2026 COMSAE PHASE 2 –
FORM 116 Exam Questions
Correct Answers Rationales
Question 1
A 24-year-old man presents with fatigue, weight loss, and
increased thirst. Laboratory studies show glucose of 310
mg/dL, low C-peptide, and positive anti-GAD antibodies.
Which mechanism best explains his condition?
A. Increased insulin resistance from adipokine dysfunction
B. Autoimmune destruction of pancreatic β-cells
C. Excess glucagon secretion from α-cells
D. Impaired glucose absorption from the intestine
Answer: B. Autoimmune destruction of pancreatic β-cells
Type 1 diabetes mellitus results from immune-mediated β-cell
destruction, causing absolute insulin deficiency and low C-
peptide levels.
Question 2
A 68-year-old woman develops sudden right-sided weakness
and expressive aphasia. Imaging reveals an infarction
,involving the dominant inferior frontal gyrus. Which artery is
most likely affected?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Superior division of the middle cerebral artery
D. Inferior division of the middle cerebral artery
Answer: C. Superior division of the middle cerebral artery
The dominant inferior frontal gyrus contains Broca area,
supplied primarily by the superior division of the middle
cerebral artery.
Question 3
A patient develops jaundice and dark urine after receiving a
sulfonamide. Peripheral smear shows bite cells and Heinz
bodies. Which enzyme deficiency is most likely present?
A. Pyruvate kinase
B. Glucose-6-phosphate dehydrogenase
C. Hexokinase
D. Glutathione reductase
Answer: B. Glucose-6-phosphate dehydrogenase
G6PD deficiency reduces NADPH production, impairing
protection against oxidative stress and causing episodic
hemolysis after oxidant exposure.
Question 4
,A 45-year-old man has progressive dysphagia initially to solids
and later to liquids. Barium swallow shows an irregular
narrowing of the distal esophagus. Which diagnosis is most
likely?
A. Achalasia
B. Esophageal carcinoma
C. Diffuse esophageal spasm
D. Zenker diverticulum
Answer: B. Esophageal carcinoma
Progressive dysphagia beginning with solids suggests
mechanical obstruction, and an irregular distal narrowing
raises concern for malignancy.
Question 5
A 32-year-old woman has heat intolerance, tremor, weight
loss, and exophthalmos. Which antibody is most directly
responsible for her disease?
A. Anti-thyroid peroxidase antibody
B. Anti-thyroglobulin antibody
C. Anti-thyroid stimulating hormone receptor antibody
D. Anti-insulin receptor antibody
Answer: C. Anti-thyroid stimulating hormone receptor
antibody
Graves disease is caused by TSH receptor–stimulating
immunoglobulins that increase thyroid hormone synthesis
and release.
, Question 6
A patient with chronic kidney disease develops normocytic
anemia. Which mechanism is primarily responsible?
A. Reduced iron absorption
B. Increased erythropoietin production
C. Reduced erythropoietin synthesis
D. Increased red blood cell destruction
Answer: C. Reduced erythropoietin synthesis
Damaged renal tissue produces insufficient erythropoietin,
leading to decreased erythrocyte production and normocytic
anemia.
Question 7
A 19-year-old college student presents with fever, headache,
neck stiffness, and petechial rash. Cerebrospinal fluid shows
neutrophilic pleocytosis and low glucose. Which organism is
most likely?
A. Listeria monocytogenes
B. Neisseria meningitidis
C. Cryptococcus neoformans
D. Herpes simplex virus
Answer: B. Neisseria meningitidis
FORM 116 Exam Questions
Correct Answers Rationales
Question 1
A 24-year-old man presents with fatigue, weight loss, and
increased thirst. Laboratory studies show glucose of 310
mg/dL, low C-peptide, and positive anti-GAD antibodies.
Which mechanism best explains his condition?
A. Increased insulin resistance from adipokine dysfunction
B. Autoimmune destruction of pancreatic β-cells
C. Excess glucagon secretion from α-cells
D. Impaired glucose absorption from the intestine
Answer: B. Autoimmune destruction of pancreatic β-cells
Type 1 diabetes mellitus results from immune-mediated β-cell
destruction, causing absolute insulin deficiency and low C-
peptide levels.
Question 2
A 68-year-old woman develops sudden right-sided weakness
and expressive aphasia. Imaging reveals an infarction
,involving the dominant inferior frontal gyrus. Which artery is
most likely affected?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Superior division of the middle cerebral artery
D. Inferior division of the middle cerebral artery
Answer: C. Superior division of the middle cerebral artery
The dominant inferior frontal gyrus contains Broca area,
supplied primarily by the superior division of the middle
cerebral artery.
Question 3
A patient develops jaundice and dark urine after receiving a
sulfonamide. Peripheral smear shows bite cells and Heinz
bodies. Which enzyme deficiency is most likely present?
A. Pyruvate kinase
B. Glucose-6-phosphate dehydrogenase
C. Hexokinase
D. Glutathione reductase
Answer: B. Glucose-6-phosphate dehydrogenase
G6PD deficiency reduces NADPH production, impairing
protection against oxidative stress and causing episodic
hemolysis after oxidant exposure.
Question 4
,A 45-year-old man has progressive dysphagia initially to solids
and later to liquids. Barium swallow shows an irregular
narrowing of the distal esophagus. Which diagnosis is most
likely?
A. Achalasia
B. Esophageal carcinoma
C. Diffuse esophageal spasm
D. Zenker diverticulum
Answer: B. Esophageal carcinoma
Progressive dysphagia beginning with solids suggests
mechanical obstruction, and an irregular distal narrowing
raises concern for malignancy.
Question 5
A 32-year-old woman has heat intolerance, tremor, weight
loss, and exophthalmos. Which antibody is most directly
responsible for her disease?
A. Anti-thyroid peroxidase antibody
B. Anti-thyroglobulin antibody
C. Anti-thyroid stimulating hormone receptor antibody
D. Anti-insulin receptor antibody
Answer: C. Anti-thyroid stimulating hormone receptor
antibody
Graves disease is caused by TSH receptor–stimulating
immunoglobulins that increase thyroid hormone synthesis
and release.
, Question 6
A patient with chronic kidney disease develops normocytic
anemia. Which mechanism is primarily responsible?
A. Reduced iron absorption
B. Increased erythropoietin production
C. Reduced erythropoietin synthesis
D. Increased red blood cell destruction
Answer: C. Reduced erythropoietin synthesis
Damaged renal tissue produces insufficient erythropoietin,
leading to decreased erythrocyte production and normocytic
anemia.
Question 7
A 19-year-old college student presents with fever, headache,
neck stiffness, and petechial rash. Cerebrospinal fluid shows
neutrophilic pleocytosis and low glucose. Which organism is
most likely?
A. Listeria monocytogenes
B. Neisseria meningitidis
C. Cryptococcus neoformans
D. Herpes simplex virus
Answer: B. Neisseria meningitidis
