COMSAE Institutional Readiness Assessment
Form IRA 102 Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 24-year-old man presents with fatigue, dark urine, and jaundice
3 days after taking trimethoprim-sulfamethoxazole for a urinary
tract infection. Laboratory studies show hemoglobin 8.5 g/dL,
elevated lactate dehydrogenase, increased indirect bilirubin, and
Heinz bodies on peripheral smear. Which enzyme deficiency most
likely predisposed this patient to his current condition?
A. Pyruvate kinase deficiency
B. Glucose-6-phosphate dehydrogenase deficiency
C. Hexokinase deficiency
D. Spectrin deficiency
E. Adenosine deaminase deficiency
Answer: B. Glucose-6-phosphate dehydrogenase deficiency
Rationale: G6PD deficiency impairs NADPH production in red blood
cells, preventing regeneration of reduced glutathione. Oxidative drugs
such as sulfonamides cause oxidative damage, leading to Heinz body
formation and hemolysis. Bite cells and elevated indirect bilirubin are
classic findings.
2. A 58-year-old man with hypertension develops sudden tearing
chest pain radiating to his back. Blood pressure is 190/110 mm Hg
in the right arm and 160/90 mm Hg in the left arm. Chest
, radiograph reveals a widened mediastinum. Which of the
following is the most likely diagnosis?
A. Pulmonary embolism
B. Esophageal rupture
C. Acute aortic dissection
D. Tension pneumothorax
E. Acute pericarditis
Answer: C. Acute aortic dissection
Rationale: Acute tearing chest pain radiating to the back with unequal
arm blood pressures and widened mediastinum is classic for aortic
dissection. Hypertension is the major risk factor for proximal dissections.
3. A newborn has persistent vomiting after feeding. Physical
examination demonstrates a palpable olive-shaped mass in the
epigastrium. Laboratory studies reveal hypokalemic,
hypochloremic metabolic alkalosis. Which acid-base disturbance is
present?
A. Respiratory acidosis
B. High anion gap metabolic acidosis
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis
E. Mixed acidosis
Answer: C. Metabolic alkalosis with respiratory compensation
Rationale: Hypertrophic pyloric stenosis causes persistent vomiting with
loss of gastric hydrochloric acid, producing hypochloremic hypokalemic
metabolic alkalosis. The respiratory system compensates by
hypoventilation.
, 4. A researcher administers a drug that irreversibly inhibits
cyclooxygenase in platelets. Which effect is expected?
A. Increased thromboxane A2 synthesis
B. Reduced platelet aggregation
C. Increased prostacyclin production
D. Enhanced fibrin degradation
E. Increased factor VIII activity
Answer: B. Reduced platelet aggregation
Rationale: Aspirin irreversibly inhibits COX-1 in platelets, preventing
thromboxane A2 synthesis and thereby reducing platelet aggregation
for the lifespan of the platelet.
5. A patient with nephrotic syndrome develops generalized edema.
Which of the following is the primary mechanism responsible?
A. Increased capillary hydrostatic pressure
B. Decreased plasma oncotic pressure
C. Increased lymphatic drainage
D. Increased erythropoiesis
E. Vasodilation of arterioles
Answer: B. Decreased plasma oncotic pressure
Rationale: Heavy proteinuria leads to hypoalbuminemia. The reduction
in plasma oncotic pressure causes fluid to shift into interstitial spaces,
resulting in edema.
6. A 34-year-old woman has episodes of palpitations, sweating, and
headache. Blood pressure is 210/120 mm Hg during attacks.
Urinary catecholamine metabolites are markedly elevated. The
tumor originates from which embryologic structure?
, A. Surface ectoderm
B. Neural crest
C. Endoderm
D. Mesoderm
E. Paraxial mesoderm
Answer: B. Neural crest
Rationale: Pheochromocytomas arise from chromaffin cells of the
adrenal medulla, which are derived from neural crest cells.
7. A child develops recurrent Neisseria infections. Laboratory studies
reveal absence of the membrane attack complex. Which
complement component deficiency is most likely?
A. C1 inhibitor
B. C2
C. C3
D. C5-C9
E. Factor H
Answer: D. C5-C9
Rationale: Deficiency of terminal complement components C5 through
C9 prevents formation of the membrane attack complex, predisposing
to recurrent Neisseria infections.
8. A 67-year-old smoker develops hematuria and flank pain. CT scan
reveals a renal mass with extension into the renal vein. Which
paraneoplastic syndrome is most commonly associated with this
tumor?
A. Hypercalcemia from PTHrP
B. Erythrocytosis
C. SIADH
Form IRA 102 Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 24-year-old man presents with fatigue, dark urine, and jaundice
3 days after taking trimethoprim-sulfamethoxazole for a urinary
tract infection. Laboratory studies show hemoglobin 8.5 g/dL,
elevated lactate dehydrogenase, increased indirect bilirubin, and
Heinz bodies on peripheral smear. Which enzyme deficiency most
likely predisposed this patient to his current condition?
A. Pyruvate kinase deficiency
B. Glucose-6-phosphate dehydrogenase deficiency
C. Hexokinase deficiency
D. Spectrin deficiency
E. Adenosine deaminase deficiency
Answer: B. Glucose-6-phosphate dehydrogenase deficiency
Rationale: G6PD deficiency impairs NADPH production in red blood
cells, preventing regeneration of reduced glutathione. Oxidative drugs
such as sulfonamides cause oxidative damage, leading to Heinz body
formation and hemolysis. Bite cells and elevated indirect bilirubin are
classic findings.
2. A 58-year-old man with hypertension develops sudden tearing
chest pain radiating to his back. Blood pressure is 190/110 mm Hg
in the right arm and 160/90 mm Hg in the left arm. Chest
, radiograph reveals a widened mediastinum. Which of the
following is the most likely diagnosis?
A. Pulmonary embolism
B. Esophageal rupture
C. Acute aortic dissection
D. Tension pneumothorax
E. Acute pericarditis
Answer: C. Acute aortic dissection
Rationale: Acute tearing chest pain radiating to the back with unequal
arm blood pressures and widened mediastinum is classic for aortic
dissection. Hypertension is the major risk factor for proximal dissections.
3. A newborn has persistent vomiting after feeding. Physical
examination demonstrates a palpable olive-shaped mass in the
epigastrium. Laboratory studies reveal hypokalemic,
hypochloremic metabolic alkalosis. Which acid-base disturbance is
present?
A. Respiratory acidosis
B. High anion gap metabolic acidosis
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis
E. Mixed acidosis
Answer: C. Metabolic alkalosis with respiratory compensation
Rationale: Hypertrophic pyloric stenosis causes persistent vomiting with
loss of gastric hydrochloric acid, producing hypochloremic hypokalemic
metabolic alkalosis. The respiratory system compensates by
hypoventilation.
, 4. A researcher administers a drug that irreversibly inhibits
cyclooxygenase in platelets. Which effect is expected?
A. Increased thromboxane A2 synthesis
B. Reduced platelet aggregation
C. Increased prostacyclin production
D. Enhanced fibrin degradation
E. Increased factor VIII activity
Answer: B. Reduced platelet aggregation
Rationale: Aspirin irreversibly inhibits COX-1 in platelets, preventing
thromboxane A2 synthesis and thereby reducing platelet aggregation
for the lifespan of the platelet.
5. A patient with nephrotic syndrome develops generalized edema.
Which of the following is the primary mechanism responsible?
A. Increased capillary hydrostatic pressure
B. Decreased plasma oncotic pressure
C. Increased lymphatic drainage
D. Increased erythropoiesis
E. Vasodilation of arterioles
Answer: B. Decreased plasma oncotic pressure
Rationale: Heavy proteinuria leads to hypoalbuminemia. The reduction
in plasma oncotic pressure causes fluid to shift into interstitial spaces,
resulting in edema.
6. A 34-year-old woman has episodes of palpitations, sweating, and
headache. Blood pressure is 210/120 mm Hg during attacks.
Urinary catecholamine metabolites are markedly elevated. The
tumor originates from which embryologic structure?
, A. Surface ectoderm
B. Neural crest
C. Endoderm
D. Mesoderm
E. Paraxial mesoderm
Answer: B. Neural crest
Rationale: Pheochromocytomas arise from chromaffin cells of the
adrenal medulla, which are derived from neural crest cells.
7. A child develops recurrent Neisseria infections. Laboratory studies
reveal absence of the membrane attack complex. Which
complement component deficiency is most likely?
A. C1 inhibitor
B. C2
C. C3
D. C5-C9
E. Factor H
Answer: D. C5-C9
Rationale: Deficiency of terminal complement components C5 through
C9 prevents formation of the membrane attack complex, predisposing
to recurrent Neisseria infections.
8. A 67-year-old smoker develops hematuria and flank pain. CT scan
reveals a renal mass with extension into the renal vein. Which
paraneoplastic syndrome is most commonly associated with this
tumor?
A. Hypercalcemia from PTHrP
B. Erythrocytosis
C. SIADH
