1|Page
COMSAE Phase 2 – BSA 111 Practice Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+ Brand New Version!!
1. A 72-year-old male with a history of hypertension and type 2
diabetes mellitus presents with a three-day history of progressive,
painless vision loss in his right eye. He denies any trauma or flashes of
light. Fundoscopic examination reveals a cherry-red spot at the fovea
with a pale, ischemic retina. What is the most likely diagnosis?
A. Central retinal vein occlusion
B. Branch retinal artery occlusion
C. Central retinal artery occlusion
D. Vitreous hemorrhage
Answer: C. Central retinal artery occlusion
The acute, painless, profound vision loss with a cherry-red spot (which is
the fovea appearing red against the pale, ischemic retina) is classic for a
central retinal artery occlusion (CRAO). The pale retina is due to inner
retinal infarction. A central retinal vein occlusion typically presents with
a "blood and thunder" appearance and is often painful. A branch retinal
artery occlusion would affect a sector of the visual field, not the entire
,2|Page
eye. Vitreous hemorrhage would obscure the funduscopic view and is
not associated with a cherry-red spot.
2. A 45-year-old female with a history of systemic lupus erythematosus
presents with acute-onset shortness of breath and pleuritic chest pain.
She is tachypneic and hypoxic. Her D-dimer is elevated, and a CT
pulmonary angiogram reveals a filling defect in a segmental artery of
the left lower lobe. In the context of her autoimmune disease, which of
the following is the most significant predisposing factor for her
condition?
A. Antiphospholipid antibody syndrome
B. Rheumatoid factor positivity
C. Anti-Sm antibody
D. Elevated anti-dsDNA antibodies
Answer: A. Antiphospholipid antibody syndrome
Patients with SLE are at increased risk for thromboembolic events,
particularly if they have antiphospholipid antibodies (lupus
anticoagulant, anticardiolipin, or anti-beta2-glycoprotein I).
Antiphospholipid antibody syndrome (APS) is a hypercoagulable state
that predisposes to both arterial and venous thrombosis, including
pulmonary embolism. The other antibodies are specific to SLE but are
not directly associated with the hypercoagulable state that leads to the
thrombosis seen in this patient.
,3|Page
3. A 6-year-old boy is brought to the emergency department with a
fever of 104°F, a harsh, barking cough, and inspiratory stridor that is
worse at night. He is sitting upright with his chin thrust forward and is
drooling. What is the most appropriate next step in management?
A. Immediate intubation
B. Lateral neck radiograph
C. Nebulized racemic epinephrine and dexamethasone
D. Obtain a blood culture and administer broad-spectrum antibiotics
Answer: B. Lateral neck radiograph
The presentation of fever, stridor, drooling, and the tripod position is
classic for acute epiglottitis, which is a medical emergency. The most
important next step is to secure the airway, but before attempting any
invasive procedure that could precipitate complete airway obstruction
(like intubation) or leaving the patient alone for imaging, the diagnosis
must be confirmed. A lateral neck x-ray showing the "thumbprint sign"
(swollen epiglottis) is the standard, safe way to confirm the diagnosis
without agitating the child. Nebulized racemic epinephrine and steroids
are the treatment for croup (laryngotracheobronchitis), not epiglottitis.
4. A 55-year-old male with a 30-pack-year smoking history presents
with hemoptysis and weight loss. A chest x-ray reveals a large hilar
mass. A bronchoscopy with biopsy is performed, and the pathology
report describes small, oval cells with scant cytoplasm, nuclear molding,
and prominent mitotic figures. Which of the following paraneoplastic
syndromes is most characteristically associated with this type of lung
cancer?
, 4|Page
A. Hyponatremia
B. Hypercalcemia
C. Digital clubbing and hypertrophic pulmonary osteoarthropathy
D. Gynecomastia
Answer: A. Hyponatremia
The description of small, oval cells with nuclear molding is classic for
small cell lung cancer (SCLC). SCLC is highly associated with
paraneoplastic syndromes, most notably the syndrome of inappropriate
antidiuretic hormone (SIADH) secretion, leading to hyponatremia.
Hypercalcemia is more commonly associated with squamous cell
carcinoma. Digital clubbing and hypertrophic pulmonary
osteoarthropathy are often seen with non-small cell lung cancer,
particularly adenocarcinoma. Gynecomastia is associated with ectopic
hCG production, which is rare but can be seen in some lung cancers.
5. A 28-year-old G1P0 woman at 39 weeks gestation presents to the
labor and delivery unit with regular, painful contractions occurring
every 3-4 minutes. Her cervix is 5 cm dilated and 90% effaced. The fetal
heart rate tracing shows a baseline of 140 bpm with moderate
variability and no decelerations. An intrauterine pressure catheter
shows a contraction pattern with a resting tone of 25 mmHg. What is
the most appropriate next step?
A. Administer terbutaline
B. Perform an amniotomy
C. Administer oxytocin
COMSAE Phase 2 – BSA 111 Practice Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+ Brand New Version!!
1. A 72-year-old male with a history of hypertension and type 2
diabetes mellitus presents with a three-day history of progressive,
painless vision loss in his right eye. He denies any trauma or flashes of
light. Fundoscopic examination reveals a cherry-red spot at the fovea
with a pale, ischemic retina. What is the most likely diagnosis?
A. Central retinal vein occlusion
B. Branch retinal artery occlusion
C. Central retinal artery occlusion
D. Vitreous hemorrhage
Answer: C. Central retinal artery occlusion
The acute, painless, profound vision loss with a cherry-red spot (which is
the fovea appearing red against the pale, ischemic retina) is classic for a
central retinal artery occlusion (CRAO). The pale retina is due to inner
retinal infarction. A central retinal vein occlusion typically presents with
a "blood and thunder" appearance and is often painful. A branch retinal
artery occlusion would affect a sector of the visual field, not the entire
,2|Page
eye. Vitreous hemorrhage would obscure the funduscopic view and is
not associated with a cherry-red spot.
2. A 45-year-old female with a history of systemic lupus erythematosus
presents with acute-onset shortness of breath and pleuritic chest pain.
She is tachypneic and hypoxic. Her D-dimer is elevated, and a CT
pulmonary angiogram reveals a filling defect in a segmental artery of
the left lower lobe. In the context of her autoimmune disease, which of
the following is the most significant predisposing factor for her
condition?
A. Antiphospholipid antibody syndrome
B. Rheumatoid factor positivity
C. Anti-Sm antibody
D. Elevated anti-dsDNA antibodies
Answer: A. Antiphospholipid antibody syndrome
Patients with SLE are at increased risk for thromboembolic events,
particularly if they have antiphospholipid antibodies (lupus
anticoagulant, anticardiolipin, or anti-beta2-glycoprotein I).
Antiphospholipid antibody syndrome (APS) is a hypercoagulable state
that predisposes to both arterial and venous thrombosis, including
pulmonary embolism. The other antibodies are specific to SLE but are
not directly associated with the hypercoagulable state that leads to the
thrombosis seen in this patient.
,3|Page
3. A 6-year-old boy is brought to the emergency department with a
fever of 104°F, a harsh, barking cough, and inspiratory stridor that is
worse at night. He is sitting upright with his chin thrust forward and is
drooling. What is the most appropriate next step in management?
A. Immediate intubation
B. Lateral neck radiograph
C. Nebulized racemic epinephrine and dexamethasone
D. Obtain a blood culture and administer broad-spectrum antibiotics
Answer: B. Lateral neck radiograph
The presentation of fever, stridor, drooling, and the tripod position is
classic for acute epiglottitis, which is a medical emergency. The most
important next step is to secure the airway, but before attempting any
invasive procedure that could precipitate complete airway obstruction
(like intubation) or leaving the patient alone for imaging, the diagnosis
must be confirmed. A lateral neck x-ray showing the "thumbprint sign"
(swollen epiglottis) is the standard, safe way to confirm the diagnosis
without agitating the child. Nebulized racemic epinephrine and steroids
are the treatment for croup (laryngotracheobronchitis), not epiglottitis.
4. A 55-year-old male with a 30-pack-year smoking history presents
with hemoptysis and weight loss. A chest x-ray reveals a large hilar
mass. A bronchoscopy with biopsy is performed, and the pathology
report describes small, oval cells with scant cytoplasm, nuclear molding,
and prominent mitotic figures. Which of the following paraneoplastic
syndromes is most characteristically associated with this type of lung
cancer?
, 4|Page
A. Hyponatremia
B. Hypercalcemia
C. Digital clubbing and hypertrophic pulmonary osteoarthropathy
D. Gynecomastia
Answer: A. Hyponatremia
The description of small, oval cells with nuclear molding is classic for
small cell lung cancer (SCLC). SCLC is highly associated with
paraneoplastic syndromes, most notably the syndrome of inappropriate
antidiuretic hormone (SIADH) secretion, leading to hyponatremia.
Hypercalcemia is more commonly associated with squamous cell
carcinoma. Digital clubbing and hypertrophic pulmonary
osteoarthropathy are often seen with non-small cell lung cancer,
particularly adenocarcinoma. Gynecomastia is associated with ectopic
hCG production, which is rare but can be seen in some lung cancers.
5. A 28-year-old G1P0 woman at 39 weeks gestation presents to the
labor and delivery unit with regular, painful contractions occurring
every 3-4 minutes. Her cervix is 5 cm dilated and 90% effaced. The fetal
heart rate tracing shows a baseline of 140 bpm with moderate
variability and no decelerations. An intrauterine pressure catheter
shows a contraction pattern with a resting tone of 25 mmHg. What is
the most appropriate next step?
A. Administer terbutaline
B. Perform an amniotomy
C. Administer oxytocin
