COMSAE Phase 3 Form CSA 115 Advanced
Clinical Synthesis Exam Practice Questions
& [Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
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1. A 67-year-old man is hospitalized with community-acquired
pneumonia. On day 3, he develops sudden pleuritic chest pain,
tachycardia, and oxygen desaturation despite improving
pulmonary infiltrates. D-dimer is elevated. Which is the most
appropriate next diagnostic step?
A. Repeat chest radiograph
B. Ventilation-perfusion scan without further evaluation
C. CT pulmonary angiography
D. Bronchoscopy
E. Sputum culture
Answer: C. CT pulmonary angiography
Rationale: Sudden hypoxemia, pleuritic chest pain, and tachycardia in
a hospitalized patient strongly suggest pulmonary embolism. CT
pulmonary angiography is the preferred diagnostic test in
hemodynamically stable patients with suspected PE.
2. A 58-year-old woman with diabetes presents with crushing
substernal chest pain. ECG demonstrates ST-segment elevation in
, leads II, III, and aVF. Which coronary vessel is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Diagonal branch
E. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions involving leads II, III,
and aVF most commonly result from occlusion of the right coronary
artery.
3. A 26-year-old woman presents with fatigue, arthralgias,
photosensitive rash, and proteinuria. Laboratory testing reveals
anti-dsDNA antibodies. Which diagnosis is most likely?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Mixed connective tissue disease
D. Sjögren syndrome
E. Dermatomyositis
Answer: B. Systemic lupus erythematosus
Rationale: Anti-dsDNA antibodies are highly specific for SLE and
correlate with disease activity, especially lupus nephritis.
4. A patient with chronic alcoholism presents with confusion,
ophthalmoplegia, and ataxia. What is the most appropriate
immediate treatment?
,A. Folic acid
B. Vitamin B12
C. Thiamine before glucose
D. Glucose before thiamine
E. Diazepam
Answer: C. Thiamine before glucose
Rationale: Wernicke encephalopathy requires prompt thiamine
administration before glucose to prevent worsening neurologic injury.
5. A 72-year-old woman presents with acute unilateral vision loss
and jaw claudication. ESR is markedly elevated. What is the next
best step?
A. MRI brain
B. Temporal artery biopsy after corticosteroids
C. Observation
D. Carotid ultrasound only
E. Acetazolamide
Answer: B. Temporal artery biopsy after corticosteroids
Rationale: Giant cell arteritis is an ophthalmologic emergency. High-
dose corticosteroids should begin immediately before biopsy
confirmation.
6. Which acid-base disorder is expected in severe salicylate
intoxication?
A. Pure metabolic acidosis
B. Pure respiratory acidosis
C. Respiratory alkalosis and metabolic acidosis
, D. Respiratory alkalosis only
E. Metabolic alkalosis
Answer: C. Respiratory alkalosis and metabolic acidosis
Rationale: Salicylates stimulate the respiratory center causing
respiratory alkalosis and later produce an anion-gap metabolic
acidosis.
7. A patient develops fever, rigidity, autonomic instability, and
elevated CK after receiving haloperidol. Diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Malignant hyperthermia
D. Acute dystonia
E. Catatonia
Answer: B. Neuroleptic malignant syndrome
Rationale: Dopamine blockade from antipsychotics causes NMS
characterized by rigidity, hyperthermia, autonomic dysfunction, and
rhabdomyolysis.
8. Which pathogen most commonly causes osteomyelitis in adults?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Salmonella species
D. E. coli
E. Enterococcus
Answer: B. Staphylococcus aureus
Clinical Synthesis Exam Practice Questions
& [Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man is hospitalized with community-acquired
pneumonia. On day 3, he develops sudden pleuritic chest pain,
tachycardia, and oxygen desaturation despite improving
pulmonary infiltrates. D-dimer is elevated. Which is the most
appropriate next diagnostic step?
A. Repeat chest radiograph
B. Ventilation-perfusion scan without further evaluation
C. CT pulmonary angiography
D. Bronchoscopy
E. Sputum culture
Answer: C. CT pulmonary angiography
Rationale: Sudden hypoxemia, pleuritic chest pain, and tachycardia in
a hospitalized patient strongly suggest pulmonary embolism. CT
pulmonary angiography is the preferred diagnostic test in
hemodynamically stable patients with suspected PE.
2. A 58-year-old woman with diabetes presents with crushing
substernal chest pain. ECG demonstrates ST-segment elevation in
, leads II, III, and aVF. Which coronary vessel is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Diagonal branch
E. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions involving leads II, III,
and aVF most commonly result from occlusion of the right coronary
artery.
3. A 26-year-old woman presents with fatigue, arthralgias,
photosensitive rash, and proteinuria. Laboratory testing reveals
anti-dsDNA antibodies. Which diagnosis is most likely?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Mixed connective tissue disease
D. Sjögren syndrome
E. Dermatomyositis
Answer: B. Systemic lupus erythematosus
Rationale: Anti-dsDNA antibodies are highly specific for SLE and
correlate with disease activity, especially lupus nephritis.
4. A patient with chronic alcoholism presents with confusion,
ophthalmoplegia, and ataxia. What is the most appropriate
immediate treatment?
,A. Folic acid
B. Vitamin B12
C. Thiamine before glucose
D. Glucose before thiamine
E. Diazepam
Answer: C. Thiamine before glucose
Rationale: Wernicke encephalopathy requires prompt thiamine
administration before glucose to prevent worsening neurologic injury.
5. A 72-year-old woman presents with acute unilateral vision loss
and jaw claudication. ESR is markedly elevated. What is the next
best step?
A. MRI brain
B. Temporal artery biopsy after corticosteroids
C. Observation
D. Carotid ultrasound only
E. Acetazolamide
Answer: B. Temporal artery biopsy after corticosteroids
Rationale: Giant cell arteritis is an ophthalmologic emergency. High-
dose corticosteroids should begin immediately before biopsy
confirmation.
6. Which acid-base disorder is expected in severe salicylate
intoxication?
A. Pure metabolic acidosis
B. Pure respiratory acidosis
C. Respiratory alkalosis and metabolic acidosis
, D. Respiratory alkalosis only
E. Metabolic alkalosis
Answer: C. Respiratory alkalosis and metabolic acidosis
Rationale: Salicylates stimulate the respiratory center causing
respiratory alkalosis and later produce an anion-gap metabolic
acidosis.
7. A patient develops fever, rigidity, autonomic instability, and
elevated CK after receiving haloperidol. Diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Malignant hyperthermia
D. Acute dystonia
E. Catatonia
Answer: B. Neuroleptic malignant syndrome
Rationale: Dopamine blockade from antipsychotics causes NMS
characterized by rigidity, hyperthermia, autonomic dysfunction, and
rhabdomyolysis.
8. Which pathogen most commonly causes osteomyelitis in adults?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Salmonella species
D. E. coli
E. Enterococcus
Answer: B. Staphylococcus aureus
