2026 UPDATED QUESTIONS DOWNLOAD
Ultimate COMSAE Phase 1 (Form 114) Practice Set - 150
High-Yield Questions & Rationales.
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 65-year-old male with a history of hypertension and smoking presents with
sudden onset "tearing" chest pain radiating to his back. His blood pressure is
180/100 mmHg in the right arm and 140/90 mmHg in the left arm. What is the most
likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
/C) Aortic dissection
D) Tension pneumothorax
E) Pericarditis
Answer: C
,2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Aortic dissection typically presents with sudden, tearing chest pain radiating
to the back and a blood pressure discrepancy between the arms.
2. A 24-year-old female presents with a "velvety" patch of darkened skin on the
back of her neck. She has a BMI of 34. This skin finding is most commonly
associated with which of the following?
A) Vitamin B12 deficiency
B) Hypothyroidism
C) Insulin resistance
D) Excess sun exposure
E) Iron deficiency anemia
Answer: C
Rationale: Acanthosis nigricans is a clinical sign of insulin resistance, often seen in
Type 2 Diabetes or PCOS.
3. During a structural exam, a patient's T4 vertebrae is found to be rotated right
and sidebent right. The dysfunction improves in extension and worsens in
flexion. What is the diagnosis?
A) T4 Neutral Sidebent Left Rotated Right
B) T4 Flexed Sidebent Right Rotated Right
C) T4 Extended Sidebent Right Rotated Right
D) T4 Neutral Sidebent Right Rotated Right
E) T4 Extended Sidebent Left Rotated Left
Answer: C
Rationale: Improvement in extension makes it "Extended" (E). Same-side
rotation/sidebending (RRSR) follows Fryette Type II mechanics (ESRR).
4. Which of the following Chapman points is located on the lateral aspect of the
middle-to-lower humerus?
A) Bladder
B) Eye
C) Ear
D) Sinuses
E) Thyroid
Answer: B
Rationale: The anterior Chapman point for the eye is located on the surgical neck/lateral
humerus.
5. A 4-year-old boy presents with a "barking" cough and inspiratory stridor. A
neck X-ray shows subglottic narrowing (Steeple sign). What is the most likely
,2026 UPDATED QUESTIONS DOWNLOAD
causative agent?
A) Respiratory syncytial virus (RSV)
B) Haemophilus influenzae type b
C) Parainfluenza virus
D) Bordetella pertussis
E) Mycoplasma pneumoniae
Answer: C
Rationale: Laryngotracheobronchitis (Croup) is most commonly caused by the
Parainfluenza virus and shows the "Steeple sign" on X-ray.
6. A patient with long-standing rheumatoid arthritis is undergoing elective
surgery. Which of the following must be evaluated pre-operatively to prevent
neurological injury during intubation?
A) Lumbar spine
B) Sacroiliac joints
C) Cervical spine (C1-C2)
D) Temporomandibular joint
E) Thoracic inlet
Answer: C
Rationale: RA can cause atlantoaxial subluxation; intubation can lead to spinal cord
compression if not screened.
7. A 30-year-old male presents with a painless, hard testicular mass. Serum
alpha-fetoprotein (AFP) is elevated. Which of the following is the most likely
diagnosis?
A) Seminoma
B) Yolk sac tumor
C) Choriocarcinoma
D) Teratoma
E) Leydig cell tumor
Answer: B
Rationale: Yolk sac tumors (endodermal sinus tumors) are characterized by elevated
AFP and Schiller-Duval bodies.
8. Which cranial strain pattern is described as the sphenoid and occiput rotating
in the same direction about two parallel transverse axes?
A) Torsion
B) Sidebending-Rotation
C) Superior Vertical Strain
, 2026 UPDATED QUESTIONS DOWNLOAD
D) Inferior Vertical Strain
E) Extension
Answer: C
Rationale: Vertical strains occur when the sphenoid base moves superiorly (superior
strain) or inferiorly (inferior strain) relative to the occiput.
9. A 55-year-old female presents with dry eyes and a dry mouth. She also has a
positive Rheumatoid Factor and ANA. Which antibody is most specific for this
condition?
A) Anti-dsDNA
B) Anti-Smith
C) Anti-Ro (SSA)
D) Anti-centromere
E) Anti-Jo-1
Answer: C
Rationale: Sjögren’s syndrome is associated with Anti-Ro (SSA) and Anti-La (SSB)
antibodies.
10. A patient presents with a L5 vertebrae that is neutral, sidebent right, and
rotated left. What is the expected position of the sacrum?
A) Left on Left forward torsion
B) Right on Right forward torsion
C) Left on Right backward torsion
D) Right on Left backward torsion
E) Unilateral sacral shear
Answer: D
Rationale: Per Fryette’s/Sutherland’s rules: L5 sidebending induces the sacral oblique
axis (Right), and L5 rotation is opposite the sacral rotation (Left). This results in a Right
on Left backward torsion.
11. Which of the following medications is a direct thrombin inhibitor used in the
treatment of Heparin-Induced Thrombocytopenia (HIT)?
A) Warfarin
B) Argatroban
C) Apixaban
D) Enoxaparin
E) Clopidogrel
Answer: B
Ultimate COMSAE Phase 1 (Form 114) Practice Set - 150
High-Yield Questions & Rationales.
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 65-year-old male with a history of hypertension and smoking presents with
sudden onset "tearing" chest pain radiating to his back. His blood pressure is
180/100 mmHg in the right arm and 140/90 mmHg in the left arm. What is the most
likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
/C) Aortic dissection
D) Tension pneumothorax
E) Pericarditis
Answer: C
,2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Aortic dissection typically presents with sudden, tearing chest pain radiating
to the back and a blood pressure discrepancy between the arms.
2. A 24-year-old female presents with a "velvety" patch of darkened skin on the
back of her neck. She has a BMI of 34. This skin finding is most commonly
associated with which of the following?
A) Vitamin B12 deficiency
B) Hypothyroidism
C) Insulin resistance
D) Excess sun exposure
E) Iron deficiency anemia
Answer: C
Rationale: Acanthosis nigricans is a clinical sign of insulin resistance, often seen in
Type 2 Diabetes or PCOS.
3. During a structural exam, a patient's T4 vertebrae is found to be rotated right
and sidebent right. The dysfunction improves in extension and worsens in
flexion. What is the diagnosis?
A) T4 Neutral Sidebent Left Rotated Right
B) T4 Flexed Sidebent Right Rotated Right
C) T4 Extended Sidebent Right Rotated Right
D) T4 Neutral Sidebent Right Rotated Right
E) T4 Extended Sidebent Left Rotated Left
Answer: C
Rationale: Improvement in extension makes it "Extended" (E). Same-side
rotation/sidebending (RRSR) follows Fryette Type II mechanics (ESRR).
4. Which of the following Chapman points is located on the lateral aspect of the
middle-to-lower humerus?
A) Bladder
B) Eye
C) Ear
D) Sinuses
E) Thyroid
Answer: B
Rationale: The anterior Chapman point for the eye is located on the surgical neck/lateral
humerus.
5. A 4-year-old boy presents with a "barking" cough and inspiratory stridor. A
neck X-ray shows subglottic narrowing (Steeple sign). What is the most likely
,2026 UPDATED QUESTIONS DOWNLOAD
causative agent?
A) Respiratory syncytial virus (RSV)
B) Haemophilus influenzae type b
C) Parainfluenza virus
D) Bordetella pertussis
E) Mycoplasma pneumoniae
Answer: C
Rationale: Laryngotracheobronchitis (Croup) is most commonly caused by the
Parainfluenza virus and shows the "Steeple sign" on X-ray.
6. A patient with long-standing rheumatoid arthritis is undergoing elective
surgery. Which of the following must be evaluated pre-operatively to prevent
neurological injury during intubation?
A) Lumbar spine
B) Sacroiliac joints
C) Cervical spine (C1-C2)
D) Temporomandibular joint
E) Thoracic inlet
Answer: C
Rationale: RA can cause atlantoaxial subluxation; intubation can lead to spinal cord
compression if not screened.
7. A 30-year-old male presents with a painless, hard testicular mass. Serum
alpha-fetoprotein (AFP) is elevated. Which of the following is the most likely
diagnosis?
A) Seminoma
B) Yolk sac tumor
C) Choriocarcinoma
D) Teratoma
E) Leydig cell tumor
Answer: B
Rationale: Yolk sac tumors (endodermal sinus tumors) are characterized by elevated
AFP and Schiller-Duval bodies.
8. Which cranial strain pattern is described as the sphenoid and occiput rotating
in the same direction about two parallel transverse axes?
A) Torsion
B) Sidebending-Rotation
C) Superior Vertical Strain
, 2026 UPDATED QUESTIONS DOWNLOAD
D) Inferior Vertical Strain
E) Extension
Answer: C
Rationale: Vertical strains occur when the sphenoid base moves superiorly (superior
strain) or inferiorly (inferior strain) relative to the occiput.
9. A 55-year-old female presents with dry eyes and a dry mouth. She also has a
positive Rheumatoid Factor and ANA. Which antibody is most specific for this
condition?
A) Anti-dsDNA
B) Anti-Smith
C) Anti-Ro (SSA)
D) Anti-centromere
E) Anti-Jo-1
Answer: C
Rationale: Sjögren’s syndrome is associated with Anti-Ro (SSA) and Anti-La (SSB)
antibodies.
10. A patient presents with a L5 vertebrae that is neutral, sidebent right, and
rotated left. What is the expected position of the sacrum?
A) Left on Left forward torsion
B) Right on Right forward torsion
C) Left on Right backward torsion
D) Right on Left backward torsion
E) Unilateral sacral shear
Answer: D
Rationale: Per Fryette’s/Sutherland’s rules: L5 sidebending induces the sacral oblique
axis (Right), and L5 rotation is opposite the sacral rotation (Left). This results in a Right
on Left backward torsion.
11. Which of the following medications is a direct thrombin inhibitor used in the
treatment of Heparin-Induced Thrombocytopenia (HIT)?
A) Warfarin
B) Argatroban
C) Apixaban
D) Enoxaparin
E) Clopidogrel
Answer: B
