COMSAE PHASE 1 FORM 114 EXAM / LATEST COMSAE PHASE 1 FORM 114
ACTUAL 2026/2027 EXAM TESTBANK PRACTICE QUESTIONS (MOST TESTED
QUESTIONS FROM PAST EXAM PLUS CURRENT QUESTIONS) & A NEW
UPDATED STUDY GUIDE COMPLETE ACCURATE EXAM REAL QUESTIONS
WITH WELL ELABORATED ANSWERS AND RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) LATEST UPDATED VERSION 2026 EDITION
||GUARANTEED SUCCESS A+ |FULL REVISED
1. A 72-year-old man presents with a 3-day history of severe, constant pain in his
left lower back and flank. He has a history of hypertension and benign prostatic
hyperplasia. Vital signs: temperature 37.2°C, heart rate 102/min, blood pressure
158/92 mmHg. Physical examination reveals tenderness in the left costovertebral
angle. Urinalysis shows microscopic hematuria. Which of the following is the most
likely diagnosis?
A) Acute pyelonephritis
B) Renal cell carcinoma
C) Nephrolithiasis
D) Ruptured abdominal aortic aneurysm
E) Herpes zoster
Correct Answer: D – Ruptured abdominal aortic aneurysm presents with severe
back/flank pain, pulsatile mass (often not palpable if ruptured), hypotension
(though early may have hypertension due to pain), and hematuria can occur due
to ureteral compression or renal artery involvement. This patient’s age, vascular
risk factors, and pain pattern make this a life-threatening differential that must
be ruled out first.
2. A 28-year-old woman presents with fatigue, weight gain, cold intolerance, and
constipation for 4 months. Physical examination shows dry skin, bradycardia (heart
rate 52/min), and delayed relaxation of deep tendon reflexes. Laboratory studies:
TSH 35 µIU/mL (normal 0.4–4.0), free T4 0.3 ng/dL (normal 0.8–1.8). Which of
the following is the most appropriate next step in management?
,A) Levothyroxine 200 mcg daily
B) Liothyronine 25 mcg daily
C) Thyroid ultrasound
D) Levothyroxine 50 mcg daily
E) Observation and repeat TSH in 6 weeks
Correct Answer: D – This patient has overt primary hypothyroidism.
Levothyroxine should be initiated at a low dose (25–50 mcg daily) in young,
otherwise healthy patients, with titration every 6–8 weeks. Starting at a full
replacement dose (1.6 mcg/kg, ~100–125 mcg for a 70 kg person) can cause
palpitations or arrhythmias. Liothyronine (T3) is not first-line due to shorter
half-life and risk of supraphysiologic peaks.
3. A 55-year-old man with a 30-pack-year smoking history presents with
hemoptysis and unintentional weight loss of 10 kg over 6 months. Chest x-ray
shows a right hilar mass. CT-guided biopsy reveals small cell lung cancer (SCLC).
Which of the following is the most common paraneoplastic syndrome associated
with SCLC?
A) Hypercalcemia
B) SIADH (euvolemic hyponatremia)
C) Cushing syndrome
D) Lambert-Eaton myasthenic syndrome
E) Acanthosis nigricans
Correct Answer: B – SIADH is the most common paraneoplastic syndrome in
SCLC (10–15% at diagnosis). Hypercalcemia is more common in squamous cell
lung cancer. Cushing (ectopic ACTH) occurs in ~5% of SCLC. Lambert-Eaton
also occurs but is less frequent than SIADH.
,4. A 42-year-old woman presents with episodic palpitations, anxiety, sweating, and
headache lasting 10–15 minutes, occurring 2–3 times per week. During one
episode in the emergency department, her blood pressure is 210/110 mmHg and
heart rate 130/min. Which of the following laboratory findings would most support
the diagnosis?
A) Elevated serum metanephrines
B) Elevated 5-HIAA
C) Elevated serum calcitonin
D) Elevated plasma fractionated metanephrines
E) Hypokalemia with metabolic alkalosis
Correct Answer: D – This presentation suggests pheochromocytoma. Plasma
fractionated metanephrines (normetanephrine and metanephrine) have the
highest sensitivity (96–100%) for diagnosis. Urinary metanephrines are also
diagnostic but less convenient in acute setting. 5-HIAA is for carcinoid.
Calcitonin for medullary thyroid cancer.
5. A 67-year-old man with type 2 diabetes and hypertension presents with a 2-
week history of progressive weakness in his right arm and leg. He also has word-
finding difficulty. Symptoms are maximal at onset. CT head shows no hemorrhage.
MRI brain reveals multiple small, hyperintense lesions on diffusion-weighted
imaging in different vascular territories. Which of the following is the most likely
diagnosis?
A) Primary brain tumor
B) Cerebral venous sinus thrombosis
C) Cardioembolic stroke
D) Lacunar infarct
E) Subdural hematoma
, Correct Answer: C – Multiple acute infarcts in different vascular territories
suggest an embolic source, most commonly atrial fibrillation (often paroxysmal
and undiagnosed). Cardioembolic strokes have maximal deficit at onset.
Lacunar infarcts are small, deep, single vessel. Venous thrombosis usually
presents with headache and seizure.
6. A 34-year-old man has had 3 episodes of angioedema without urticaria over the
past year. He has no known allergies. Family history: his mother died suddenly of
laryngeal edema. C3 and C4 levels are decreased, with a low C1 esterase inhibitor
level. Which of the following is the most appropriate treatment for an acute attack?
A) Epinephrine 1:1000 IM
B) Diphenhydramine IV
C) Methylprednisolone IV
D) C1 esterase inhibitor concentrate IV
E) Fresh frozen plasma
Correct Answer: D – This is hereditary angioedema (C1 esterase inhibitor
deficiency). First-line treatment for acute attack is C1 inhibitor concentrate (or
ecallantide/icatibant if unavailable). Epinephrine and antihistamines are
ineffective because bradykinin, not histamine, mediates the swelling. FFP can
worsen attacks due to kininogen substrate.
7. A 60-year-old woman with osteoporosis presents with a 1-day history of severe,
constant back pain after lifting a heavy box. She is unable to stand upright. On
examination, she has point tenderness over the T12 vertebra. Radiograph shows a
wedge compression fracture. Which of the following is the most appropriate next
step?
A) MRI spine
B) CT myelogram
C) Pain control and bracing
ACTUAL 2026/2027 EXAM TESTBANK PRACTICE QUESTIONS (MOST TESTED
QUESTIONS FROM PAST EXAM PLUS CURRENT QUESTIONS) & A NEW
UPDATED STUDY GUIDE COMPLETE ACCURATE EXAM REAL QUESTIONS
WITH WELL ELABORATED ANSWERS AND RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) LATEST UPDATED VERSION 2026 EDITION
||GUARANTEED SUCCESS A+ |FULL REVISED
1. A 72-year-old man presents with a 3-day history of severe, constant pain in his
left lower back and flank. He has a history of hypertension and benign prostatic
hyperplasia. Vital signs: temperature 37.2°C, heart rate 102/min, blood pressure
158/92 mmHg. Physical examination reveals tenderness in the left costovertebral
angle. Urinalysis shows microscopic hematuria. Which of the following is the most
likely diagnosis?
A) Acute pyelonephritis
B) Renal cell carcinoma
C) Nephrolithiasis
D) Ruptured abdominal aortic aneurysm
E) Herpes zoster
Correct Answer: D – Ruptured abdominal aortic aneurysm presents with severe
back/flank pain, pulsatile mass (often not palpable if ruptured), hypotension
(though early may have hypertension due to pain), and hematuria can occur due
to ureteral compression or renal artery involvement. This patient’s age, vascular
risk factors, and pain pattern make this a life-threatening differential that must
be ruled out first.
2. A 28-year-old woman presents with fatigue, weight gain, cold intolerance, and
constipation for 4 months. Physical examination shows dry skin, bradycardia (heart
rate 52/min), and delayed relaxation of deep tendon reflexes. Laboratory studies:
TSH 35 µIU/mL (normal 0.4–4.0), free T4 0.3 ng/dL (normal 0.8–1.8). Which of
the following is the most appropriate next step in management?
,A) Levothyroxine 200 mcg daily
B) Liothyronine 25 mcg daily
C) Thyroid ultrasound
D) Levothyroxine 50 mcg daily
E) Observation and repeat TSH in 6 weeks
Correct Answer: D – This patient has overt primary hypothyroidism.
Levothyroxine should be initiated at a low dose (25–50 mcg daily) in young,
otherwise healthy patients, with titration every 6–8 weeks. Starting at a full
replacement dose (1.6 mcg/kg, ~100–125 mcg for a 70 kg person) can cause
palpitations or arrhythmias. Liothyronine (T3) is not first-line due to shorter
half-life and risk of supraphysiologic peaks.
3. A 55-year-old man with a 30-pack-year smoking history presents with
hemoptysis and unintentional weight loss of 10 kg over 6 months. Chest x-ray
shows a right hilar mass. CT-guided biopsy reveals small cell lung cancer (SCLC).
Which of the following is the most common paraneoplastic syndrome associated
with SCLC?
A) Hypercalcemia
B) SIADH (euvolemic hyponatremia)
C) Cushing syndrome
D) Lambert-Eaton myasthenic syndrome
E) Acanthosis nigricans
Correct Answer: B – SIADH is the most common paraneoplastic syndrome in
SCLC (10–15% at diagnosis). Hypercalcemia is more common in squamous cell
lung cancer. Cushing (ectopic ACTH) occurs in ~5% of SCLC. Lambert-Eaton
also occurs but is less frequent than SIADH.
,4. A 42-year-old woman presents with episodic palpitations, anxiety, sweating, and
headache lasting 10–15 minutes, occurring 2–3 times per week. During one
episode in the emergency department, her blood pressure is 210/110 mmHg and
heart rate 130/min. Which of the following laboratory findings would most support
the diagnosis?
A) Elevated serum metanephrines
B) Elevated 5-HIAA
C) Elevated serum calcitonin
D) Elevated plasma fractionated metanephrines
E) Hypokalemia with metabolic alkalosis
Correct Answer: D – This presentation suggests pheochromocytoma. Plasma
fractionated metanephrines (normetanephrine and metanephrine) have the
highest sensitivity (96–100%) for diagnosis. Urinary metanephrines are also
diagnostic but less convenient in acute setting. 5-HIAA is for carcinoid.
Calcitonin for medullary thyroid cancer.
5. A 67-year-old man with type 2 diabetes and hypertension presents with a 2-
week history of progressive weakness in his right arm and leg. He also has word-
finding difficulty. Symptoms are maximal at onset. CT head shows no hemorrhage.
MRI brain reveals multiple small, hyperintense lesions on diffusion-weighted
imaging in different vascular territories. Which of the following is the most likely
diagnosis?
A) Primary brain tumor
B) Cerebral venous sinus thrombosis
C) Cardioembolic stroke
D) Lacunar infarct
E) Subdural hematoma
, Correct Answer: C – Multiple acute infarcts in different vascular territories
suggest an embolic source, most commonly atrial fibrillation (often paroxysmal
and undiagnosed). Cardioembolic strokes have maximal deficit at onset.
Lacunar infarcts are small, deep, single vessel. Venous thrombosis usually
presents with headache and seizure.
6. A 34-year-old man has had 3 episodes of angioedema without urticaria over the
past year. He has no known allergies. Family history: his mother died suddenly of
laryngeal edema. C3 and C4 levels are decreased, with a low C1 esterase inhibitor
level. Which of the following is the most appropriate treatment for an acute attack?
A) Epinephrine 1:1000 IM
B) Diphenhydramine IV
C) Methylprednisolone IV
D) C1 esterase inhibitor concentrate IV
E) Fresh frozen plasma
Correct Answer: D – This is hereditary angioedema (C1 esterase inhibitor
deficiency). First-line treatment for acute attack is C1 inhibitor concentrate (or
ecallantide/icatibant if unavailable). Epinephrine and antihistamines are
ineffective because bradykinin, not histamine, mediates the swelling. FFP can
worsen attacks due to kininogen substrate.
7. A 60-year-old woman with osteoporosis presents with a 1-day history of severe,
constant back pain after lifting a heavy box. She is unable to stand upright. On
examination, she has point tenderness over the T12 vertebra. Radiograph shows a
wedge compression fracture. Which of the following is the most appropriate next
step?
A) MRI spine
B) CT myelogram
C) Pain control and bracing
