium and absorbable alkali cause hypercalcemia, metabolic alkalosis, and renal
insufficiency.
12. A 30-year-old with HIV and CD4 count 50 has a seizure. MRI shows a ring-enhancing lesion in the
basal ganglia. What is the most likely pathogen?
A) Cryptococcus neoformans
B) Toxoplasma gondii
C) JC virus
D) Cytomegalovirus
Answer: B
Page 4 of 82 GOOD LUCK!!!
