COMSAE Phase 7 Practice Exam 2026
Edition Questions with Answers &
Rationales
Question 1
A 24-year-old man presents with severe epigastric pain
radiating to the back after a weekend of heavy alcohol
consumption. Serum lipase is markedly elevated. Which
pancreatic enzyme is primarily responsible for the fat necrosis
seen in acute pancreatitis?
A. Amylase
B. Trypsin
C. Lipase
D. Elastase
Answer: C. Lipase
Pancreatic lipase hydrolyzes triglycerides, releasing free fatty
acids that combine with calcium and cause enzymatic fat
necrosis.
Question 2
A 67-year-old woman with hypertension develops sudden
right-sided weakness and expressive aphasia. CT shows an
,acute hemorrhage in the left putamen. Which vessel is most
likely ruptured?
A. Lenticulostriate artery
B. Anterior cerebral artery
C. Middle cerebral artery
D. Anterior choroidal artery
Answer: A. Lenticulostriate artery
Chronic hypertension causes lipohyalinosis of small
penetrating vessels, particularly the lenticulostriate arteries,
producing hypertensive intracerebral hemorrhage in the basal
ganglia.
Question 3
A 19-year-old college student presents with fever, headache,
neck stiffness, and photophobia. Cerebrospinal fluid shows
neutrophilic predominance, low glucose, and elevated
protein. Which organism is most likely in an unimmunized
patient?
A. Cryptococcus neoformans
B. Neisseria meningitidis
C. Listeria monocytogenes
D. Herpes simplex virus
Answer: B. Neisseria meningitidis
Neisseria meningitidis commonly causes acute bacterial
meningitis in adolescents and young adults, especially
without adequate vaccination.
,Question 4
A 58-year-old man with a 40-pack-year smoking history
presents with painless hematuria. Cystoscopy reveals a
papillary bladder mass. Histology demonstrates malignant
transitional cells. Which carcinogen is most strongly
associated with this malignancy?
A. Vinyl chloride
B. Aromatic amines
C. Aflatoxin B1
D. Asbestos
Answer: B. Aromatic amines
Occupational exposure to aromatic amines, especially β-
naphthylamine, is strongly associated with urothelial
carcinoma of the bladder.
Question 5
A 32-year-old woman develops fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffusely
enlarged thyroid and exophthalmos. Which antibody is most
likely present?
A. Anti-thyroid peroxidase
B. Anti-thyroglobulin
C. Anti-thyroid-stimulating hormone receptor
D. Anti-centromere
Answer: C. Anti-thyroid-stimulating hormone receptor
, Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, causing
diffuse hyperthyroidism and ophthalmopathy.
Question 6
A 72-year-old man develops exertional chest pain that
resolves with rest. ECG shows ST-segment depression during
symptoms. Which mechanism best explains his condition?
A. Complete coronary occlusion
B. Transient myocardial oxygen supply-demand mismatch
C. Coronary artery vasospasm
D. Acute inflammation of the myocardium
Answer: B. Transient myocardial oxygen supply-demand
mismatch
Stable angina occurs when fixed coronary atherosclerotic
narrowing limits blood flow during increased myocardial
oxygen demand.
Question 7
A patient with diabetic ketoacidosis has a serum potassium
concentration of 5.8 mEq/L. Despite this value, total-body
potassium is decreased. What explains this finding?
A. Increased renal potassium retention
B. Insulin-mediated intracellular potassium shift
C. Extracellular potassium shift from acidosis
D. Increased gastrointestinal potassium absorption
Edition Questions with Answers &
Rationales
Question 1
A 24-year-old man presents with severe epigastric pain
radiating to the back after a weekend of heavy alcohol
consumption. Serum lipase is markedly elevated. Which
pancreatic enzyme is primarily responsible for the fat necrosis
seen in acute pancreatitis?
A. Amylase
B. Trypsin
C. Lipase
D. Elastase
Answer: C. Lipase
Pancreatic lipase hydrolyzes triglycerides, releasing free fatty
acids that combine with calcium and cause enzymatic fat
necrosis.
Question 2
A 67-year-old woman with hypertension develops sudden
right-sided weakness and expressive aphasia. CT shows an
,acute hemorrhage in the left putamen. Which vessel is most
likely ruptured?
A. Lenticulostriate artery
B. Anterior cerebral artery
C. Middle cerebral artery
D. Anterior choroidal artery
Answer: A. Lenticulostriate artery
Chronic hypertension causes lipohyalinosis of small
penetrating vessels, particularly the lenticulostriate arteries,
producing hypertensive intracerebral hemorrhage in the basal
ganglia.
Question 3
A 19-year-old college student presents with fever, headache,
neck stiffness, and photophobia. Cerebrospinal fluid shows
neutrophilic predominance, low glucose, and elevated
protein. Which organism is most likely in an unimmunized
patient?
A. Cryptococcus neoformans
B. Neisseria meningitidis
C. Listeria monocytogenes
D. Herpes simplex virus
Answer: B. Neisseria meningitidis
Neisseria meningitidis commonly causes acute bacterial
meningitis in adolescents and young adults, especially
without adequate vaccination.
,Question 4
A 58-year-old man with a 40-pack-year smoking history
presents with painless hematuria. Cystoscopy reveals a
papillary bladder mass. Histology demonstrates malignant
transitional cells. Which carcinogen is most strongly
associated with this malignancy?
A. Vinyl chloride
B. Aromatic amines
C. Aflatoxin B1
D. Asbestos
Answer: B. Aromatic amines
Occupational exposure to aromatic amines, especially β-
naphthylamine, is strongly associated with urothelial
carcinoma of the bladder.
Question 5
A 32-year-old woman develops fatigue, weight loss, heat
intolerance, and palpitations. Examination reveals a diffusely
enlarged thyroid and exophthalmos. Which antibody is most
likely present?
A. Anti-thyroid peroxidase
B. Anti-thyroglobulin
C. Anti-thyroid-stimulating hormone receptor
D. Anti-centromere
Answer: C. Anti-thyroid-stimulating hormone receptor
, Graves disease results from thyroid-stimulating
immunoglobulins that activate the TSH receptor, causing
diffuse hyperthyroidism and ophthalmopathy.
Question 6
A 72-year-old man develops exertional chest pain that
resolves with rest. ECG shows ST-segment depression during
symptoms. Which mechanism best explains his condition?
A. Complete coronary occlusion
B. Transient myocardial oxygen supply-demand mismatch
C. Coronary artery vasospasm
D. Acute inflammation of the myocardium
Answer: B. Transient myocardial oxygen supply-demand
mismatch
Stable angina occurs when fixed coronary atherosclerotic
narrowing limits blood flow during increased myocardial
oxygen demand.
Question 7
A patient with diabetic ketoacidosis has a serum potassium
concentration of 5.8 mEq/L. Despite this value, total-body
potassium is decreased. What explains this finding?
A. Increased renal potassium retention
B. Insulin-mediated intracellular potassium shift
C. Extracellular potassium shift from acidosis
D. Increased gastrointestinal potassium absorption
