COMSAE Phase 1 Form 116 Practice Exam | 250
High-Yield Q&A Bank 2026
Ace your upcoming exam with 250 highly realistic questions meticulously mapped to the
NBOME COMLEX-USA Blueprint for Form 116. Each question features a bolded
answer key and a high-yield italicized rationale crafted for quick scanning and rapid
active recall during dedicated study. This comprehensive bank delivers the exact
practice you need across complex OMM, pathology, and pharmacology concepts to
confidently secure your pass. [1]
Question 1:
A 43-year-old female presents with severe, burning epigastric pain that worsens a few
hours after eating. Physical examination reveals an anterior Chapman reflex point at the
right 5th intercostal space near the sternum. Which of the following organs is most likely
associated with this finding?
A) Stomach
B) Gallbladder
C) Spleen
D) Pancreas
Answer:
B) Gallbladder
Rationale:
The anterior Chapman reflex point for the gallbladder and liver is located at the right 5th
intercostal space between the midclavicular line and the sternum. The stomach
acid/pylorus point sits at the left 5th intercostal space. The pancreas maps to the right
7th intercostal space near the costochondral junction.
Question 2:
A 22-year-old male is evaluated for a cranial somatic dysfunction following minor head
trauma. The osteopathic physician notes that during the flexion phase of the primary
respiratory mechanism, the sphenobasilar synchondrosis (SBS) moves inferiorly, while
the greater wings of the sphenoid move anteriorly and inferiorly. This clinical
presentation describes which of the following cranial strain patterns?
A) Flexion strain
B) Extension strain
C) Torsion
D) Lateral strain
,Answer:
A) Flexion strain
Rationale:
In a cranial flexion strain, the SBS moves inferiorly during the primary respiratory
mechanism, forcing the greater wings of the sphenoid to move anteriorly, inferiorly, and
laterally. This yields a short, wide head configuration. Extension strains exhibit the exact
opposite anatomical movement profile.
Question 3:
A 27-year-old female presents with acute, foul-smelling, watery diarrhea and abdominal
bloating 5 days after a wilderness hiking trip. Stool microscopy demonstrates
flagellated, pear-shaped trophozoites with two nuclei resembling "old man glasses."
Which of the following mechanisms describes the first-line treatment for this infection?
A) Inhibition of squalene epoxidase
B) Interception of DNA synthesis via free radical generation
C) Binding to ergosterol to form membrane pores
D) Inhibition of 50S ribosomal subunits
Answer:
B) Interception of DNA synthesis via free radical generation
Rationale:
The clinical picture is diagnostic for Giardiasis caused by Giardia lamblia. The first-line
therapy is metronidazole, which works by accepting electrons from microbial transport
chains to form reactive nitro free radicals that disrupt DNA pathways. Squalene
epoxidase inhibition describes terbinafine, used for fungal dermatophyte states.
Question 4:
A 55-year-old female presents with chronic lower back pain. Structural examination
demonstrates a positive standing flexion test on the right. Assessment of the pelvis
reveals that the right ASIS is inferior and the right PSIS is superior. What is the most
likely structural diagnosis?
A) Right anterior innominate rotation
B) Right posterior innominate rotation
C) Right superior innominate shear
D) Right inferior innominate shear
Answer:
A) Right anterior innominate rotation
Rationale:
A positive standing flexion test on the right identifies the dysfunctional side. An anterior
innominate rotation presents with an inferior ASIS paired with a superior PSIS on the
dysfunctional side. A posterior innominate rotation features a superior ASIS and an
inferior PSIS.
Question 5:
A 68-year-old male with a history of atherosclerosis presents with sudden-onset, severe
abdominal pain out of proportion to physical exam findings. The physician suspects
,acute mesenteric ischemia affecting the cecum and ascending colon. Which spinal
segments host the preganglionic sympathetic cell bodies for this region?
A) T1–T4
B) T5–T9
C) T10–T11
D) T12–L2
Answer:
C) T10–T11
Rationale:
The superior mesenteric artery supplies the midgut (cecum, ascending colon, proximal
two-thirds of the transverse colon), which receives sympathetic preganglionic
innervation from the T10 to T11 spinal cord levels via the lesser splanchnic nerve.
Foregut structures map to T5–T9, and hindgut structures map to T12–L2.
Question 6:
A 24-year-old male presents with acute dysuria, urethral discharge, and a swollen left
knee. Joint fluid analysis reveals an elevated white blood cell count but no organisms on
Gram stain. Intracellular organisms are suspected. What is the mechanism of action of
the first-line pharmacotherapy used to treat the most likely underlying cause of non-
gonococcal urethritis?
A) Binds to the 30S ribosomal subunit to inhibit protein synthesis
B) Binds to the 50S ribosomal subunit to inhibit translocational protein synthesis
C) Inhibits bacterial DNA topoisomerase IV and DNA gyrase
D) Inhibits cell wall synthesis by binding to penicillin-binding proteins
Answer:
B) Binds to the 50S ribosomal subunit to inhibit translocational protein synthesis
Rationale:
The patient presents with Chlamydia urethritis leading to reactive arthritis. Azithromycin
(a macrolide) is a primary treatment choice that binds to the 23S rRNA of the 50S
ribosomal subunit, preventing bacterial translocation. Doxycycline targets the 30S
subunit but is an alternative option, while macrolides provide a standard single-dose
regimen.
Question 7:
A 50-year-old male presents with deep, localized lower back pain. Physical examination
demonstrates an elevated right base of the sacrum and a shallow left sacral sulcus. The
spring test is positive (poor spring). Which of the following is the most likely sacral
diagnosis?
A) L on L forward sacral torsion
B) R on R forward sacral torsion
C) L on R backward sacral torsion
D) R on L backward sacral torsion
Answer:
C) L on R backward sacral torsion
, Rationale:
A positive spring test indicates a backward sacral torsion or unilateral extension (non-
physiological). A shallow left sacral sulcus means the left base has moved posteriorly.
An elevated right base correlates with a deep right sulcus or asymmetric right-sided
metrics. This profile fits an L on R backward torsion where the left sacral base is
posterior, rotating right around a right oblique axis.
Question 8:
A 34-year-old female presents with progressive fatigue, weight gain, and cold
intolerance. Physical examination reveals a non-tender, diffusely enlarged thyroid gland.
Laboratory evaluation shows an elevated TSH and low free T4. Which of the following
antibodies is most specific for diagnosing this patient’s condition?
A) Anti-thyrotropin receptor antibodies
B) Anti-thyroid peroxidase (TPO) antibodies
C) Anti-double-stranded DNA (dsDNA) antibodies
D) Anti-centromere antibodies
Answer:
B) Anti-thyroid peroxidase (TPO) antibodies
Rationale:
The patient has primary hypothyroidism secondary to Hashimoto thyroiditis. Chronic
autoimmune thyroiditis is strongly associated with anti-thyroid peroxidase (TPO) and
anti-thyroglobulin antibodies. Anti-thyrotropin receptor antibodies are specific for
Graves' disease (hyperthyroidism).
Question 9:
A 61-year-old male presents with persistent epigastric pain that radiates directly to his
back, accompanied by unexplained weight loss. Physical examination reveals an
anterior Chapman reflex point at the right 7th intercostal space near the costochondral
junction. Which of the following conditions is most likely associated with this finding?
A) Acute cholecystitis
B) Appendicitis
C) Chronic pancreatitis
D) Duodenal ulcer
Answer:
C) Chronic pancreatitis
Rationale:
The anterior Chapman point for the pancreas is located at the right 7th intercostal space
near the costochondral junction. The posterior point is located between the spinous and
transverse processes of T7 and T8 on the right side. The gallbladder maps to the 5th
intercostal space, and the appendix maps to the tip of the 12th rib.
Question 10:
A 19-year-old male college student presents to the emergency department with a high
fever, severe headache, and neck stiffness. A lumbar puncture is performed. CSF
analysis reveals elevated opening pressure, marked polymorphonuclear leukocytosis,
High-Yield Q&A Bank 2026
Ace your upcoming exam with 250 highly realistic questions meticulously mapped to the
NBOME COMLEX-USA Blueprint for Form 116. Each question features a bolded
answer key and a high-yield italicized rationale crafted for quick scanning and rapid
active recall during dedicated study. This comprehensive bank delivers the exact
practice you need across complex OMM, pathology, and pharmacology concepts to
confidently secure your pass. [1]
Question 1:
A 43-year-old female presents with severe, burning epigastric pain that worsens a few
hours after eating. Physical examination reveals an anterior Chapman reflex point at the
right 5th intercostal space near the sternum. Which of the following organs is most likely
associated with this finding?
A) Stomach
B) Gallbladder
C) Spleen
D) Pancreas
Answer:
B) Gallbladder
Rationale:
The anterior Chapman reflex point for the gallbladder and liver is located at the right 5th
intercostal space between the midclavicular line and the sternum. The stomach
acid/pylorus point sits at the left 5th intercostal space. The pancreas maps to the right
7th intercostal space near the costochondral junction.
Question 2:
A 22-year-old male is evaluated for a cranial somatic dysfunction following minor head
trauma. The osteopathic physician notes that during the flexion phase of the primary
respiratory mechanism, the sphenobasilar synchondrosis (SBS) moves inferiorly, while
the greater wings of the sphenoid move anteriorly and inferiorly. This clinical
presentation describes which of the following cranial strain patterns?
A) Flexion strain
B) Extension strain
C) Torsion
D) Lateral strain
,Answer:
A) Flexion strain
Rationale:
In a cranial flexion strain, the SBS moves inferiorly during the primary respiratory
mechanism, forcing the greater wings of the sphenoid to move anteriorly, inferiorly, and
laterally. This yields a short, wide head configuration. Extension strains exhibit the exact
opposite anatomical movement profile.
Question 3:
A 27-year-old female presents with acute, foul-smelling, watery diarrhea and abdominal
bloating 5 days after a wilderness hiking trip. Stool microscopy demonstrates
flagellated, pear-shaped trophozoites with two nuclei resembling "old man glasses."
Which of the following mechanisms describes the first-line treatment for this infection?
A) Inhibition of squalene epoxidase
B) Interception of DNA synthesis via free radical generation
C) Binding to ergosterol to form membrane pores
D) Inhibition of 50S ribosomal subunits
Answer:
B) Interception of DNA synthesis via free radical generation
Rationale:
The clinical picture is diagnostic for Giardiasis caused by Giardia lamblia. The first-line
therapy is metronidazole, which works by accepting electrons from microbial transport
chains to form reactive nitro free radicals that disrupt DNA pathways. Squalene
epoxidase inhibition describes terbinafine, used for fungal dermatophyte states.
Question 4:
A 55-year-old female presents with chronic lower back pain. Structural examination
demonstrates a positive standing flexion test on the right. Assessment of the pelvis
reveals that the right ASIS is inferior and the right PSIS is superior. What is the most
likely structural diagnosis?
A) Right anterior innominate rotation
B) Right posterior innominate rotation
C) Right superior innominate shear
D) Right inferior innominate shear
Answer:
A) Right anterior innominate rotation
Rationale:
A positive standing flexion test on the right identifies the dysfunctional side. An anterior
innominate rotation presents with an inferior ASIS paired with a superior PSIS on the
dysfunctional side. A posterior innominate rotation features a superior ASIS and an
inferior PSIS.
Question 5:
A 68-year-old male with a history of atherosclerosis presents with sudden-onset, severe
abdominal pain out of proportion to physical exam findings. The physician suspects
,acute mesenteric ischemia affecting the cecum and ascending colon. Which spinal
segments host the preganglionic sympathetic cell bodies for this region?
A) T1–T4
B) T5–T9
C) T10–T11
D) T12–L2
Answer:
C) T10–T11
Rationale:
The superior mesenteric artery supplies the midgut (cecum, ascending colon, proximal
two-thirds of the transverse colon), which receives sympathetic preganglionic
innervation from the T10 to T11 spinal cord levels via the lesser splanchnic nerve.
Foregut structures map to T5–T9, and hindgut structures map to T12–L2.
Question 6:
A 24-year-old male presents with acute dysuria, urethral discharge, and a swollen left
knee. Joint fluid analysis reveals an elevated white blood cell count but no organisms on
Gram stain. Intracellular organisms are suspected. What is the mechanism of action of
the first-line pharmacotherapy used to treat the most likely underlying cause of non-
gonococcal urethritis?
A) Binds to the 30S ribosomal subunit to inhibit protein synthesis
B) Binds to the 50S ribosomal subunit to inhibit translocational protein synthesis
C) Inhibits bacterial DNA topoisomerase IV and DNA gyrase
D) Inhibits cell wall synthesis by binding to penicillin-binding proteins
Answer:
B) Binds to the 50S ribosomal subunit to inhibit translocational protein synthesis
Rationale:
The patient presents with Chlamydia urethritis leading to reactive arthritis. Azithromycin
(a macrolide) is a primary treatment choice that binds to the 23S rRNA of the 50S
ribosomal subunit, preventing bacterial translocation. Doxycycline targets the 30S
subunit but is an alternative option, while macrolides provide a standard single-dose
regimen.
Question 7:
A 50-year-old male presents with deep, localized lower back pain. Physical examination
demonstrates an elevated right base of the sacrum and a shallow left sacral sulcus. The
spring test is positive (poor spring). Which of the following is the most likely sacral
diagnosis?
A) L on L forward sacral torsion
B) R on R forward sacral torsion
C) L on R backward sacral torsion
D) R on L backward sacral torsion
Answer:
C) L on R backward sacral torsion
, Rationale:
A positive spring test indicates a backward sacral torsion or unilateral extension (non-
physiological). A shallow left sacral sulcus means the left base has moved posteriorly.
An elevated right base correlates with a deep right sulcus or asymmetric right-sided
metrics. This profile fits an L on R backward torsion where the left sacral base is
posterior, rotating right around a right oblique axis.
Question 8:
A 34-year-old female presents with progressive fatigue, weight gain, and cold
intolerance. Physical examination reveals a non-tender, diffusely enlarged thyroid gland.
Laboratory evaluation shows an elevated TSH and low free T4. Which of the following
antibodies is most specific for diagnosing this patient’s condition?
A) Anti-thyrotropin receptor antibodies
B) Anti-thyroid peroxidase (TPO) antibodies
C) Anti-double-stranded DNA (dsDNA) antibodies
D) Anti-centromere antibodies
Answer:
B) Anti-thyroid peroxidase (TPO) antibodies
Rationale:
The patient has primary hypothyroidism secondary to Hashimoto thyroiditis. Chronic
autoimmune thyroiditis is strongly associated with anti-thyroid peroxidase (TPO) and
anti-thyroglobulin antibodies. Anti-thyrotropin receptor antibodies are specific for
Graves' disease (hyperthyroidism).
Question 9:
A 61-year-old male presents with persistent epigastric pain that radiates directly to his
back, accompanied by unexplained weight loss. Physical examination reveals an
anterior Chapman reflex point at the right 7th intercostal space near the costochondral
junction. Which of the following conditions is most likely associated with this finding?
A) Acute cholecystitis
B) Appendicitis
C) Chronic pancreatitis
D) Duodenal ulcer
Answer:
C) Chronic pancreatitis
Rationale:
The anterior Chapman point for the pancreas is located at the right 7th intercostal space
near the costochondral junction. The posterior point is located between the spinous and
transverse processes of T7 and T8 on the right side. The gallbladder maps to the 5th
intercostal space, and the appendix maps to the tip of the 12th rib.
Question 10:
A 19-year-old male college student presents to the emergency department with a high
fever, severe headache, and neck stiffness. A lumbar puncture is performed. CSF
analysis reveals elevated opening pressure, marked polymorphonuclear leukocytosis,
