COMSAE Phase 2 Form BSA 109 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with crushing substernal chest pain
radiating to his left arm for 90 minutes. ECG demonstrates ST
elevations in leads II, III, and aVF. Blood pressure is 92/60 mm Hg.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Diagonal artery
Answer: C. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF most
commonly results from right coronary artery occlusion. Hypotension
may indicate associated right ventricular infarction. Immediate
reperfusion therapy is indicated.
2. A 24-year-old woman presents with sudden right lower quadrant
pain, amenorrhea for 7 weeks, and vaginal spotting. β-hCG is
positive. Transvaginal ultrasound shows no intrauterine
pregnancy and an adnexal mass. Most likely diagnosis?
,A. Ovarian torsion
B. Ruptured ovarian cyst
C. Ectopic pregnancy
D. Endometriosis
E. Appendicitis
Answer: C. Ectopic pregnancy
Rationale: Positive pregnancy test, absent intrauterine gestation, and
adnexal mass strongly suggest ectopic pregnancy. Tubal implantation
is the most common location.
3. A 5-year-old boy develops fever, conjunctivitis, strawberry
tongue, cervical lymphadenopathy, and desquamation of fingers.
Most important complication?
A. Glomerulonephritis
B. Coronary artery aneurysm
C. Rheumatic fever
D. Meningitis
E. Endocarditis
Answer: B. Coronary artery aneurysm
Rationale: Kawasaki disease can produce coronary artery aneurysms.
Treatment with IVIG and aspirin reduces this risk substantially.
4. A patient with COPD has:
pH 7.35
PaCO₂ 58 mmHg
HCO₃⁻ 31 mEq/L
Diagnosis?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with compensation
,C. Metabolic alkalosis
D. Mixed disorder
E. Respiratory alkalosis
Answer: B. Chronic respiratory acidosis with compensation
Rationale: Chronic CO₂ retention causes renal bicarbonate retention,
producing near-normal pH despite elevated CO₂.
5. A pregnant woman at 36 weeks presents with hypertension,
headache, and visual disturbances. BP 170/110 mmHg. Urinalysis
shows 3+ proteinuria. Initial management?
A. Oral nifedipine only
B. Immediate cesarean without stabilization
C. Magnesium sulfate and delivery planning
D. Bed rest
E. Aspirin therapy
Answer: C. Magnesium sulfate and delivery planning
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and prompt delivery after maternal stabilization.
6. A patient develops lip swelling after lisinopril use. Mechanism?
A. IgE-mediated allergy
B. Histamine release
C. Bradykinin accumulation
D. Complement deficiency
E. Autoimmunity
Answer: C. Bradykinin accumulation
Rationale: ACE inhibitors increase bradykinin levels, producing
angioedema independent of histamine pathways.
, 7. A 32-year-old woman reports palpitations, heat intolerance, and
weight loss. TSH is suppressed and free T4 elevated. Most likely
diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic adenoma
E. Pituitary adenoma
Answer: B. Graves disease
Rationale: Graves disease is characterized by stimulating TSH receptor
antibodies causing hyperthyroidism and diffuse goiter.
8. The best initial diagnostic test for suspected pulmonary embolism
in a hemodynamically stable patient is:
A. Chest X-ray
B. D-dimer alone
C. CT pulmonary angiography
D. MRI chest
E. Echocardiogram
Answer: C. CT pulmonary angiography
Rationale: CT pulmonary angiography is the preferred diagnostic test
in stable patients with moderate or high suspicion of PE.
9. A newborn presents with continuous machinery murmur.
Diagnosis?
A. ASD
B. PDA
C. VSD
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man presents with crushing substernal chest pain
radiating to his left arm for 90 minutes. ECG demonstrates ST
elevations in leads II, III, and aVF. Blood pressure is 92/60 mm Hg.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Diagonal artery
Answer: C. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF most
commonly results from right coronary artery occlusion. Hypotension
may indicate associated right ventricular infarction. Immediate
reperfusion therapy is indicated.
2. A 24-year-old woman presents with sudden right lower quadrant
pain, amenorrhea for 7 weeks, and vaginal spotting. β-hCG is
positive. Transvaginal ultrasound shows no intrauterine
pregnancy and an adnexal mass. Most likely diagnosis?
,A. Ovarian torsion
B. Ruptured ovarian cyst
C. Ectopic pregnancy
D. Endometriosis
E. Appendicitis
Answer: C. Ectopic pregnancy
Rationale: Positive pregnancy test, absent intrauterine gestation, and
adnexal mass strongly suggest ectopic pregnancy. Tubal implantation
is the most common location.
3. A 5-year-old boy develops fever, conjunctivitis, strawberry
tongue, cervical lymphadenopathy, and desquamation of fingers.
Most important complication?
A. Glomerulonephritis
B. Coronary artery aneurysm
C. Rheumatic fever
D. Meningitis
E. Endocarditis
Answer: B. Coronary artery aneurysm
Rationale: Kawasaki disease can produce coronary artery aneurysms.
Treatment with IVIG and aspirin reduces this risk substantially.
4. A patient with COPD has:
pH 7.35
PaCO₂ 58 mmHg
HCO₃⁻ 31 mEq/L
Diagnosis?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with compensation
,C. Metabolic alkalosis
D. Mixed disorder
E. Respiratory alkalosis
Answer: B. Chronic respiratory acidosis with compensation
Rationale: Chronic CO₂ retention causes renal bicarbonate retention,
producing near-normal pH despite elevated CO₂.
5. A pregnant woman at 36 weeks presents with hypertension,
headache, and visual disturbances. BP 170/110 mmHg. Urinalysis
shows 3+ proteinuria. Initial management?
A. Oral nifedipine only
B. Immediate cesarean without stabilization
C. Magnesium sulfate and delivery planning
D. Bed rest
E. Aspirin therapy
Answer: C. Magnesium sulfate and delivery planning
Rationale: Severe preeclampsia requires seizure prophylaxis with
magnesium sulfate and prompt delivery after maternal stabilization.
6. A patient develops lip swelling after lisinopril use. Mechanism?
A. IgE-mediated allergy
B. Histamine release
C. Bradykinin accumulation
D. Complement deficiency
E. Autoimmunity
Answer: C. Bradykinin accumulation
Rationale: ACE inhibitors increase bradykinin levels, producing
angioedema independent of histamine pathways.
, 7. A 32-year-old woman reports palpitations, heat intolerance, and
weight loss. TSH is suppressed and free T4 elevated. Most likely
diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic adenoma
E. Pituitary adenoma
Answer: B. Graves disease
Rationale: Graves disease is characterized by stimulating TSH receptor
antibodies causing hyperthyroidism and diffuse goiter.
8. The best initial diagnostic test for suspected pulmonary embolism
in a hemodynamically stable patient is:
A. Chest X-ray
B. D-dimer alone
C. CT pulmonary angiography
D. MRI chest
E. Echocardiogram
Answer: C. CT pulmonary angiography
Rationale: CT pulmonary angiography is the preferred diagnostic test
in stable patients with moderate or high suspicion of PE.
9. A newborn presents with continuous machinery murmur.
Diagnosis?
A. ASD
B. PDA
C. VSD
