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COMSAE PHASE 2 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 62-year-old woman with type 2 diabetes, hypertension, and
chronic kidney disease presents with fatigue and dyspnea on
exertion. Labs: hemoglobin 9.2 g/dL, MCV 80 fL, serum ferritin
180 ng/mL, transferrin saturation 18%. What is the most likely
cause of her 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 is normocytic or mildly
microcytic with normal/high ferritin and low transferrin
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saturation; common in CKD, diabetes, and chronic
inflammation.
Question 2
A 34-year-old man presents with acute right lower quadrant
pain, fever, and nausea. Physical exam shows rebound
tenderness at McBurney's point. WBC 14,000. 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 imaging to
confirm appendicitis in an adult before proceeding to surgery.
Question 3
A 70-year-old man with atrial fibrillation and a CHA₂DS₂-VASc
score of 4 is started on rivaroxaban. Which lab test should be
monitored?
A. INR
B. aPTT
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C. Anti-factor Xa (if concern for bleeding or renal impairment)
D. Platelet count
E. Fibrinogen
Answer: C
Rationale: DOACs generally do not require routine monitoring,
but anti-factor Xa can be measured in special situations (e.g.,
renal impairment, bleeding).
Question 4
A 55-year-old woman presents with sudden severe headache,
nausea, and neck stiffness. CT head shows no hemorrhage.
Lumbar puncture reveals xanthochromia. What is the most
likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Meningitis
D. Cluster headache
E. Tension headache
Answer: B
Rationale: Xanthochromia in CSF after negative CT indicates
subarachnoid hemorrhage.
Question 5
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A 28-year-old G1P0 at 36 weeks gestation presents with
headache, visual changes, and blood pressure 165/100 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 only
Answer: A
Rationale: Severe preeclampsia requires magnesium sulfate for
seizure prophylaxis and antihypertensive therapy; delivery may
be indicated depending on status.
Question 6
A 45-year-old man presents with right upper quadrant pain
after fatty meals, fever, and a positive Murphy's sign. WBC
13,000. What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Hepatitis
E. Appendicitis
COMSAE PHASE 2 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 62-year-old woman with type 2 diabetes, hypertension, and
chronic kidney disease presents with fatigue and dyspnea on
exertion. Labs: hemoglobin 9.2 g/dL, MCV 80 fL, serum ferritin
180 ng/mL, transferrin saturation 18%. What is the most likely
cause of her 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 is normocytic or mildly
microcytic with normal/high ferritin and low transferrin
, Page |2
saturation; common in CKD, diabetes, and chronic
inflammation.
Question 2
A 34-year-old man presents with acute right lower quadrant
pain, fever, and nausea. Physical exam shows rebound
tenderness at McBurney's point. WBC 14,000. 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 imaging to
confirm appendicitis in an adult before proceeding to surgery.
Question 3
A 70-year-old man with atrial fibrillation and a CHA₂DS₂-VASc
score of 4 is started on rivaroxaban. Which lab test should be
monitored?
A. INR
B. aPTT
, Page |3
C. Anti-factor Xa (if concern for bleeding or renal impairment)
D. Platelet count
E. Fibrinogen
Answer: C
Rationale: DOACs generally do not require routine monitoring,
but anti-factor Xa can be measured in special situations (e.g.,
renal impairment, bleeding).
Question 4
A 55-year-old woman presents with sudden severe headache,
nausea, and neck stiffness. CT head shows no hemorrhage.
Lumbar puncture reveals xanthochromia. What is the most
likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Meningitis
D. Cluster headache
E. Tension headache
Answer: B
Rationale: Xanthochromia in CSF after negative CT indicates
subarachnoid hemorrhage.
Question 5
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A 28-year-old G1P0 at 36 weeks gestation presents with
headache, visual changes, and blood pressure 165/100 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 only
Answer: A
Rationale: Severe preeclampsia requires magnesium sulfate for
seizure prophylaxis and antihypertensive therapy; delivery may
be indicated depending on status.
Question 6
A 45-year-old man presents with right upper quadrant pain
after fatty meals, fever, and a positive Murphy's sign. WBC
13,000. What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Hepatitis
E. Appendicitis
