COMSAE Exam 44: Practice Questions with
Answers and Rationales
Section 1: Internal Medicine (Questions 1-25)
,Question 1
A 65-year-old male with a history of hypertension and diabetes presents with substernal chest
pressure radiating to the left arm, associated with diaphoresis and nausea for the past 2 hours.
ECG shows ST-segment elevation in leads V1-V4. What is the most appropriate immediate
intervention?
A) Administer aspirin and sublingual nitroglycerin
B) Immediate reperfusion therapy (PCI or fibrinolysis)
C) Obtain a troponin level before treatment
D) Start intravenous beta-blocker
Correct Answer: B
Rationale: ST-segment elevation myocardial infarction (STEMI) requires immediate reperfusion
therapy to restore blood flow to ischemic myocardium. Aspirin is an adjunct but reperfusion is the
priority. PCI is preferred if available within 120 minutes; otherwise, fibrinolysis. Waiting for troponin
levels should not delay reperfusion .
,Question 2
A 55-year-old male with a 40-pack-year smoking history presents with a chronic cough,
hemoptysis, and weight loss. Chest x-ray shows a right hilar mass. What is the most appropriate
next step?
A) CT scan of the chest
B) Bronchoscopy with biopsy
C) Sputum cytology
D) PET scan
Correct Answer: B
Rationale: Suspected lung cancer requires tissue diagnosis for confirmation. Bronchoscopy with
biopsy is the preferred initial procedure for central lesions. CT and PET scans are staging studies
that should be performed after tissue diagnosis is obtained .
, Question 3
A 72-year-old female with a history of atrial fibrillation on warfarin presents with sudden onset of
severe headache and vomiting. INR is 4.5. Non-contrast head CT shows a left parietal
intraparenchymal hemorrhage. What is the most appropriate immediate management?
A) Administer fresh frozen plasma
B) Hold warfarin and administer vitamin K 10 mg IV
C) Give prothrombin complex concentrate (PCC)
D) Administer aspirin
Correct Answer: C
Rationale: For life-threatening intracranial hemorrhage on warfarin, prothrombin complex
concentrate (PCC) is preferred over fresh frozen plasma for rapid reversal. Vitamin K is given
concurrently but takes hours to work. PCC provides faster and more effective reversal of
anticoagulation .
Answers and Rationales
Section 1: Internal Medicine (Questions 1-25)
,Question 1
A 65-year-old male with a history of hypertension and diabetes presents with substernal chest
pressure radiating to the left arm, associated with diaphoresis and nausea for the past 2 hours.
ECG shows ST-segment elevation in leads V1-V4. What is the most appropriate immediate
intervention?
A) Administer aspirin and sublingual nitroglycerin
B) Immediate reperfusion therapy (PCI or fibrinolysis)
C) Obtain a troponin level before treatment
D) Start intravenous beta-blocker
Correct Answer: B
Rationale: ST-segment elevation myocardial infarction (STEMI) requires immediate reperfusion
therapy to restore blood flow to ischemic myocardium. Aspirin is an adjunct but reperfusion is the
priority. PCI is preferred if available within 120 minutes; otherwise, fibrinolysis. Waiting for troponin
levels should not delay reperfusion .
,Question 2
A 55-year-old male with a 40-pack-year smoking history presents with a chronic cough,
hemoptysis, and weight loss. Chest x-ray shows a right hilar mass. What is the most appropriate
next step?
A) CT scan of the chest
B) Bronchoscopy with biopsy
C) Sputum cytology
D) PET scan
Correct Answer: B
Rationale: Suspected lung cancer requires tissue diagnosis for confirmation. Bronchoscopy with
biopsy is the preferred initial procedure for central lesions. CT and PET scans are staging studies
that should be performed after tissue diagnosis is obtained .
, Question 3
A 72-year-old female with a history of atrial fibrillation on warfarin presents with sudden onset of
severe headache and vomiting. INR is 4.5. Non-contrast head CT shows a left parietal
intraparenchymal hemorrhage. What is the most appropriate immediate management?
A) Administer fresh frozen plasma
B) Hold warfarin and administer vitamin K 10 mg IV
C) Give prothrombin complex concentrate (PCC)
D) Administer aspirin
Correct Answer: C
Rationale: For life-threatening intracranial hemorrhage on warfarin, prothrombin complex
concentrate (PCC) is preferred over fresh frozen plasma for rapid reversal. Vitamin K is given
concurrently but takes hours to work. PCC provides faster and more effective reversal of
anticoagulation .
