COMSAE PHASE 1 FORM 114 EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS
| PLUS RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
• Cardiovascular System
• Respiratory System
• Gastrointestinal System
• Musculoskeletal System
• Neurology
• Psychiatry and Behavioral Science
• Pharmacology
• Microbiology and Immunology
• Biostatistics and Epidemiology
• Medical Ethics and Professionalism
Introduction
,This comprehensive examination is designed to assess a student's readiness for the COMSAE Phase 1, focusing on
the foundational knowledge and clinical skills essential for medical practice. The assessment covers a broad range
of core medical disciplines, integrating basic science principles with clinical application. It employs a multiple-
choice format with scenario-based questions to evaluate critical thinking, diagnostic reasoning, and decision-
making abilities. The emphasis is on the application of knowledge to real-world clinical situations, preparing
students to make sound judgments and provide effective patient care. This rigorous evaluation serves as a
benchmark for identifying areas of strength and weakness, guiding further study and professional development.
SECTION ONE: QUESTIONS 1–50
1. A 65-year-old male presents with a 3-day history of crushing substernal chest pain radiating to his left
arm, accompanied by diaphoresis and nausea. An EKG reveals ST-segment elevation in leads V1-V4. Which of
the following is the most appropriate immediate management strategy?
A. Administer sublingual nitroglycerin and schedule a stress test for the next day.
B. Administer oral aspirin and arrange for a transthoracic echocardiogram.
C. Administer oxygen, aspirin, and sublingual nitroglycerin, and prepare for primary percutaneous coronary
,intervention (PCI).
D. Administer intravenous morphine and admit to the general medical ward for observation.
🟢 Correct Answer: C. Administer oxygen, aspirin, and sublingual nitroglycerin, and prepare for primary
percutaneous coronary intervention (PCI).
🔴 Explanation: The patient's presentation is classic for an ST-segment elevation myocardial infarction (STEMI).
The standard of care for STEMI is immediate reperfusion therapy, with primary PCI being the preferred method
if it can be performed within 90 minutes of first medical contact. Oxygen, aspirin, and nitroglycerin are the initial
medical therapies administered concurrently while preparing for PCI.
2. A 28-year-old woman presents with complaints of palpitations, heat intolerance, and a 10-pound weight
loss over the past two months despite an increased appetite. On examination, she has a fine tremor and a
diffusely enlarged, non-tender thyroid gland. Which of the following laboratory findings is most consistent
with this presentation?
A. Elevated TSH and decreased free T4
B. Decreased TSH and elevated free T4
, C. Elevated TSH and elevated free T4
D. Decreased TSH and decreased free T4
🟢 Correct Answer: B. Decreased TSH and elevated free T4
🔴 Explanation: The patient's symptoms (palpitations, heat intolerance, weight loss, tremor, goiter) are
consistent with hyperthyroidism, most likely Graves' disease. In primary hyperthyroidism, the pituitary gland
suppresses TSH secretion due to negative feedback from elevated thyroid hormones, resulting in a decreased
TSH and elevated free T4.
3. A 45-year-old male with a history of chronic alcohol use disorder presents with jaundice, ascites, and
confusion. His laboratory results show elevated AST and ALT with an AST/ALT ratio > 2, prolonged PT/INR,
and low serum albumin. Which of the following is the most likely underlying pathophysiological mechanism
for his confusion?
A. Accumulation of ammonia due to impaired hepatic urea cycle
B. Direct neurotoxic effect of alcohol on the brain
C. Thiamine deficiency leading to Wernicke-Korsakoff syndrome
D. Cerebral edema secondary to hyponatremia
| PLUS RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
• Cardiovascular System
• Respiratory System
• Gastrointestinal System
• Musculoskeletal System
• Neurology
• Psychiatry and Behavioral Science
• Pharmacology
• Microbiology and Immunology
• Biostatistics and Epidemiology
• Medical Ethics and Professionalism
Introduction
,This comprehensive examination is designed to assess a student's readiness for the COMSAE Phase 1, focusing on
the foundational knowledge and clinical skills essential for medical practice. The assessment covers a broad range
of core medical disciplines, integrating basic science principles with clinical application. It employs a multiple-
choice format with scenario-based questions to evaluate critical thinking, diagnostic reasoning, and decision-
making abilities. The emphasis is on the application of knowledge to real-world clinical situations, preparing
students to make sound judgments and provide effective patient care. This rigorous evaluation serves as a
benchmark for identifying areas of strength and weakness, guiding further study and professional development.
SECTION ONE: QUESTIONS 1–50
1. A 65-year-old male presents with a 3-day history of crushing substernal chest pain radiating to his left
arm, accompanied by diaphoresis and nausea. An EKG reveals ST-segment elevation in leads V1-V4. Which of
the following is the most appropriate immediate management strategy?
A. Administer sublingual nitroglycerin and schedule a stress test for the next day.
B. Administer oral aspirin and arrange for a transthoracic echocardiogram.
C. Administer oxygen, aspirin, and sublingual nitroglycerin, and prepare for primary percutaneous coronary
,intervention (PCI).
D. Administer intravenous morphine and admit to the general medical ward for observation.
🟢 Correct Answer: C. Administer oxygen, aspirin, and sublingual nitroglycerin, and prepare for primary
percutaneous coronary intervention (PCI).
🔴 Explanation: The patient's presentation is classic for an ST-segment elevation myocardial infarction (STEMI).
The standard of care for STEMI is immediate reperfusion therapy, with primary PCI being the preferred method
if it can be performed within 90 minutes of first medical contact. Oxygen, aspirin, and nitroglycerin are the initial
medical therapies administered concurrently while preparing for PCI.
2. A 28-year-old woman presents with complaints of palpitations, heat intolerance, and a 10-pound weight
loss over the past two months despite an increased appetite. On examination, she has a fine tremor and a
diffusely enlarged, non-tender thyroid gland. Which of the following laboratory findings is most consistent
with this presentation?
A. Elevated TSH and decreased free T4
B. Decreased TSH and elevated free T4
, C. Elevated TSH and elevated free T4
D. Decreased TSH and decreased free T4
🟢 Correct Answer: B. Decreased TSH and elevated free T4
🔴 Explanation: The patient's symptoms (palpitations, heat intolerance, weight loss, tremor, goiter) are
consistent with hyperthyroidism, most likely Graves' disease. In primary hyperthyroidism, the pituitary gland
suppresses TSH secretion due to negative feedback from elevated thyroid hormones, resulting in a decreased
TSH and elevated free T4.
3. A 45-year-old male with a history of chronic alcohol use disorder presents with jaundice, ascites, and
confusion. His laboratory results show elevated AST and ALT with an AST/ALT ratio > 2, prolonged PT/INR,
and low serum albumin. Which of the following is the most likely underlying pathophysiological mechanism
for his confusion?
A. Accumulation of ammonia due to impaired hepatic urea cycle
B. Direct neurotoxic effect of alcohol on the brain
C. Thiamine deficiency leading to Wernicke-Korsakoff syndrome
D. Cerebral edema secondary to hyponatremia
