COMSAE PHASE 2 – FORM 117 EXAM
Questions Answers & Rationales 2026
Edition
Question 1
A 24-year-old man presents with fatigue, weight loss, and
heat intolerance. He has a fine tremor, diffuse goiter, and
bilateral exophthalmos. Laboratory studies show elevated
free T4 and suppressed TSH. Which mechanism best explains
his condition?
A. Antibodies against thyroid peroxidase
B. Antibodies stimulating the TSH receptor
C. Destruction of thyroid follicles by cytotoxic T cells
D. Autonomous thyroid hormone secretion from a toxic
adenoma
Answer: B. Antibodies stimulating the TSH receptor
Graves disease results from IgG autoantibodies that activate
TSH receptors, causing diffuse thyroid enlargement and
excess hormone production. Ophthalmopathy is a
characteristic extrathyroidal manifestation.
Question 2
,A 63-year-old man with a 50-pack-year smoking history
develops painless hematuria. Cystoscopy reveals a papillary
bladder mass. Histology demonstrates malignant cells
resembling transitional epithelium. Which exposure is most
strongly associated with this malignancy?
A. Asbestos
B. Benzene
C. Aromatic amines
D. Vinyl chloride
Answer: C. Aromatic amines
Urothelial carcinoma is strongly associated with cigarette
smoking and occupational exposure to aromatic amines used
in dyes and rubber manufacturing.
Question 3
A 7-year-old child develops periorbital edema and frothy
urine two weeks after recovering from an upper respiratory
infection. Urinalysis shows heavy proteinuria without
hematuria. Serum albumin is decreased. Which finding is
most likely on electron microscopy?
A. Subepithelial immune complexes
B. Mesangial IgA deposition
C. Fusion of podocyte foot processes
D. Thickened glomerular basement membrane
Answer: C. Fusion of podocyte foot processes
,Minimal change disease is the most common nephrotic
syndrome in children. Electron microscopy shows diffuse
podocyte foot-process effacement, while light microscopy is
usually normal.
Question 4
A 45-year-old woman develops severe watery diarrhea after
receiving clindamycin for a dental infection. Colonoscopy
reveals raised yellow-white plaques. Which organism is
responsible?
A. Escherichia coli
B. Clostridioides difficile
C. Salmonella enterica
D. Campylobacter jejuni
Answer: B. Clostridioides difficile
Antibiotic exposure disrupts normal intestinal flora, allowing
C. difficile overgrowth and toxin-mediated
pseudomembranous colitis.
Question 5
A patient develops weakness and difficulty climbing stairs
several weeks after beginning a new medication. Examination
reveals proximal muscle weakness without sensory loss.
Which drug is most likely responsible?
A. Atorvastatin
B. Omeprazole
, C. Metformin
D. Losartan
Answer: A. Atorvastatin
Statins can cause myopathy ranging from mild muscle pain to
rhabdomyolysis. Proximal weakness with elevated creatine
kinase supports statin-associated muscle injury.
Question 6
A 58-year-old man presents with crushing substernal chest
pain radiating to his left arm. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior-wall
myocardial infarction, most commonly caused by right
coronary artery occlusion.
Question 7
A 29-year-old woman presents with episodic palpitations,
sweating, and severe headaches. Blood pressure is 210/120
mm Hg. A catecholamine-secreting adrenal tumor is
Questions Answers & Rationales 2026
Edition
Question 1
A 24-year-old man presents with fatigue, weight loss, and
heat intolerance. He has a fine tremor, diffuse goiter, and
bilateral exophthalmos. Laboratory studies show elevated
free T4 and suppressed TSH. Which mechanism best explains
his condition?
A. Antibodies against thyroid peroxidase
B. Antibodies stimulating the TSH receptor
C. Destruction of thyroid follicles by cytotoxic T cells
D. Autonomous thyroid hormone secretion from a toxic
adenoma
Answer: B. Antibodies stimulating the TSH receptor
Graves disease results from IgG autoantibodies that activate
TSH receptors, causing diffuse thyroid enlargement and
excess hormone production. Ophthalmopathy is a
characteristic extrathyroidal manifestation.
Question 2
,A 63-year-old man with a 50-pack-year smoking history
develops painless hematuria. Cystoscopy reveals a papillary
bladder mass. Histology demonstrates malignant cells
resembling transitional epithelium. Which exposure is most
strongly associated with this malignancy?
A. Asbestos
B. Benzene
C. Aromatic amines
D. Vinyl chloride
Answer: C. Aromatic amines
Urothelial carcinoma is strongly associated with cigarette
smoking and occupational exposure to aromatic amines used
in dyes and rubber manufacturing.
Question 3
A 7-year-old child develops periorbital edema and frothy
urine two weeks after recovering from an upper respiratory
infection. Urinalysis shows heavy proteinuria without
hematuria. Serum albumin is decreased. Which finding is
most likely on electron microscopy?
A. Subepithelial immune complexes
B. Mesangial IgA deposition
C. Fusion of podocyte foot processes
D. Thickened glomerular basement membrane
Answer: C. Fusion of podocyte foot processes
,Minimal change disease is the most common nephrotic
syndrome in children. Electron microscopy shows diffuse
podocyte foot-process effacement, while light microscopy is
usually normal.
Question 4
A 45-year-old woman develops severe watery diarrhea after
receiving clindamycin for a dental infection. Colonoscopy
reveals raised yellow-white plaques. Which organism is
responsible?
A. Escherichia coli
B. Clostridioides difficile
C. Salmonella enterica
D. Campylobacter jejuni
Answer: B. Clostridioides difficile
Antibiotic exposure disrupts normal intestinal flora, allowing
C. difficile overgrowth and toxin-mediated
pseudomembranous colitis.
Question 5
A patient develops weakness and difficulty climbing stairs
several weeks after beginning a new medication. Examination
reveals proximal muscle weakness without sensory loss.
Which drug is most likely responsible?
A. Atorvastatin
B. Omeprazole
, C. Metformin
D. Losartan
Answer: A. Atorvastatin
Statins can cause myopathy ranging from mild muscle pain to
rhabdomyolysis. Proximal weakness with elevated creatine
kinase supports statin-associated muscle injury.
Question 6
A 58-year-old man presents with crushing substernal chest
pain radiating to his left arm. ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior-wall
myocardial infarction, most commonly caused by right
coronary artery occlusion.
Question 7
A 29-year-old woman presents with episodic palpitations,
sweating, and severe headaches. Blood pressure is 210/120
mm Hg. A catecholamine-secreting adrenal tumor is
