2026 Original COMSAE Phase 2 –
Assessment Series B Form 113i Style Practice
Exam | Verified Comprehensive Questions
with Detailed Rationales & Answers
Question 1
A 67-year-old man presents with crushing substernal chest pain
for 45 minutes. ECG demonstrates ST-segment elevation in
leads II, III, and aVF. Blood pressure is 84/56 mmHg. Lung
examination is clear. Which intervention should be avoided
initially?
A. Aspirin
B. Emergent PCI
C. Intravenous nitroglycerin
D. Intravenous fluids
E. Clopidogrel
Answer: C. Intravenous nitroglycerin
Rationale: Inferior STEMI with hypotension suggests right
ventricular infarction. Nitroglycerin decreases preload and may
precipitate profound hypotension. Initial management includes
,aspirin, prompt reperfusion, and cautious IV fluids to improve
right ventricular preload.
Question 2
A 28-year-old woman presents with fever, hypotension, diffuse
erythroderma, vomiting, and desquamation of her palms after
prolonged tampon use. What organism is most likely
responsible?
A. Streptococcus pyogenes
B. Escherichia coli
C. Staphylococcus aureus
D. Clostridium difficile
E. Neisseria meningitidis
Answer: C. Staphylococcus aureus
Rationale: Toxic shock syndrome is caused by TSST-1-producing
Staphylococcus aureus. Treatment requires aggressive fluid
resuscitation, source control, and antibiotics including
clindamycin to inhibit toxin production.
Question 3
,A 4-year-old child presents with fever, drooling, muffled voice,
and tripod positioning. Oxygen saturation is 92%. What is the
next best step?
A. Throat culture
B. Lateral neck radiograph
C. Immediate airway management
D. Oral amoxicillin
E. Nebulized albuterol
Answer: C. Immediate airway management
Rationale: Epiglottitis is a life-threatening airway emergency.
The airway should be secured before diagnostic testing.
Visualization should occur in a controlled environment.
Question 4
A 59-year-old diabetic patient presents with severe abdominal
pain that is disproportionate to physical examination findings.
Lactate is elevated. CT angiography demonstrates occlusion of
the superior mesenteric artery.
Which diagnosis is most likely?
A. Acute pancreatitis
, B. Mesenteric ischemia
C. Perforated ulcer
D. Diverticulitis
E. Cholecystitis
Answer: B. Mesenteric ischemia
Rationale: Sudden severe abdominal pain out of proportion to
examination with elevated lactate strongly suggests acute
mesenteric ischemia requiring urgent revascularization.
Question 5
A patient with chronic alcoholism develops confusion,
ophthalmoplegia, and gait instability after receiving IV
dextrose.
Which vitamin deficiency caused this complication?
A. Pyridoxine
B. Folate
C. Thiamine
D. Riboflavin
E. Vitamin B12
Assessment Series B Form 113i Style Practice
Exam | Verified Comprehensive Questions
with Detailed Rationales & Answers
Question 1
A 67-year-old man presents with crushing substernal chest pain
for 45 minutes. ECG demonstrates ST-segment elevation in
leads II, III, and aVF. Blood pressure is 84/56 mmHg. Lung
examination is clear. Which intervention should be avoided
initially?
A. Aspirin
B. Emergent PCI
C. Intravenous nitroglycerin
D. Intravenous fluids
E. Clopidogrel
Answer: C. Intravenous nitroglycerin
Rationale: Inferior STEMI with hypotension suggests right
ventricular infarction. Nitroglycerin decreases preload and may
precipitate profound hypotension. Initial management includes
,aspirin, prompt reperfusion, and cautious IV fluids to improve
right ventricular preload.
Question 2
A 28-year-old woman presents with fever, hypotension, diffuse
erythroderma, vomiting, and desquamation of her palms after
prolonged tampon use. What organism is most likely
responsible?
A. Streptococcus pyogenes
B. Escherichia coli
C. Staphylococcus aureus
D. Clostridium difficile
E. Neisseria meningitidis
Answer: C. Staphylococcus aureus
Rationale: Toxic shock syndrome is caused by TSST-1-producing
Staphylococcus aureus. Treatment requires aggressive fluid
resuscitation, source control, and antibiotics including
clindamycin to inhibit toxin production.
Question 3
,A 4-year-old child presents with fever, drooling, muffled voice,
and tripod positioning. Oxygen saturation is 92%. What is the
next best step?
A. Throat culture
B. Lateral neck radiograph
C. Immediate airway management
D. Oral amoxicillin
E. Nebulized albuterol
Answer: C. Immediate airway management
Rationale: Epiglottitis is a life-threatening airway emergency.
The airway should be secured before diagnostic testing.
Visualization should occur in a controlled environment.
Question 4
A 59-year-old diabetic patient presents with severe abdominal
pain that is disproportionate to physical examination findings.
Lactate is elevated. CT angiography demonstrates occlusion of
the superior mesenteric artery.
Which diagnosis is most likely?
A. Acute pancreatitis
, B. Mesenteric ischemia
C. Perforated ulcer
D. Diverticulitis
E. Cholecystitis
Answer: B. Mesenteric ischemia
Rationale: Sudden severe abdominal pain out of proportion to
examination with elevated lactate strongly suggests acute
mesenteric ischemia requiring urgent revascularization.
Question 5
A patient with chronic alcoholism develops confusion,
ophthalmoplegia, and gait instability after receiving IV
dextrose.
Which vitamin deficiency caused this complication?
A. Pyridoxine
B. Folate
C. Thiamine
D. Riboflavin
E. Vitamin B12
