,COMSAE PhASE 1 FORM 115 Full 176
QUESTIONS Contents
SECTION 1 ....................................................................................................... 2
SECTION 2 ..................................................................................................... 83
SECTION 3 ................................................................................................... 166
SECTION 4 ................................................................................................... 237
SECTION 1
Question 1 of 44
A 62-year-old man with a history of hypertension, hyperlipidemia, and a 35-pack-
year smoking history presents to the emergency department with the sudden
onset of severe substernal chest pain that began 45 minutes ago while mowing his
lawn. The pain radiates to his left shoulder and jaw and is associated with
diaphoresis, nausea, and shortness of breath. On examination, he appears anxious
and diaphoretic. His blood pressure is 148/92 mmHg, pulse is 102/min, respiratory
rate is 22/min, and oxygen saturation is 96% on room air. Cardiac examination
reveals tachycardia without murmurs. An ECG demonstrates ST-segment elevation
in leads II, III, and aVF.
What is the most appropriate next step in management?
A. Start intravenous broad-spectrum antibiotics
B. Immediate percutaneous coronary intervention (PCI)
C. Schedule an outpatient exercise stress test
D. Administer an oral beta-blocker only
,Mark for Review □
Correct Answer: B. Immediate percutaneous coronary intervention (PCI)
Rationale:
This patient has an acute inferior ST-elevation myocardial infarction (STEMI),
evidenced by crushing substernal chest pain, diaphoresis, and ST-segment
elevation in leads II, III, and aVF. STEMI is a medical emergency that requires
immediate reperfusion therapy. Primary PCI is the preferred strategy when it can
be performed within 90 minutes of first medical contact because it rapidly
restores coronary perfusion, limits infarct size, preserves ventricular function, and
significantly reduces mortality. If timely PCI is unavailable, fibrinolytic therapy
should be considered when appropriate.
Why the other answers are incorrect:
A. Antibiotics have no role in the treatment of acute coronary syndrome unless
there is evidence of infection.
C. Stress testing is contraindicated during an acute STEMI because it delays
definitive treatment and may worsen ischemia.
D. Beta-blockers may be administered after stabilization if there are no
contraindications, but they do not replace emergent reperfusion therapy.
Key COMSAE Point:
STEMI = immediate reperfusion. Primary PCI within 90 minutes is the treatment of
choice whenever available.
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, Question 2 of 44
A 24-year-old woman presents to the emergency department with a 3-day history
of fever, chills, dysuria, urinary frequency, and progressively worsening left flank
pain. She reports nausea but denies vomiting. She has no significant past medical
history and is sexually active with one partner. On examination, her temperature is
38.9°C (102°F), blood pressure is 116/74 mmHg, pulse is 108/min, and respiratory
rate is 18/min. Costovertebral angle tenderness is present on the left side.
Urinalysis demonstrates positive nitrites, positive leukocyte esterase, numerous
white blood cells, and white blood cell casts.
What is the most likely diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Urethritis
Mark for Review □
Correct Answer: B. Pyelonephritis
Rationale:
This patient has classic findings of acute pyelonephritis, including fever, flank
pain, costovertebral angle tenderness, and urinalysis showing WBC casts. White
blood cell casts indicate renal parenchymal inflammation and strongly suggest an
upper urinary tract infection. Escherichia coli is the most common causative
organism. Prompt treatment with systemic antibiotics is necessary to prevent
renal scarring and sepsis.
Why the other answers are incorrect:
QUESTIONS Contents
SECTION 1 ....................................................................................................... 2
SECTION 2 ..................................................................................................... 83
SECTION 3 ................................................................................................... 166
SECTION 4 ................................................................................................... 237
SECTION 1
Question 1 of 44
A 62-year-old man with a history of hypertension, hyperlipidemia, and a 35-pack-
year smoking history presents to the emergency department with the sudden
onset of severe substernal chest pain that began 45 minutes ago while mowing his
lawn. The pain radiates to his left shoulder and jaw and is associated with
diaphoresis, nausea, and shortness of breath. On examination, he appears anxious
and diaphoretic. His blood pressure is 148/92 mmHg, pulse is 102/min, respiratory
rate is 22/min, and oxygen saturation is 96% on room air. Cardiac examination
reveals tachycardia without murmurs. An ECG demonstrates ST-segment elevation
in leads II, III, and aVF.
What is the most appropriate next step in management?
A. Start intravenous broad-spectrum antibiotics
B. Immediate percutaneous coronary intervention (PCI)
C. Schedule an outpatient exercise stress test
D. Administer an oral beta-blocker only
,Mark for Review □
Correct Answer: B. Immediate percutaneous coronary intervention (PCI)
Rationale:
This patient has an acute inferior ST-elevation myocardial infarction (STEMI),
evidenced by crushing substernal chest pain, diaphoresis, and ST-segment
elevation in leads II, III, and aVF. STEMI is a medical emergency that requires
immediate reperfusion therapy. Primary PCI is the preferred strategy when it can
be performed within 90 minutes of first medical contact because it rapidly
restores coronary perfusion, limits infarct size, preserves ventricular function, and
significantly reduces mortality. If timely PCI is unavailable, fibrinolytic therapy
should be considered when appropriate.
Why the other answers are incorrect:
A. Antibiotics have no role in the treatment of acute coronary syndrome unless
there is evidence of infection.
C. Stress testing is contraindicated during an acute STEMI because it delays
definitive treatment and may worsen ischemia.
D. Beta-blockers may be administered after stabilization if there are no
contraindications, but they do not replace emergent reperfusion therapy.
Key COMSAE Point:
STEMI = immediate reperfusion. Primary PCI within 90 minutes is the treatment of
choice whenever available.
Navigation Bar
Question 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 |
18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 |
35 | 36 | 37 | 38 | 39 | 40 | 41 | 42 | 43 | 44
, Question 2 of 44
A 24-year-old woman presents to the emergency department with a 3-day history
of fever, chills, dysuria, urinary frequency, and progressively worsening left flank
pain. She reports nausea but denies vomiting. She has no significant past medical
history and is sexually active with one partner. On examination, her temperature is
38.9°C (102°F), blood pressure is 116/74 mmHg, pulse is 108/min, and respiratory
rate is 18/min. Costovertebral angle tenderness is present on the left side.
Urinalysis demonstrates positive nitrites, positive leukocyte esterase, numerous
white blood cells, and white blood cell casts.
What is the most likely diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Urethritis
Mark for Review □
Correct Answer: B. Pyelonephritis
Rationale:
This patient has classic findings of acute pyelonephritis, including fever, flank
pain, costovertebral angle tenderness, and urinalysis showing WBC casts. White
blood cell casts indicate renal parenchymal inflammation and strongly suggest an
upper urinary tract infection. Escherichia coli is the most common causative
organism. Prompt treatment with systemic antibiotics is necessary to prevent
renal scarring and sepsis.
Why the other answers are incorrect:
