, COMSAE Phase 2 Form 118 Practice Exam 176 Questions Answers & Explanations | COMLEX Level 2 Study Guide
1. A 67-year-old man with a history of hypertension and hyperlipidemia
presents to the emergency department 45 minutes after developing crushing
substernal chest pain radiating to his left arm. ECG shows ST-segment elevation
in leads II, III, and aVF. Blood pressure is 94/60 mm Hg, and lungs are clear.
What is the most appropriate next step?
A. Administer fibrinolytic therapy immediately
B. Obtain an echocardiogram before treatment
C. Activate the cardiac catheterization laboratory for immediate percutaneous
coronary intervention (PCI)
D. Observe and repeat troponin levels in 6 hours
E. Schedule an outpatient stress test
Explanation: This patient has an acute inferior ST-elevation myocardial infarction
(STEMI). The preferred reperfusion strategy is immediate PCI when it can be
performed promptly. Fibrinolysis is reserved for situations where timely PCI is
unavailable.
2. A 24-year-old woman presents with dysuria, urinary frequency, and urgency
for 2 days. She has no fever, flank pain, or vaginal discharge. Urinalysis is
positive for leukocyte esterase and nitrites.
What is the most likely diagnosis?
,A. Acute pyelonephritis
B. Acute uncomplicated cystitis
C. Interstitial cystitis
D. Vulvovaginal candidiasis
E. Nephrolithiasis
Explanation: Typical lower urinary tract symptoms with positive nitrites and
leukocyte esterase in an otherwise healthy young woman are most consistent with
uncomplicated cystitis.
3. A 6-year-old boy is brought to the clinic because of fever, sore throat, and a
sandpaper-like rash. Examination reveals strawberry tongue and tonsillar
exudates.
Which organism is the most likely cause?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
E. Corynebacterium diphtheriae
Explanation: Scarlet fever is caused by toxin-producing Group A Streptococcus (S.
pyogenes) and presents with pharyngitis, strawberry tongue, and a characteristic
sandpaper rash.
, 4. A 30-year-old pregnant woman at 34 weeks' gestation presents with severe
headache, visual disturbances, blood pressure of 170/110 mm Hg, and
proteinuria.
Which medication should be administered first to reduce the risk of maternal
seizures?
A. Diazepam
B. Phenytoin
C. Magnesium sulfate
D. Levetiracetam
E. Valproic acid
Explanation: Severe preeclampsia is treated with magnesium sulfate for seizure
prophylaxis. Blood pressure should also be controlled, and delivery planned when
appropriate.
5. A 72-year-old man suddenly develops right facial droop, right arm weakness,
and expressive aphasia. Symptoms began 45 minutes ago. Noncontrast head CT
shows no hemorrhage.
What is the next best step?
A. Aspirin only
B. Administer intravenous thrombolytic therapy if no contraindications exist
C. Begin heparin infusion immediately
D. Schedule carotid endarterectomy today
E. Observe for 24 hours
1. A 67-year-old man with a history of hypertension and hyperlipidemia
presents to the emergency department 45 minutes after developing crushing
substernal chest pain radiating to his left arm. ECG shows ST-segment elevation
in leads II, III, and aVF. Blood pressure is 94/60 mm Hg, and lungs are clear.
What is the most appropriate next step?
A. Administer fibrinolytic therapy immediately
B. Obtain an echocardiogram before treatment
C. Activate the cardiac catheterization laboratory for immediate percutaneous
coronary intervention (PCI)
D. Observe and repeat troponin levels in 6 hours
E. Schedule an outpatient stress test
Explanation: This patient has an acute inferior ST-elevation myocardial infarction
(STEMI). The preferred reperfusion strategy is immediate PCI when it can be
performed promptly. Fibrinolysis is reserved for situations where timely PCI is
unavailable.
2. A 24-year-old woman presents with dysuria, urinary frequency, and urgency
for 2 days. She has no fever, flank pain, or vaginal discharge. Urinalysis is
positive for leukocyte esterase and nitrites.
What is the most likely diagnosis?
,A. Acute pyelonephritis
B. Acute uncomplicated cystitis
C. Interstitial cystitis
D. Vulvovaginal candidiasis
E. Nephrolithiasis
Explanation: Typical lower urinary tract symptoms with positive nitrites and
leukocyte esterase in an otherwise healthy young woman are most consistent with
uncomplicated cystitis.
3. A 6-year-old boy is brought to the clinic because of fever, sore throat, and a
sandpaper-like rash. Examination reveals strawberry tongue and tonsillar
exudates.
Which organism is the most likely cause?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
E. Corynebacterium diphtheriae
Explanation: Scarlet fever is caused by toxin-producing Group A Streptococcus (S.
pyogenes) and presents with pharyngitis, strawberry tongue, and a characteristic
sandpaper rash.
, 4. A 30-year-old pregnant woman at 34 weeks' gestation presents with severe
headache, visual disturbances, blood pressure of 170/110 mm Hg, and
proteinuria.
Which medication should be administered first to reduce the risk of maternal
seizures?
A. Diazepam
B. Phenytoin
C. Magnesium sulfate
D. Levetiracetam
E. Valproic acid
Explanation: Severe preeclampsia is treated with magnesium sulfate for seizure
prophylaxis. Blood pressure should also be controlled, and delivery planned when
appropriate.
5. A 72-year-old man suddenly develops right facial droop, right arm weakness,
and expressive aphasia. Symptoms began 45 minutes ago. Noncontrast head CT
shows no hemorrhage.
What is the next best step?
A. Aspirin only
B. Administer intravenous thrombolytic therapy if no contraindications exist
C. Begin heparin infusion immediately
D. Schedule carotid endarterectomy today
E. Observe for 24 hours
