COMSAE Level 2 – Form 111 | 100 Verified Questions &
Correct Answers | Latest Version 2026 | Guaranteed Pass
1. A 45-year-old man with a history of type 2 diabetes and hypertension presents with acute
abdominal pain. He is hemodynamically stable. An abdominal CT with IV contrast is obtained
and reveals mesenteric ischemia. Which of the following is the most appropriate next step in
management?
A. Start systemic anticoagulation with intravenous heparin and admit to the ICU for monitoring
B. Immediate surgical consultation for possible revascularization or bowel resection
C. Initiate bowel rest, IV fluids, and broad-spectrum antibiotics
D. Obtain a plain abdominal radiograph to assess for pneumoperitoneum
Answer: B. Immediate surgical consultation for possible revascularization or bowel resection
2. A 62-year-old man is brought to the emergency department after a high-speed motor vehicle
collision. He is intubated and has a blood pressure of 80/50 mm Hg. A focused assessment with
sonography in trauma (FAST) exam is positive for fluid in the splenorenal recess. Which of the
following is the best initial management?
A. Immediate laparotomy
B. CT scan of the abdomen with IV contrast
C. Angiographic embolization of the spleen
D. Nonoperative management with serial hemoglobin checks
Answer: A. Immediate laparotomy
3. A 3-year-old girl is brought to the clinic by her mother who is concerned about the child's
speech development. The child was born at 38 weeks and has no significant medical history.
She uses single words and can follow simple commands but does not combine two words.
Which of the following is the most likely diagnosis?
A. Expressive language disorder
B. Intellectual disability
C. Normal speech development
D. Autism spectrum disorder
Answer: C. Normal speech development
4. A 56-year-old man with a history of cirrhosis and ascites presents with fever and abdominal
pain. Paracentesis shows a polymorphonuclear (PMN) cell count of 300/mm³. Which of the
following is the most appropriate next step in management?
A. Start ceftriaxone 1 g IV daily
B. Start cefotaxime 2 g IV every 8 hours
C. Observe and repeat paracentesis in 48 hours
D. Start oral fluoroquinolone prophylaxis
Answer: B. Start cefotaxime 2 g IV every 8 hours
5. A 24-year-old woman develops a urinary tract infection during pregnancy at 28 weeks
gestation. Which of the following antibiotics is contraindicated in this patient?
A. Nitrofurantoin
B. Cephalexin
, C. Amoxicillin
D. Ciprofloxacin
Answer: D. Ciprofloxacin
6. A 60-year-old man with a history of chronic atrial fibrillation presents with sudden onset of
left-sided weakness and dysarthria. He last took his warfarin 3 days ago due to a dental
procedure. Which of the following is the most appropriate management?
A. Administer intravenous tissue plasminogen activator (tPA)
B. Administer vitamin K and fresh frozen plasma
C. Obtain a CT angiogram of the head and neck
D. Check a serum glucose level and start antiplatelet therapy
Answer: C. Obtain a CT angiogram of the head and neck
7. A 23-year-old woman presents with acute pelvic pain and a positive pregnancy test.
Transvaginal ultrasound shows no intrauterine pregnancy, and her ²-hCG is 2,500 mIU/mL.
Which of the following is the most appropriate next step?
A. Administer methotrexate intramuscularly
B. Repeat ²-hCG in 48 hours
C. Perform laparoscopic salpingectomy
D. Obtain a dilation and curettage
Answer: B. Repeat ²-hCG in 48 hours
8. A 12-year-old boy is brought to the emergency department with severe testicular pain and
nausea. On physical examination, the right testicle is enlarged and tender, and the cremasteric
reflex is absent. Which of the following is the most likely diagnosis?
A. Epididymitis
B. Testicular torsion
C. Torsion of the appendix testis
D. Inguinal hernia
Answer: B. Testicular torsion
9. A 45-year-old woman, a known hypertensive, is on an ACE inhibitor. She now presents with a
dry cough. Which of the following is the most appropriate change to her medication?
A. Add a beta-blocker
B. Switch to an angiotensin II receptor blocker (ARB)
C. Switch to a calcium channel blocker
D. Continue the ACE inhibitor and prescribe dextromethorphan
Answer: C. Switch to a calcium channel blocker
10. A 30-year-old man with a history of sickle cell disease presents with acute chest syndrome.
He is not in respiratory distress but has oxygen saturation of 92% on room air. Which of the
following is the most appropriate initial treatment?
A. Supplemental oxygen and incentive spirometry
B. Immediate exchange transfusion
C. Pain management with NSAIDs
D. IV fluids and prophylactic antibiotics
Answer: A. Supplemental oxygen and incentive spirometry
, 11. A 70-year-old woman with osteoporosis is started on alendronate. Which of the following
instructions should be given to the patient?
A. Take the medication with a full glass of water and remain upright for 30 minutes
B. Take the medication with a calcium supplement to enhance absorption
C. Take the medication at night to avoid stomach irritation
D. Take the medication with orange juice for better absorption
Answer: A. Take the medication with a full glass of water and remain upright for 30 minutes
12. A 25-year-old male athlete has a blood pressure of 145/90 mm Hg on three separate
occasions. He has no other medical problems. Which of the following is the most appropriate
initial management?
A. Start a thiazide diuretic
B. Start an ACE inhibitor
C. Lifestyle modifications, including diet and exercise
D. Start a calcium channel blocker
Answer: C. Lifestyle modifications, including diet and exercise
13. A 55-year-old man with a history of heart failure with reduced ejection fraction (EF 25%)
presents with worsening dyspnea and orthopnea. He is on lisinopril, carvedilol, and
furosemide. Which of the following medication changes is most appropriate?
A. Discontinue carvedilol and start a beta-agonist
B. Increase the furosemide dose and add spironolactone
C. Add digoxin to his regimen
D. Switch lisinopril to an ARB
Answer: B. Increase the furosemide dose and add spironolactone
14. A 65-year-old man with a 30-pack-year smoking history and a chronic cough presents with a
lung nodule seen on a routine chest X-ray. His life expectancy is estimated to be 10 years.
Which of the following is the most appropriate next step?
A. Immediate PET-CT scan
B. Follow-up CT in 3 months
C. Percutaneous needle biopsy
D. Video-assisted thoracoscopic surgery (VATS)
Answer: B. Follow-up CT in 3 months
15. A 28-year-old woman in her second trimester of pregnancy has a random blood glucose
level of 200 mg/dL. She has a family history of type 2 diabetes. Which of the following is the
most appropriate next step?
A. Initiate insulin therapy
B. Obtain a 75-g oral glucose tolerance test (OGTT)
C. Start metformin
D. Repeat random blood glucose in 2 weeks
Answer: B. Obtain a 75-g oral glucose tolerance test (OGTT)
16. A 3-year-old child is brought to the clinic with a 3-day history of low-grade fever and a
vesicular rash. The mother reports the lesions appeared in crops and are on the trunk and
scalp. Which of the following is the most likely diagnosis?
Correct Answers | Latest Version 2026 | Guaranteed Pass
1. A 45-year-old man with a history of type 2 diabetes and hypertension presents with acute
abdominal pain. He is hemodynamically stable. An abdominal CT with IV contrast is obtained
and reveals mesenteric ischemia. Which of the following is the most appropriate next step in
management?
A. Start systemic anticoagulation with intravenous heparin and admit to the ICU for monitoring
B. Immediate surgical consultation for possible revascularization or bowel resection
C. Initiate bowel rest, IV fluids, and broad-spectrum antibiotics
D. Obtain a plain abdominal radiograph to assess for pneumoperitoneum
Answer: B. Immediate surgical consultation for possible revascularization or bowel resection
2. A 62-year-old man is brought to the emergency department after a high-speed motor vehicle
collision. He is intubated and has a blood pressure of 80/50 mm Hg. A focused assessment with
sonography in trauma (FAST) exam is positive for fluid in the splenorenal recess. Which of the
following is the best initial management?
A. Immediate laparotomy
B. CT scan of the abdomen with IV contrast
C. Angiographic embolization of the spleen
D. Nonoperative management with serial hemoglobin checks
Answer: A. Immediate laparotomy
3. A 3-year-old girl is brought to the clinic by her mother who is concerned about the child's
speech development. The child was born at 38 weeks and has no significant medical history.
She uses single words and can follow simple commands but does not combine two words.
Which of the following is the most likely diagnosis?
A. Expressive language disorder
B. Intellectual disability
C. Normal speech development
D. Autism spectrum disorder
Answer: C. Normal speech development
4. A 56-year-old man with a history of cirrhosis and ascites presents with fever and abdominal
pain. Paracentesis shows a polymorphonuclear (PMN) cell count of 300/mm³. Which of the
following is the most appropriate next step in management?
A. Start ceftriaxone 1 g IV daily
B. Start cefotaxime 2 g IV every 8 hours
C. Observe and repeat paracentesis in 48 hours
D. Start oral fluoroquinolone prophylaxis
Answer: B. Start cefotaxime 2 g IV every 8 hours
5. A 24-year-old woman develops a urinary tract infection during pregnancy at 28 weeks
gestation. Which of the following antibiotics is contraindicated in this patient?
A. Nitrofurantoin
B. Cephalexin
, C. Amoxicillin
D. Ciprofloxacin
Answer: D. Ciprofloxacin
6. A 60-year-old man with a history of chronic atrial fibrillation presents with sudden onset of
left-sided weakness and dysarthria. He last took his warfarin 3 days ago due to a dental
procedure. Which of the following is the most appropriate management?
A. Administer intravenous tissue plasminogen activator (tPA)
B. Administer vitamin K and fresh frozen plasma
C. Obtain a CT angiogram of the head and neck
D. Check a serum glucose level and start antiplatelet therapy
Answer: C. Obtain a CT angiogram of the head and neck
7. A 23-year-old woman presents with acute pelvic pain and a positive pregnancy test.
Transvaginal ultrasound shows no intrauterine pregnancy, and her ²-hCG is 2,500 mIU/mL.
Which of the following is the most appropriate next step?
A. Administer methotrexate intramuscularly
B. Repeat ²-hCG in 48 hours
C. Perform laparoscopic salpingectomy
D. Obtain a dilation and curettage
Answer: B. Repeat ²-hCG in 48 hours
8. A 12-year-old boy is brought to the emergency department with severe testicular pain and
nausea. On physical examination, the right testicle is enlarged and tender, and the cremasteric
reflex is absent. Which of the following is the most likely diagnosis?
A. Epididymitis
B. Testicular torsion
C. Torsion of the appendix testis
D. Inguinal hernia
Answer: B. Testicular torsion
9. A 45-year-old woman, a known hypertensive, is on an ACE inhibitor. She now presents with a
dry cough. Which of the following is the most appropriate change to her medication?
A. Add a beta-blocker
B. Switch to an angiotensin II receptor blocker (ARB)
C. Switch to a calcium channel blocker
D. Continue the ACE inhibitor and prescribe dextromethorphan
Answer: C. Switch to a calcium channel blocker
10. A 30-year-old man with a history of sickle cell disease presents with acute chest syndrome.
He is not in respiratory distress but has oxygen saturation of 92% on room air. Which of the
following is the most appropriate initial treatment?
A. Supplemental oxygen and incentive spirometry
B. Immediate exchange transfusion
C. Pain management with NSAIDs
D. IV fluids and prophylactic antibiotics
Answer: A. Supplemental oxygen and incentive spirometry
, 11. A 70-year-old woman with osteoporosis is started on alendronate. Which of the following
instructions should be given to the patient?
A. Take the medication with a full glass of water and remain upright for 30 minutes
B. Take the medication with a calcium supplement to enhance absorption
C. Take the medication at night to avoid stomach irritation
D. Take the medication with orange juice for better absorption
Answer: A. Take the medication with a full glass of water and remain upright for 30 minutes
12. A 25-year-old male athlete has a blood pressure of 145/90 mm Hg on three separate
occasions. He has no other medical problems. Which of the following is the most appropriate
initial management?
A. Start a thiazide diuretic
B. Start an ACE inhibitor
C. Lifestyle modifications, including diet and exercise
D. Start a calcium channel blocker
Answer: C. Lifestyle modifications, including diet and exercise
13. A 55-year-old man with a history of heart failure with reduced ejection fraction (EF 25%)
presents with worsening dyspnea and orthopnea. He is on lisinopril, carvedilol, and
furosemide. Which of the following medication changes is most appropriate?
A. Discontinue carvedilol and start a beta-agonist
B. Increase the furosemide dose and add spironolactone
C. Add digoxin to his regimen
D. Switch lisinopril to an ARB
Answer: B. Increase the furosemide dose and add spironolactone
14. A 65-year-old man with a 30-pack-year smoking history and a chronic cough presents with a
lung nodule seen on a routine chest X-ray. His life expectancy is estimated to be 10 years.
Which of the following is the most appropriate next step?
A. Immediate PET-CT scan
B. Follow-up CT in 3 months
C. Percutaneous needle biopsy
D. Video-assisted thoracoscopic surgery (VATS)
Answer: B. Follow-up CT in 3 months
15. A 28-year-old woman in her second trimester of pregnancy has a random blood glucose
level of 200 mg/dL. She has a family history of type 2 diabetes. Which of the following is the
most appropriate next step?
A. Initiate insulin therapy
B. Obtain a 75-g oral glucose tolerance test (OGTT)
C. Start metformin
D. Repeat random blood glucose in 2 weeks
Answer: B. Obtain a 75-g oral glucose tolerance test (OGTT)
16. A 3-year-old child is brought to the clinic with a 3-day history of low-grade fever and a
vesicular rash. The mother reports the lesions appeared in crops and are on the trunk and
scalp. Which of the following is the most likely diagnosis?
