COMSAE Phase 2-Form BSA 108 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man is admitted to the emergency department with
fever, productive cough, tachypnea, and confusion. He has a
history of hypertension and chronic obstructive pulmonary
disease. Temperature is 39.2°C (102.6°F), blood pressure is 82/50
mm Hg, pulse is 124/min, respirations are 30/min, and oxygen
saturation is 88% on room air. Chest radiograph shows right lower
lobe consolidation. Initial serum lactate is elevated. Which of the
following is the most appropriate immediate management?
A. Oral antibiotics and discharge home
B. Intravenous fluids, blood cultures, broad-spectrum antibiotics, and
vasopressors if hypotension persists
C. Nebulized bronchodilators only
D. Immediate bronchoscopy
E. High-dose corticosteroids alone
Answer: B
Rationale: This patient has septic shock secondary to community-
acquired pneumonia. Immediate management includes aggressive IV
crystalloid resuscitation, obtaining blood cultures, administration of
broad-spectrum antibiotics within the first hour, and vasopressors such
as norepinephrine if hypotension persists after fluids. Early intervention
significantly decreases mortality.
, 2. A 34-year-old woman develops sudden pleuritic chest pain and
dyspnea two days after knee arthroscopy. Heart rate is 118/min
and oxygen saturation is 89%. CT angiography confirms
pulmonary embolism. She is hemodynamically stable. What is the
best initial therapy?
A. Aspirin alone
B. Intravenous nitroglycerin
C. Anticoagulation with heparin
D. Emergent thrombolysis
E. Surgical embolectomy
Answer: C
Rationale: Stable pulmonary embolism is initially treated with
anticoagulation, usually unfractionated heparin or low-molecular-
weight heparin. Thrombolysis is reserved for patients with
hemodynamic instability or massive PE.
3. A 55-year-old woman presents with crushing substernal chest
pain radiating to her left arm for 45 minutes. ECG demonstrates
ST-segment elevations in leads II, III, and aVF. What is the most
important next step?
A. Schedule stress testing
B. Immediate reperfusion therapy
C. Observe for six hours
D. Start oral beta blockers only
E. Obtain echocardiography before treatment
Answer: B
Rationale: Inferior STEMI requires immediate reperfusion with primary
PCI or fibrinolysis if PCI is unavailable. Delaying reperfusion worsens
myocardial injury and outcomes.
, 4. A patient in the intensive care unit develops sudden hypotension,
distended neck veins, muffled heart sounds, and pulsus
paradoxus. What is the diagnosis?
A. Pulmonary edema
B. Tension pneumothorax
C. Cardiac tamponade
D. Acute mitral regurgitation
E. Septic shock
Answer: C
Rationale: Beck triad—hypotension, jugular venous distention, and
muffled heart sounds—is classic for cardiac tamponade. Pulsus
paradoxus is another hallmark. Immediate pericardiocentesis is
lifesaving.
5. A 27-year-old woman presents with fever, pelvic pain, cervical
motion tenderness, and purulent cervical discharge. Pregnancy
test is negative. Which diagnosis is most likely?
A. Ovarian torsion
B. Pelvic inflammatory disease
C. Ectopic pregnancy
D. Endometriosis
E. Fibroid degeneration
Answer: B
Rationale: PID is diagnosed clinically with pelvic pain, cervical motion
tenderness, uterine tenderness, and adnexal tenderness, often
associated with sexually transmitted infections.
6. A newborn develops cyanosis shortly after birth. Oxygen
administration does not improve saturation. Echocardiography
, demonstrates transposition of the great arteries. Which
medication should be started immediately?
A. Indomethacin
B. Propranolol
C. Prostaglandin E1
D. Furosemide
E. Digoxin
Answer: C
Rationale: Prostaglandin E1 maintains patency of the ductus arteriosus,
allowing mixing of oxygenated and deoxygenated blood until definitive
surgical correction.
7. A 72-year-old smoker presents with painless hematuria. Which
diagnosis must be excluded first?
A. Nephrolithiasis
B. Glomerulonephritis
C. Bladder cancer
D. Prostatitis
E. Pyelonephritis
Answer: C
Rationale: Painless hematuria in an older smoker is bladder cancer until
proven otherwise. Evaluation includes cystoscopy and imaging.
8. A 40-year-old woman presents with tremor, heat intolerance,
weight loss, and diffuse goiter. TSH is suppressed and free T4 is
elevated. The most likely diagnosis is:
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 68-year-old man is admitted to the emergency department with
fever, productive cough, tachypnea, and confusion. He has a
history of hypertension and chronic obstructive pulmonary
disease. Temperature is 39.2°C (102.6°F), blood pressure is 82/50
mm Hg, pulse is 124/min, respirations are 30/min, and oxygen
saturation is 88% on room air. Chest radiograph shows right lower
lobe consolidation. Initial serum lactate is elevated. Which of the
following is the most appropriate immediate management?
A. Oral antibiotics and discharge home
B. Intravenous fluids, blood cultures, broad-spectrum antibiotics, and
vasopressors if hypotension persists
C. Nebulized bronchodilators only
D. Immediate bronchoscopy
E. High-dose corticosteroids alone
Answer: B
Rationale: This patient has septic shock secondary to community-
acquired pneumonia. Immediate management includes aggressive IV
crystalloid resuscitation, obtaining blood cultures, administration of
broad-spectrum antibiotics within the first hour, and vasopressors such
as norepinephrine if hypotension persists after fluids. Early intervention
significantly decreases mortality.
, 2. A 34-year-old woman develops sudden pleuritic chest pain and
dyspnea two days after knee arthroscopy. Heart rate is 118/min
and oxygen saturation is 89%. CT angiography confirms
pulmonary embolism. She is hemodynamically stable. What is the
best initial therapy?
A. Aspirin alone
B. Intravenous nitroglycerin
C. Anticoagulation with heparin
D. Emergent thrombolysis
E. Surgical embolectomy
Answer: C
Rationale: Stable pulmonary embolism is initially treated with
anticoagulation, usually unfractionated heparin or low-molecular-
weight heparin. Thrombolysis is reserved for patients with
hemodynamic instability or massive PE.
3. A 55-year-old woman presents with crushing substernal chest
pain radiating to her left arm for 45 minutes. ECG demonstrates
ST-segment elevations in leads II, III, and aVF. What is the most
important next step?
A. Schedule stress testing
B. Immediate reperfusion therapy
C. Observe for six hours
D. Start oral beta blockers only
E. Obtain echocardiography before treatment
Answer: B
Rationale: Inferior STEMI requires immediate reperfusion with primary
PCI or fibrinolysis if PCI is unavailable. Delaying reperfusion worsens
myocardial injury and outcomes.
, 4. A patient in the intensive care unit develops sudden hypotension,
distended neck veins, muffled heart sounds, and pulsus
paradoxus. What is the diagnosis?
A. Pulmonary edema
B. Tension pneumothorax
C. Cardiac tamponade
D. Acute mitral regurgitation
E. Septic shock
Answer: C
Rationale: Beck triad—hypotension, jugular venous distention, and
muffled heart sounds—is classic for cardiac tamponade. Pulsus
paradoxus is another hallmark. Immediate pericardiocentesis is
lifesaving.
5. A 27-year-old woman presents with fever, pelvic pain, cervical
motion tenderness, and purulent cervical discharge. Pregnancy
test is negative. Which diagnosis is most likely?
A. Ovarian torsion
B. Pelvic inflammatory disease
C. Ectopic pregnancy
D. Endometriosis
E. Fibroid degeneration
Answer: B
Rationale: PID is diagnosed clinically with pelvic pain, cervical motion
tenderness, uterine tenderness, and adnexal tenderness, often
associated with sexually transmitted infections.
6. A newborn develops cyanosis shortly after birth. Oxygen
administration does not improve saturation. Echocardiography
, demonstrates transposition of the great arteries. Which
medication should be started immediately?
A. Indomethacin
B. Propranolol
C. Prostaglandin E1
D. Furosemide
E. Digoxin
Answer: C
Rationale: Prostaglandin E1 maintains patency of the ductus arteriosus,
allowing mixing of oxygenated and deoxygenated blood until definitive
surgical correction.
7. A 72-year-old smoker presents with painless hematuria. Which
diagnosis must be excluded first?
A. Nephrolithiasis
B. Glomerulonephritis
C. Bladder cancer
D. Prostatitis
E. Pyelonephritis
Answer: C
Rationale: Painless hematuria in an older smoker is bladder cancer until
proven otherwise. Evaluation includes cystoscopy and imaging.
8. A 40-year-old woman presents with tremor, heat intolerance,
weight loss, and diffuse goiter. TSH is suppressed and free T4 is
elevated. The most likely diagnosis is:
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
