2026 UPDATED QUESTIONS DOWNLOAD
All Ultimate COMSAE Phase 1 (Form 114) Practice Set - 150
High-Yield Questions & Rationales 2026
This comprehensive study resource is specifically designed for osteopathic medical
students preparing for the COMSAE Phase 1 (Form 114) and the COMLEX-USA Level
1. It contains meticulously crafted multiple-choice questions (MCQs) that mirror the
style, difficulty, and content distribution of the actual NBOME assessment.
What’s Included?
• Practice Questions: Covering all major systems (Cardiovascular, GI, Renal,
Respiratory, Reproductive, etc.).
• Heavy OMM Focus: Detailed questions on Cranial strains, Sacral
torsions, Chapman points, Viscerosomatic reflexes, and Fryette’s Laws.
• Bolded Answers: For quick-review and self-testing.
• In-Depth Rationales: Every answer includes an italicized rationale explaining
the underlying physiology, pathology, or osteopathic principle to ensure deep
conceptual understanding.
• High-Yield Topics: Focused on the most "testable" concepts for Form 114,
including Microbiology (gram stains/spores), Pharmacology (MOAs/Antidotes),
and Biochemistry (rate-limiting enzymes).
1. A 30-year-old female presents with a "crunching" sound in her jaw and ear
pain. Physical exam reveals a tender point located on the lateral aspect of the
ascending ramus of the mandible. Which of the following is the correct treatment
position for this counterstrain point?
A) Mandible deviated toward the side of the tender point
B) Mandible deviated away from the side of the tender point
C) Jaw held in extreme flexion
D) Jaw held in extreme extension
E) Protrusion of the mandible
Answer: B
Rationale: This is the Masseter tender point. The treatment involves gently opening the
,2026 UPDATED QUESTIONS DOWNLOAD
jaw and deviating the mandible away from the side of the tender point to shorten the
muscle.
2. A 68-year-old male with a history of chronic atrial fibrillation presents with
sudden onset, severe abdominal pain that is "out of proportion to the physical
exam." What is the most likely diagnosis?
A) Acute cholecystitis
B) Acute pancreatitis
C) Acute mesenteric ischemia
D) Small bowel obstruction
E) Diverticulitis
Answer: C
Rationale: Sudden, severe pain "out of proportion to exam" in a patient with a history of
A-fib (embolic source) is a classic presentation for acute mesenteric ischemia.
3. During a routine physical, a patient is found to have T6 rotated right and
sidebent right. The dysfunction worsens when the patient is asked to slump
forward. Which of the following is the correct diagnosis?
A) T6 Neutral Sidebent Left Rotated Right
B) T6 Flexed Sidebent Right Rotated Right
C) T6 Extended Sidebent Right Rotated Right
D) T6 Neutral Sidebent Right Rotated Right
E) T6 Extended Sidebent Left Rotated Left
Answer: C
Rationale: The segment worsens in flexion, meaning it "prefers" extension (E). Since
rotation and sidebending are to the same side (Right), it follows Type II mechanics
(ESRR).
4. A 24-year-old male presents with a painless, firm lump on his right testicle. He
notes that it does not transilluminate. Which of the following tumor markers
would most likely be elevated if this were a Yolk Sac tumor?
A) Beta-hCG
B) Alpha-fetoprotein (AFP)
C) Alkaline phosphatase
D) LDH
E) CA-125
Answer: B
Rationale: Yolk sac tumors (endodermal sinus tumors) are associated with elevated
AFP and Schiller-Duval bodies on histology.
,2026 UPDATED QUESTIONS DOWNLOAD
5. A patient has a "Positive Standing Flexion Test" on the left and a "Positive
Seated Flexion Test" on the left. The left PSIS is superior and the left ASIS is
superior. What is the diagnosis?
A) Left Anterior Innominate
B) Left Posterior Innominate
C) Left Superior Innominate Shear
D) Left Inferior Innominate Shear
E) Left Outflare
Answer: C
Rationale: A "Superior Shear" (Upslip) results in all landmarks (ASIS and PSIS) on the
affected side moving superiorly.
6. Which of the following medications is a "Direct Factor Xa Inhibitor" used for
stroke prevention in non-valvular atrial fibrillation?
A) Warfarin
B) Rivaroxaban
C) Dabigatran
D) Heparin
E) Clopidogrel
Answer: B
Rationale: Drugs ending in "-xaban" (Rivaroxaban, Apixaban) are direct Factor Xa
inhibitors.
7. A 3-year-old child presents with a "strawberry tongue," high fever for 6 days,
and swelling of the hands and feet. What is the most feared complication of this
condition?
A) Glomerulonephritis
B) Rheumatic Fever
C) Coronary Artery Aneurysm
D) Splenic Rupture
E) Encephalitis
Answer: C
Rationale: Kawasaki Disease presents with the "CRASH and Burn" symptoms. The
major risk is the development of coronary artery aneurysms.
8. During a cranial exam, the physician finds that the sphenoid base has moved
superiorly relative to the occiput. This is described as a:
A) Superior Vertical Strain
B) Inferior Vertical Strain
, 2026 UPDATED QUESTIONS DOWNLOAD
C) Torsion
D) Sidebending-Rotation
E) Compression
Answer: A
Rationale: Vertical strains are named for the direction of the sphenoid base. If the base
moves superiorly, it is a Superior Vertical Strain.
9. A 45-year-old male presents with severe pain in his right great toe. Joint
aspiration reveals needle-shaped crystals with negative birefringence. What is the
mechanism of the first-line chronic medication used to prevent future attacks?
A) Inhibits Cyclooxygenase
B) Inhibits Xanthine Oxidase
C) Inhibits Microtubule polymerization
D) Enhances Uric Acid excretion
E) Inhibits TNF-alpha
Answer: B
Rationale: The diagnosis is Gout. Allopurinol is the chronic treatment, which works by
inhibiting xanthine oxidase.
10. A patient has a "Positive Thomas Test" on the right. Which Chapman point
would you most likely find to be tender?
A) 1 inch superior and 1 inch lateral to the umbilicus
B) 2 inches superior and 1 inch lateral to the umbilicus
C) Lateral aspect of the middle humerus
D) 5th intercostal space on the right
E) Tip of the 12th rib on the right
Answer: A
Rationale: A positive Thomas test indicates iliopsoas tightness. The anterior Chapman
point for the iliopsoas/adrenal region is 1 inch superior and 1 inch lateral to the
umbilicus.
11. Which of the following is the most common cause of "Croup"
(Laryngotracheobronchitis) in children?
A) RSV
B) Adenovirus
C) Parainfluenza virus
D) Haemophilus influenzae
E) Rhinovirus
Answer: C
All Ultimate COMSAE Phase 1 (Form 114) Practice Set - 150
High-Yield Questions & Rationales 2026
This comprehensive study resource is specifically designed for osteopathic medical
students preparing for the COMSAE Phase 1 (Form 114) and the COMLEX-USA Level
1. It contains meticulously crafted multiple-choice questions (MCQs) that mirror the
style, difficulty, and content distribution of the actual NBOME assessment.
What’s Included?
• Practice Questions: Covering all major systems (Cardiovascular, GI, Renal,
Respiratory, Reproductive, etc.).
• Heavy OMM Focus: Detailed questions on Cranial strains, Sacral
torsions, Chapman points, Viscerosomatic reflexes, and Fryette’s Laws.
• Bolded Answers: For quick-review and self-testing.
• In-Depth Rationales: Every answer includes an italicized rationale explaining
the underlying physiology, pathology, or osteopathic principle to ensure deep
conceptual understanding.
• High-Yield Topics: Focused on the most "testable" concepts for Form 114,
including Microbiology (gram stains/spores), Pharmacology (MOAs/Antidotes),
and Biochemistry (rate-limiting enzymes).
1. A 30-year-old female presents with a "crunching" sound in her jaw and ear
pain. Physical exam reveals a tender point located on the lateral aspect of the
ascending ramus of the mandible. Which of the following is the correct treatment
position for this counterstrain point?
A) Mandible deviated toward the side of the tender point
B) Mandible deviated away from the side of the tender point
C) Jaw held in extreme flexion
D) Jaw held in extreme extension
E) Protrusion of the mandible
Answer: B
Rationale: This is the Masseter tender point. The treatment involves gently opening the
,2026 UPDATED QUESTIONS DOWNLOAD
jaw and deviating the mandible away from the side of the tender point to shorten the
muscle.
2. A 68-year-old male with a history of chronic atrial fibrillation presents with
sudden onset, severe abdominal pain that is "out of proportion to the physical
exam." What is the most likely diagnosis?
A) Acute cholecystitis
B) Acute pancreatitis
C) Acute mesenteric ischemia
D) Small bowel obstruction
E) Diverticulitis
Answer: C
Rationale: Sudden, severe pain "out of proportion to exam" in a patient with a history of
A-fib (embolic source) is a classic presentation for acute mesenteric ischemia.
3. During a routine physical, a patient is found to have T6 rotated right and
sidebent right. The dysfunction worsens when the patient is asked to slump
forward. Which of the following is the correct diagnosis?
A) T6 Neutral Sidebent Left Rotated Right
B) T6 Flexed Sidebent Right Rotated Right
C) T6 Extended Sidebent Right Rotated Right
D) T6 Neutral Sidebent Right Rotated Right
E) T6 Extended Sidebent Left Rotated Left
Answer: C
Rationale: The segment worsens in flexion, meaning it "prefers" extension (E). Since
rotation and sidebending are to the same side (Right), it follows Type II mechanics
(ESRR).
4. A 24-year-old male presents with a painless, firm lump on his right testicle. He
notes that it does not transilluminate. Which of the following tumor markers
would most likely be elevated if this were a Yolk Sac tumor?
A) Beta-hCG
B) Alpha-fetoprotein (AFP)
C) Alkaline phosphatase
D) LDH
E) CA-125
Answer: B
Rationale: Yolk sac tumors (endodermal sinus tumors) are associated with elevated
AFP and Schiller-Duval bodies on histology.
,2026 UPDATED QUESTIONS DOWNLOAD
5. A patient has a "Positive Standing Flexion Test" on the left and a "Positive
Seated Flexion Test" on the left. The left PSIS is superior and the left ASIS is
superior. What is the diagnosis?
A) Left Anterior Innominate
B) Left Posterior Innominate
C) Left Superior Innominate Shear
D) Left Inferior Innominate Shear
E) Left Outflare
Answer: C
Rationale: A "Superior Shear" (Upslip) results in all landmarks (ASIS and PSIS) on the
affected side moving superiorly.
6. Which of the following medications is a "Direct Factor Xa Inhibitor" used for
stroke prevention in non-valvular atrial fibrillation?
A) Warfarin
B) Rivaroxaban
C) Dabigatran
D) Heparin
E) Clopidogrel
Answer: B
Rationale: Drugs ending in "-xaban" (Rivaroxaban, Apixaban) are direct Factor Xa
inhibitors.
7. A 3-year-old child presents with a "strawberry tongue," high fever for 6 days,
and swelling of the hands and feet. What is the most feared complication of this
condition?
A) Glomerulonephritis
B) Rheumatic Fever
C) Coronary Artery Aneurysm
D) Splenic Rupture
E) Encephalitis
Answer: C
Rationale: Kawasaki Disease presents with the "CRASH and Burn" symptoms. The
major risk is the development of coronary artery aneurysms.
8. During a cranial exam, the physician finds that the sphenoid base has moved
superiorly relative to the occiput. This is described as a:
A) Superior Vertical Strain
B) Inferior Vertical Strain
, 2026 UPDATED QUESTIONS DOWNLOAD
C) Torsion
D) Sidebending-Rotation
E) Compression
Answer: A
Rationale: Vertical strains are named for the direction of the sphenoid base. If the base
moves superiorly, it is a Superior Vertical Strain.
9. A 45-year-old male presents with severe pain in his right great toe. Joint
aspiration reveals needle-shaped crystals with negative birefringence. What is the
mechanism of the first-line chronic medication used to prevent future attacks?
A) Inhibits Cyclooxygenase
B) Inhibits Xanthine Oxidase
C) Inhibits Microtubule polymerization
D) Enhances Uric Acid excretion
E) Inhibits TNF-alpha
Answer: B
Rationale: The diagnosis is Gout. Allopurinol is the chronic treatment, which works by
inhibiting xanthine oxidase.
10. A patient has a "Positive Thomas Test" on the right. Which Chapman point
would you most likely find to be tender?
A) 1 inch superior and 1 inch lateral to the umbilicus
B) 2 inches superior and 1 inch lateral to the umbilicus
C) Lateral aspect of the middle humerus
D) 5th intercostal space on the right
E) Tip of the 12th rib on the right
Answer: A
Rationale: A positive Thomas test indicates iliopsoas tightness. The anterior Chapman
point for the iliopsoas/adrenal region is 1 inch superior and 1 inch lateral to the
umbilicus.
11. Which of the following is the most common cause of "Croup"
(Laryngotracheobronchitis) in children?
A) RSV
B) Adenovirus
C) Parainfluenza virus
D) Haemophilus influenzae
E) Rhinovirus
Answer: C
