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COMSAE COMBINED PHASES FORM 116 – Questions with Detailed
Rationales UPDATED.
Total Exam: 704 Questions | This Part: Questions 1–44
SECTION 1 (Questions 1–44)
Question 1
A 62-year-old man with a 40-pack-year smoking history
presents with a painless, pearly papule with telangiectasias on
his cheek. What is the most likely diagnosis?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Actinic keratosis
E. Seborrheic keratosis
Answer: B
Rationale: Basal cell carcinoma typically presents as a pearly
papule with telangiectasias on sun-exposed skin. Squamous cell
carcinoma is often a scaly, erythematous plaque; melanoma is
pigmented and asymmetric; actinic keratosis is a rough, scaly
patch.
Question 2
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Which of the following is the rate-limiting enzyme of glycolysis?
A. Hexokinase
B. Phosphofructokinase-1
C. Pyruvate kinase
D. Aldolase
E. Glyceraldehyde-3-phosphate dehydrogenase
Answer: B
Rationale: Phosphofructokinase-1 (PFK-1) is the committed,
rate-limiting step of glycolysis and is allosterically regulated by
ATP, AMP, and citrate.
Question 3
A 58-year-old woman with type 2 diabetes and hypertension
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 is normocytic or mildly
microcytic with normal/high ferritin and low transferrin
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saturation. It is common in CKD, diabetes, and chronic
inflammation.
Question 4
A 70-year-old woman presents with sudden onset of 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
Answer: B
Rationale: Xanthochromia (bilirubin from RBC breakdown) in
CSF after a negative CT indicates subarachnoid hemorrhage. CT
can miss small SAH; LP is essential if suspicion remains.
Question 5
Which of the following is the primary inhibitory
neurotransmitter in the brain?
A. Glutamate
B. GABA
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C. Glycine
D. Dopamine
E. Acetylcholine
Answer: B
Rationale: GABA is the major inhibitory neurotransmitter in the
central nervous system. Glycine is predominant in the spinal
cord and brainstem.
Question 6
A 45-year-old woman presents with right upper quadrant pain
after fatty meals, fever, and a positive Murphy's sign. WBC
13,000/µL. What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Hepatitis
E. Appendicitis
Answer: A
Rationale: RUQ pain after fatty meals, fever, and positive
Murphy's sign (pain on inspiration during RUQ palpation) are
classic for acute cholecystitis. Ultrasound is initial imaging.
Question 7
COMSAE COMBINED PHASES FORM 116 – Questions with Detailed
Rationales UPDATED.
Total Exam: 704 Questions | This Part: Questions 1–44
SECTION 1 (Questions 1–44)
Question 1
A 62-year-old man with a 40-pack-year smoking history
presents with a painless, pearly papule with telangiectasias on
his cheek. What is the most likely diagnosis?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Actinic keratosis
E. Seborrheic keratosis
Answer: B
Rationale: Basal cell carcinoma typically presents as a pearly
papule with telangiectasias on sun-exposed skin. Squamous cell
carcinoma is often a scaly, erythematous plaque; melanoma is
pigmented and asymmetric; actinic keratosis is a rough, scaly
patch.
Question 2
, Page |2
Which of the following is the rate-limiting enzyme of glycolysis?
A. Hexokinase
B. Phosphofructokinase-1
C. Pyruvate kinase
D. Aldolase
E. Glyceraldehyde-3-phosphate dehydrogenase
Answer: B
Rationale: Phosphofructokinase-1 (PFK-1) is the committed,
rate-limiting step of glycolysis and is allosterically regulated by
ATP, AMP, and citrate.
Question 3
A 58-year-old woman with type 2 diabetes and hypertension
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 is normocytic or mildly
microcytic with normal/high ferritin and low transferrin
, Page |3
saturation. It is common in CKD, diabetes, and chronic
inflammation.
Question 4
A 70-year-old woman presents with sudden onset of 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
Answer: B
Rationale: Xanthochromia (bilirubin from RBC breakdown) in
CSF after a negative CT indicates subarachnoid hemorrhage. CT
can miss small SAH; LP is essential if suspicion remains.
Question 5
Which of the following is the primary inhibitory
neurotransmitter in the brain?
A. Glutamate
B. GABA
, Page |4
C. Glycine
D. Dopamine
E. Acetylcholine
Answer: B
Rationale: GABA is the major inhibitory neurotransmitter in the
central nervous system. Glycine is predominant in the spinal
cord and brainstem.
Question 6
A 45-year-old woman presents with right upper quadrant pain
after fatty meals, fever, and a positive Murphy's sign. WBC
13,000/µL. What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Hepatitis
E. Appendicitis
Answer: A
Rationale: RUQ pain after fatty meals, fever, and positive
Murphy's sign (pain on inspiration during RUQ palpation) are
classic for acute cholecystitis. Ultrasound is initial imaging.
Question 7
