COMSAE Phase 2 Form BSA 115 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
Question 1
A 67-year-old man presents with crushing substernal chest pain for 45
minutes associated with diaphoresis and nausea. ECG demonstrates ST-
segment elevations in leads V1-V4. Troponin I is elevated. Which of the
following is the most appropriate immediate management?
A. Alteplase therapy regardless of PCI availability
B. Aspirin and emergent PCI
C. Heparin only
D. Stress echocardiography
E. Observe overnight
Answer: B. Aspirin and emergent PCI
Rationale: Anterior STEMI requires immediate reperfusion therapy.
Primary PCI is preferred when available rapidly. Aspirin should be
administered immediately because it decreases mortality through
irreversible platelet inhibition. Stress testing is contraindicated during
active MI. Fibrinolysis is reserved when PCI is unavailable within
recommended time windows.
,Question 2
A 25-year-old woman presents with fever, dysuria, right flank pain, and
costovertebral angle tenderness. Urinalysis reveals WBC casts and
nitrites. What is the most likely diagnosis?
A. Cystitis
B. Interstitial nephritis
C. Acute pyelonephritis
D. Nephrolithiasis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Fever, flank pain, and WBC casts are classic for
pyelonephritis. WBC casts indicate renal parenchymal inflammation.
Cystitis lacks flank pain and systemic symptoms. Nephrolithiasis
usually presents with hematuria and colicky pain rather than pyuria
with casts.
Question 3
A 32-year-old woman complains of heat intolerance, palpitations,
weight loss, and tremor. Examination reveals diffuse goiter and
exophthalmos. Laboratory studies show suppressed TSH and elevated
free T4. Which is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Toxic adenoma
D. Subacute thyroiditis
E. Pituitary adenoma
Answer: B. Graves disease
,Rationale: Graves disease is characterized by hyperthyroidism, diffuse
goiter, ophthalmopathy, and thyroid-stimulating immunoglobulins.
Ophthalmopathy differentiates Graves disease from toxic adenoma
and thyroiditis.
Question 4
A 72-year-old man with COPD presents with worsening dyspnea. ABG
shows:
pH 7.32
PaCO₂ 60 mmHg
HCO₃⁻ 31 mEq/L
What acid-base disorder is present?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis
D. Chronic compensated respiratory acidosis
E. Mixed disorder
Answer: D. Chronic compensated respiratory acidosis
Rationale: COPD causes chronic CO₂ retention. Elevated bicarbonate
indicates renal compensation. The partially corrected pH supports
chronic compensated respiratory acidosis.
Question 5
A 7-year-old boy develops fever, strawberry tongue, circumoral pallor,
and a sandpaper rash after pharyngitis. Which organism is responsible?
, A. Staphylococcus aureus
B. Group A Streptococcus
C. Epstein-Barr virus
D. Corynebacterium diphtheriae
E. Adenovirus
Answer: B. Group A Streptococcus
Rationale: Scarlet fever results from erythrogenic toxin-producing
Group A Streptococcus. The classic findings include strawberry tongue,
sandpaper rash, and pharyngitis.
Question 6
A pregnant woman at 34 weeks develops severe hypertension,
headache, visual disturbances, and proteinuria. Which is the definitive
treatment?
A. Methyldopa
B. Magnesium sulfate alone
C. Hydralazine alone
D. Immediate delivery after stabilization
E. Bed rest
Answer: D. Immediate delivery after stabilization
Rationale: Severe preeclampsia after fetal viability requires maternal
stabilization followed by delivery. Magnesium prevents seizures but is
not definitive treatment.
Question 7
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
Question 1
A 67-year-old man presents with crushing substernal chest pain for 45
minutes associated with diaphoresis and nausea. ECG demonstrates ST-
segment elevations in leads V1-V4. Troponin I is elevated. Which of the
following is the most appropriate immediate management?
A. Alteplase therapy regardless of PCI availability
B. Aspirin and emergent PCI
C. Heparin only
D. Stress echocardiography
E. Observe overnight
Answer: B. Aspirin and emergent PCI
Rationale: Anterior STEMI requires immediate reperfusion therapy.
Primary PCI is preferred when available rapidly. Aspirin should be
administered immediately because it decreases mortality through
irreversible platelet inhibition. Stress testing is contraindicated during
active MI. Fibrinolysis is reserved when PCI is unavailable within
recommended time windows.
,Question 2
A 25-year-old woman presents with fever, dysuria, right flank pain, and
costovertebral angle tenderness. Urinalysis reveals WBC casts and
nitrites. What is the most likely diagnosis?
A. Cystitis
B. Interstitial nephritis
C. Acute pyelonephritis
D. Nephrolithiasis
E. Glomerulonephritis
Answer: C. Acute pyelonephritis
Rationale: Fever, flank pain, and WBC casts are classic for
pyelonephritis. WBC casts indicate renal parenchymal inflammation.
Cystitis lacks flank pain and systemic symptoms. Nephrolithiasis
usually presents with hematuria and colicky pain rather than pyuria
with casts.
Question 3
A 32-year-old woman complains of heat intolerance, palpitations,
weight loss, and tremor. Examination reveals diffuse goiter and
exophthalmos. Laboratory studies show suppressed TSH and elevated
free T4. Which is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Toxic adenoma
D. Subacute thyroiditis
E. Pituitary adenoma
Answer: B. Graves disease
,Rationale: Graves disease is characterized by hyperthyroidism, diffuse
goiter, ophthalmopathy, and thyroid-stimulating immunoglobulins.
Ophthalmopathy differentiates Graves disease from toxic adenoma
and thyroiditis.
Question 4
A 72-year-old man with COPD presents with worsening dyspnea. ABG
shows:
pH 7.32
PaCO₂ 60 mmHg
HCO₃⁻ 31 mEq/L
What acid-base disorder is present?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis
D. Chronic compensated respiratory acidosis
E. Mixed disorder
Answer: D. Chronic compensated respiratory acidosis
Rationale: COPD causes chronic CO₂ retention. Elevated bicarbonate
indicates renal compensation. The partially corrected pH supports
chronic compensated respiratory acidosis.
Question 5
A 7-year-old boy develops fever, strawberry tongue, circumoral pallor,
and a sandpaper rash after pharyngitis. Which organism is responsible?
, A. Staphylococcus aureus
B. Group A Streptococcus
C. Epstein-Barr virus
D. Corynebacterium diphtheriae
E. Adenovirus
Answer: B. Group A Streptococcus
Rationale: Scarlet fever results from erythrogenic toxin-producing
Group A Streptococcus. The classic findings include strawberry tongue,
sandpaper rash, and pharyngitis.
Question 6
A pregnant woman at 34 weeks develops severe hypertension,
headache, visual disturbances, and proteinuria. Which is the definitive
treatment?
A. Methyldopa
B. Magnesium sulfate alone
C. Hydralazine alone
D. Immediate delivery after stabilization
E. Bed rest
Answer: D. Immediate delivery after stabilization
Rationale: Severe preeclampsia after fetal viability requires maternal
stabilization followed by delivery. Magnesium prevents seizures but is
not definitive treatment.
Question 7
