COMSAE Phase 2 Form BSA 123 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with COPD presents with increased dyspnea,
increased sputum purulence, and wheezing for 3 days. ABG shows
pH 7.31, PaCO₂ 58 mmHg, HCO₃⁻ 30 mEq/L. What is the most
appropriate initial management?
A. Oral azithromycin only
B. Noninvasive positive pressure ventilation (BiPAP)
C. Immediate intubation
D. High-dose diuretics
Answer: B. Noninvasive positive pressure ventilation (BiPAP)
Rationale: This patient has acute on chronic hypercapnic respiratory
failure from COPD exacerbation; BiPAP improves ventilation, reduces
CO₂ retention, and decreases work of breathing.
2. A 24-year-old woman presents with fever, flank pain, and dysuria.
UA shows WBC casts. What is the best treatment?
A. Nitrofurantoin
B. Ceftriaxone
,C. Amoxicillin
D. Metronidazole
Answer: B. Ceftriaxone
Rationale: WBC casts indicate pyelonephritis, requiring systemic
antibiotics such as ceftriaxone; nitrofurantoin is inadequate for renal
tissue infection.
3. A patient presents with chest pain radiating to the back, unequal
blood pressures in arms, and widened mediastinum. Diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B. Aortic dissection
Rationale: Classic tearing chest pain with mediastinal widening and
BP discrepancy suggests aortic dissection.
4. A 55-year-old diabetic has foot ulcer with foul odor and gas on X-
ray. Most likely organism?
A. Staphylococcus epidermidis
B. Clostridium perfringens
C. Streptococcus pneumoniae
D. Candida albicans
Answer: B. Clostridium perfringens
Rationale: Gas gangrene is caused by anaerobic Clostridium species
producing exotoxins leading to tissue necrosis.
, 5. A child presents with barking cough and inspiratory stridor. Best
initial treatment?
A. Albuterol
B. Nebulized epinephrine and dexamethasone
C. Antibiotics
D. Antihistamines
Answer: B. Nebulized epinephrine and dexamethasone
Rationale: Croup (laryngotracheitis) is treated with steroids and
nebulized epinephrine for airway inflammation.
6. A patient has tremor, heat intolerance, and exophthalmos. Lab
findings show low TSH, high T3/T4. Diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
Answer: B. Graves disease
Rationale: Autoimmune TSH receptor stimulation leads to
hyperthyroidism and ophthalmopathy.
7. A man presents with painless hematuria. Most likely diagnosis?
A. Kidney stone
B. Bladder cancer
C. Pyelonephritis
D. Urethritis
Answer: B. Bladder cancer
Rationale: Painless gross hematuria is classic for urothelial carcinoma.
, 8. A patient develops sudden shortness of breath after surgery.
Vitals: tachycardia, hypoxia. Best next step?
A. Chest X-ray only
B. D-dimer only
C. CT pulmonary angiography
D. Echocardiogram only
Answer: C. CT pulmonary angiography
Rationale: High suspicion for pulmonary embolism requires definitive
imaging with CT angiography.
9. A newborn has failure to pass meconium and abdominal
distension. Diagnosis?
A. Pyloric stenosis
B. Hirschsprung disease
C. Necrotizing enterocolitis
D. Intussusception
Answer: B. Hirschsprung disease
Rationale: Congenital absence of ganglion cells leads to functional
obstruction.
10. A patient on heparin develops thrombocytopenia.
Mechanism?
A. Autoimmune platelet destruction via drug-dependent antibodies
B. Bone marrow failure
C. Vitamin K deficiency
D. Liver failure
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man with COPD presents with increased dyspnea,
increased sputum purulence, and wheezing for 3 days. ABG shows
pH 7.31, PaCO₂ 58 mmHg, HCO₃⁻ 30 mEq/L. What is the most
appropriate initial management?
A. Oral azithromycin only
B. Noninvasive positive pressure ventilation (BiPAP)
C. Immediate intubation
D. High-dose diuretics
Answer: B. Noninvasive positive pressure ventilation (BiPAP)
Rationale: This patient has acute on chronic hypercapnic respiratory
failure from COPD exacerbation; BiPAP improves ventilation, reduces
CO₂ retention, and decreases work of breathing.
2. A 24-year-old woman presents with fever, flank pain, and dysuria.
UA shows WBC casts. What is the best treatment?
A. Nitrofurantoin
B. Ceftriaxone
,C. Amoxicillin
D. Metronidazole
Answer: B. Ceftriaxone
Rationale: WBC casts indicate pyelonephritis, requiring systemic
antibiotics such as ceftriaxone; nitrofurantoin is inadequate for renal
tissue infection.
3. A patient presents with chest pain radiating to the back, unequal
blood pressures in arms, and widened mediastinum. Diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B. Aortic dissection
Rationale: Classic tearing chest pain with mediastinal widening and
BP discrepancy suggests aortic dissection.
4. A 55-year-old diabetic has foot ulcer with foul odor and gas on X-
ray. Most likely organism?
A. Staphylococcus epidermidis
B. Clostridium perfringens
C. Streptococcus pneumoniae
D. Candida albicans
Answer: B. Clostridium perfringens
Rationale: Gas gangrene is caused by anaerobic Clostridium species
producing exotoxins leading to tissue necrosis.
, 5. A child presents with barking cough and inspiratory stridor. Best
initial treatment?
A. Albuterol
B. Nebulized epinephrine and dexamethasone
C. Antibiotics
D. Antihistamines
Answer: B. Nebulized epinephrine and dexamethasone
Rationale: Croup (laryngotracheitis) is treated with steroids and
nebulized epinephrine for airway inflammation.
6. A patient has tremor, heat intolerance, and exophthalmos. Lab
findings show low TSH, high T3/T4. Diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
Answer: B. Graves disease
Rationale: Autoimmune TSH receptor stimulation leads to
hyperthyroidism and ophthalmopathy.
7. A man presents with painless hematuria. Most likely diagnosis?
A. Kidney stone
B. Bladder cancer
C. Pyelonephritis
D. Urethritis
Answer: B. Bladder cancer
Rationale: Painless gross hematuria is classic for urothelial carcinoma.
, 8. A patient develops sudden shortness of breath after surgery.
Vitals: tachycardia, hypoxia. Best next step?
A. Chest X-ray only
B. D-dimer only
C. CT pulmonary angiography
D. Echocardiogram only
Answer: C. CT pulmonary angiography
Rationale: High suspicion for pulmonary embolism requires definitive
imaging with CT angiography.
9. A newborn has failure to pass meconium and abdominal
distension. Diagnosis?
A. Pyloric stenosis
B. Hirschsprung disease
C. Necrotizing enterocolitis
D. Intussusception
Answer: B. Hirschsprung disease
Rationale: Congenital absence of ganglion cells leads to functional
obstruction.
10. A patient on heparin develops thrombocytopenia.
Mechanism?
A. Autoimmune platelet destruction via drug-dependent antibodies
B. Bone marrow failure
C. Vitamin K deficiency
D. Liver failure
