COMSAE Phase 1 Form 115 Exam (2026 context)
A 55yo M presents with crushing substernal chest pain radiating to the jaw. ECG shows ST elevation in II,
III, aVF. Which artery is occluded?
A) LAD
B) RCA
C) LCX
D) Left Main
ANSWER: B
Rationale A: Supplies anterior wall.
Rationale B: Supplies inferior wall.
Rationale C: Supplies lateral wall.
Rationale D: Supplies most of LV.
A 25yo F presents with fever, migratory arthritis, and subcutaneous nodules. She had a sore throat 3
weeks ago. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Rheumatic fever
C) Lyme disease
D) SLE
ANSWER: B
Rationale A: Chronic symmetric polyarthritis.
Rationale B: Post-strep autoimmune reaction.
Rationale C: Tick-borne spirochete.
Rationale D: Autoimmune multiorgan disease.
A 60yo M with COPD presents with worsening dyspnea. ABG shows pH 7.32, pCO2 60, pO2 55, HCO3 32.
What is the acid-base disorder?
,A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Metabolic alkalosis
D) Mixed disorder
ANSWER: B
Rationale A: Acute would have normal HCO3.
Rationale B: Compensated chronic elevation.
Rationale C: Primary metabolic issue.
Rationale D: Would have abnormal pH/HCO3.
A 30yo F presents with weight loss, heat intolerance, and exophthalmos. TSH is low, free T4 is high.
What is the most likely diagnosis?
A) Hashimoto's
B) Graves' disease
C) Toxic multinodular goiter
D) Subacute thyroiditis
ANSWER: B
Rationale A: Hypothyroidism.
Rationale B: Autoimmune hyperthyroidism.
Rationale C: Nodular hyperthyroidism.
Rationale D: Painful transient hyperthyroidism.
A 45yo M presents with right upper quadrant pain, fever, and jaundice. Ultrasound shows gallstones and
dilated common bile duct. What is the diagnosis?
A) Cholecystitis
B) Cholangitis
C) Pancreatitis
D) Hepatitis
ANSWER: B
Rationale A: Inflamed gallbladder.
Rationale B: Infected biliary tree.
,Rationale C: Inflamed pancreas.
Rationale D: Inflamed liver.
A 70yo F presents with sudden onset severe headache and neck stiffness. CT head shows hyperdensity
in the basal cisterns. What is the most likely diagnosis?
A) Ischemic stroke
B) Subarachnoid hemorrhage
C) Subdural hematoma
D) Epidural hematoma
ANSWER: B
Rationale A: Hypodense infarct.
Rationale B: Blood in subarachnoid space.
Rationale C: Crescent-shaped bleed.
Rationale D: Lens-shaped bleed.
A 10yo M presents with periorbital edema and dark urine 2 weeks after a skin infection. Urinalysis
shows RBC casts. What is the most likely diagnosis?
A) Minimal change disease
B) Poststreptococcal glomerulonephritis
C) IgA nephropathy
D) Alport syndrome
ANSWER: B
Rationale A: Nephrotic syndrome.
Rationale B: Post-strep nephritic syndrome.
Rationale C: Concurrent with URI.
Rationale D: Hearing loss and hematuria.
A 50yo M with a history of alcohol abuse presents with confusion, ataxia, and ophthalmoplegia. What is
the most likely diagnosis?
A) Hepatic encephalopathy
B) Wernicke encephalopathy
C) Alcohol withdrawal
D) Subdural hematoma
, ANSWER: B
Rationale A: Asterixis and high ammonia.
Rationale B: Thiamine deficiency triad.
Rationale C: Tremor and tachycardia.
Rationale D: History of trauma.
A 25yo M presents with a painless testicular mass. Ultrasound shows a solid intratesticular mass. What
is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Seminoma
D) Hydrocele
ANSWER: C
Rationale A: Painful inflammation.
Rationale B: Acute severe pain.
Rationale C: Most common testicular cancer.
Rationale D: Fluid collection.
A 65yo F presents with progressive memory loss, aphasia, and apraxia. MRI shows diffuse cortical
atrophy. What is the most likely diagnosis?
A) Vascular dementia
B) Alzheimer's disease
C) Lewy body dementia
D) Frontotemporal dementia
ANSWER: B
Rationale A: Stepwise decline.
Rationale B: Gradual memory loss.
Rationale C: Visual hallucinations.
Rationale D: Behavioral changes first.
A 40yo F presents with fatigue, weight gain, and cold intolerance. TSH is high, free T4 is low. What is the
most likely diagnosis?
A) Graves' disease
A 55yo M presents with crushing substernal chest pain radiating to the jaw. ECG shows ST elevation in II,
III, aVF. Which artery is occluded?
A) LAD
B) RCA
C) LCX
D) Left Main
ANSWER: B
Rationale A: Supplies anterior wall.
Rationale B: Supplies inferior wall.
Rationale C: Supplies lateral wall.
Rationale D: Supplies most of LV.
A 25yo F presents with fever, migratory arthritis, and subcutaneous nodules. She had a sore throat 3
weeks ago. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Rheumatic fever
C) Lyme disease
D) SLE
ANSWER: B
Rationale A: Chronic symmetric polyarthritis.
Rationale B: Post-strep autoimmune reaction.
Rationale C: Tick-borne spirochete.
Rationale D: Autoimmune multiorgan disease.
A 60yo M with COPD presents with worsening dyspnea. ABG shows pH 7.32, pCO2 60, pO2 55, HCO3 32.
What is the acid-base disorder?
,A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Metabolic alkalosis
D) Mixed disorder
ANSWER: B
Rationale A: Acute would have normal HCO3.
Rationale B: Compensated chronic elevation.
Rationale C: Primary metabolic issue.
Rationale D: Would have abnormal pH/HCO3.
A 30yo F presents with weight loss, heat intolerance, and exophthalmos. TSH is low, free T4 is high.
What is the most likely diagnosis?
A) Hashimoto's
B) Graves' disease
C) Toxic multinodular goiter
D) Subacute thyroiditis
ANSWER: B
Rationale A: Hypothyroidism.
Rationale B: Autoimmune hyperthyroidism.
Rationale C: Nodular hyperthyroidism.
Rationale D: Painful transient hyperthyroidism.
A 45yo M presents with right upper quadrant pain, fever, and jaundice. Ultrasound shows gallstones and
dilated common bile duct. What is the diagnosis?
A) Cholecystitis
B) Cholangitis
C) Pancreatitis
D) Hepatitis
ANSWER: B
Rationale A: Inflamed gallbladder.
Rationale B: Infected biliary tree.
,Rationale C: Inflamed pancreas.
Rationale D: Inflamed liver.
A 70yo F presents with sudden onset severe headache and neck stiffness. CT head shows hyperdensity
in the basal cisterns. What is the most likely diagnosis?
A) Ischemic stroke
B) Subarachnoid hemorrhage
C) Subdural hematoma
D) Epidural hematoma
ANSWER: B
Rationale A: Hypodense infarct.
Rationale B: Blood in subarachnoid space.
Rationale C: Crescent-shaped bleed.
Rationale D: Lens-shaped bleed.
A 10yo M presents with periorbital edema and dark urine 2 weeks after a skin infection. Urinalysis
shows RBC casts. What is the most likely diagnosis?
A) Minimal change disease
B) Poststreptococcal glomerulonephritis
C) IgA nephropathy
D) Alport syndrome
ANSWER: B
Rationale A: Nephrotic syndrome.
Rationale B: Post-strep nephritic syndrome.
Rationale C: Concurrent with URI.
Rationale D: Hearing loss and hematuria.
A 50yo M with a history of alcohol abuse presents with confusion, ataxia, and ophthalmoplegia. What is
the most likely diagnosis?
A) Hepatic encephalopathy
B) Wernicke encephalopathy
C) Alcohol withdrawal
D) Subdural hematoma
, ANSWER: B
Rationale A: Asterixis and high ammonia.
Rationale B: Thiamine deficiency triad.
Rationale C: Tremor and tachycardia.
Rationale D: History of trauma.
A 25yo M presents with a painless testicular mass. Ultrasound shows a solid intratesticular mass. What
is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Seminoma
D) Hydrocele
ANSWER: C
Rationale A: Painful inflammation.
Rationale B: Acute severe pain.
Rationale C: Most common testicular cancer.
Rationale D: Fluid collection.
A 65yo F presents with progressive memory loss, aphasia, and apraxia. MRI shows diffuse cortical
atrophy. What is the most likely diagnosis?
A) Vascular dementia
B) Alzheimer's disease
C) Lewy body dementia
D) Frontotemporal dementia
ANSWER: B
Rationale A: Stepwise decline.
Rationale B: Gradual memory loss.
Rationale C: Visual hallucinations.
Rationale D: Behavioral changes first.
A 40yo F presents with fatigue, weight gain, and cold intolerance. TSH is high, free T4 is low. What is the
most likely diagnosis?
A) Graves' disease
