COMSAE Phase 2 Practice Exam (2026–2027) | COMLEX Level 2-
Style Practice Questions with Detailed Answers & Rationales |
Comprehensive Clinical Review
1. A 68-year-old man presents with crushing substernal chest pain radiating to his
left arm for 45 minutes. ECG demonstrates ST-segment elevation in leads II, III, and
aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior STEMIs involving leads II, III, and aVF are most commonly caused by
occlusion of the right coronary artery.
2. A 24-year-old woman develops fever, dysuria, flank pain, and costovertebral angle
tenderness. Urinalysis reveals white blood cell casts. What is the most likely
diagnosis?
A. Cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Glomerulonephritis
Answer: B. Pyelonephritis
Rationale: Fever, flank pain, CVA tenderness, and WBC casts indicate an upper urinary
tract infection.
3. A patient with asthma develops sudden wheezing after exposure to cats. Which
medication provides the fastest relief?
A. Fluticasone
B. Salmeterol
,C. Albuterol
D. Montelukast
Answer: C. Albuterol
Rationale: Short-acting β2-agonists rapidly relieve acute bronchospasm.
4. A diabetic patient presents with polyuria, polydipsia, abdominal pain, and
Kussmaul respirations. Laboratory testing reveals metabolic acidosis with elevated
ketones. Which diagnosis is most likely?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Lactic acidosis
D. Addisonian crisis
Answer: B. Diabetic ketoacidosis
Rationale: DKA presents with ketosis, metabolic acidosis, dehydration, and hyperglycemia.
5. Which organism is the most common cause of community-acquired pneumonia?
A. Staphylococcus aureus
B. Pseudomonas aeruginosa
C. Streptococcus pneumoniae
D. Klebsiella pneumoniae
Answer: C. Streptococcus pneumoniae
Rationale: S. pneumoniae remains the leading cause of community-acquired pneumonia.
6. A patient with atrial fibrillation has an irregularly irregular pulse. Which
complication is most concerning?
A. Pulmonary fibrosis
B. Ischemic stroke
C. Pneumothorax
D. Pericarditis
Answer: B. Ischemic stroke
, Rationale: Atrial fibrillation predisposes to atrial thrombus formation and embolic stroke.
7. Which electrolyte abnormality is most commonly associated with peaked T waves
on ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
Answer: B. Hyperkalemia
Rationale: Hyperkalemia classically causes tall peaked T waves.
8. A 70-year-old smoker presents with painless hematuria. Which diagnosis should
be strongly suspected?
A. Renal calculi
B. Bladder cancer
C. Urethritis
D. Pyelonephritis
Answer: B. Bladder cancer
Rationale: Painless gross hematuria in an older smoker is concerning for urothelial
carcinoma.
9. Which thyroid disorder is associated with low TSH and elevated free T4?
A. Primary hypothyroidism
B. Graves disease
C. Hashimoto thyroiditis
D. Secondary hypothyroidism
Answer: B. Graves disease
Rationale: Graves disease causes primary hyperthyroidism with suppressed TSH.
Style Practice Questions with Detailed Answers & Rationales |
Comprehensive Clinical Review
1. A 68-year-old man presents with crushing substernal chest pain radiating to his
left arm for 45 minutes. ECG demonstrates ST-segment elevation in leads II, III, and
aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior STEMIs involving leads II, III, and aVF are most commonly caused by
occlusion of the right coronary artery.
2. A 24-year-old woman develops fever, dysuria, flank pain, and costovertebral angle
tenderness. Urinalysis reveals white blood cell casts. What is the most likely
diagnosis?
A. Cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Glomerulonephritis
Answer: B. Pyelonephritis
Rationale: Fever, flank pain, CVA tenderness, and WBC casts indicate an upper urinary
tract infection.
3. A patient with asthma develops sudden wheezing after exposure to cats. Which
medication provides the fastest relief?
A. Fluticasone
B. Salmeterol
,C. Albuterol
D. Montelukast
Answer: C. Albuterol
Rationale: Short-acting β2-agonists rapidly relieve acute bronchospasm.
4. A diabetic patient presents with polyuria, polydipsia, abdominal pain, and
Kussmaul respirations. Laboratory testing reveals metabolic acidosis with elevated
ketones. Which diagnosis is most likely?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Lactic acidosis
D. Addisonian crisis
Answer: B. Diabetic ketoacidosis
Rationale: DKA presents with ketosis, metabolic acidosis, dehydration, and hyperglycemia.
5. Which organism is the most common cause of community-acquired pneumonia?
A. Staphylococcus aureus
B. Pseudomonas aeruginosa
C. Streptococcus pneumoniae
D. Klebsiella pneumoniae
Answer: C. Streptococcus pneumoniae
Rationale: S. pneumoniae remains the leading cause of community-acquired pneumonia.
6. A patient with atrial fibrillation has an irregularly irregular pulse. Which
complication is most concerning?
A. Pulmonary fibrosis
B. Ischemic stroke
C. Pneumothorax
D. Pericarditis
Answer: B. Ischemic stroke
, Rationale: Atrial fibrillation predisposes to atrial thrombus formation and embolic stroke.
7. Which electrolyte abnormality is most commonly associated with peaked T waves
on ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
Answer: B. Hyperkalemia
Rationale: Hyperkalemia classically causes tall peaked T waves.
8. A 70-year-old smoker presents with painless hematuria. Which diagnosis should
be strongly suspected?
A. Renal calculi
B. Bladder cancer
C. Urethritis
D. Pyelonephritis
Answer: B. Bladder cancer
Rationale: Painless gross hematuria in an older smoker is concerning for urothelial
carcinoma.
9. Which thyroid disorder is associated with low TSH and elevated free T4?
A. Primary hypothyroidism
B. Graves disease
C. Hashimoto thyroiditis
D. Secondary hypothyroidism
Answer: B. Graves disease
Rationale: Graves disease causes primary hyperthyroidism with suppressed TSH.
