COMSAE Phase 2 Form 115
Exam2026 Edition Questions
with Answers and Concise
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 stimulating the TSH receptor
B. Antibodies destroying thyroid follicular cells
C. Immune complexes deposited in the thyroid
D. T-cell destruction of thyroid tissue
Answer: A. Antibodies stimulating the TSH receptor
Graves disease is caused by thyroid-stimulating
immunoglobulins that activate the TSH receptor, increasing
thyroid hormone synthesis and causing diffuse gland
enlargement.
,2.
A 67-year-old man with hypertension develops sudden right-
sided weakness and aphasia. Imaging reveals an infarct
involving the left middle cerebral artery territory. Which
vascular structure is most likely affected?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Answer: B. Middle cerebral artery
The middle cerebral artery supplies the lateral cerebral
hemisphere, including motor and sensory areas for the face
and upper extremity and language regions in the dominant
hemisphere.
3.
A 5-year-old boy develops periorbital edema and frothy urine.
Laboratory studies reveal heavy proteinuria,
hypoalbuminemia, and hyperlipidemia. Renal biopsy is
normal by light microscopy. Which diagnosis is most likely?
A. Focal segmental glomerulosclerosis
B. Membranous nephropathy
C. Minimal change disease
D. IgA nephropathy
Answer: C. Minimal change disease
,Minimal change disease causes nephrotic syndrome in
children and shows diffuse podocyte foot-process effacement
on electron microscopy.
4.
A patient with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. Which treatment should be
administered immediately?
A. Folic acid
B. Glucose
C. Niacin
D. Thiamine
Answer: D. Thiamine
Thiamine deficiency causes Wernicke encephalopathy.
Thiamine should be given before glucose because glucose
metabolism can worsen neurologic injury in deficient patients.
5.
A 32-year-old woman presents with proximal muscle
weakness, difficulty climbing stairs, and a heliotrope rash.
Laboratory testing reveals elevated creatine kinase. Which
diagnosis is most likely?
A. Dermatomyositis
B. Polymyalgia rheumatica
C. Rheumatoid arthritis
D. Systemic sclerosis
, Answer: A. Dermatomyositis
Dermatomyositis causes inflammatory proximal muscle
weakness with characteristic skin findings such as a
heliotrope rash and Gottron papules.
6.
A 3-year-old child has recurrent respiratory infections, chronic
diarrhea, and failure to thrive. Laboratory studies show
markedly decreased immunoglobulin levels and absent
mature B cells. Which condition is most likely?
A. DiGeorge syndrome
B. Selective IgA deficiency
C. Severe combined immunodeficiency
D. X-linked agammaglobulinemia
Answer: D. X-linked agammaglobulinemia
Bruton disease results from defective BTK signaling,
preventing B-cell maturation and causing profound
hypogammaglobulinemia in boys.
7.
A 70-year-old man develops progressive resting tremor,
bradykinesia, and rigidity. Degeneration of which neuronal
population is responsible?
A. Dopaminergic neurons in the substantia nigra pars
compacta
Exam2026 Edition Questions
with Answers and Concise
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 stimulating the TSH receptor
B. Antibodies destroying thyroid follicular cells
C. Immune complexes deposited in the thyroid
D. T-cell destruction of thyroid tissue
Answer: A. Antibodies stimulating the TSH receptor
Graves disease is caused by thyroid-stimulating
immunoglobulins that activate the TSH receptor, increasing
thyroid hormone synthesis and causing diffuse gland
enlargement.
,2.
A 67-year-old man with hypertension develops sudden right-
sided weakness and aphasia. Imaging reveals an infarct
involving the left middle cerebral artery territory. Which
vascular structure is most likely affected?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Answer: B. Middle cerebral artery
The middle cerebral artery supplies the lateral cerebral
hemisphere, including motor and sensory areas for the face
and upper extremity and language regions in the dominant
hemisphere.
3.
A 5-year-old boy develops periorbital edema and frothy urine.
Laboratory studies reveal heavy proteinuria,
hypoalbuminemia, and hyperlipidemia. Renal biopsy is
normal by light microscopy. Which diagnosis is most likely?
A. Focal segmental glomerulosclerosis
B. Membranous nephropathy
C. Minimal change disease
D. IgA nephropathy
Answer: C. Minimal change disease
,Minimal change disease causes nephrotic syndrome in
children and shows diffuse podocyte foot-process effacement
on electron microscopy.
4.
A patient with chronic alcohol use presents with confusion,
ataxia, and ophthalmoplegia. Which treatment should be
administered immediately?
A. Folic acid
B. Glucose
C. Niacin
D. Thiamine
Answer: D. Thiamine
Thiamine deficiency causes Wernicke encephalopathy.
Thiamine should be given before glucose because glucose
metabolism can worsen neurologic injury in deficient patients.
5.
A 32-year-old woman presents with proximal muscle
weakness, difficulty climbing stairs, and a heliotrope rash.
Laboratory testing reveals elevated creatine kinase. Which
diagnosis is most likely?
A. Dermatomyositis
B. Polymyalgia rheumatica
C. Rheumatoid arthritis
D. Systemic sclerosis
, Answer: A. Dermatomyositis
Dermatomyositis causes inflammatory proximal muscle
weakness with characteristic skin findings such as a
heliotrope rash and Gottron papules.
6.
A 3-year-old child has recurrent respiratory infections, chronic
diarrhea, and failure to thrive. Laboratory studies show
markedly decreased immunoglobulin levels and absent
mature B cells. Which condition is most likely?
A. DiGeorge syndrome
B. Selective IgA deficiency
C. Severe combined immunodeficiency
D. X-linked agammaglobulinemia
Answer: D. X-linked agammaglobulinemia
Bruton disease results from defective BTK signaling,
preventing B-cell maturation and causing profound
hypogammaglobulinemia in boys.
7.
A 70-year-old man develops progressive resting tremor,
bradykinesia, and rigidity. Degeneration of which neuronal
population is responsible?
A. Dopaminergic neurons in the substantia nigra pars
compacta
