COMSAE 115 ACTUAL TEST PAPER WITH
VERIFIED ANSWERS
●● High-dose prednisone commonly causes steroid-induced psychosis
or cognitive changes (impaired attention, concentration, memory, mood
changes), and albuterol can cause a fine tremor .
Answer: Alcohol withdrawal usually occurs 6-48 hours after stopping
alcohol and presents with autonomic hyperactivity (tachycardia,
hypertension, sweating), anxiety, agitation, and possibly seizures or
delirium tremens
●● Multiple sharply circumscribed, firm, gray-white uterine nodules are
classic benign smooth-muscle fibroids, which commonly cause heavy or
irregular uterine bleeding.
Answer: Endometrial polyps arise from the endometrial lining and are
usually soft, localized projections rather than multiple firm myometrial
nodules.
●● Using a topical α- agonist decongestant such as phenylephrine for
more than about 3-5 days can cause rhinitis medicamentosa , where
congestion worsens as the drug wears off.
Answer: Nasal polyps are associated more with chronic inflammation,
asthma, or aspirin sensitivity—not short-term decongestant use.
,●● Lactulose is an osmotic laxative fermented by colonic bacteria,
producing gas, bloating, abdominal distention, and potentially profuse
diarrhea.
Answer: Docusate is a stool softener and is much less likely to cause
marked flatulence and diarrhea.
●● The clue is that 45 people developed symptoms shortly after moving
into a newly built office , with normal labs, ABG, and pulmonary
function tests .
Answer: This is classic building-related illness ("sick building
syndrome") , caused by poor ventilation or indoor irritants (volatile
organic compounds, mold, low humidity), leading to headaches, eye
irritation, dry mucous membranes, fatigue, and sometimes epistaxis .
●● A tracheostomy is typically performed between the 2nd and 4th
tracheal rings , where the thyroid isthmus lies directly in front of the
trachea.
Answer: During the procedure, the thyroid isthmus is retracted (or
sometimes divided) to expose the trachea. The parathyroid glands are
located on the posterior surface of the thyroid gland , well away from the
anterior surgical field of a tracheostomy, so they are not retracted during
the procedure.
●● The dog with hair loss , hyphae on skin scraping , and growth on
Sabouraud agar point to tinea (dermatophyte infection) , commonly
transmitted from animals.
,Answer: The usual topical treatment is an azole (e.g., clotrimazole),
which works by inhibiting ergosterol synthesis , disrupting the fungal
cell membrane. 70s= macrolides
●● A patient with hypertension and diabetes who develops pure sensory
loss (numbness of the face and extremities on one side) has a classic
lacunar infarct of the ventral posterolateral (VPL) and/or ventral
posteromedial (VPM) thalamus .
Answer: The VPL carries sensation from the body , and the VPM carries
sensation from the face . The posterior limb of the internal capsule is the
classic location for a pure motor lacunar stroke , causing contralateral
weakness without sensory loss .
●● She likely has functional hypothalamic amenorrhea from low energy
availability/excess exercise , so treatment is nutritional rehabilitation and
weight gain .
Answer: When feeding resumes, insulin drives phosphate into cells ,
causing an initial drop in serum phosphate—this is the key electrolyte
change in refeeding syndrome .
●● Perianal fistulas, fissures, and sinus tracts are classic for Crohn
disease because its inflammation is transmural .
Answer: Condylomata acuminata causes HPV-related genital warts , not
diarrhea or fistulas.
, ●● Flank/right abdominal pain radiating to the groin with oliguria is
classic for an obstructing kidney stone .
Answer: Renal artery stenosis causes chronic hypertension and renal
hypoperfusion, not acute colicky pain.
●● This patient has Alzheimer disease , which is treated
symptomatically with an acetylcholinesterase inhibitor to increase brain
acetylcholine.
Answer: GABA agonists (benzodiazepines) can actually worsen
confusion and memory in older adults.
●● This patient is having a panic attack (normal ECG/troponins with
sudden chest pain, dyspnea, anxiety, impending doom), which is rapidly
relieved by a benzodiazepine like diazepam.
Answer: Buspirone is for chronic generalized anxiety and takes weeks to
work.
●● The triad of confusion, ophthalmoplegia, and ataxia in a chronic
alcoholic is Wernicke encephalopathy due to thiamine deficiency, which
classically involves the mammillary bodies .
Answer: Caudate atrophy is seen in Huntington disease .
●● Erythromycin inhibits CYP3A4 , increasing simvastatin levels and
causing statin-induced myopathy .
VERIFIED ANSWERS
●● High-dose prednisone commonly causes steroid-induced psychosis
or cognitive changes (impaired attention, concentration, memory, mood
changes), and albuterol can cause a fine tremor .
Answer: Alcohol withdrawal usually occurs 6-48 hours after stopping
alcohol and presents with autonomic hyperactivity (tachycardia,
hypertension, sweating), anxiety, agitation, and possibly seizures or
delirium tremens
●● Multiple sharply circumscribed, firm, gray-white uterine nodules are
classic benign smooth-muscle fibroids, which commonly cause heavy or
irregular uterine bleeding.
Answer: Endometrial polyps arise from the endometrial lining and are
usually soft, localized projections rather than multiple firm myometrial
nodules.
●● Using a topical α- agonist decongestant such as phenylephrine for
more than about 3-5 days can cause rhinitis medicamentosa , where
congestion worsens as the drug wears off.
Answer: Nasal polyps are associated more with chronic inflammation,
asthma, or aspirin sensitivity—not short-term decongestant use.
,●● Lactulose is an osmotic laxative fermented by colonic bacteria,
producing gas, bloating, abdominal distention, and potentially profuse
diarrhea.
Answer: Docusate is a stool softener and is much less likely to cause
marked flatulence and diarrhea.
●● The clue is that 45 people developed symptoms shortly after moving
into a newly built office , with normal labs, ABG, and pulmonary
function tests .
Answer: This is classic building-related illness ("sick building
syndrome") , caused by poor ventilation or indoor irritants (volatile
organic compounds, mold, low humidity), leading to headaches, eye
irritation, dry mucous membranes, fatigue, and sometimes epistaxis .
●● A tracheostomy is typically performed between the 2nd and 4th
tracheal rings , where the thyroid isthmus lies directly in front of the
trachea.
Answer: During the procedure, the thyroid isthmus is retracted (or
sometimes divided) to expose the trachea. The parathyroid glands are
located on the posterior surface of the thyroid gland , well away from the
anterior surgical field of a tracheostomy, so they are not retracted during
the procedure.
●● The dog with hair loss , hyphae on skin scraping , and growth on
Sabouraud agar point to tinea (dermatophyte infection) , commonly
transmitted from animals.
,Answer: The usual topical treatment is an azole (e.g., clotrimazole),
which works by inhibiting ergosterol synthesis , disrupting the fungal
cell membrane. 70s= macrolides
●● A patient with hypertension and diabetes who develops pure sensory
loss (numbness of the face and extremities on one side) has a classic
lacunar infarct of the ventral posterolateral (VPL) and/or ventral
posteromedial (VPM) thalamus .
Answer: The VPL carries sensation from the body , and the VPM carries
sensation from the face . The posterior limb of the internal capsule is the
classic location for a pure motor lacunar stroke , causing contralateral
weakness without sensory loss .
●● She likely has functional hypothalamic amenorrhea from low energy
availability/excess exercise , so treatment is nutritional rehabilitation and
weight gain .
Answer: When feeding resumes, insulin drives phosphate into cells ,
causing an initial drop in serum phosphate—this is the key electrolyte
change in refeeding syndrome .
●● Perianal fistulas, fissures, and sinus tracts are classic for Crohn
disease because its inflammation is transmural .
Answer: Condylomata acuminata causes HPV-related genital warts , not
diarrhea or fistulas.
, ●● Flank/right abdominal pain radiating to the groin with oliguria is
classic for an obstructing kidney stone .
Answer: Renal artery stenosis causes chronic hypertension and renal
hypoperfusion, not acute colicky pain.
●● This patient has Alzheimer disease , which is treated
symptomatically with an acetylcholinesterase inhibitor to increase brain
acetylcholine.
Answer: GABA agonists (benzodiazepines) can actually worsen
confusion and memory in older adults.
●● This patient is having a panic attack (normal ECG/troponins with
sudden chest pain, dyspnea, anxiety, impending doom), which is rapidly
relieved by a benzodiazepine like diazepam.
Answer: Buspirone is for chronic generalized anxiety and takes weeks to
work.
●● The triad of confusion, ophthalmoplegia, and ataxia in a chronic
alcoholic is Wernicke encephalopathy due to thiamine deficiency, which
classically involves the mammillary bodies .
Answer: Caudate atrophy is seen in Huntington disease .
●● Erythromycin inhibits CYP3A4 , increasing simvastatin levels and
causing statin-induced myopathy .
