COMSAE Phase 2 Form 117: High-Yield Board
Questions with Answers & Rationales
SECTION 1: CARDIOLOGY & PULMONOLOGY
,Question 1
A 62-year-old man with a 40-pack-year smoking history presents with worsening dyspnea and
chronic cough. Spirometry shows FEV1/FVC of 0.55 and FEV1 45% of predicted. Which
medication has been shown to reduce mortality when hypoxemia is present?
A) Inhaled corticosteroid
B) Long-acting beta agonist
C) Long-term oxygen therapy
D) Tiotropium
Answer: C) Long-term oxygen therapy
Rationale: Long-term oxygen therapy reduces mortality in COPD patients with resting PaO₂ ≤55
mmHg or evidence of cor pulmonale. The MRC and NOTT trials demonstrated survival benefit
with continuous oxygen use in hypoxemic COPD patients. Inhaled corticosteroids, LABAs, and
tiotropium improve symptoms and reduce exacerbations but have not been shown to reduce
mortality .
,Question 2
A 68-year-old man develops crushing substernal chest pain for 2 hours. ECG shows ST elevation
in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Circumflex artery
C) Right coronary artery
D) Diagonal artery
Answer: C) Right coronary artery
Rationale: Inferior wall myocardial infarctions typically involve the right coronary artery, producing
ST elevations in leads II, III, and aVF. The LAD supplies the anterior wall (V1-V4), and the
circumflex supplies the lateral wall (I, aVL, V5-V6). Recognition of infarct location guides emergent
reperfusion therapy .
, Question 3
A 58-year-old man with hypertension and type 2 diabetes presents with acute substernal chest
pain radiating to the left arm. ECG shows ST elevations in leads II, III, and aVF. Which is the most
appropriate next step?
A) Aspirin and immediate PCI
B) Aspirin and IV tPA
C) Aspirin and clopidogrel with medical management
D) Aspirin and urgent CABG
Answer: A) Aspirin and immediate percutaneous coronary intervention (PCI)
Rationale: Inferior STEMI with acute presentation requires immediate reperfusion therapy; PCI is
the preferred definitive treatment when available promptly. Time to reperfusion is the major
Questions with Answers & Rationales
SECTION 1: CARDIOLOGY & PULMONOLOGY
,Question 1
A 62-year-old man with a 40-pack-year smoking history presents with worsening dyspnea and
chronic cough. Spirometry shows FEV1/FVC of 0.55 and FEV1 45% of predicted. Which
medication has been shown to reduce mortality when hypoxemia is present?
A) Inhaled corticosteroid
B) Long-acting beta agonist
C) Long-term oxygen therapy
D) Tiotropium
Answer: C) Long-term oxygen therapy
Rationale: Long-term oxygen therapy reduces mortality in COPD patients with resting PaO₂ ≤55
mmHg or evidence of cor pulmonale. The MRC and NOTT trials demonstrated survival benefit
with continuous oxygen use in hypoxemic COPD patients. Inhaled corticosteroids, LABAs, and
tiotropium improve symptoms and reduce exacerbations but have not been shown to reduce
mortality .
,Question 2
A 68-year-old man develops crushing substernal chest pain for 2 hours. ECG shows ST elevation
in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Circumflex artery
C) Right coronary artery
D) Diagonal artery
Answer: C) Right coronary artery
Rationale: Inferior wall myocardial infarctions typically involve the right coronary artery, producing
ST elevations in leads II, III, and aVF. The LAD supplies the anterior wall (V1-V4), and the
circumflex supplies the lateral wall (I, aVL, V5-V6). Recognition of infarct location guides emergent
reperfusion therapy .
, Question 3
A 58-year-old man with hypertension and type 2 diabetes presents with acute substernal chest
pain radiating to the left arm. ECG shows ST elevations in leads II, III, and aVF. Which is the most
appropriate next step?
A) Aspirin and immediate PCI
B) Aspirin and IV tPA
C) Aspirin and clopidogrel with medical management
D) Aspirin and urgent CABG
Answer: A) Aspirin and immediate percutaneous coronary intervention (PCI)
Rationale: Inferior STEMI with acute presentation requires immediate reperfusion therapy; PCI is
the preferred definitive treatment when available promptly. Time to reperfusion is the major
