COMSAE Institutional Readiness
Assessment Form IRA 104 Exam Practice
Questions & [Verified Answers], Plus
Explained Rationales|2026 Latest Update|
Instant Download PDF
1. A 23-year-old man presents with recurrent episodes of wheezing,
cough, and chest tightness that worsen at night and after
exercise. Pulmonary function testing shows FEV1 improvement of
18% after bronchodilator administration. Which of the following is
the primary pathophysiologic mechanism underlying this disease?
A. Irreversible destruction of alveolar septa
B. Chronic neutrophilic inflammation with fibrosis
C. IgE-mediated mast cell activation causing bronchial hyperreactivity
D. Loss of pulmonary surfactant
E. Restrictive chest wall dysfunction
Answer: C. IgE-mediated mast cell activation causing bronchial
hyperreactivity
Rationale: Asthma is characterized by airway hyperresponsiveness,
reversible airflow obstruction, and chronic inflammation. Allergic
asthma involves Th2 cells producing IL-4, IL-5, and IL-13, stimulating IgE
production and eosinophilic inflammation. Bronchodilator reversibility
exceeding 12% strongly supports asthma.
2. A 67-year-old smoker presents with hematuria and painless
urinary frequency. Cystoscopy reveals a papillary bladder tumor.
, Which risk factor is most strongly associated with this
malignancy?
A. Chronic aspirin use
B. Tobacco smoking
C. Hyperlipidemia
D. Peptic ulcer disease
E. Hypothyroidism
Answer: B. Tobacco smoking
Rationale: Smoking is the leading risk factor for transitional cell
carcinoma of the bladder. Aromatic amines and carcinogens in tobacco
concentrate in urine and chronically expose the urothelium to
mutagenic substances.
3. A 56-year-old woman develops fatigue, pruritus, and jaundice.
Laboratory studies reveal elevated alkaline phosphatase and
positive antimitochondrial antibodies. The most likely diagnosis is:
A. Primary sclerosing cholangitis
B. Autoimmune hepatitis
C. Primary biliary cholangitis
D. Alcoholic hepatitis
E. Wilson disease
Answer: C. Primary biliary cholangitis
Rationale: Primary biliary cholangitis is an autoimmune destruction of
intrahepatic bile ducts characterized by cholestatic liver enzymes and
antimitochondrial antibodies. Middle-aged women are most commonly
affected.
, 4. A newborn develops bilious vomiting within hours after birth.
Abdominal radiography demonstrates a "double bubble" sign. The
most likely embryologic defect is:
A. Failure of neural crest migration
B. Incomplete intestinal rotation
C. Failure of duodenal recanalization
D. Persistent vitelline duct
E. Failure of pancreatic fusion
Answer: C. Failure of duodenal recanalization
Rationale: Duodenal atresia results from failure of recanalization during
embryogenesis. The classic double-bubble sign represents gas in the
stomach and proximal duodenum.
5. A patient with chronic kidney disease develops secondary
hyperparathyroidism. Which biochemical abnormality is most
responsible?
A. Hypercalcemia
B. Increased calcitriol production
C. Phosphate retention with hypocalcemia
D. Hypermagnesemia
E. Hyperalbuminemia
Answer: C. Phosphate retention with hypocalcemia
Rationale: CKD causes phosphate retention and decreased vitamin D
activation. Resulting hypocalcemia stimulates parathyroid hormone
secretion, leading to secondary hyperparathyroidism.
6. A patient develops fever, flank pain, and costovertebral angle
tenderness. Urinalysis reveals white blood cell casts. The diagnosis
is:
, A. Cystitis
B. Acute pyelonephritis
C. Nephrotic syndrome
D. Interstitial cystitis
E. Renal artery stenosis
Answer: B. Acute pyelonephritis
Rationale: White blood cell casts are highly suggestive of renal
parenchymal infection. Pyelonephritis commonly presents with fever,
flank pain, pyuria, and CVA tenderness.
7. A 40-year-old woman presents with exophthalmos, heat
intolerance, and weight loss. Laboratory testing shows elevated
T3/T4 and suppressed TSH. The disease is mediated by:
A. Antibodies blocking TSH receptors
B. Cytotoxic T cells destroying follicles
C. IgG antibodies stimulating TSH receptors
D. Decreased iodine uptake
E. Pituitary infarction
Answer: C. IgG antibodies stimulating TSH receptors
Rationale: Graves disease is caused by thyroid-stimulating
immunoglobulins activating TSH receptors, resulting in diffuse
hyperthyroidism and ophthalmopathy.
8. A patient with severe pancreatitis develops hypocalcemia. This
occurs primarily because:
A. Increased calcitonin secretion
B. Vitamin D deficiency
C. Fat necrosis binds calcium into soaps
Assessment Form IRA 104 Exam Practice
Questions & [Verified Answers], Plus
Explained Rationales|2026 Latest Update|
Instant Download PDF
1. A 23-year-old man presents with recurrent episodes of wheezing,
cough, and chest tightness that worsen at night and after
exercise. Pulmonary function testing shows FEV1 improvement of
18% after bronchodilator administration. Which of the following is
the primary pathophysiologic mechanism underlying this disease?
A. Irreversible destruction of alveolar septa
B. Chronic neutrophilic inflammation with fibrosis
C. IgE-mediated mast cell activation causing bronchial hyperreactivity
D. Loss of pulmonary surfactant
E. Restrictive chest wall dysfunction
Answer: C. IgE-mediated mast cell activation causing bronchial
hyperreactivity
Rationale: Asthma is characterized by airway hyperresponsiveness,
reversible airflow obstruction, and chronic inflammation. Allergic
asthma involves Th2 cells producing IL-4, IL-5, and IL-13, stimulating IgE
production and eosinophilic inflammation. Bronchodilator reversibility
exceeding 12% strongly supports asthma.
2. A 67-year-old smoker presents with hematuria and painless
urinary frequency. Cystoscopy reveals a papillary bladder tumor.
, Which risk factor is most strongly associated with this
malignancy?
A. Chronic aspirin use
B. Tobacco smoking
C. Hyperlipidemia
D. Peptic ulcer disease
E. Hypothyroidism
Answer: B. Tobacco smoking
Rationale: Smoking is the leading risk factor for transitional cell
carcinoma of the bladder. Aromatic amines and carcinogens in tobacco
concentrate in urine and chronically expose the urothelium to
mutagenic substances.
3. A 56-year-old woman develops fatigue, pruritus, and jaundice.
Laboratory studies reveal elevated alkaline phosphatase and
positive antimitochondrial antibodies. The most likely diagnosis is:
A. Primary sclerosing cholangitis
B. Autoimmune hepatitis
C. Primary biliary cholangitis
D. Alcoholic hepatitis
E. Wilson disease
Answer: C. Primary biliary cholangitis
Rationale: Primary biliary cholangitis is an autoimmune destruction of
intrahepatic bile ducts characterized by cholestatic liver enzymes and
antimitochondrial antibodies. Middle-aged women are most commonly
affected.
, 4. A newborn develops bilious vomiting within hours after birth.
Abdominal radiography demonstrates a "double bubble" sign. The
most likely embryologic defect is:
A. Failure of neural crest migration
B. Incomplete intestinal rotation
C. Failure of duodenal recanalization
D. Persistent vitelline duct
E. Failure of pancreatic fusion
Answer: C. Failure of duodenal recanalization
Rationale: Duodenal atresia results from failure of recanalization during
embryogenesis. The classic double-bubble sign represents gas in the
stomach and proximal duodenum.
5. A patient with chronic kidney disease develops secondary
hyperparathyroidism. Which biochemical abnormality is most
responsible?
A. Hypercalcemia
B. Increased calcitriol production
C. Phosphate retention with hypocalcemia
D. Hypermagnesemia
E. Hyperalbuminemia
Answer: C. Phosphate retention with hypocalcemia
Rationale: CKD causes phosphate retention and decreased vitamin D
activation. Resulting hypocalcemia stimulates parathyroid hormone
secretion, leading to secondary hyperparathyroidism.
6. A patient develops fever, flank pain, and costovertebral angle
tenderness. Urinalysis reveals white blood cell casts. The diagnosis
is:
, A. Cystitis
B. Acute pyelonephritis
C. Nephrotic syndrome
D. Interstitial cystitis
E. Renal artery stenosis
Answer: B. Acute pyelonephritis
Rationale: White blood cell casts are highly suggestive of renal
parenchymal infection. Pyelonephritis commonly presents with fever,
flank pain, pyuria, and CVA tenderness.
7. A 40-year-old woman presents with exophthalmos, heat
intolerance, and weight loss. Laboratory testing shows elevated
T3/T4 and suppressed TSH. The disease is mediated by:
A. Antibodies blocking TSH receptors
B. Cytotoxic T cells destroying follicles
C. IgG antibodies stimulating TSH receptors
D. Decreased iodine uptake
E. Pituitary infarction
Answer: C. IgG antibodies stimulating TSH receptors
Rationale: Graves disease is caused by thyroid-stimulating
immunoglobulins activating TSH receptors, resulting in diffuse
hyperthyroidism and ophthalmopathy.
8. A patient with severe pancreatitis develops hypocalcemia. This
occurs primarily because:
A. Increased calcitonin secretion
B. Vitamin D deficiency
C. Fat necrosis binds calcium into soaps
