“COMSAE Form 110 – Complete Exam
with Answer Key & Step-by-Step
Explanations | Ideal for COMLEX Level 1
Review”
1. A 65-year-old male with a history of hypertension presents with sudden
onset of severe, tearing chest pain that radiates to his back. His blood pressure
is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm. Which of
the following is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
• Correct ,,,,answer,,,,: C
• Rationale: The classic presentation of aortic dissection is sudden, severe,
tearing chest pain that radiates to the back, often with a difference in blood
pressure between the arms. This is a medical emergency requiring
immediate intervention.
2. A 55-year-old female with a history of heart failure is prescribed
furosemide. Which laboratory value should be monitored closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum glucose
• Correct ,,,,answer,,,,: B
, • Rationale: Furosemide is a loop diuretic that can cause hypokalemia.
Monitoring serum potassium is essential to prevent cardiac arrhythmias.
3. A 70-year-old male with a history of coronary artery disease presents with
chest pain that occurs at rest and is relieved by nitroglycerin. Which of the
following is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Prinzmetal's angina
D. Myocardial infarction
• Correct ,,,,answer,,,,: B
• Rationale: Unstable angina is characterized by chest pain that occurs at rest
or with minimal exertion, is more severe or prolonged than stable angina,
and may not be fully relieved by nitroglycerin. It is a medical emergency.
4. A 60-year-old male with a history of hypertension and diabetes presents
with sudden onset of severe headache, nausea, and vomiting. His blood
pressure is 220/120 mmHg. Which of the following is the most likely
diagnosis?
A. Migraine headache
B. Hypertensive emergency
C. Subarachnoid hemorrhage
D. Meningitis
• Correct ,,,,answer,,,,: B
• Rationale: Hypertensive emergency is defined as severe hypertension (SBP
>180 or DBP >120) with evidence of acute target organ damage, such as
headache, nausea, vomiting, or altered mental status. This requires
immediate reduction of blood pressure.
5. A 55-year-old male with a history of heart failure is prescribed digoxin.
Which finding indicates digoxin toxicity?
,A. Heart rate 60 bpm
B. Anorexia and nausea
C. Blood pressure 120/80 mmHg
D. Weight gain
• Correct ,,,,answer,,,,: B
• Rationale: Early signs of digoxin toxicity include anorexia, nausea,
vomiting, and visual disturbances (yellow-green halos). Bradycardia can
also occur but may be expected at therapeutic levels.
6. A 45-year-old female with a history of mitral valve prolapse presents with
palpitations and chest pain. On auscultation, a mid-systolic click is heard
followed by a late systolic murmur. Which of the following is the most likely
diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Tricuspid regurgitation
• Correct ,,,,answer,,,,: C
• Rationale: Mitral valve prolapse is characterized by a mid-systolic click
followed by a late systolic murmur. It is often benign but can cause
palpitations and chest pain.
7. A 60-year-old male with a history of smoking and hypertension presents
with a pulsatile abdominal mass. Which of the following is the most likely
diagnosis?
A. Abdominal aortic aneurysm
B. Pancreatic pseudocyst
C. Renal cell carcinoma
D. Splenomegaly
• Correct ,,,,answer,,,,: A
, • Rationale: A pulsatile abdominal mass in a patient with risk factors for
atherosclerosis (smoking, hypertension) is concerning for an abdominal
aortic aneurysm. This requires prompt evaluation with ultrasound or CT.
8. A 50-year-old female with a history of hypertension is prescribed lisinopril.
Which adverse effect should be included in patient teaching?
A. Hyperkalemia
B. Persistent cough
C. Bradycardia
D. Weight gain
• Correct ,,,,answer,,,,: B
• Rationale: Lisinopril is an ACE inhibitor. A persistent, dry cough is a
common adverse effect. If the cough becomes bothersome, the provider may
switch to an ARB.
9. A 65-year-old male with a history of coronary artery disease presents with
chest pain that is relieved by rest and nitroglycerin. Which of the following is
the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Prinzmetal's angina
D. Myocardial infarction
• Correct ,,,,answer,,,,: A
• Rationale: Stable angina is characterized by chest pain that occurs with
exertion and is relieved by rest or nitroglycerin. It is caused by fixed
coronary artery stenosis.
10. A 55-year-old female with a history of heart failure and atrial fibrillation
is prescribed warfarin. Which laboratory value should be monitored to assess
the effectiveness of the medication?
A. PT/INR
with Answer Key & Step-by-Step
Explanations | Ideal for COMLEX Level 1
Review”
1. A 65-year-old male with a history of hypertension presents with sudden
onset of severe, tearing chest pain that radiates to his back. His blood pressure
is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm. Which of
the following is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
• Correct ,,,,answer,,,,: C
• Rationale: The classic presentation of aortic dissection is sudden, severe,
tearing chest pain that radiates to the back, often with a difference in blood
pressure between the arms. This is a medical emergency requiring
immediate intervention.
2. A 55-year-old female with a history of heart failure is prescribed
furosemide. Which laboratory value should be monitored closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum glucose
• Correct ,,,,answer,,,,: B
, • Rationale: Furosemide is a loop diuretic that can cause hypokalemia.
Monitoring serum potassium is essential to prevent cardiac arrhythmias.
3. A 70-year-old male with a history of coronary artery disease presents with
chest pain that occurs at rest and is relieved by nitroglycerin. Which of the
following is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Prinzmetal's angina
D. Myocardial infarction
• Correct ,,,,answer,,,,: B
• Rationale: Unstable angina is characterized by chest pain that occurs at rest
or with minimal exertion, is more severe or prolonged than stable angina,
and may not be fully relieved by nitroglycerin. It is a medical emergency.
4. A 60-year-old male with a history of hypertension and diabetes presents
with sudden onset of severe headache, nausea, and vomiting. His blood
pressure is 220/120 mmHg. Which of the following is the most likely
diagnosis?
A. Migraine headache
B. Hypertensive emergency
C. Subarachnoid hemorrhage
D. Meningitis
• Correct ,,,,answer,,,,: B
• Rationale: Hypertensive emergency is defined as severe hypertension (SBP
>180 or DBP >120) with evidence of acute target organ damage, such as
headache, nausea, vomiting, or altered mental status. This requires
immediate reduction of blood pressure.
5. A 55-year-old male with a history of heart failure is prescribed digoxin.
Which finding indicates digoxin toxicity?
,A. Heart rate 60 bpm
B. Anorexia and nausea
C. Blood pressure 120/80 mmHg
D. Weight gain
• Correct ,,,,answer,,,,: B
• Rationale: Early signs of digoxin toxicity include anorexia, nausea,
vomiting, and visual disturbances (yellow-green halos). Bradycardia can
also occur but may be expected at therapeutic levels.
6. A 45-year-old female with a history of mitral valve prolapse presents with
palpitations and chest pain. On auscultation, a mid-systolic click is heard
followed by a late systolic murmur. Which of the following is the most likely
diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Tricuspid regurgitation
• Correct ,,,,answer,,,,: C
• Rationale: Mitral valve prolapse is characterized by a mid-systolic click
followed by a late systolic murmur. It is often benign but can cause
palpitations and chest pain.
7. A 60-year-old male with a history of smoking and hypertension presents
with a pulsatile abdominal mass. Which of the following is the most likely
diagnosis?
A. Abdominal aortic aneurysm
B. Pancreatic pseudocyst
C. Renal cell carcinoma
D. Splenomegaly
• Correct ,,,,answer,,,,: A
, • Rationale: A pulsatile abdominal mass in a patient with risk factors for
atherosclerosis (smoking, hypertension) is concerning for an abdominal
aortic aneurysm. This requires prompt evaluation with ultrasound or CT.
8. A 50-year-old female with a history of hypertension is prescribed lisinopril.
Which adverse effect should be included in patient teaching?
A. Hyperkalemia
B. Persistent cough
C. Bradycardia
D. Weight gain
• Correct ,,,,answer,,,,: B
• Rationale: Lisinopril is an ACE inhibitor. A persistent, dry cough is a
common adverse effect. If the cough becomes bothersome, the provider may
switch to an ARB.
9. A 65-year-old male with a history of coronary artery disease presents with
chest pain that is relieved by rest and nitroglycerin. Which of the following is
the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Prinzmetal's angina
D. Myocardial infarction
• Correct ,,,,answer,,,,: A
• Rationale: Stable angina is characterized by chest pain that occurs with
exertion and is relieved by rest or nitroglycerin. It is caused by fixed
coronary artery stenosis.
10. A 55-year-old female with a history of heart failure and atrial fibrillation
is prescribed warfarin. Which laboratory value should be monitored to assess
the effectiveness of the medication?
A. PT/INR
