COMSAE Phase 2 Form BSA 102 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with a history of hypertension, hyperlipidemia,
and smoking presents with crushing substernal chest pain
radiating to his left arm for 45 minutes. ECG shows ST-segment
elevations in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions involving leads II, III, and
aVF are most commonly caused by occlusion of the right coronary
artery. Associated findings may include bradycardia, hypotension, and
right ventricular infarction. The LAD causes anterior MI, while LCX
commonly causes lateral wall infarction.
2. A 26-year-old woman presents with fever, malar rash, arthritis,
and proteinuria. Laboratory testing reveals positive ANA and anti-
dsDNA antibodies. What is the most likely diagnosis?
,A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Sjögren syndrome
D. Dermatomyositis
Answer: B. Systemic lupus erythematosus
Rationale: The combination of malar rash, arthritis, nephritis, and anti-
dsDNA antibodies is classic for SLE. Anti-dsDNA antibodies correlate
with lupus nephritis activity and disease severity.
3. A 70-year-old man presents with sudden onset right-sided
weakness and aphasia. CT head is negative for hemorrhage.
Symptoms began 90 minutes ago. Blood pressure is 170/95
mmHg. What is the next best step?
A. Aspirin only
B. Intravenous alteplase
C. Heparin infusion
D. Emergency carotid endarterectomy
Answer: B. Intravenous alteplase
Rationale: The patient has an acute ischemic stroke within the
therapeutic window (<4.5 hours) and no contraindications to
thrombolysis. A negative CT excludes hemorrhage, making alteplase the
preferred treatment.
4. A patient with diabetic ketoacidosis is admitted with glucose 650
mg/dL, pH 7.10, bicarbonate 9 mEq/L, and potassium 5.8 mEq/L.
Which intervention should be initiated first?
,A. Intravenous bicarbonate
B. Intravenous insulin infusion
C. Aggressive isotonic saline administration
D. Potassium replacement
Answer: C. Aggressive isotonic saline administration
Rationale: Fluid resuscitation is the first priority in DKA because
patients are profoundly volume depleted. Insulin is started after fluids
and confirmation that potassium levels are adequate.
5. A 58-year-old woman complains of exertional dyspnea and
fatigue. Echocardiography reveals an ejection fraction of 30%.
Which medication has been shown to reduce mortality?
A. Digoxin
B. Furosemide
C. Lisinopril
D. Verapamil
Answer: C. Lisinopril
Rationale: ACE inhibitors improve survival in heart failure with reduced
ejection fraction by decreasing afterload, reducing ventricular
remodeling, and improving cardiac output.
6. A 22-year-old college student presents with fever, headache, neck
stiffness, and photophobia. CSF shows elevated neutrophils, low
glucose, and elevated protein. Which is the most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
, C. Fungal meningitis
D. Tuberculous meningitis
Answer: B. Bacterial meningitis
Rationale: Neutrophilic pleocytosis with low CSF glucose and elevated
protein strongly suggests bacterial meningitis. Viral meningitis typically
demonstrates lymphocytic predominance and normal glucose.
7. A 55-year-old smoker presents with hematuria without pain.
Which diagnosis is most concerning?
A. Nephrolithiasis
B. Pyelonephritis
C. Bladder cancer
D. Benign prostatic hyperplasia
Answer: C. Bladder cancer
Rationale: Painless gross hematuria in a smoker is bladder cancer until
proven otherwise. Smoking is the strongest risk factor for urothelial
carcinoma.
8. A patient develops fever, hypotension, warm extremities, and
elevated lactate due to pneumonia. Which type of shock is
present?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Obstructive shock
Answer: C. Septic shock
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with a history of hypertension, hyperlipidemia,
and smoking presents with crushing substernal chest pain
radiating to his left arm for 45 minutes. ECG shows ST-segment
elevations in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions involving leads II, III, and
aVF are most commonly caused by occlusion of the right coronary
artery. Associated findings may include bradycardia, hypotension, and
right ventricular infarction. The LAD causes anterior MI, while LCX
commonly causes lateral wall infarction.
2. A 26-year-old woman presents with fever, malar rash, arthritis,
and proteinuria. Laboratory testing reveals positive ANA and anti-
dsDNA antibodies. What is the most likely diagnosis?
,A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Sjögren syndrome
D. Dermatomyositis
Answer: B. Systemic lupus erythematosus
Rationale: The combination of malar rash, arthritis, nephritis, and anti-
dsDNA antibodies is classic for SLE. Anti-dsDNA antibodies correlate
with lupus nephritis activity and disease severity.
3. A 70-year-old man presents with sudden onset right-sided
weakness and aphasia. CT head is negative for hemorrhage.
Symptoms began 90 minutes ago. Blood pressure is 170/95
mmHg. What is the next best step?
A. Aspirin only
B. Intravenous alteplase
C. Heparin infusion
D. Emergency carotid endarterectomy
Answer: B. Intravenous alteplase
Rationale: The patient has an acute ischemic stroke within the
therapeutic window (<4.5 hours) and no contraindications to
thrombolysis. A negative CT excludes hemorrhage, making alteplase the
preferred treatment.
4. A patient with diabetic ketoacidosis is admitted with glucose 650
mg/dL, pH 7.10, bicarbonate 9 mEq/L, and potassium 5.8 mEq/L.
Which intervention should be initiated first?
,A. Intravenous bicarbonate
B. Intravenous insulin infusion
C. Aggressive isotonic saline administration
D. Potassium replacement
Answer: C. Aggressive isotonic saline administration
Rationale: Fluid resuscitation is the first priority in DKA because
patients are profoundly volume depleted. Insulin is started after fluids
and confirmation that potassium levels are adequate.
5. A 58-year-old woman complains of exertional dyspnea and
fatigue. Echocardiography reveals an ejection fraction of 30%.
Which medication has been shown to reduce mortality?
A. Digoxin
B. Furosemide
C. Lisinopril
D. Verapamil
Answer: C. Lisinopril
Rationale: ACE inhibitors improve survival in heart failure with reduced
ejection fraction by decreasing afterload, reducing ventricular
remodeling, and improving cardiac output.
6. A 22-year-old college student presents with fever, headache, neck
stiffness, and photophobia. CSF shows elevated neutrophils, low
glucose, and elevated protein. Which is the most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
, C. Fungal meningitis
D. Tuberculous meningitis
Answer: B. Bacterial meningitis
Rationale: Neutrophilic pleocytosis with low CSF glucose and elevated
protein strongly suggests bacterial meningitis. Viral meningitis typically
demonstrates lymphocytic predominance and normal glucose.
7. A 55-year-old smoker presents with hematuria without pain.
Which diagnosis is most concerning?
A. Nephrolithiasis
B. Pyelonephritis
C. Bladder cancer
D. Benign prostatic hyperplasia
Answer: C. Bladder cancer
Rationale: Painless gross hematuria in a smoker is bladder cancer until
proven otherwise. Smoking is the strongest risk factor for urothelial
carcinoma.
8. A patient develops fever, hypotension, warm extremities, and
elevated lactate due to pneumonia. Which type of shock is
present?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Obstructive shock
Answer: C. Septic shock
