COMLEX-USA Level 1 Prep | COMSAE Phase 1 Form
113 Direct Content Practice Exam – 150+ Questions
with Bold Italic Answers & Rationales for Osteopathic
Medical Students | pdf
⭐⭐⭐⭐⭐ COMSAE Phase 1 Form 113 & Form 114 Practice Exams – Complete Study
Guide Bundle The Ultimate Resource That Helped Thousands of Osteopathic Medical Students Pass with
Confidence
Section 1: Foundational Sciences & Clinical Medicine
Question 1: Biochemistry (Metabolic Pathways)
A 2-day-old neonate presents with poor feeding, vomiting, and "maple syrup" smelling
urine. A deficiency in the branched-chain alpha-keto acid dehydrogenase
complex is suspected. Which of the following amino acids is most likely to be elevated
in this patient's serum?
A) Phenylalanine
B) Tyrosine
C) Leucine
D) Methionine
Maple Syrup Urine Disease (MSUD) is caused by a deficiency in the enzyme complex
that breaks down branched-chain amino acids: Isoleucine, Leucine, and Valine (I
Love Vermont). Leucine elevation is particularly neurotoxic in these infants.
Question 2: Microbiology (Gram-Positive Cocci)
A 65-year-old male with a history of COPD presents with fever and a cough productive
of "rust-colored" sputum. A Gram stain of the sputum reveals Gram-positive, lancet-
shaped diplococci. Which of the following is the most likely pathogen?
, A) Staphylococcus aureus
B) Streptococcus pneumoniae
C) Klebsiella pneumoniae
D) Mycoplasma pneumoniae
Streptococcus pneumoniae is the most common cause of community-acquired
pneumonia. The classic clinical "buzzword" is rust-colored sputum, and the classic
microscopic finding is Gram-positive, lancet-shaped diplococci.
Question 3: Pharmacology (Autonomic Nervous System)
A 55-year-old male is being treated for chronic open-angle glaucoma. He is prescribed
a medication that acts as a non-selective beta-adrenergic antagonist to decrease
aqueous humor production. Which of the following is a potential contraindication for this
medication?
A) Hypertension
B) Hyperthyroidism
C) Asthma
D) Glaucoma
Timolol is a non-selective beta-blocker used topically for glaucoma. Because it
blocks Beta-2 receptors in the lungs as well as Beta-1 in the heart, it can cause
bronchoconstriction and is generally contraindicated in patients with Asthma or severe
COPD.
Question 4: Osteopathic Principles (Sacral Diagnosis)
During a physical exam, a physician determines that the patient has a Forward Sacral
Torsion. Specifically, the diagnosis is a Left-on-Left (LoL) torsion. Which of the
following physical exam findings is most consistent with this diagnosis?
A) Positive seated flexion test on the right
B) Deep right sacral sulcus
C) Positive seated flexion test on the right
D) Posterior ILA on the left
In a Left-on-Left (LoL) sacral torsion, the seated flexion test is positive on
the Right (opposite the axis). Because it is a forward torsion, the sulcus opposite the
113 Direct Content Practice Exam – 150+ Questions
with Bold Italic Answers & Rationales for Osteopathic
Medical Students | pdf
⭐⭐⭐⭐⭐ COMSAE Phase 1 Form 113 & Form 114 Practice Exams – Complete Study
Guide Bundle The Ultimate Resource That Helped Thousands of Osteopathic Medical Students Pass with
Confidence
Section 1: Foundational Sciences & Clinical Medicine
Question 1: Biochemistry (Metabolic Pathways)
A 2-day-old neonate presents with poor feeding, vomiting, and "maple syrup" smelling
urine. A deficiency in the branched-chain alpha-keto acid dehydrogenase
complex is suspected. Which of the following amino acids is most likely to be elevated
in this patient's serum?
A) Phenylalanine
B) Tyrosine
C) Leucine
D) Methionine
Maple Syrup Urine Disease (MSUD) is caused by a deficiency in the enzyme complex
that breaks down branched-chain amino acids: Isoleucine, Leucine, and Valine (I
Love Vermont). Leucine elevation is particularly neurotoxic in these infants.
Question 2: Microbiology (Gram-Positive Cocci)
A 65-year-old male with a history of COPD presents with fever and a cough productive
of "rust-colored" sputum. A Gram stain of the sputum reveals Gram-positive, lancet-
shaped diplococci. Which of the following is the most likely pathogen?
, A) Staphylococcus aureus
B) Streptococcus pneumoniae
C) Klebsiella pneumoniae
D) Mycoplasma pneumoniae
Streptococcus pneumoniae is the most common cause of community-acquired
pneumonia. The classic clinical "buzzword" is rust-colored sputum, and the classic
microscopic finding is Gram-positive, lancet-shaped diplococci.
Question 3: Pharmacology (Autonomic Nervous System)
A 55-year-old male is being treated for chronic open-angle glaucoma. He is prescribed
a medication that acts as a non-selective beta-adrenergic antagonist to decrease
aqueous humor production. Which of the following is a potential contraindication for this
medication?
A) Hypertension
B) Hyperthyroidism
C) Asthma
D) Glaucoma
Timolol is a non-selective beta-blocker used topically for glaucoma. Because it
blocks Beta-2 receptors in the lungs as well as Beta-1 in the heart, it can cause
bronchoconstriction and is generally contraindicated in patients with Asthma or severe
COPD.
Question 4: Osteopathic Principles (Sacral Diagnosis)
During a physical exam, a physician determines that the patient has a Forward Sacral
Torsion. Specifically, the diagnosis is a Left-on-Left (LoL) torsion. Which of the
following physical exam findings is most consistent with this diagnosis?
A) Positive seated flexion test on the right
B) Deep right sacral sulcus
C) Positive seated flexion test on the right
D) Posterior ILA on the left
In a Left-on-Left (LoL) sacral torsion, the seated flexion test is positive on
the Right (opposite the axis). Because it is a forward torsion, the sulcus opposite the
