COMSAE Phase 2 Form 112-Style Practice
Exam: Questions with Answers and
Rationales
,SECTION 1: INTERNAL MEDICINE (Questions 1-30)
Question 1
A 62-year-old male with type 2 diabetes, hypertension, and CKD stage 3 presents with
progressive fatigue and dyspnea on exertion. Hb 8.9 g/dL, MCV 78 fL, ferritin 450 ng/mL, TIBC
210 μg/dL, serum iron 85 μg/dL. What is the most likely diagnosis?
A) Iron deficiency anemia
B) Anemia of chronic disease
C) Beta-thalassemia trait
D) Sideroblastic anemia
E) Vitamin B12 deficiency
Correct Answer: B
,Rationale: Anemia of chronic disease (ACD) is common in CKD, diabetes, and hypertension.
Ferritin is normal/elevated, TIBC low/normal, and MCV normocytic or mildly microcytic. Iron
deficiency would show low ferritin and high TIBC. B12 deficiency causes macrocytic anemia.
Sideroblastic anemia typically shows high iron and ferritin with ringed sideroblasts on bone
marrow.
Question 2
A 55-year-old female presents with acute-onset severe chest pain that is sharp, pleuritic, and
relieved by leaning forward. BP 140/85, HR 102. Faint pericardial friction rub heard. ECG shows
diffuse ST elevations and PR depression. Troponin I 0.08 ng/mL (normal <0.04). Which
medication is contraindicated?
A) Ibuprofen
B) Colchicine
C) Aspirin
D) Prednisone
, E) Acetaminophen
Correct Answer: D
Rationale: Acute pericarditis is treated with NSAIDs (ibuprofen, aspirin) or colchicine.
Corticosteroids (prednisone) are avoided unless refractory or specific indications (e.g.,
autoimmune, uremic) because they may increase recurrence risk. Acetaminophen is safe for pain.
Diffuse ST elevations with PR depression are classic for pericarditis.
Question 3
A 72-year-old male with history of heart failure with reduced ejection fraction (HFrEF) presents
with increasing leg edema and dyspnea. Medications: lisinopril, carvedilol, furosemide. BP 95/60,
HR 55, potassium 5.5 mEq/L. What is the most appropriate next step?
A) Increase furosemide
Exam: Questions with Answers and
Rationales
,SECTION 1: INTERNAL MEDICINE (Questions 1-30)
Question 1
A 62-year-old male with type 2 diabetes, hypertension, and CKD stage 3 presents with
progressive fatigue and dyspnea on exertion. Hb 8.9 g/dL, MCV 78 fL, ferritin 450 ng/mL, TIBC
210 μg/dL, serum iron 85 μg/dL. What is the most likely diagnosis?
A) Iron deficiency anemia
B) Anemia of chronic disease
C) Beta-thalassemia trait
D) Sideroblastic anemia
E) Vitamin B12 deficiency
Correct Answer: B
,Rationale: Anemia of chronic disease (ACD) is common in CKD, diabetes, and hypertension.
Ferritin is normal/elevated, TIBC low/normal, and MCV normocytic or mildly microcytic. Iron
deficiency would show low ferritin and high TIBC. B12 deficiency causes macrocytic anemia.
Sideroblastic anemia typically shows high iron and ferritin with ringed sideroblasts on bone
marrow.
Question 2
A 55-year-old female presents with acute-onset severe chest pain that is sharp, pleuritic, and
relieved by leaning forward. BP 140/85, HR 102. Faint pericardial friction rub heard. ECG shows
diffuse ST elevations and PR depression. Troponin I 0.08 ng/mL (normal <0.04). Which
medication is contraindicated?
A) Ibuprofen
B) Colchicine
C) Aspirin
D) Prednisone
, E) Acetaminophen
Correct Answer: D
Rationale: Acute pericarditis is treated with NSAIDs (ibuprofen, aspirin) or colchicine.
Corticosteroids (prednisone) are avoided unless refractory or specific indications (e.g.,
autoimmune, uremic) because they may increase recurrence risk. Acetaminophen is safe for pain.
Diffuse ST elevations with PR depression are classic for pericarditis.
Question 3
A 72-year-old male with history of heart failure with reduced ejection fraction (HFrEF) presents
with increasing leg edema and dyspnea. Medications: lisinopril, carvedilol, furosemide. BP 95/60,
HR 55, potassium 5.5 mEq/L. What is the most appropriate next step?
A) Increase furosemide
