2026 COMSAE Phase2 FORM 118 Exam
Question Verified Answers with
Rationales
1.
A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffuse,
nontender goiter and bilateral exophthalmos. Laboratory
studies show elevated free T4 and suppressed TSH. Which
mechanism best explains her condition?
A. Antibodies against thyroid peroxidase causing gland
destruction
B. IgG antibodies stimulating the TSH receptor
C. T-cell destruction of thyroid follicular cells
D. Excessive iodine-mediated inhibition of thyroid hormone
release
Answer: B. IgG antibodies stimulating the TSH receptor
Graves disease results from thyroid-stimulating
immunoglobulins that activate TSH receptors, producing
diffuse hyperthyroidism and ophthalmopathy.
2.
,A 67-year-old man develops sudden right-sided weakness and
expressive aphasia. Imaging reveals an infarct involving the
dominant frontal lobe. Which artery is most likely occluded?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Superior division of the middle cerebral artery
D. Anterior inferior cerebellar artery
Answer: C. Superior division of the middle cerebral artery
The dominant MCA superior division supplies Broca area and
lateral frontal cortex; infarction causes contralateral face/arm
weakness with expressive aphasia.
3.
A patient with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. Which treatment should be
administered immediately?
A. Intravenous glucose
B. Intravenous folate
C. Intravenous thiamine
D. Intramuscular vitamin B12
Answer: C. Intravenous thiamine
Thiamine deficiency causes Wernicke encephalopathy.
Thiamine should precede glucose to avoid worsening
neurologic injury.
,4.
A 45-year-old woman has progressive proximal muscle
weakness and difficulty climbing stairs. Laboratory studies
show elevated creatine kinase. Muscle biopsy reveals
perifascicular atrophy. Which diagnosis is most likely?
A. Polymyalgia rheumatica
B. Polymyositis
C. Dermatomyositis
D. Inclusion body myositis
Answer: C. Dermatomyositis
Perifascicular atrophy is characteristic of dermatomyositis,
which commonly causes symmetric proximal weakness and
may be associated with malignancy.
5.
A 32-year-old woman presents with episodic headaches,
sweating, palpitations, and hypertension. A catecholamine-
secreting adrenal tumor is suspected. Which medication
should be initiated before beta-blockade?
A. Propranolol
B. Metoprolol
C. Phenoxybenzamine
D. Verapamil
Answer: C. Phenoxybenzamine
, Alpha blockade must precede beta blockade in
pheochromocytoma to prevent unopposed alpha-mediated
vasoconstriction and hypertensive crisis.
6.
A 70-year-old man develops painless jaundice and weight
loss. Imaging reveals a mass in the pancreatic head. Which
additional finding is most likely?
A. Hematemesis
B. Courvoisier sign
C. Esophageal varices
D. Splenomegaly
Answer: B. Courvoisier sign
Pancreatic head malignancy can obstruct the common bile
duct, causing painless jaundice and a palpable, nontender
gallbladder.
7.
A newborn develops respiratory distress shortly after birth.
The infant was delivered at 30 weeks' gestation. Which
substance is deficient?
A. Surfactant protein A
B. Pulmonary elastin
C. Surfactant produced by type II pneumocytes
D. Mucociliary secretions
Question Verified Answers with
Rationales
1.
A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffuse,
nontender goiter and bilateral exophthalmos. Laboratory
studies show elevated free T4 and suppressed TSH. Which
mechanism best explains her condition?
A. Antibodies against thyroid peroxidase causing gland
destruction
B. IgG antibodies stimulating the TSH receptor
C. T-cell destruction of thyroid follicular cells
D. Excessive iodine-mediated inhibition of thyroid hormone
release
Answer: B. IgG antibodies stimulating the TSH receptor
Graves disease results from thyroid-stimulating
immunoglobulins that activate TSH receptors, producing
diffuse hyperthyroidism and ophthalmopathy.
2.
,A 67-year-old man develops sudden right-sided weakness and
expressive aphasia. Imaging reveals an infarct involving the
dominant frontal lobe. Which artery is most likely occluded?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Superior division of the middle cerebral artery
D. Anterior inferior cerebellar artery
Answer: C. Superior division of the middle cerebral artery
The dominant MCA superior division supplies Broca area and
lateral frontal cortex; infarction causes contralateral face/arm
weakness with expressive aphasia.
3.
A patient with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. Which treatment should be
administered immediately?
A. Intravenous glucose
B. Intravenous folate
C. Intravenous thiamine
D. Intramuscular vitamin B12
Answer: C. Intravenous thiamine
Thiamine deficiency causes Wernicke encephalopathy.
Thiamine should precede glucose to avoid worsening
neurologic injury.
,4.
A 45-year-old woman has progressive proximal muscle
weakness and difficulty climbing stairs. Laboratory studies
show elevated creatine kinase. Muscle biopsy reveals
perifascicular atrophy. Which diagnosis is most likely?
A. Polymyalgia rheumatica
B. Polymyositis
C. Dermatomyositis
D. Inclusion body myositis
Answer: C. Dermatomyositis
Perifascicular atrophy is characteristic of dermatomyositis,
which commonly causes symmetric proximal weakness and
may be associated with malignancy.
5.
A 32-year-old woman presents with episodic headaches,
sweating, palpitations, and hypertension. A catecholamine-
secreting adrenal tumor is suspected. Which medication
should be initiated before beta-blockade?
A. Propranolol
B. Metoprolol
C. Phenoxybenzamine
D. Verapamil
Answer: C. Phenoxybenzamine
, Alpha blockade must precede beta blockade in
pheochromocytoma to prevent unopposed alpha-mediated
vasoconstriction and hypertensive crisis.
6.
A 70-year-old man develops painless jaundice and weight
loss. Imaging reveals a mass in the pancreatic head. Which
additional finding is most likely?
A. Hematemesis
B. Courvoisier sign
C. Esophageal varices
D. Splenomegaly
Answer: B. Courvoisier sign
Pancreatic head malignancy can obstruct the common bile
duct, causing painless jaundice and a palpable, nontender
gallbladder.
7.
A newborn develops respiratory distress shortly after birth.
The infant was delivered at 30 weeks' gestation. Which
substance is deficient?
A. Surfactant protein A
B. Pulmonary elastin
C. Surfactant produced by type II pneumocytes
D. Mucociliary secretions
