COMSAE PHASE 1 FORM 114 EXAM COMPLETE PRACTICE EXAM WITH
DETAILED ANSWERS | 2026–2027 LATEST UPDATE | FULL STUDY GUIDE | EXAM
PREP | PRACTICE TEST | CERTIFICATION PREPARATION
1. A 45-year-old man presents with fatigue, weight loss, increased thirst, and frequent
urination. Laboratory testing shows elevated fasting glucose and an increased HbA1c
level. Which pancreatic cell type is primarily affected in this condition?
A. Alpha cells producing glucagon
B. Delta cells producing somatostatin
C. Acinar cells producing digestive enzymes
D. Beta cells producing insulin
Type 2 diabetes mellitus involves progressive dysfunction of pancreatic beta cells, leading to
impaired insulin secretion. Although insulin resistance is also present, beta-cell failure
contributes significantly to disease progression.
2. A 32-year-old woman develops weakness, difficulty climbing stairs, and trouble rising
from a seated position. Laboratory testing shows elevated creatine kinase levels. Muscle
biopsy demonstrates inflammation affecting skeletal muscle fibers. Which diagnosis is
most likely?
A. Myasthenia gravis
B. Polymyositis
C. Lambert-Eaton syndrome
D. Peripheral neuropathy
Polymyositis is an inflammatory myopathy characterized by proximal muscle weakness and
elevated muscle enzymes. Unlike neuromuscular junction disorders, it directly affects skeletal
muscle tissue.
3. A patient develops fever, hypotension, and confusion two days after a major abdominal
surgery. Blood cultures grow gram-negative bacteria. Which mechanism is responsible
for the patient's shock?
A. IgE-mediated mast cell activation
B. Antibody-mediated cytotoxicity
C. Endotoxin-induced inflammatory cytokine release
,D. Direct viral destruction of tissues
Gram-negative bacterial endotoxin triggers immune activation and release of inflammatory
cytokines such as TNF-alpha and IL-1. This systemic inflammatory response can cause septic
shock.
4. A 6-year-old child presents with recurrent infections involving encapsulated bacteria.
Laboratory testing shows absent immunoglobulin production. Which immune deficiency
is most likely?
A. Severe combined immunodeficiency
B. Chronic granulomatous disease
C. X-linked agammaglobulinemia
D. DiGeorge syndrome
X-linked agammaglobulinemia results from defective B-cell maturation and markedly reduced
antibody production. Patients are especially susceptible to infections with encapsulated
organisms.
5. A 60-year-old smoker presents with progressive shortness of breath. Pulmonary function
testing shows decreased FEV1/FVC ratio. Which structural change is most likely
present?
A. Increased alveolar surface area
B. Thickened alveolar septa
C. Destruction of alveolar walls
D. Increased airway cartilage
Emphysema involves destruction of alveolar walls, resulting in decreased elastic recoil and
airflow obstruction. Smoking is the most common risk factor.
6. A patient receives a medication that blocks beta-1 adrenergic receptors. Which
physiologic effect is expected?
A. Increased heart rate
B. Increased renin release
C. Decreased cardiac contractility and heart rate
,D. Increased bronchodilation
Beta-1 blockers reduce sympathetic stimulation of the heart, decreasing heart rate,
contractility, and renin secretion.
7. A 22-year-old woman presents with fever, fatigue, and painless cervical
lymphadenopathy. A lymph node biopsy shows Reed-Sternberg cells. Which diagnosis is
most likely?
A. Non-Hodgkin lymphoma
B. Chronic lymphocytic leukemia
C. Hodgkin lymphoma
D. Multiple myeloma
Reed-Sternberg cells are characteristic of Hodgkin lymphoma. The disease commonly presents
with painless lymphadenopathy in young adults.
8. A patient develops muscle rigidity, fever, and altered mental status after receiving
antipsychotic medication. Which condition is most likely?
A. Serotonin syndrome
B. Malignant hyperthermia
C. Neuroleptic malignant syndrome
D. Anticholinergic toxicity
Neuroleptic malignant syndrome is associated with dopamine blockade from antipsychotic
medications. It presents with rigidity, hyperthermia, autonomic instability, and altered mental
status.
9. A newborn develops respiratory distress shortly after birth. The infant was born
prematurely. Which deficiency most likely caused this condition?
A. Excess surfactant production
B. Insufficient pulmonary surfactant
C. Increased alveolar elasticity
D. Excess pulmonary blood flow
, Premature infants have insufficient surfactant production, causing alveolar collapse and
neonatal respiratory distress syndrome.
10. A patient with chronic kidney disease develops anemia. Which hormone deficiency
contributes to this finding?
A. Renin
B. Aldosterone
C. Erythropoietin
D. Cortisol
The kidneys produce erythropoietin, which stimulates red blood cell production. Chronic
kidney disease reduces erythropoietin production, causing anemia.
11. A 65-year-old patient develops sudden weakness on one side of the body and difficulty
speaking. Which artery is most likely affected?
A. Posterior cerebral artery
B. Middle cerebral artery
C. Basilar artery
D. Anterior inferior cerebellar artery
The middle cerebral artery supplies large areas of the lateral cerebral hemisphere. Occlusion
commonly causes contralateral weakness and language disturbances.
12. A patient taking warfarin requires monitoring of which laboratory value?
A. Bleeding time
B. Platelet count
C. INR
D. Activated partial thromboplastin time
Warfarin therapy is monitored using the international normalized ratio (INR), which
evaluates the extrinsic coagulation pathway.
13. A patient with hyperthyroidism has weight loss, heat intolerance, and tachycardia. Which
hormone is elevated?
DETAILED ANSWERS | 2026–2027 LATEST UPDATE | FULL STUDY GUIDE | EXAM
PREP | PRACTICE TEST | CERTIFICATION PREPARATION
1. A 45-year-old man presents with fatigue, weight loss, increased thirst, and frequent
urination. Laboratory testing shows elevated fasting glucose and an increased HbA1c
level. Which pancreatic cell type is primarily affected in this condition?
A. Alpha cells producing glucagon
B. Delta cells producing somatostatin
C. Acinar cells producing digestive enzymes
D. Beta cells producing insulin
Type 2 diabetes mellitus involves progressive dysfunction of pancreatic beta cells, leading to
impaired insulin secretion. Although insulin resistance is also present, beta-cell failure
contributes significantly to disease progression.
2. A 32-year-old woman develops weakness, difficulty climbing stairs, and trouble rising
from a seated position. Laboratory testing shows elevated creatine kinase levels. Muscle
biopsy demonstrates inflammation affecting skeletal muscle fibers. Which diagnosis is
most likely?
A. Myasthenia gravis
B. Polymyositis
C. Lambert-Eaton syndrome
D. Peripheral neuropathy
Polymyositis is an inflammatory myopathy characterized by proximal muscle weakness and
elevated muscle enzymes. Unlike neuromuscular junction disorders, it directly affects skeletal
muscle tissue.
3. A patient develops fever, hypotension, and confusion two days after a major abdominal
surgery. Blood cultures grow gram-negative bacteria. Which mechanism is responsible
for the patient's shock?
A. IgE-mediated mast cell activation
B. Antibody-mediated cytotoxicity
C. Endotoxin-induced inflammatory cytokine release
,D. Direct viral destruction of tissues
Gram-negative bacterial endotoxin triggers immune activation and release of inflammatory
cytokines such as TNF-alpha and IL-1. This systemic inflammatory response can cause septic
shock.
4. A 6-year-old child presents with recurrent infections involving encapsulated bacteria.
Laboratory testing shows absent immunoglobulin production. Which immune deficiency
is most likely?
A. Severe combined immunodeficiency
B. Chronic granulomatous disease
C. X-linked agammaglobulinemia
D. DiGeorge syndrome
X-linked agammaglobulinemia results from defective B-cell maturation and markedly reduced
antibody production. Patients are especially susceptible to infections with encapsulated
organisms.
5. A 60-year-old smoker presents with progressive shortness of breath. Pulmonary function
testing shows decreased FEV1/FVC ratio. Which structural change is most likely
present?
A. Increased alveolar surface area
B. Thickened alveolar septa
C. Destruction of alveolar walls
D. Increased airway cartilage
Emphysema involves destruction of alveolar walls, resulting in decreased elastic recoil and
airflow obstruction. Smoking is the most common risk factor.
6. A patient receives a medication that blocks beta-1 adrenergic receptors. Which
physiologic effect is expected?
A. Increased heart rate
B. Increased renin release
C. Decreased cardiac contractility and heart rate
,D. Increased bronchodilation
Beta-1 blockers reduce sympathetic stimulation of the heart, decreasing heart rate,
contractility, and renin secretion.
7. A 22-year-old woman presents with fever, fatigue, and painless cervical
lymphadenopathy. A lymph node biopsy shows Reed-Sternberg cells. Which diagnosis is
most likely?
A. Non-Hodgkin lymphoma
B. Chronic lymphocytic leukemia
C. Hodgkin lymphoma
D. Multiple myeloma
Reed-Sternberg cells are characteristic of Hodgkin lymphoma. The disease commonly presents
with painless lymphadenopathy in young adults.
8. A patient develops muscle rigidity, fever, and altered mental status after receiving
antipsychotic medication. Which condition is most likely?
A. Serotonin syndrome
B. Malignant hyperthermia
C. Neuroleptic malignant syndrome
D. Anticholinergic toxicity
Neuroleptic malignant syndrome is associated with dopamine blockade from antipsychotic
medications. It presents with rigidity, hyperthermia, autonomic instability, and altered mental
status.
9. A newborn develops respiratory distress shortly after birth. The infant was born
prematurely. Which deficiency most likely caused this condition?
A. Excess surfactant production
B. Insufficient pulmonary surfactant
C. Increased alveolar elasticity
D. Excess pulmonary blood flow
, Premature infants have insufficient surfactant production, causing alveolar collapse and
neonatal respiratory distress syndrome.
10. A patient with chronic kidney disease develops anemia. Which hormone deficiency
contributes to this finding?
A. Renin
B. Aldosterone
C. Erythropoietin
D. Cortisol
The kidneys produce erythropoietin, which stimulates red blood cell production. Chronic
kidney disease reduces erythropoietin production, causing anemia.
11. A 65-year-old patient develops sudden weakness on one side of the body and difficulty
speaking. Which artery is most likely affected?
A. Posterior cerebral artery
B. Middle cerebral artery
C. Basilar artery
D. Anterior inferior cerebellar artery
The middle cerebral artery supplies large areas of the lateral cerebral hemisphere. Occlusion
commonly causes contralateral weakness and language disturbances.
12. A patient taking warfarin requires monitoring of which laboratory value?
A. Bleeding time
B. Platelet count
C. INR
D. Activated partial thromboplastin time
Warfarin therapy is monitored using the international normalized ratio (INR), which
evaluates the extrinsic coagulation pathway.
13. A patient with hyperthyroidism has weight loss, heat intolerance, and tachycardia. Which
hormone is elevated?
