NBOME COMSAE Phase 1 Form 110 Exam
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Master the COMLEX-USA Level 1 blueprint with this complete study guide for the NBOME COMSAE
Phase 1 Form 110 exam. Features highly detailed multiple-choice questions, verified correct
answers, and thorough medical rationales. Comprehensive coverage includes high-yield
Osteopathic Manipulative Medicine (OMM/OPP), Fryette’s laws, cranial/sacral somatic
dysfunctions, pathology, pharmacology, and key organ systems. Perfect for diagnostic
benchmarking and securing your school board clearance.
1. A 45-year-old male presents with a painful, swollen right great toe. Synovial fluid
analysis under polarized light microscopy demonstrates negatively birefringent,
needle-shaped crystals. What is the most appropriate first-line medical therapy for
this acute flare?
A) Allopurinol
B) Febuxostat
C) Indomethacin
D) Probenecid
Rationale: Acute gouty arthritis flares are treated first-line with Nonsteroidal Anti-
inflammatory Drugs (NSAIDs) like indomethacin, or alternatives like colchicine and
glucocorticoids. Urate-lowering therapies like allopurinol or febuxostat should not be
initiated during an acute flare as sudden shifts in serum uric acid levels can worsen
or prolong the acute attack.
2. An osteopathic physician diagnoses a patient with a T4-T8 Type I somatic
dysfunction. According to Fryette's laws, in which relative directions do sidebending
and rotation occur for this type of dysfunction?
A) Same direction, in a non-neutral position
B) Opposite directions, in a neutral position
C) Same direction, in a neutral position
D) Opposite directions, in a flexed position
Rationale: Fryette's Principle I states that when the thoracic or lumbar spine is in a
neutral position, sidebending and rotation occur in opposite directions. This typically
involves a group of segments. Principle II states that in non-neutral positions (flexion
or extension), rotation and sidebending occur in the same direction for a single
segment.
, 3. A 62-year-old male with a history of chronic smoking presents with a cough
and unintended weight loss. Lab results show severe hyponatremia. A chest X-ray
reveals a central hilar mass. What tumor cell origin is most strongly associated with
this clinical picture?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Large cell carcinoma
D) Small cell carcinoma
Rationale: Small cell lung carcinoma is a neuroendocrine tumor highly associated
with smoking, centrally located lesions, and paraneoplastic syndromes. The severe
hyponatremia is caused by ectopic Syndrome of Inappropriate Antidiuretic Hormone
(SIADH) secretion. Squamous cell carcinoma is also central but more commonly
causes hypercalcemia via PTHrP.
4. A physician tests a patient's pupillary light reflex. Shining light into the right
eye prompts constriction of both the right and left pupils. However, when the light is
swung to the left eye, both pupils paradoxically dilate. Where is the lesion located?
A) Left oculomotor nerve (CN III)
B) Left optic nerve (CN II)
C) Right optic tract
D) Edinger-Westphal nucleus
Rationale: This scenario describes a relative afferent pupillary defect (RAPD), or
Marcus Gunn pupil, in the left eye. Because the left optic nerve (CN II) is damaged, it
fails to sense the light intensity appropriately, causing the brain to perceive less light
than when it was in the right eye, leading to consensual pupillary dilation.
5. A 2-year-old boy presents with progressive muscle weakness and calf
pseudohypertrophy. Genetic testing reveals a frame-shift mutation in the gene
encoding a structural protein that anchors the cellular cytoskeleton to the
extracellular matrix. What protein is defective?
A) Dystrophin
B) Actin
C) Myosin
D) Collagen Type I
Rationale: Duchenne muscular dystrophy is an X-linked recessive disorder caused
by a frameshift mutation resulting in the complete absence of the dystrophin protein.
Dystrophin anchors the actin cytoskeleton of muscle fibers to the extracellular matrix
via the dystroglycan complex. Out-of-frame deletions contrast with Becker muscular
dystrophy, which involves in-frame mutations and a partially functional protein.
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Master the COMLEX-USA Level 1 blueprint with this complete study guide for the NBOME COMSAE
Phase 1 Form 110 exam. Features highly detailed multiple-choice questions, verified correct
answers, and thorough medical rationales. Comprehensive coverage includes high-yield
Osteopathic Manipulative Medicine (OMM/OPP), Fryette’s laws, cranial/sacral somatic
dysfunctions, pathology, pharmacology, and key organ systems. Perfect for diagnostic
benchmarking and securing your school board clearance.
1. A 45-year-old male presents with a painful, swollen right great toe. Synovial fluid
analysis under polarized light microscopy demonstrates negatively birefringent,
needle-shaped crystals. What is the most appropriate first-line medical therapy for
this acute flare?
A) Allopurinol
B) Febuxostat
C) Indomethacin
D) Probenecid
Rationale: Acute gouty arthritis flares are treated first-line with Nonsteroidal Anti-
inflammatory Drugs (NSAIDs) like indomethacin, or alternatives like colchicine and
glucocorticoids. Urate-lowering therapies like allopurinol or febuxostat should not be
initiated during an acute flare as sudden shifts in serum uric acid levels can worsen
or prolong the acute attack.
2. An osteopathic physician diagnoses a patient with a T4-T8 Type I somatic
dysfunction. According to Fryette's laws, in which relative directions do sidebending
and rotation occur for this type of dysfunction?
A) Same direction, in a non-neutral position
B) Opposite directions, in a neutral position
C) Same direction, in a neutral position
D) Opposite directions, in a flexed position
Rationale: Fryette's Principle I states that when the thoracic or lumbar spine is in a
neutral position, sidebending and rotation occur in opposite directions. This typically
involves a group of segments. Principle II states that in non-neutral positions (flexion
or extension), rotation and sidebending occur in the same direction for a single
segment.
, 3. A 62-year-old male with a history of chronic smoking presents with a cough
and unintended weight loss. Lab results show severe hyponatremia. A chest X-ray
reveals a central hilar mass. What tumor cell origin is most strongly associated with
this clinical picture?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Large cell carcinoma
D) Small cell carcinoma
Rationale: Small cell lung carcinoma is a neuroendocrine tumor highly associated
with smoking, centrally located lesions, and paraneoplastic syndromes. The severe
hyponatremia is caused by ectopic Syndrome of Inappropriate Antidiuretic Hormone
(SIADH) secretion. Squamous cell carcinoma is also central but more commonly
causes hypercalcemia via PTHrP.
4. A physician tests a patient's pupillary light reflex. Shining light into the right
eye prompts constriction of both the right and left pupils. However, when the light is
swung to the left eye, both pupils paradoxically dilate. Where is the lesion located?
A) Left oculomotor nerve (CN III)
B) Left optic nerve (CN II)
C) Right optic tract
D) Edinger-Westphal nucleus
Rationale: This scenario describes a relative afferent pupillary defect (RAPD), or
Marcus Gunn pupil, in the left eye. Because the left optic nerve (CN II) is damaged, it
fails to sense the light intensity appropriately, causing the brain to perceive less light
than when it was in the right eye, leading to consensual pupillary dilation.
5. A 2-year-old boy presents with progressive muscle weakness and calf
pseudohypertrophy. Genetic testing reveals a frame-shift mutation in the gene
encoding a structural protein that anchors the cellular cytoskeleton to the
extracellular matrix. What protein is defective?
A) Dystrophin
B) Actin
C) Myosin
D) Collagen Type I
Rationale: Duchenne muscular dystrophy is an X-linked recessive disorder caused
by a frameshift mutation resulting in the complete absence of the dystrophin protein.
Dystrophin anchors the actin cytoskeleton of muscle fibers to the extracellular matrix
via the dystroglycan complex. Out-of-frame deletions contrast with Becker muscular
dystrophy, which involves in-frame mutations and a partially functional protein.
