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COMSAE PHASE 2 PROFESSIONAL EXAM – FORM 114 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 man with a history of hypertension and
hyperlipidemia presents to the emergency department with
sudden onset of substernal chest pressure radiating to the left
arm, diaphoresis, and nausea. ECG shows ST-segment elevation
in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main
E. Posterior descending artery
Answer: C
Rationale: ST elevation in inferior leads (II, III, aVF) indicates an
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inferior wall myocardial infarction, which is most commonly
caused by occlusion of the right coronary artery (RCA). The RCA
supplies the inferior wall and often the AV node in right-
dominant circulation.
Question 2
A 35-year-old woman presents with a 3-day history of dysuria,
urinary frequency, and suprapubic pain. She is afebrile and has
no flank pain. Urinalysis shows leukocyte esterase positive,
nitrites positive, and 20–30 WBC/hpf. What is the most
appropriate initial antibiotic?
A. Nitrofurantoin
B. Levofloxacin
C. Ceftriaxone
D. Azithromycin
E. Metronidazole
Answer: A
Rationale: Uncomplicated cystitis in a nonpregnant woman is
treated with nitrofurantoin, TMP-SMX (if local resistance <20%),
or fosfomycin. Nitrofurantoin is effective and has minimal
systemic absorption, reducing resistance concerns.
Fluoroquinolones are reserved for complicated infections.
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Question 3
A 58-year-old man with type 2 diabetes and chronic kidney
disease (eGFR 35 mL/min/1.73m²) presents with fatigue and
dyspnea on exertion. Labs: hemoglobin 9.1 g/dL, MCV 85 fL,
ferritin 200 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
(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 4
A 70-year-old woman presents with acute onset of severe
headache, nausea, and neck stiffness. CT head is negative.
Lumbar puncture reveals xanthochromia. What is the most
likely diagnosis?
A. Migraine
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B. Subarachnoid hemorrhage
C. Bacterial meningitis
D. Cluster headache
E. Tension headache
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.
COMSAE PHASE 2 PROFESSIONAL EXAM – FORM 114 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 man with a history of hypertension and
hyperlipidemia presents to the emergency department with
sudden onset of substernal chest pressure radiating to the left
arm, diaphoresis, and nausea. ECG shows ST-segment elevation
in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main
E. Posterior descending artery
Answer: C
Rationale: ST elevation in inferior leads (II, III, aVF) indicates an
, Page |2
inferior wall myocardial infarction, which is most commonly
caused by occlusion of the right coronary artery (RCA). The RCA
supplies the inferior wall and often the AV node in right-
dominant circulation.
Question 2
A 35-year-old woman presents with a 3-day history of dysuria,
urinary frequency, and suprapubic pain. She is afebrile and has
no flank pain. Urinalysis shows leukocyte esterase positive,
nitrites positive, and 20–30 WBC/hpf. What is the most
appropriate initial antibiotic?
A. Nitrofurantoin
B. Levofloxacin
C. Ceftriaxone
D. Azithromycin
E. Metronidazole
Answer: A
Rationale: Uncomplicated cystitis in a nonpregnant woman is
treated with nitrofurantoin, TMP-SMX (if local resistance <20%),
or fosfomycin. Nitrofurantoin is effective and has minimal
systemic absorption, reducing resistance concerns.
Fluoroquinolones are reserved for complicated infections.
, Page |3
Question 3
A 58-year-old man with type 2 diabetes and chronic kidney
disease (eGFR 35 mL/min/1.73m²) presents with fatigue and
dyspnea on exertion. Labs: hemoglobin 9.1 g/dL, MCV 85 fL,
ferritin 200 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
(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 4
A 70-year-old woman presents with acute onset of severe
headache, nausea, and neck stiffness. CT head is negative.
Lumbar puncture reveals xanthochromia. What is the most
likely diagnosis?
A. Migraine
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B. Subarachnoid hemorrhage
C. Bacterial meningitis
D. Cluster headache
E. Tension headache
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.
