COMSAE PhASE 1 FORM 115 Full 176 QuESTIONS
,COMSAE PhASE 1 FORM 115 Full 176 QuESTIONS
Question 1 of 40
A 55-year-old man with a history of hypertension presents with sudden onset of
severe tearing chest pain radiating to the back. Blood pressure is 190/100 mmHg
in the right arm and 160/90 mmHg in the left arm. Chest X-ray demonstrates a
widened mediastinum. Which is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. Pneumothorax
Mark for Review □
Correct Answer: C. Aortic dissection
Rationale: Aortic dissection classically presents with abrupt tearing chest pain
radiating to the back, unequal blood pressures between arms, and widened
mediastinum on chest X-ray.
Why the other answers are incorrect:
A. MI usually presents with pressure-like substernal chest pain and ECG
abnormalities.
B. PE commonly presents with pleuritic chest pain, dyspnea, and hypoxemia.
D. Pericarditis causes positional chest pain relieved by leaning forward.
E. Pneumothorax causes unilateral absent breath sounds and hyperresonance.
Key COMSAE Point: Tearing chest pain + BP discrepancy + widened mediastinum =
aortic dissection.
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,Question 2 of 40
A 23-year-old woman presents with heat intolerance, weight loss despite
increased appetite, and palpitations. Examination reveals exophthalmos and
diffuse thyroid enlargement. Which antibody is most likely responsible?
A. Anti-thyroglobulin antibody
B. Thyroid-stimulating immunoglobulin
C. Anti-TPO antibody
D. Anti-dsDNA antibody
E. Anti-centromere antibody
Mark for Review □
Correct Answer: B. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from IgG antibodies stimulating the TSH
receptor, leading to hyperthyroidism and ophthalmopathy.
Why the other answers are incorrect:
A. Seen in Hashimoto thyroiditis.
C. Commonly elevated in Hashimoto thyroiditis.
D. Associated with systemic lupus erythematosus.
E. Associated with limited scleroderma.
Key COMSAE Point: Hyperthyroidism + exophthalmos = Graves disease.
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Question 3 of 40
A 68-year-old smoker develops hematuria without pain. Urinalysis confirms blood
but no infection. Which diagnosis should be most strongly suspected?
A. Renal stone
B. Bladder carcinoma
C. Acute cystitis
D. Glomerulonephritis
E. Polycystic kidney disease
, Mark for Review □
Correct Answer: B. Bladder carcinoma
Rationale: Painless hematuria in an older smoker is bladder cancer until proven
otherwise.
Why the other answers are incorrect:
A. Usually causes severe flank pain.
C. Produces dysuria and frequency.
D. Usually associated with proteinuria and casts.
E. Typically presents with bilateral enlarged kidneys.
Key COMSAE Point: Painless hematuria = urothelial carcinoma.
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Question 4 of 40
A patient develops fever, hypotension, and warm extremities after gram-negative
bacteremia. Which mediator is primarily responsible for septic shock?
A. Histamine
B. IL-2
C. TNF-alpha
D. Bradykinin
E. Dopamine
Mark for Review □
Correct Answer: C. TNF-alpha
Rationale: Endotoxin activates macrophages to release TNF-alpha, leading to
vasodilation, capillary leak, and shock.
Why the other answers are incorrect:
A. More important in allergic reactions.
B. Stimulates T-cell proliferation.
D. Mediates pain and edema.
E. Neurotransmitter, not primary mediator.
,COMSAE PhASE 1 FORM 115 Full 176 QuESTIONS
Question 1 of 40
A 55-year-old man with a history of hypertension presents with sudden onset of
severe tearing chest pain radiating to the back. Blood pressure is 190/100 mmHg
in the right arm and 160/90 mmHg in the left arm. Chest X-ray demonstrates a
widened mediastinum. Which is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. Pneumothorax
Mark for Review □
Correct Answer: C. Aortic dissection
Rationale: Aortic dissection classically presents with abrupt tearing chest pain
radiating to the back, unequal blood pressures between arms, and widened
mediastinum on chest X-ray.
Why the other answers are incorrect:
A. MI usually presents with pressure-like substernal chest pain and ECG
abnormalities.
B. PE commonly presents with pleuritic chest pain, dyspnea, and hypoxemia.
D. Pericarditis causes positional chest pain relieved by leaning forward.
E. Pneumothorax causes unilateral absent breath sounds and hyperresonance.
Key COMSAE Point: Tearing chest pain + BP discrepancy + widened mediastinum =
aortic dissection.
Navigation Bar Question 1 | 2 | 3 | 4 | 5 | ... | 40
,Question 2 of 40
A 23-year-old woman presents with heat intolerance, weight loss despite
increased appetite, and palpitations. Examination reveals exophthalmos and
diffuse thyroid enlargement. Which antibody is most likely responsible?
A. Anti-thyroglobulin antibody
B. Thyroid-stimulating immunoglobulin
C. Anti-TPO antibody
D. Anti-dsDNA antibody
E. Anti-centromere antibody
Mark for Review □
Correct Answer: B. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from IgG antibodies stimulating the TSH
receptor, leading to hyperthyroidism and ophthalmopathy.
Why the other answers are incorrect:
A. Seen in Hashimoto thyroiditis.
C. Commonly elevated in Hashimoto thyroiditis.
D. Associated with systemic lupus erythematosus.
E. Associated with limited scleroderma.
Key COMSAE Point: Hyperthyroidism + exophthalmos = Graves disease.
Navigation Bar Question 1 | 2 | 3 | 4 | 5 | ... | 40
Question 3 of 40
A 68-year-old smoker develops hematuria without pain. Urinalysis confirms blood
but no infection. Which diagnosis should be most strongly suspected?
A. Renal stone
B. Bladder carcinoma
C. Acute cystitis
D. Glomerulonephritis
E. Polycystic kidney disease
, Mark for Review □
Correct Answer: B. Bladder carcinoma
Rationale: Painless hematuria in an older smoker is bladder cancer until proven
otherwise.
Why the other answers are incorrect:
A. Usually causes severe flank pain.
C. Produces dysuria and frequency.
D. Usually associated with proteinuria and casts.
E. Typically presents with bilateral enlarged kidneys.
Key COMSAE Point: Painless hematuria = urothelial carcinoma.
Navigation Bar Question 1 | 2 | 3 | 4 | 5 | ... | 40
Question 4 of 40
A patient develops fever, hypotension, and warm extremities after gram-negative
bacteremia. Which mediator is primarily responsible for septic shock?
A. Histamine
B. IL-2
C. TNF-alpha
D. Bradykinin
E. Dopamine
Mark for Review □
Correct Answer: C. TNF-alpha
Rationale: Endotoxin activates macrophages to release TNF-alpha, leading to
vasodilation, capillary leak, and shock.
Why the other answers are incorrect:
A. More important in allergic reactions.
B. Stimulates T-cell proliferation.
D. Mediates pain and edema.
E. Neurotransmitter, not primary mediator.
