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COMSAE PHASE 3 PROFESSIONAL PRACTICE EXAM Questions
with Detailed Rationales UPDATED
Updated 2026/2027 Edition
Total Questions: 176
Sections: 4 × 44 Questions
Time Allowed: 4 hours
SECTION 1 (Questions 1–44)
Question 1
A 65-year-old man with type 2 diabetes, hypertension, and
chronic kidney disease (eGFR 35) presents with fatigue and
dyspnea on exertion. Labs: hemoglobin 9.0 g/dL, MCV 82 fL,
ferritin 220 ng/mL, transferrin saturation 15%. What is the most
likely cause of anemia?
A. Iron deficiency anemia
B. Anemia of chronic disease
C. Vitamin B12 deficiency
D. Hemolytic anemia
E. Aplastic anemia
Answer: B
Rationale: Anemia of chronic disease (ACD) is common in CKD,
diabetes, and chronic inflammation. It is typically normocytic
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(MCV 80–100) or mildly microcytic, with normal or elevated
ferritin and low transferrin saturation (<20%). Iron deficiency
would show low ferritin. B12 deficiency would be macrocytic.
Question 2
A 34-year-old woman presents with acute right lower quadrant
abdominal pain, anorexia, and nausea. On exam she has
rebound tenderness at McBurney's point. WBC 14,500/µL.
What is the most appropriate next step?
A. CT abdomen/pelvis
B. Immediate appendectomy without imaging
C. Barium enema
D. Upper endoscopy
E. Outpatient observation
Answer: A
Rationale: CT abdomen/pelvis is the preferred initial imaging
for suspected appendicitis in nonpregnant adults to confirm
diagnosis and identify complications. Immediate surgery
without imaging is not standard unless perforation or
hemodynamic instability. In children, ultrasound may be used
first.
Question 3
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A 70-year-old man with nonvalvular atrial fibrillation and a
CHA₂DS₂-VASc score of 5 is started on apixaban. Which lab test
should be monitored routinely?
A. INR
B. aPTT
C. Anti-factor Xa
D. Platelet count
E. No routine monitoring
Answer: E
Rationale: Direct oral anticoagulants (DOACs) like apixaban do
not require routine coagulation monitoring. INR is for warfarin;
anti-factor Xa may be used in special situations (e.g., bleeding,
renal impairment) but not routinely.
Question 4
A 55-year-old woman presents with sudden severe headache,
nausea, and neck stiffness. CT head is negative. Lumbar
puncture shows xanthochromia. What is the most likely
diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Bacterial meningitis
D. Cluster headache
E. Tension headache
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Answer: B
Rationale: Xanthochromia (yellowish CSF supernatant from
bilirubin) after a negative CT indicates subarachnoid
hemorrhage. CT can miss small SAH, so LP is necessary if
suspicion remains.
Question 5
A 28-year-old G1P0 at 36 weeks gestation presents with
headache, visual changes, and BP 165/105 mmHg. Urine
protein 2+. What is the most appropriate initial treatment?
A. Magnesium sulfate and antihypertensive therapy
B. Immediate cesarean delivery
C. Bed rest only
D. Oral labetalol alone
E. Induction of labor without magnesium
Answer: A
Rationale: Severe preeclampsia requires magnesium sulfate for
seizure prophylaxis and antihypertensive therapy to prevent
stroke. Delivery is indicated but timing depends on maternal-
fetal status; immediate cesarean not always necessary if stable.
Question 6
COMSAE PHASE 3 PROFESSIONAL PRACTICE EXAM Questions
with Detailed Rationales UPDATED
Updated 2026/2027 Edition
Total Questions: 176
Sections: 4 × 44 Questions
Time Allowed: 4 hours
SECTION 1 (Questions 1–44)
Question 1
A 65-year-old man with type 2 diabetes, hypertension, and
chronic kidney disease (eGFR 35) presents with fatigue and
dyspnea on exertion. Labs: hemoglobin 9.0 g/dL, MCV 82 fL,
ferritin 220 ng/mL, transferrin saturation 15%. What is the most
likely cause of anemia?
A. Iron deficiency anemia
B. Anemia of chronic disease
C. Vitamin B12 deficiency
D. Hemolytic anemia
E. Aplastic anemia
Answer: B
Rationale: Anemia of chronic disease (ACD) is common in CKD,
diabetes, and chronic inflammation. It is typically normocytic
, Page |2
(MCV 80–100) or mildly microcytic, with normal or elevated
ferritin and low transferrin saturation (<20%). Iron deficiency
would show low ferritin. B12 deficiency would be macrocytic.
Question 2
A 34-year-old woman presents with acute right lower quadrant
abdominal pain, anorexia, and nausea. On exam she has
rebound tenderness at McBurney's point. WBC 14,500/µL.
What is the most appropriate next step?
A. CT abdomen/pelvis
B. Immediate appendectomy without imaging
C. Barium enema
D. Upper endoscopy
E. Outpatient observation
Answer: A
Rationale: CT abdomen/pelvis is the preferred initial imaging
for suspected appendicitis in nonpregnant adults to confirm
diagnosis and identify complications. Immediate surgery
without imaging is not standard unless perforation or
hemodynamic instability. In children, ultrasound may be used
first.
Question 3
, Page |3
A 70-year-old man with nonvalvular atrial fibrillation and a
CHA₂DS₂-VASc score of 5 is started on apixaban. Which lab test
should be monitored routinely?
A. INR
B. aPTT
C. Anti-factor Xa
D. Platelet count
E. No routine monitoring
Answer: E
Rationale: Direct oral anticoagulants (DOACs) like apixaban do
not require routine coagulation monitoring. INR is for warfarin;
anti-factor Xa may be used in special situations (e.g., bleeding,
renal impairment) but not routinely.
Question 4
A 55-year-old woman presents with sudden severe headache,
nausea, and neck stiffness. CT head is negative. Lumbar
puncture shows xanthochromia. What is the most likely
diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Bacterial meningitis
D. Cluster headache
E. Tension headache
, Page |4
Answer: B
Rationale: Xanthochromia (yellowish CSF supernatant from
bilirubin) after a negative CT indicates subarachnoid
hemorrhage. CT can miss small SAH, so LP is necessary if
suspicion remains.
Question 5
A 28-year-old G1P0 at 36 weeks gestation presents with
headache, visual changes, and BP 165/105 mmHg. Urine
protein 2+. What is the most appropriate initial treatment?
A. Magnesium sulfate and antihypertensive therapy
B. Immediate cesarean delivery
C. Bed rest only
D. Oral labetalol alone
E. Induction of labor without magnesium
Answer: A
Rationale: Severe preeclampsia requires magnesium sulfate for
seizure prophylaxis and antihypertensive therapy to prevent
stroke. Delivery is indicated but timing depends on maternal-
fetal status; immediate cesarean not always necessary if stable.
Question 6
