COMSAE Phase 2 Form BSA 120 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man is brought to the emergency department
because of progressive confusion, fever, and cough for 3 days. His
temperature is 39.4°C (102.9°F), blood pressure is 88/54 mm Hg,
pulse is 122/min, and respiratory rate is 28/min. Oxygen
saturation is 89% on room air. Lung examination reveals crackles
in the right lower lobe. Laboratory studies show WBC
21,000/mm³, lactate 5.8 mmol/L, and creatinine 2.1 mg/dL. What
is the most appropriate initial management?
A. Start vasopressors immediately
B. Administer IV corticosteroids only
C. Delay antibiotics until blood cultures return
D. Administer IV crystalloids, broad-spectrum antibiotics, and obtain
cultures
E. Intubate before initiating therapy
Answer: D. Administer IV crystalloids, broad-spectrum antibiotics, and
obtain cultures
Rationale: This patient has septic shock secondary to pneumonia.
Immediate management includes rapid IV crystalloid resuscitation (30
mL/kg), prompt broad-spectrum antibiotics within the first hour, blood
cultures before antibiotics if this does not delay therapy, and close
,monitoring. Vasopressors are added if hypotension persists after fluid
resuscitation.
2. A 56-year-old woman presents with sudden crushing substernal
chest pain radiating to her jaw for 45 minutes. ECG demonstrates
ST elevations in leads II, III, and aVF. Blood pressure is 96/60 mm
Hg. Which is the most appropriate next step?
A. Stress test
B. Emergent PCI
C. Echocardiography only
D. Aspirin after troponin results
E. Coronary CT angiography
Answer: B. Emergent PCI
Rationale: This patient has an inferior STEMI. Immediate reperfusion
with PCI within 90 minutes is the standard of care. Aspirin and
anticoagulation should also be initiated promptly.
3. A 26-year-old woman develops palpitations and dizziness. ECG
shows a narrow-complex tachycardia at 190/min without visible P
waves. Vagal maneuvers fail. What is the next best step?
A. Metoprolol
B. Amiodarone
C. Adenosine
D. Digoxin
E. Verapamil infusion
Answer: C. Adenosine
,Rationale: Stable paroxysmal supraventricular tachycardia is treated
first with vagal maneuvers and then rapid IV adenosine, which
transiently blocks AV nodal conduction.
4. A 70-year-old man suddenly develops right facial droop, right arm
weakness, and aphasia 1 hour ago. CT head reveals no
hemorrhage. Blood pressure is 170/96 mm Hg. What is the most
appropriate treatment?
A. Aspirin only
B. IV alteplase
C. Heparin infusion
D. Carotid endarterectomy
E. Observation
Answer: B. IV alteplase
Rationale: This patient presents within the thrombolytic window for
acute ischemic stroke. Absence of hemorrhage on CT and BP below
185/110 make IV alteplase appropriate.
5. A 58-year-old man with alcoholism presents with hematemesis
and hypotension. Endoscopy reveals bleeding esophageal varices.
Which medication should be administered immediately?
A. Pantoprazole
B. Octreotide
C. Famotidine
D. Misoprostol
E. Metoclopramide
Answer: B. Octreotide
, Rationale: Octreotide decreases portal venous pressure and is first-line
pharmacologic therapy for acute variceal bleeding along with
antibiotics and endoscopic band ligation.
6. A 35-year-old man is admitted with diabetic ketoacidosis. His
glucose is 680 mg/dL, bicarbonate 9 mEq/L, and potassium 3.0
mEq/L. Which should be done before insulin administration?
A. Sodium bicarbonate
B. Potassium replacement
C. Dextrose infusion
D. Phosphate infusion
E. Calcium gluconate
Answer: B. Potassium replacement
Rationale: Insulin drives potassium intracellularly and can precipitate
dangerous hypokalemia. Potassium must be corrected first when K+ is
below 3.3 mEq/L.
7. A 23-year-old woman presents with fever, hypotension, and
diffuse petechiae. She has neck stiffness and altered mental
status. What is the most likely diagnosis?
A. Viral meningitis
B. Subarachnoid hemorrhage
C. Meningococcemia with meningitis
D. Brain abscess
E. Encephalitis
Answer: C. Meningococcemia with meningitis
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man is brought to the emergency department
because of progressive confusion, fever, and cough for 3 days. His
temperature is 39.4°C (102.9°F), blood pressure is 88/54 mm Hg,
pulse is 122/min, and respiratory rate is 28/min. Oxygen
saturation is 89% on room air. Lung examination reveals crackles
in the right lower lobe. Laboratory studies show WBC
21,000/mm³, lactate 5.8 mmol/L, and creatinine 2.1 mg/dL. What
is the most appropriate initial management?
A. Start vasopressors immediately
B. Administer IV corticosteroids only
C. Delay antibiotics until blood cultures return
D. Administer IV crystalloids, broad-spectrum antibiotics, and obtain
cultures
E. Intubate before initiating therapy
Answer: D. Administer IV crystalloids, broad-spectrum antibiotics, and
obtain cultures
Rationale: This patient has septic shock secondary to pneumonia.
Immediate management includes rapid IV crystalloid resuscitation (30
mL/kg), prompt broad-spectrum antibiotics within the first hour, blood
cultures before antibiotics if this does not delay therapy, and close
,monitoring. Vasopressors are added if hypotension persists after fluid
resuscitation.
2. A 56-year-old woman presents with sudden crushing substernal
chest pain radiating to her jaw for 45 minutes. ECG demonstrates
ST elevations in leads II, III, and aVF. Blood pressure is 96/60 mm
Hg. Which is the most appropriate next step?
A. Stress test
B. Emergent PCI
C. Echocardiography only
D. Aspirin after troponin results
E. Coronary CT angiography
Answer: B. Emergent PCI
Rationale: This patient has an inferior STEMI. Immediate reperfusion
with PCI within 90 minutes is the standard of care. Aspirin and
anticoagulation should also be initiated promptly.
3. A 26-year-old woman develops palpitations and dizziness. ECG
shows a narrow-complex tachycardia at 190/min without visible P
waves. Vagal maneuvers fail. What is the next best step?
A. Metoprolol
B. Amiodarone
C. Adenosine
D. Digoxin
E. Verapamil infusion
Answer: C. Adenosine
,Rationale: Stable paroxysmal supraventricular tachycardia is treated
first with vagal maneuvers and then rapid IV adenosine, which
transiently blocks AV nodal conduction.
4. A 70-year-old man suddenly develops right facial droop, right arm
weakness, and aphasia 1 hour ago. CT head reveals no
hemorrhage. Blood pressure is 170/96 mm Hg. What is the most
appropriate treatment?
A. Aspirin only
B. IV alteplase
C. Heparin infusion
D. Carotid endarterectomy
E. Observation
Answer: B. IV alteplase
Rationale: This patient presents within the thrombolytic window for
acute ischemic stroke. Absence of hemorrhage on CT and BP below
185/110 make IV alteplase appropriate.
5. A 58-year-old man with alcoholism presents with hematemesis
and hypotension. Endoscopy reveals bleeding esophageal varices.
Which medication should be administered immediately?
A. Pantoprazole
B. Octreotide
C. Famotidine
D. Misoprostol
E. Metoclopramide
Answer: B. Octreotide
, Rationale: Octreotide decreases portal venous pressure and is first-line
pharmacologic therapy for acute variceal bleeding along with
antibiotics and endoscopic band ligation.
6. A 35-year-old man is admitted with diabetic ketoacidosis. His
glucose is 680 mg/dL, bicarbonate 9 mEq/L, and potassium 3.0
mEq/L. Which should be done before insulin administration?
A. Sodium bicarbonate
B. Potassium replacement
C. Dextrose infusion
D. Phosphate infusion
E. Calcium gluconate
Answer: B. Potassium replacement
Rationale: Insulin drives potassium intracellularly and can precipitate
dangerous hypokalemia. Potassium must be corrected first when K+ is
below 3.3 mEq/L.
7. A 23-year-old woman presents with fever, hypotension, and
diffuse petechiae. She has neck stiffness and altered mental
status. What is the most likely diagnosis?
A. Viral meningitis
B. Subarachnoid hemorrhage
C. Meningococcemia with meningitis
D. Brain abscess
E. Encephalitis
Answer: C. Meningococcemia with meningitis
