COMSAE Phase 1 Form 115 Practice Exam Questions And
Correct Answers (Verified Answers) Plus Rationales Q&A |
Instant Download Pdf 2026
Master your exam with 250 highly realistic practice questions meticulously mapped to the NBOME
COMLEX-USA Blueprint for Form 115. 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.
COMSAE Phase 1 High-Yield Practice Questions
Question 1
A 24-year-old female presents to the clinic with a 3-day history of dysuria, urinary
frequency, and suprapubic pain. She denies fever, chills, or flank pain. Urinalysis
reveals positive leukocyte esterase, nitrites, and WBCs. An osteopathic structural
examination is performed. At which of the following spinal levels would you most likely
expect to find a tissue texture abnormality associated with a sympathetic viscerosomatic
reflex from this condition?
A. T1–T4
B. T5–T9
C. T10–T11
D. T12–L2
E. S2–S4
Answer: D
Rationale: The clinical presentation is highly suggestive of uncomplicated acute cystitis
(bladder infection). The sympathetic innervation to the urinary bladder originates from
the T12 to L2 spinal cord levels. Viscerosomatic reflexes from the bladder will manifest
as tissue texture changes, asymmetry, restriction of motion, and tenderness (TART)
within the T12–L2 paraspinal region. Option A is incorrect because T1–T4 handles
sympethatics to the head and neck. Option B is incorrect because T5–T9 innervates
upper GI structures. Option C is incorrect because T10–T11 innervates the kidneys and
upper ureters. Option E is incorrect because S2–S4 represents parasympathetic
innervation to the pelvic splanchnic organs, not sympathetic.
Question 2
A 62-year-old male with a history of chronic smoking presents with a cough and a 15-lb
,weight loss over the past 2 months. A chest X-ray reveals a central hilar mass and hilar
lymphadenopathy. Laboratory results reveal a serum calcium level of 12.2 mg/dL. A
biopsy of the mass is performed. Which of the following histopathological findings is
most likely to be seen?
A. Small round blue cells with neuroendocrine granules
B. Keratin pearls and intercellular bridges
C. Glandular formation with mucin production
D. Sheets of uniform cells with "fried egg" appearance
E. Spindle-shaped cells with prominent necrosis
Answer: B
Rationale: The patient has clinical signs of lung cancer presenting with hypercalcaemia,
which is a classic paraneoplastic syndrome caused by the secretion of parathyroid
hormone-related protein (PTHrP). This syndrome is most frequently associated with
squamous cell carcinoma of the lung, which typically presents as a central hilar mass in
smokers. Histologically, squamous cell carcinoma is characterized by keratin pearls and
intercellular bridges. Option A describes small cell lung carcinoma, which causes other
paraneoplastic syndromes like SIADH or Cushing, not PTHrP secretion. Option C
describes adenocarcinoma, which is usually peripheral and not classically associated
with hypercalcaemia. Options D and E are not characteristic of primary epithelial lung
malignancies.
Question 3
A 43-year-old female presents to her osteopathic physician complaining of persistent
pelvic pain and heavy menstrual bleeding. Palpation of her anterior pelvic structures
reveals a distinct, tender, pea-sized nodule located along the posterior aspect of the
iliotibial band bilaterally. This finding most likely represents a Chapman reflex point for
which of the following organs?
A. Ovaries
B. Broad ligament
C. Uterus
D. Fallopian tubes
E. Cervix
Answer: B
Rationale: The anterior Chapman reflex point for the broad ligament is located along the
posterior aspect of the iliotibial band. Understanding the exact locations of pelvic
Chapman points is high yield for COMSAE exams. Option A is incorrect because the
anterior point for the ovaries/testes is found on the superior pubic ramus. Option C is
incorrect because the anterior point for the uterus is located on the inferior pubic ramus.
Option D is incorrect because the fallopian tubes share a similar region but do not track
down the IT band like the broad ligament. Option E is incorrect because the cervix point
is located near the junction of the pubic symphysis.
,Question 4
A 31-year-old male is evaluated for a mechanical restriction of his pelvis. Structural
examination reveals a positive seated flexion test on the right side. Palpation of the
sacral landmarks demonstrates a deep right sacral sulcus and a prominent left posterior
inferior iliac spine (ILA). The lumbosacral spring test is negative. What is the most likely
diagnosis?
A. Left-on-left forward sacral torsion
B. Right-on-right forward sacral torsion
C. Right-on-left backward sacral torsion
D. Left-on-right backward sacral torsion
E. Bilateral sacral flexion
Answer: B
Rationale: To diagnose a sacral torsion, evaluate the spring test first; a negative spring
test indicates a physiological forward torsion (rotation and axis are on the same side,
e.g., L-on-L or R-on-R). A deep right sacral sulcus and a posterior left ILA mean the
sacrum is rotated to the right. In a forward torsion, rotation and axis match, meaning it
must be a Right-on-Right sacral torsion. The seated flexion test is positive on the right
because it occurs on the side opposite the oblique axis (the left oblique axis runs from
the left superior sulcus to the right ILA). Options C and D are incorrect because
backward torsions present with a positive spring test. Option A describes a left-rotated
sacrum.
Question 5
A 19-year-old college student is brought to the emergency department with a rigid neck,
high fever, and altered mental status. A lumbar puncture is performed, and
cerebrospinal fluid analysis shows elevated opening pressure, elevated neutrophils,
decreased glucose, and elevated protein. Gram stain reveals Gram-negative diplococci.
Which of the following structural components serves as the primary virulence factor
preventing phagocytosis for the causative organism?
A. Lipooligosaccharide (LOS)
B. Polysaccharide capsule
C. IgA protease
D. Pili/Fimbriae
E. Outer membrane proteins
Answer: B
Rationale: The patient has acute bacterial meningitis caused by Neisseria meningitidis,
confirmed by the Gram-negative diplococci. The primary virulence factor that allows N.
meningitidis to evade host immune clearance via phagocytosis in the bloodstream and
, CNS is its capsule. Option A is incorrect because LOS is an endotoxin responsible for
the severe inflammatory cascade, petechiae, and septic shock, but it does not directly
prevent phagocytosis. Option C is incorrect because IgA protease aids in mucosal
attachment by cleaving secretory antibodies. Option D is incorrect because pili mediate
initial attachment to nasopharyngeal epithelial cells.
Question 6
An osteopathic structural examination of a 28-year-old postpartum female reveals a
somatic dysfunction of the cranium. Upon palpation of the sphenobasilar synchondrosis
(SBS), the physician notes that during the expansive phase of the primary respiratory
mechanism, the sphenoid moves such that its greater wings shift superiorly, while the
base of the occiput moves inferiorly. This finding is indicative of which cranial motion?
A. Flexion
B. Extension
C. Torsion
D. Sidebending-Rotation
E. Vertical strain
Answer: A
Rationale: During the flexion phase of the primary respiratory mechanism (PRM), the
midline bones (sphenoid and occiput) rotate in opposite directions around parallel
transverse axes. This causes the sphenobasilar synchondrosis (SBS) to move
superiorly, which forces the greater wings of the sphenoid to move anteriorly and
superiorly, while the squamous portion of the occiput moves posteriorly and inferiorly.
Option B is incorrect because extension features the exact opposite motions. Options C,
D, and E represent non-physiological or asymmetric strains rather than normal
respiratory excursions.
Question 7
A 50-year-old male presents with severe pain in his right big toe that woke him up in the
middle of the night. He notes that he attended a seafood and wine banquet the previous
evening. Physical examination reveals an erythematous, warm, and exquisitely tender
first metatarsophalangeal joint. Polarized light microscopy of joint aspirate fluid is
performed. Which of the following microscopic descriptions matches the expected
finding?
A. Positively birefringent, rhomboid-shaped crystals
B. Negatively birefringent, needle-shaped crystals
C. Positively birefringent, needle-shaped crystals
Correct Answers (Verified Answers) Plus Rationales Q&A |
Instant Download Pdf 2026
Master your exam with 250 highly realistic practice questions meticulously mapped to the NBOME
COMLEX-USA Blueprint for Form 115. 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.
COMSAE Phase 1 High-Yield Practice Questions
Question 1
A 24-year-old female presents to the clinic with a 3-day history of dysuria, urinary
frequency, and suprapubic pain. She denies fever, chills, or flank pain. Urinalysis
reveals positive leukocyte esterase, nitrites, and WBCs. An osteopathic structural
examination is performed. At which of the following spinal levels would you most likely
expect to find a tissue texture abnormality associated with a sympathetic viscerosomatic
reflex from this condition?
A. T1–T4
B. T5–T9
C. T10–T11
D. T12–L2
E. S2–S4
Answer: D
Rationale: The clinical presentation is highly suggestive of uncomplicated acute cystitis
(bladder infection). The sympathetic innervation to the urinary bladder originates from
the T12 to L2 spinal cord levels. Viscerosomatic reflexes from the bladder will manifest
as tissue texture changes, asymmetry, restriction of motion, and tenderness (TART)
within the T12–L2 paraspinal region. Option A is incorrect because T1–T4 handles
sympethatics to the head and neck. Option B is incorrect because T5–T9 innervates
upper GI structures. Option C is incorrect because T10–T11 innervates the kidneys and
upper ureters. Option E is incorrect because S2–S4 represents parasympathetic
innervation to the pelvic splanchnic organs, not sympathetic.
Question 2
A 62-year-old male with a history of chronic smoking presents with a cough and a 15-lb
,weight loss over the past 2 months. A chest X-ray reveals a central hilar mass and hilar
lymphadenopathy. Laboratory results reveal a serum calcium level of 12.2 mg/dL. A
biopsy of the mass is performed. Which of the following histopathological findings is
most likely to be seen?
A. Small round blue cells with neuroendocrine granules
B. Keratin pearls and intercellular bridges
C. Glandular formation with mucin production
D. Sheets of uniform cells with "fried egg" appearance
E. Spindle-shaped cells with prominent necrosis
Answer: B
Rationale: The patient has clinical signs of lung cancer presenting with hypercalcaemia,
which is a classic paraneoplastic syndrome caused by the secretion of parathyroid
hormone-related protein (PTHrP). This syndrome is most frequently associated with
squamous cell carcinoma of the lung, which typically presents as a central hilar mass in
smokers. Histologically, squamous cell carcinoma is characterized by keratin pearls and
intercellular bridges. Option A describes small cell lung carcinoma, which causes other
paraneoplastic syndromes like SIADH or Cushing, not PTHrP secretion. Option C
describes adenocarcinoma, which is usually peripheral and not classically associated
with hypercalcaemia. Options D and E are not characteristic of primary epithelial lung
malignancies.
Question 3
A 43-year-old female presents to her osteopathic physician complaining of persistent
pelvic pain and heavy menstrual bleeding. Palpation of her anterior pelvic structures
reveals a distinct, tender, pea-sized nodule located along the posterior aspect of the
iliotibial band bilaterally. This finding most likely represents a Chapman reflex point for
which of the following organs?
A. Ovaries
B. Broad ligament
C. Uterus
D. Fallopian tubes
E. Cervix
Answer: B
Rationale: The anterior Chapman reflex point for the broad ligament is located along the
posterior aspect of the iliotibial band. Understanding the exact locations of pelvic
Chapman points is high yield for COMSAE exams. Option A is incorrect because the
anterior point for the ovaries/testes is found on the superior pubic ramus. Option C is
incorrect because the anterior point for the uterus is located on the inferior pubic ramus.
Option D is incorrect because the fallopian tubes share a similar region but do not track
down the IT band like the broad ligament. Option E is incorrect because the cervix point
is located near the junction of the pubic symphysis.
,Question 4
A 31-year-old male is evaluated for a mechanical restriction of his pelvis. Structural
examination reveals a positive seated flexion test on the right side. Palpation of the
sacral landmarks demonstrates a deep right sacral sulcus and a prominent left posterior
inferior iliac spine (ILA). The lumbosacral spring test is negative. What is the most likely
diagnosis?
A. Left-on-left forward sacral torsion
B. Right-on-right forward sacral torsion
C. Right-on-left backward sacral torsion
D. Left-on-right backward sacral torsion
E. Bilateral sacral flexion
Answer: B
Rationale: To diagnose a sacral torsion, evaluate the spring test first; a negative spring
test indicates a physiological forward torsion (rotation and axis are on the same side,
e.g., L-on-L or R-on-R). A deep right sacral sulcus and a posterior left ILA mean the
sacrum is rotated to the right. In a forward torsion, rotation and axis match, meaning it
must be a Right-on-Right sacral torsion. The seated flexion test is positive on the right
because it occurs on the side opposite the oblique axis (the left oblique axis runs from
the left superior sulcus to the right ILA). Options C and D are incorrect because
backward torsions present with a positive spring test. Option A describes a left-rotated
sacrum.
Question 5
A 19-year-old college student is brought to the emergency department with a rigid neck,
high fever, and altered mental status. A lumbar puncture is performed, and
cerebrospinal fluid analysis shows elevated opening pressure, elevated neutrophils,
decreased glucose, and elevated protein. Gram stain reveals Gram-negative diplococci.
Which of the following structural components serves as the primary virulence factor
preventing phagocytosis for the causative organism?
A. Lipooligosaccharide (LOS)
B. Polysaccharide capsule
C. IgA protease
D. Pili/Fimbriae
E. Outer membrane proteins
Answer: B
Rationale: The patient has acute bacterial meningitis caused by Neisseria meningitidis,
confirmed by the Gram-negative diplococci. The primary virulence factor that allows N.
meningitidis to evade host immune clearance via phagocytosis in the bloodstream and
, CNS is its capsule. Option A is incorrect because LOS is an endotoxin responsible for
the severe inflammatory cascade, petechiae, and septic shock, but it does not directly
prevent phagocytosis. Option C is incorrect because IgA protease aids in mucosal
attachment by cleaving secretory antibodies. Option D is incorrect because pili mediate
initial attachment to nasopharyngeal epithelial cells.
Question 6
An osteopathic structural examination of a 28-year-old postpartum female reveals a
somatic dysfunction of the cranium. Upon palpation of the sphenobasilar synchondrosis
(SBS), the physician notes that during the expansive phase of the primary respiratory
mechanism, the sphenoid moves such that its greater wings shift superiorly, while the
base of the occiput moves inferiorly. This finding is indicative of which cranial motion?
A. Flexion
B. Extension
C. Torsion
D. Sidebending-Rotation
E. Vertical strain
Answer: A
Rationale: During the flexion phase of the primary respiratory mechanism (PRM), the
midline bones (sphenoid and occiput) rotate in opposite directions around parallel
transverse axes. This causes the sphenobasilar synchondrosis (SBS) to move
superiorly, which forces the greater wings of the sphenoid to move anteriorly and
superiorly, while the squamous portion of the occiput moves posteriorly and inferiorly.
Option B is incorrect because extension features the exact opposite motions. Options C,
D, and E represent non-physiological or asymmetric strains rather than normal
respiratory excursions.
Question 7
A 50-year-old male presents with severe pain in his right big toe that woke him up in the
middle of the night. He notes that he attended a seafood and wine banquet the previous
evening. Physical examination reveals an erythematous, warm, and exquisitely tender
first metatarsophalangeal joint. Polarized light microscopy of joint aspirate fluid is
performed. Which of the following microscopic descriptions matches the expected
finding?
A. Positively birefringent, rhomboid-shaped crystals
B. Negatively birefringent, needle-shaped crystals
C. Positively birefringent, needle-shaped crystals
