COMSAE Phase 2-Form BSA 125 Clinical
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man is brought to the emergency department
because of acute shortness of breath that began 2 hours ago. He
has a history of hypertension, coronary artery disease, and a
myocardial infarction 3 years ago. Blood pressure is 188/110 mm
Hg, pulse is 118/min, respirations are 30/min, and oxygen
saturation is 86% on room air. He is sitting upright, anxious, and
coughing pink frothy sputum. Bibasilar crackles are present, and
jugular venous distention is noted. Which of the following is the
most appropriate immediate management?
A. Intravenous normal saline
B. Intravenous furosemide and nitrates
C. Oral amlodipine
D. Intramuscular epinephrine
E. Emergent dialysis
Answer: B. Intravenous furosemide and nitrates
Rationale: Acute pulmonary edema due to decompensated heart
failure presents with severe dyspnea, orthopnea, crackles, JVD, and
pink frothy sputum. Immediate treatment includes oxygen, noninvasive
positive pressure ventilation if needed, IV nitrates to reduce preload,
and IV loop diuretics to relieve pulmonary congestion.
, 2. A 28-year-old woman presents with fever, pleuritic chest pain,
and productive cough for 4 days. Chest radiograph shows right
lower lobe consolidation. She becomes hypotensive with BP
84/50 mm Hg despite 2 liters of IV fluids. Serum lactate is
elevated. Which intervention is most appropriate next?
A. IV methylprednisolone only
B. Immediate vasopressors after fluid resuscitation
C. Observation
D. Oral antibiotics
E. Diuresis
Answer: B. Immediate vasopressors after fluid resuscitation
Rationale: Persistent hypotension after adequate fluid resuscitation in
septic shock requires vasopressors, with norepinephrine as first-line
therapy. Early antibiotics and source control are also essential.
3. A 58-year-old smoker develops crushing substernal chest pain
radiating to the left arm. ECG demonstrates ST elevations in leads
II, III, and aVF. Blood pressure is 90/60 mm Hg. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most
commonly caused by occlusion of the right coronary artery.
Hypotension may indicate right ventricular involvement.
, 4. A 34-year-old woman reports episodic palpitations, tremor, heat
intolerance, and weight loss despite increased appetite. Physical
examination reveals diffuse goiter and exophthalmos. Laboratory
studies show suppressed TSH and elevated free T4. Which is the
most likely diagnosis?
A. Toxic multinodular goiter
B. Graves disease
C. Hashimoto thyroiditis
D. Subacute thyroiditis
E. Pituitary adenoma
Answer: B. Graves disease
Rationale: Graves disease is an autoimmune hyperthyroid disorder
caused by TSH receptor-stimulating antibodies. Diffuse goiter,
ophthalmopathy, and hyperthyroidism are classic features.
5. A 72-year-old man develops sudden inability to speak and right-
sided weakness. Symptoms began 1 hour ago. CT head shows no
hemorrhage. Which is the next best step?
A. Aspirin only
B. IV alteplase if eligible
C. Carotid endarterectomy immediately
D. Heparin infusion
E. Observation
Answer: B. IV alteplase if eligible
Rationale: Acute ischemic stroke patients presenting within the
treatment window and without contraindications should receive
thrombolytic therapy after hemorrhage has been excluded.
, 6. A 22-year-old college student presents with fever, neck stiffness,
headache, and photophobia. Cerebrospinal fluid shows
neutrophilic pleocytosis, elevated protein, and low glucose. What
is the most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Fungal meningitis
D. Tuberculous meningitis
E. Migraine
Answer: B. Bacterial meningitis
Rationale: Low CSF glucose, elevated protein, and neutrophilic
predominance strongly suggest bacterial meningitis. Prompt empiric
antibiotics should not be delayed.
7. A 62-year-old woman presents with fatigue and pruritus.
Laboratory tests show elevated alkaline phosphatase and positive
antimitochondrial antibodies. Which diagnosis is most likely?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune hepatitis
D. Hepatitis C
E. Wilson disease
Answer: A. Primary biliary cholangitis
Rationale: Primary biliary cholangitis is characterized by autoimmune
destruction of intrahepatic bile ducts, cholestatic liver enzyme
elevation, and antimitochondrial antibodies.
Simulation Exam Practice Questions &
[Verified Answers], Plus Explained
Rationales|2026 Latest Update| Instant
Download PDF
1. A 67-year-old man is brought to the emergency department
because of acute shortness of breath that began 2 hours ago. He
has a history of hypertension, coronary artery disease, and a
myocardial infarction 3 years ago. Blood pressure is 188/110 mm
Hg, pulse is 118/min, respirations are 30/min, and oxygen
saturation is 86% on room air. He is sitting upright, anxious, and
coughing pink frothy sputum. Bibasilar crackles are present, and
jugular venous distention is noted. Which of the following is the
most appropriate immediate management?
A. Intravenous normal saline
B. Intravenous furosemide and nitrates
C. Oral amlodipine
D. Intramuscular epinephrine
E. Emergent dialysis
Answer: B. Intravenous furosemide and nitrates
Rationale: Acute pulmonary edema due to decompensated heart
failure presents with severe dyspnea, orthopnea, crackles, JVD, and
pink frothy sputum. Immediate treatment includes oxygen, noninvasive
positive pressure ventilation if needed, IV nitrates to reduce preload,
and IV loop diuretics to relieve pulmonary congestion.
, 2. A 28-year-old woman presents with fever, pleuritic chest pain,
and productive cough for 4 days. Chest radiograph shows right
lower lobe consolidation. She becomes hypotensive with BP
84/50 mm Hg despite 2 liters of IV fluids. Serum lactate is
elevated. Which intervention is most appropriate next?
A. IV methylprednisolone only
B. Immediate vasopressors after fluid resuscitation
C. Observation
D. Oral antibiotics
E. Diuresis
Answer: B. Immediate vasopressors after fluid resuscitation
Rationale: Persistent hypotension after adequate fluid resuscitation in
septic shock requires vasopressors, with norepinephrine as first-line
therapy. Early antibiotics and source control are also essential.
3. A 58-year-old smoker develops crushing substernal chest pain
radiating to the left arm. ECG demonstrates ST elevations in leads
II, III, and aVF. Blood pressure is 90/60 mm Hg. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most
commonly caused by occlusion of the right coronary artery.
Hypotension may indicate right ventricular involvement.
, 4. A 34-year-old woman reports episodic palpitations, tremor, heat
intolerance, and weight loss despite increased appetite. Physical
examination reveals diffuse goiter and exophthalmos. Laboratory
studies show suppressed TSH and elevated free T4. Which is the
most likely diagnosis?
A. Toxic multinodular goiter
B. Graves disease
C. Hashimoto thyroiditis
D. Subacute thyroiditis
E. Pituitary adenoma
Answer: B. Graves disease
Rationale: Graves disease is an autoimmune hyperthyroid disorder
caused by TSH receptor-stimulating antibodies. Diffuse goiter,
ophthalmopathy, and hyperthyroidism are classic features.
5. A 72-year-old man develops sudden inability to speak and right-
sided weakness. Symptoms began 1 hour ago. CT head shows no
hemorrhage. Which is the next best step?
A. Aspirin only
B. IV alteplase if eligible
C. Carotid endarterectomy immediately
D. Heparin infusion
E. Observation
Answer: B. IV alteplase if eligible
Rationale: Acute ischemic stroke patients presenting within the
treatment window and without contraindications should receive
thrombolytic therapy after hemorrhage has been excluded.
, 6. A 22-year-old college student presents with fever, neck stiffness,
headache, and photophobia. Cerebrospinal fluid shows
neutrophilic pleocytosis, elevated protein, and low glucose. What
is the most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Fungal meningitis
D. Tuberculous meningitis
E. Migraine
Answer: B. Bacterial meningitis
Rationale: Low CSF glucose, elevated protein, and neutrophilic
predominance strongly suggest bacterial meningitis. Prompt empiric
antibiotics should not be delayed.
7. A 62-year-old woman presents with fatigue and pruritus.
Laboratory tests show elevated alkaline phosphatase and positive
antimitochondrial antibodies. Which diagnosis is most likely?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune hepatitis
D. Hepatitis C
E. Wilson disease
Answer: A. Primary biliary cholangitis
Rationale: Primary biliary cholangitis is characterized by autoimmune
destruction of intrahepatic bile ducts, cholestatic liver enzyme
elevation, and antimitochondrial antibodies.
