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COMSAE PHASE 3 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 68-year-old man with a history of hypertension and
hyperlipidemia presents with sudden onset of left-sided
weakness and slurred speech. Symptoms began 90 minutes
ago. CT head shows no hemorrhage. Which of the following is
the most appropriate next step?
A. Administer aspirin and clopidogrel
B. Administer IV tissue plasminogen activator (tPA) if no
contraindications
C. Begin heparin infusion
D. Observe for 24 hours
E. Perform immediate carotid endarterectomy
Answer: B
Rationale: The patient is within the 4.5-hour window for
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thrombolysis in acute ischemic stroke. IV tPA is indicated if no
contraindications. Aspirin is started later (24 hours after tPA).
Heparin is not indicated for acute ischemic stroke.
Question 2
A 32-year-old woman presents with a 3-day history of fever,
dysuria, and suprapubic pain. Urinalysis shows leukocyte
esterase positive, nitrites positive. She is not pregnant. What is
the most appropriate first-line antibiotic?
A. Nitrofurantoin or trimethoprim-sulfamethoxazole
B. Levofloxacin
C. Ceftriaxone
D. Azithromycin
E. Metronidazole
Answer: A
Rationale: Nitrofurantoin and TMP-SMX are first-line for
uncomplicated cystitis. Fluoroquinolones are reserved for
complicated infections or resistance.
Question 3
A 58-year-old woman with type 2 diabetes and hypertension
presents with a 2-day history of fever, flank pain, and nausea.
She has costovertebral angle tenderness. What is the most
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appropriate initial management?
A. Oral antibiotics and outpatient follow-up
B. IV antibiotics and fluid resuscitation
C. NSAIDs only
D. Observation
E. Nitrofurantoin oral
Answer: B
Rationale: Fever, flank pain, and CVA tenderness indicate acute
pyelonephritis with systemic signs; IV antibiotics and fluids are
needed, especially in a diabetic patient.
Question 4
A 45-year-old man presents with acute onset of severe
headache, photophobia, and neck stiffness. CT head is normal,
but lumbar puncture shows cloudy CSF with 1,200 WBC/µL
(90% neutrophils), glucose 30 mg/dL, protein 120 mg/dL. What
is the most likely organism?
A. Streptococcus pneumoniae
B. Neisseria meningitidis
C. Haemophilus influenzae
D. Listeria monocytogenes
E. Escherichia coli
Answer: A
Rationale: Classic bacterial meningitis with neutrophilic
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pleocytosis, low glucose, high protein. In adults, S. pneumoniae
is the most common cause. N. meningitidis is more common in
young adults/college settings.
Question 5
A 62-year-old man with a 50-pack-year smoking history
presents with progressive dyspnea and a nonproductive cough.
Chest X-ray shows interstitial markings. PFTs: FEV1/FVC 0.85,
FVC 60% predicted, DLCO 45% predicted. What is the most
likely diagnosis?
A. Chronic obstructive pulmonary disease
B. Idiopathic pulmonary fibrosis
C. Asthma
D. Sarcoidosis
E. Hypersensitivity pneumonitis
Answer: B
Rationale: Restrictive pattern (normal FEV1/FVC, low FVC) with
decreased DLCO suggests interstitial lung disease, most
commonly IPF in older smokers. COPD would show obstructive
pattern.
Question 6
COMSAE PHASE 3 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 68-year-old man with a history of hypertension and
hyperlipidemia presents with sudden onset of left-sided
weakness and slurred speech. Symptoms began 90 minutes
ago. CT head shows no hemorrhage. Which of the following is
the most appropriate next step?
A. Administer aspirin and clopidogrel
B. Administer IV tissue plasminogen activator (tPA) if no
contraindications
C. Begin heparin infusion
D. Observe for 24 hours
E. Perform immediate carotid endarterectomy
Answer: B
Rationale: The patient is within the 4.5-hour window for
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thrombolysis in acute ischemic stroke. IV tPA is indicated if no
contraindications. Aspirin is started later (24 hours after tPA).
Heparin is not indicated for acute ischemic stroke.
Question 2
A 32-year-old woman presents with a 3-day history of fever,
dysuria, and suprapubic pain. Urinalysis shows leukocyte
esterase positive, nitrites positive. She is not pregnant. What is
the most appropriate first-line antibiotic?
A. Nitrofurantoin or trimethoprim-sulfamethoxazole
B. Levofloxacin
C. Ceftriaxone
D. Azithromycin
E. Metronidazole
Answer: A
Rationale: Nitrofurantoin and TMP-SMX are first-line for
uncomplicated cystitis. Fluoroquinolones are reserved for
complicated infections or resistance.
Question 3
A 58-year-old woman with type 2 diabetes and hypertension
presents with a 2-day history of fever, flank pain, and nausea.
She has costovertebral angle tenderness. What is the most
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appropriate initial management?
A. Oral antibiotics and outpatient follow-up
B. IV antibiotics and fluid resuscitation
C. NSAIDs only
D. Observation
E. Nitrofurantoin oral
Answer: B
Rationale: Fever, flank pain, and CVA tenderness indicate acute
pyelonephritis with systemic signs; IV antibiotics and fluids are
needed, especially in a diabetic patient.
Question 4
A 45-year-old man presents with acute onset of severe
headache, photophobia, and neck stiffness. CT head is normal,
but lumbar puncture shows cloudy CSF with 1,200 WBC/µL
(90% neutrophils), glucose 30 mg/dL, protein 120 mg/dL. What
is the most likely organism?
A. Streptococcus pneumoniae
B. Neisseria meningitidis
C. Haemophilus influenzae
D. Listeria monocytogenes
E. Escherichia coli
Answer: A
Rationale: Classic bacterial meningitis with neutrophilic
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pleocytosis, low glucose, high protein. In adults, S. pneumoniae
is the most common cause. N. meningitidis is more common in
young adults/college settings.
Question 5
A 62-year-old man with a 50-pack-year smoking history
presents with progressive dyspnea and a nonproductive cough.
Chest X-ray shows interstitial markings. PFTs: FEV1/FVC 0.85,
FVC 60% predicted, DLCO 45% predicted. What is the most
likely diagnosis?
A. Chronic obstructive pulmonary disease
B. Idiopathic pulmonary fibrosis
C. Asthma
D. Sarcoidosis
E. Hypersensitivity pneumonitis
Answer: B
Rationale: Restrictive pattern (normal FEV1/FVC, low FVC) with
decreased DLCO suggests interstitial lung disease, most
commonly IPF in older smokers. COPD would show obstructive
pattern.
Question 6
