COMSAE Form 41-Style Practice Exam: High-
Yield Questions with Answers & Rationales
Section 1: Cardiovascular & Pulmonary (Questions 1-15)
,1. A 65-year-old man with a 40-pack-year smoking history presents with progressive dyspnea on
exertion and a chronic cough. Pulmonary function tests show a reduced FEV1/FVC ratio (<0.70)
with increased total lung capacity. Which of the following is the most likely diagnosis?
A) Restrictive lung disease
B) Asthma
C) Chronic obstructive pulmonary disease (COPD)
D) Pulmonary fibrosis
Correct Answer: C
Rationale: A reduced FEV1/FVC ratio (<0.70) with air trapping (increased total lung capacity) is
the classic spirometric pattern for obstructive lung disease. Given the patient's significant smoking
history and chronic symptoms, COPD is the most likely diagnosis. Asthma would typically show
reversibility with bronchodilators, and restrictive diseases (like pulmonary fibrosis) would show
reduced total lung capacity.
,2. A 72-year-old woman with a history of hypertension presents with acute onset of substernal
chest pain radiating to her jaw. ECG shows ST-segment elevation in leads V1-V4. Which coronary
artery is most likely occluded?
A) Left circumflex artery
B) Left anterior descending artery
C) Right coronary artery
D) Posterior descending artery
Correct Answer: B
Rationale: ST-elevation in leads V1-V4 indicates an anterior wall myocardial infarction, which is
caused by occlusion of the left anterior descending (LAD) artery. The LAD supplies the anterior
wall of the left ventricle and the interventricular septum. The right coronary artery typically causes
inferior wall MI (leads II, III, aVF), and the left circumflex often causes lateral wall MI (leads I, aVL,
V5-V6).
, 3. A 45-year-old woman presents with palpitations, fatigue, and heat intolerance. Physical exam
reveals a fine tremor and tachycardia. Laboratory studies show low TSH and elevated free T4.
What is the most likely diagnosis?
A) Hashimoto thyroiditis
B) Graves disease
C) Subacute thyroiditis
D) Toxic multinodular goiter
Correct Answer: B
Rationale: Graves disease is the most common cause of hyperthyroidism and presents with low
TSH, elevated free T4, and symptoms of hypermetabolism (tachycardia, tremor, heat intolerance).
Hashimoto thyroiditis causes hypothyroidism. Graves disease is autoimmune and often associated
with ophthalmopathy (proptosis, lid retraction) .
Yield Questions with Answers & Rationales
Section 1: Cardiovascular & Pulmonary (Questions 1-15)
,1. A 65-year-old man with a 40-pack-year smoking history presents with progressive dyspnea on
exertion and a chronic cough. Pulmonary function tests show a reduced FEV1/FVC ratio (<0.70)
with increased total lung capacity. Which of the following is the most likely diagnosis?
A) Restrictive lung disease
B) Asthma
C) Chronic obstructive pulmonary disease (COPD)
D) Pulmonary fibrosis
Correct Answer: C
Rationale: A reduced FEV1/FVC ratio (<0.70) with air trapping (increased total lung capacity) is
the classic spirometric pattern for obstructive lung disease. Given the patient's significant smoking
history and chronic symptoms, COPD is the most likely diagnosis. Asthma would typically show
reversibility with bronchodilators, and restrictive diseases (like pulmonary fibrosis) would show
reduced total lung capacity.
,2. A 72-year-old woman with a history of hypertension presents with acute onset of substernal
chest pain radiating to her jaw. ECG shows ST-segment elevation in leads V1-V4. Which coronary
artery is most likely occluded?
A) Left circumflex artery
B) Left anterior descending artery
C) Right coronary artery
D) Posterior descending artery
Correct Answer: B
Rationale: ST-elevation in leads V1-V4 indicates an anterior wall myocardial infarction, which is
caused by occlusion of the left anterior descending (LAD) artery. The LAD supplies the anterior
wall of the left ventricle and the interventricular septum. The right coronary artery typically causes
inferior wall MI (leads II, III, aVF), and the left circumflex often causes lateral wall MI (leads I, aVL,
V5-V6).
, 3. A 45-year-old woman presents with palpitations, fatigue, and heat intolerance. Physical exam
reveals a fine tremor and tachycardia. Laboratory studies show low TSH and elevated free T4.
What is the most likely diagnosis?
A) Hashimoto thyroiditis
B) Graves disease
C) Subacute thyroiditis
D) Toxic multinodular goiter
Correct Answer: B
Rationale: Graves disease is the most common cause of hyperthyroidism and presents with low
TSH, elevated free T4, and symptoms of hypermetabolism (tachycardia, tremor, heat intolerance).
Hashimoto thyroiditis causes hypothyroidism. Graves disease is autoimmune and often associated
with ophthalmopathy (proptosis, lid retraction) .
