COMSAE Phase 2 Form BSA 107 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents to the emergency department with
sudden onset crushing substernal chest pain radiating to the jaw
for 45 minutes. He is diaphoretic and nauseated. ECG
demonstrates ST-segment elevations in leads II, III, and aVF. Blood
pressure is 88/60 mmHg. Which of the following is the most
appropriate next step?
A. Intravenous nitroglycerin
B. Emergent PCI with aspirin and heparin
C. Stress echocardiography
D. Alteplase after discharge
E. Coronary CT angiography
Answer: B. Emergent PCI with aspirin and heparin
Rationale: Inferior STEMI with hypotension suggests right ventricular
involvement. Immediate reperfusion with PCI is the gold standard.
Nitroglycerin may worsen hypotension due to preload dependence.
Stress testing is contraindicated during acute MI.
2. A 23-year-old woman presents with fever, malar rash, oral ulcers,
and proteinuria. ANA and anti-dsDNA are positive. Kidney biopsy
shows diffuse proliferative glomerulonephritis. Which treatment
is most appropriate?
,A. Hydroxychloroquine alone
B. Methotrexate
C. Prednisone and mycophenolate mofetil
D. NSAIDs only
E. Azathioprine monotherapy
Answer: C. Prednisone and mycophenolate mofetil
Rationale: Class IV lupus nephritis requires aggressive
immunosuppression. Mycophenolate plus corticosteroids improves
renal outcomes and decreases progression to ESRD.
3. A 4-year-old child suddenly develops drooling, dysphagia, fever,
and respiratory distress. He is sitting forward and refuses to lie
down. What is the first step?
A. Throat culture
B. Tongue depressor examination
C. Secure the airway
D. Nebulized albuterol
E. Oral antibiotics
Answer: C. Secure the airway
Rationale: This is epiglottitis. Airway stabilization is always the
priority. Manipulating the airway before securing it can precipitate
complete obstruction.
4. A 58-year-old alcoholic presents with confusion, ophthalmoplegia,
and ataxia. Which treatment should be administered first?
A. Dextrose
B. Naloxone
C. Thiamine
,D. Folate
E. Vitamin B12
Answer: C. Thiamine
Rationale: The classic triad indicates Wernicke encephalopathy.
Thiamine must precede glucose to prevent worsening neurologic
injury.
5. A pregnant 32-year-old at 34 weeks gestation develops
hypertension, headache, RUQ pain, platelets of 80,000/mm³, and
elevated liver enzymes. The diagnosis is:
A. Acute fatty liver of pregnancy
B. HELLP syndrome
C. Gestational hypertension
D. Cholestasis of pregnancy
E. DIC
Answer: B. HELLP syndrome
Rationale: HELLP consists of Hemolysis, Elevated Liver enzymes, and
Low Platelets. It is a severe variant of preeclampsia requiring prompt
delivery after stabilization.
6. A 60-year-old smoker presents with painless hematuria. Which
diagnosis is most likely?
A. Renal cell carcinoma
B. Urolithiasis
C. Transitional cell carcinoma
D. Pyelonephritis
E. IgA nephropathy
Answer: C. Transitional cell carcinoma
, Rationale: Painless gross hematuria in a smoker is bladder cancer until
proven otherwise. Cigarette smoking is the strongest risk factor.
7. A 24-year-old presents with sudden pleuritic chest pain and
dyspnea. Examination reveals absent breath sounds on the right
and hyperresonance. What is the diagnosis?
A. Pulmonary embolism
B. Tension pneumothorax
C. Pneumonia
D. Pleural effusion
E. Asthma exacerbation
Answer: B. Tension pneumothorax
Rationale: Absent breath sounds with hyperresonance and acute
respiratory compromise indicate tension pneumothorax requiring
immediate decompression.
8. A patient with atrial fibrillation suddenly develops severe
abdominal pain out of proportion to examination findings. Which
diagnosis is most likely?
A. Appendicitis
B. Acute cholecystitis
C. Mesenteric ischemia
D. Pancreatitis
E. Diverticulitis
Answer: C. Mesenteric ischemia
Rationale: Embolization from atrial fibrillation to the SMA causes
intestinal ischemia characterized by excruciating pain with initially
benign examination findings.
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents to the emergency department with
sudden onset crushing substernal chest pain radiating to the jaw
for 45 minutes. He is diaphoretic and nauseated. ECG
demonstrates ST-segment elevations in leads II, III, and aVF. Blood
pressure is 88/60 mmHg. Which of the following is the most
appropriate next step?
A. Intravenous nitroglycerin
B. Emergent PCI with aspirin and heparin
C. Stress echocardiography
D. Alteplase after discharge
E. Coronary CT angiography
Answer: B. Emergent PCI with aspirin and heparin
Rationale: Inferior STEMI with hypotension suggests right ventricular
involvement. Immediate reperfusion with PCI is the gold standard.
Nitroglycerin may worsen hypotension due to preload dependence.
Stress testing is contraindicated during acute MI.
2. A 23-year-old woman presents with fever, malar rash, oral ulcers,
and proteinuria. ANA and anti-dsDNA are positive. Kidney biopsy
shows diffuse proliferative glomerulonephritis. Which treatment
is most appropriate?
,A. Hydroxychloroquine alone
B. Methotrexate
C. Prednisone and mycophenolate mofetil
D. NSAIDs only
E. Azathioprine monotherapy
Answer: C. Prednisone and mycophenolate mofetil
Rationale: Class IV lupus nephritis requires aggressive
immunosuppression. Mycophenolate plus corticosteroids improves
renal outcomes and decreases progression to ESRD.
3. A 4-year-old child suddenly develops drooling, dysphagia, fever,
and respiratory distress. He is sitting forward and refuses to lie
down. What is the first step?
A. Throat culture
B. Tongue depressor examination
C. Secure the airway
D. Nebulized albuterol
E. Oral antibiotics
Answer: C. Secure the airway
Rationale: This is epiglottitis. Airway stabilization is always the
priority. Manipulating the airway before securing it can precipitate
complete obstruction.
4. A 58-year-old alcoholic presents with confusion, ophthalmoplegia,
and ataxia. Which treatment should be administered first?
A. Dextrose
B. Naloxone
C. Thiamine
,D. Folate
E. Vitamin B12
Answer: C. Thiamine
Rationale: The classic triad indicates Wernicke encephalopathy.
Thiamine must precede glucose to prevent worsening neurologic
injury.
5. A pregnant 32-year-old at 34 weeks gestation develops
hypertension, headache, RUQ pain, platelets of 80,000/mm³, and
elevated liver enzymes. The diagnosis is:
A. Acute fatty liver of pregnancy
B. HELLP syndrome
C. Gestational hypertension
D. Cholestasis of pregnancy
E. DIC
Answer: B. HELLP syndrome
Rationale: HELLP consists of Hemolysis, Elevated Liver enzymes, and
Low Platelets. It is a severe variant of preeclampsia requiring prompt
delivery after stabilization.
6. A 60-year-old smoker presents with painless hematuria. Which
diagnosis is most likely?
A. Renal cell carcinoma
B. Urolithiasis
C. Transitional cell carcinoma
D. Pyelonephritis
E. IgA nephropathy
Answer: C. Transitional cell carcinoma
, Rationale: Painless gross hematuria in a smoker is bladder cancer until
proven otherwise. Cigarette smoking is the strongest risk factor.
7. A 24-year-old presents with sudden pleuritic chest pain and
dyspnea. Examination reveals absent breath sounds on the right
and hyperresonance. What is the diagnosis?
A. Pulmonary embolism
B. Tension pneumothorax
C. Pneumonia
D. Pleural effusion
E. Asthma exacerbation
Answer: B. Tension pneumothorax
Rationale: Absent breath sounds with hyperresonance and acute
respiratory compromise indicate tension pneumothorax requiring
immediate decompression.
8. A patient with atrial fibrillation suddenly develops severe
abdominal pain out of proportion to examination findings. Which
diagnosis is most likely?
A. Appendicitis
B. Acute cholecystitis
C. Mesenteric ischemia
D. Pancreatitis
E. Diverticulitis
Answer: C. Mesenteric ischemia
Rationale: Embolization from atrial fibrillation to the SMA causes
intestinal ischemia characterized by excruciating pain with initially
benign examination findings.
