Page 1 of 100
COMSAE Phase 1 Form 115 EXAM QUESTIONS AND CORRECT
VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR – JUST
RELEASED
Exam Coverage – COMSAE Phase 1 Form 115 (Latest)
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment Examination) Phase 1 is
designed to assess a student’s readiness for the COMLEX-USA Level 1. This form (115) reflects
the most current blueprint, emphasizing foundational biomedical sciences and osteopathic
principles. Key content domains include:
Human Anatomy – gross anatomy (upper/lower extremity, thorax, abdomen, pelvis, perineum,
head/neck, back, vertebral column), histology (tissue identification, organ systems), embryology
(development, congenital anomalies, germ layers, neural crest, pharyngeal arches, teratogens),
and medical imaging (radiographs, CT, MRI, ultrasound).
Biochemistry & Medical Genetics – metabolic pathways (glycolysis, TCA cycle, oxidative
phosphorylation, gluconeogenesis, glycogen metabolism, pentose phosphate pathway, fatty
acid oxidation, ketogenesis, cholesterol synthesis, urea cycle, amino acid metabolism); enzyme
kinetics (Michaelis-Menten, Lineweaver-Burk, inhibitors (competitive, non-competitive,
uncompetitive)); hormonal regulation (insulin/glucagon, cortisol, thyroid, catecholamines,
growth hormone); molecular biology (DNA replication, transcription, translation, repair,
mutations, epigenetics); genetics (Mendelian inheritance (autosomal dominant/recessive,
X-linked dominant/recessive, Y-linked, mitochondrial), chromosomal abnormalities (aneuploidy,
translocations, deletions, duplications), epigenetics (imprinting, X-inactivation), genetic testing
(PCR, FISH, microarray, sequencing), population genetics (Hardy-Weinberg, carrier frequency));
and laboratory medicine (reference ranges, diagnostic sensitivity/specificity, predictive values,
likelihood ratios).
Microbiology & Immunology – bacteriology (gram-positive/gram-negative cocci/bacilli,
spirochetes, anaerobes, mycobacteria, atypical bacteria, cell wall deficient (Mycoplasma)),
virology (DNA/RNA viruses, enveloped/non-enveloped, retroviruses, viral hepatitis,
herpesviruses, respiratory viruses, enteroviruses, arboviruses, oncogenic viruses), mycology
(systemic, subcutaneous, cutaneous, opportunistic fungi), parasitology (protozoa, helminths
(nematodes, cestodes, trematodes), ectoparasites), antimicrobial pharmacology (beta-lactams,
aminoglycosides, tetracyclines, macrolides, quinolones, sulfonamides, metronidazole,
antifungals, antivirals, antiparasitics, mechanisms of resistance), immunology (innate vs.
adaptive immunity, humoral vs. cell-mediated immunity, B cells, T cells (CD4+, CD8+), antigen
, Page 2 of 100
presentation (MHC class I/II), complement (classical, lectin, alternative pathways, deficiencies),
cytokines, chemokines, hypersensitivity reactions (Type I-IV), autoimmunity, immunodeficiency
disorders (primary (e.g., SCID, DiGeorge, CVID) and secondary (HIV/AIDS)), transplantation (HLA
matching, rejection (hyperacute, acute, chronic)), and vaccines.
Pathology & Pathophysiology – cellular injury and adaptation (atrophy, hypertrophy,
hyperplasia, metaplasia, dysplasia, necrosis (coagulative, liquefactive, caseous, fat, fibrinoid,
gangrenous), apoptosis); inflammation (acute (vasodilation, increased permeability, neutrophil
emigration, chemical mediators (histamine, prostaglandins, leukotrienes, cytokines,
complement), chronic inflammation (macrophages, lymphocytes, plasma cells, granuloma
formation, fibrosis)); hemodynamic disorders (edema, hyperemia, congestion, hemorrhage,
thrombosis (Virchow’s triad), embolism (thromboembolism, fat, air, amniotic fluid, septic),
infarction (red vs. white), shock (hypovolemic, cardiogenic, distributive (septic, anaphylactic,
neurogenic), obstructive)); neoplasia (benign vs. malignant, differentiation, anaplasia,
metastasis, carcinogenesis (initiation, promotion, progression, oncogenes, tumor suppressor
genes (p53, Rb, APC, BRCA1/2), DNA repair genes, telomeres, viral oncogenesis,
chemical/physical carcinogens, hereditary cancer syndromes)); pathophysiology of organ
systems (cardiovascular (atherosclerosis, hypertension, myocardial infarction, heart failure,
valvular diseases, cardiomyopathies, pericarditis, endocarditis), pulmonary (COPD, asthma,
restrictive lung disease, pneumonia, pulmonary embolism, ARDS, interstitial lung disease), renal
(acute kidney injury (prerenal, intrarenal, postrenal.
Pharmacology – pharmacokinetics (absorption, distribution, metabolism (CYP450), excretion,
half-life, volume of distribution, clearance), pharmacodynamics (receptor theory (agonists,
partial agonists, antagonists, inverse agonists), dose-response curves (potency, efficacy,
therapeutic index, ED50, TD50, LD50), drug antagonism, drug interactions), autonomic
pharmacology (cholinergic agonists/antagonists, adrenergic agonists/antagonists,
neuromuscular blockers), CNS pharmacology (anxiolytics/hypnotics (benzodiazepines,
barbiturates, z-drugs), antidepressants (SSRIs, SNRIs, TCAs, MAOIs, atypicals), antipsychotics
(typical, atypical), mood stabilizers (lithium, valproate, carbamazepine, lamotrigine),
antiepileptics (phenytoin, carbamazepine, valproate, levetiracetam, lamotrigine, phenobarbital,
ethosuximide, benzodiazepines), opioids (agonists (morphine, fentanyl, methadone, codeine),
antagonists (naloxone, naltrexone)), general anesthetics (inhaled (halothane, isoflurane,
sevoflurane), IV (propofol, etomidate, ketamine, thiopental)), local anesthetics (esters (procaine,
tetracaine, cocaine), amides (lidocaine, bupivacaine), vasoconstrictors (epinephrine)),
anti-Parkinson drugs (levodopa/carbidopa, dopamine agonists, MAO-B inhibitors, COMT
inhibitors, amantadine, anticholinergics)), cardiovascular pharmacology (antiarrhythmics (Class
I-IV), antihypertensives (ACE inhibitors, ARBs, calcium channel blockers, beta-blockers,
alpha-blockers, diuretics (thiazide, loop, potassium-sparing), vasodilators (hydralazine,
minoxidil, nitrates)), anticoagulants (heparin, low molecular weight heparin, warfarin, direct
thrombin inhibitors, factor Xa inhibitors), antiplatelets (aspirin, clopidogrel, prasugrel, ticagrelor,
dipyridamole, eptifibatide), thrombolytics (tPA, streptokinase)), endocrine pharmacology
(insulin and oral hypoglycemics (sulfonylureas, metformin, thiazolidinediones, GLP-1 agonists,
DPP-4 inhibitors.
, Page 3 of 100
Osteopathic Principles and Practice (OPP) – somatic dysfunction (TART criteria (Tenderness,
Asymmetry, Range of motion abnormality, Tissue texture changes)), musculoskeletal
examination and diagnosis (positioning, landmarks, motion testing, Chapman’s reflexes
(viscerosomatic reflexes), viscerosomatic reflexes, facilitated segment, myofascial release,
counterstrain, muscle energy, high velocity low amplitude (HVLA), osteopathic manipulative
treatment (OMT) for somatic dysfunction and visceral conditions, cranial osteopathy
(controversial, not always emphasized on COMLEX), lymphatic techniques (thoracic inlet, pedal
pump, splenic pump), ligamentous articular strain, functional technique, still technique,
balanced ligamentous tension, articulatory technique, and integration of OMT with
conventional medical management.
Biostatistics & Epidemiology – study designs (cross-sectional, case-control, cohort, randomized
controlled trial, meta-analysis), bias (selection, recall, measurement, observer, lead time, length
time, publication), confounding, effect modification, measures of disease frequency (incidence,
prevalence, mortality, case fatality), measures of association (relative risk, odds ratio,
attributable risk, number needed to treat/harm), diagnostic testing (sensitivity, specificity,
positive predictive value (PPV)screening (lead time bias, length time bias, overdiagnosis),
research ethics (informed consent, IRB, conflict of interest, fraud), statistical inference
(hypothesis testing (null vs. alternative hypothesis, p-values, alpha (type I error), beta (type II
error), power, confidence intervals), parametric vs. non-parametric tests (t-test, ANOVA,
chi-square, Fisher’s exact, Mann-Whitney U, Wilcoxon signed-rank, Kruskal-Wallis), correlation
(Pearson, Spearman), regression (linear, logistic), survival analysis (Kaplan-Meier, log-rank test,
Cox proportional hazards)), epidemiology of infectious diseases (transmission (direct, indirect,
airborne, droplet, vector-borne, fomite), incubation period, communicability period, herd
immunity, outbreak investigation (descriptive (person, place, time), analytic (cohort,
case-control), interventions)), public health and preventive medicine (levels of prevention
(primary, secondary, tertiary), screening recommendations (USPSTF), immunizations,
environmental health (air, water, food, occupational hazards), global health, health disparities,
quality improvement (PDSA, root cause analysis)).
200 Randomized, Scenario-Based MCQs for COMSAE Phase 1 Form 115
1. A 28-year-old woman presents with a several-day history of fever, chills, and a productive
cough with greenish sputum. A chest X-ray shows a dense consolidation in the right lower lobe
with air bronchograms. The most likely causative organism is most effectively treated by which
of the following antibiotic classes?
A) Penicillins (e.g., amoxicillin) or macrolides/fluoroquinolones (depending on local resistance
patterns)
, Page 4 of 100
B) Tetracyclines
C) Aminoglycosides
D) Vancomycin
Answer: A
RATIONALE: Community-acquired pneumonia (CAP) with lobar consolidation is often caused
by Streptococcus pneumoniae, which is generally treated with beta-lactams, macrolides, or
respiratory fluoroquinolones.
2. A newborn with respiratory distress and a history of polyhydramnios has a chest X-ray
showing a radiolucent, hyperexpanded left upper lobe with mediastinal shift to the right. Which
embryologic malformation is most likely?
A) Congenital diaphragmatic hernia (Bochdalek)
B) Congenital cystic adenomatoid malformation (CCAM)
C) Congenital lobar emphysema
D) Pulmonary sequestration
Answer: C
RATIONALE: Congenital lobar emphysema presents with overinflation of a lobe (often left
upper) due to bronchial cartilage abnormality or external compression, causing respiratory
distress and mediastinal shift.
3. A 65-year-old man with a history of hypertension and diabetes presents with acute onset of
left-sided weakness and facial droop. A non-contrast head CT shows no acute hemorrhage.
Symptoms began 2 hours ago. Which intervention is most urgent?
COMSAE Phase 1 Form 115 EXAM QUESTIONS AND CORRECT
VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR – JUST
RELEASED
Exam Coverage – COMSAE Phase 1 Form 115 (Latest)
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment Examination) Phase 1 is
designed to assess a student’s readiness for the COMLEX-USA Level 1. This form (115) reflects
the most current blueprint, emphasizing foundational biomedical sciences and osteopathic
principles. Key content domains include:
Human Anatomy – gross anatomy (upper/lower extremity, thorax, abdomen, pelvis, perineum,
head/neck, back, vertebral column), histology (tissue identification, organ systems), embryology
(development, congenital anomalies, germ layers, neural crest, pharyngeal arches, teratogens),
and medical imaging (radiographs, CT, MRI, ultrasound).
Biochemistry & Medical Genetics – metabolic pathways (glycolysis, TCA cycle, oxidative
phosphorylation, gluconeogenesis, glycogen metabolism, pentose phosphate pathway, fatty
acid oxidation, ketogenesis, cholesterol synthesis, urea cycle, amino acid metabolism); enzyme
kinetics (Michaelis-Menten, Lineweaver-Burk, inhibitors (competitive, non-competitive,
uncompetitive)); hormonal regulation (insulin/glucagon, cortisol, thyroid, catecholamines,
growth hormone); molecular biology (DNA replication, transcription, translation, repair,
mutations, epigenetics); genetics (Mendelian inheritance (autosomal dominant/recessive,
X-linked dominant/recessive, Y-linked, mitochondrial), chromosomal abnormalities (aneuploidy,
translocations, deletions, duplications), epigenetics (imprinting, X-inactivation), genetic testing
(PCR, FISH, microarray, sequencing), population genetics (Hardy-Weinberg, carrier frequency));
and laboratory medicine (reference ranges, diagnostic sensitivity/specificity, predictive values,
likelihood ratios).
Microbiology & Immunology – bacteriology (gram-positive/gram-negative cocci/bacilli,
spirochetes, anaerobes, mycobacteria, atypical bacteria, cell wall deficient (Mycoplasma)),
virology (DNA/RNA viruses, enveloped/non-enveloped, retroviruses, viral hepatitis,
herpesviruses, respiratory viruses, enteroviruses, arboviruses, oncogenic viruses), mycology
(systemic, subcutaneous, cutaneous, opportunistic fungi), parasitology (protozoa, helminths
(nematodes, cestodes, trematodes), ectoparasites), antimicrobial pharmacology (beta-lactams,
aminoglycosides, tetracyclines, macrolides, quinolones, sulfonamides, metronidazole,
antifungals, antivirals, antiparasitics, mechanisms of resistance), immunology (innate vs.
adaptive immunity, humoral vs. cell-mediated immunity, B cells, T cells (CD4+, CD8+), antigen
, Page 2 of 100
presentation (MHC class I/II), complement (classical, lectin, alternative pathways, deficiencies),
cytokines, chemokines, hypersensitivity reactions (Type I-IV), autoimmunity, immunodeficiency
disorders (primary (e.g., SCID, DiGeorge, CVID) and secondary (HIV/AIDS)), transplantation (HLA
matching, rejection (hyperacute, acute, chronic)), and vaccines.
Pathology & Pathophysiology – cellular injury and adaptation (atrophy, hypertrophy,
hyperplasia, metaplasia, dysplasia, necrosis (coagulative, liquefactive, caseous, fat, fibrinoid,
gangrenous), apoptosis); inflammation (acute (vasodilation, increased permeability, neutrophil
emigration, chemical mediators (histamine, prostaglandins, leukotrienes, cytokines,
complement), chronic inflammation (macrophages, lymphocytes, plasma cells, granuloma
formation, fibrosis)); hemodynamic disorders (edema, hyperemia, congestion, hemorrhage,
thrombosis (Virchow’s triad), embolism (thromboembolism, fat, air, amniotic fluid, septic),
infarction (red vs. white), shock (hypovolemic, cardiogenic, distributive (septic, anaphylactic,
neurogenic), obstructive)); neoplasia (benign vs. malignant, differentiation, anaplasia,
metastasis, carcinogenesis (initiation, promotion, progression, oncogenes, tumor suppressor
genes (p53, Rb, APC, BRCA1/2), DNA repair genes, telomeres, viral oncogenesis,
chemical/physical carcinogens, hereditary cancer syndromes)); pathophysiology of organ
systems (cardiovascular (atherosclerosis, hypertension, myocardial infarction, heart failure,
valvular diseases, cardiomyopathies, pericarditis, endocarditis), pulmonary (COPD, asthma,
restrictive lung disease, pneumonia, pulmonary embolism, ARDS, interstitial lung disease), renal
(acute kidney injury (prerenal, intrarenal, postrenal.
Pharmacology – pharmacokinetics (absorption, distribution, metabolism (CYP450), excretion,
half-life, volume of distribution, clearance), pharmacodynamics (receptor theory (agonists,
partial agonists, antagonists, inverse agonists), dose-response curves (potency, efficacy,
therapeutic index, ED50, TD50, LD50), drug antagonism, drug interactions), autonomic
pharmacology (cholinergic agonists/antagonists, adrenergic agonists/antagonists,
neuromuscular blockers), CNS pharmacology (anxiolytics/hypnotics (benzodiazepines,
barbiturates, z-drugs), antidepressants (SSRIs, SNRIs, TCAs, MAOIs, atypicals), antipsychotics
(typical, atypical), mood stabilizers (lithium, valproate, carbamazepine, lamotrigine),
antiepileptics (phenytoin, carbamazepine, valproate, levetiracetam, lamotrigine, phenobarbital,
ethosuximide, benzodiazepines), opioids (agonists (morphine, fentanyl, methadone, codeine),
antagonists (naloxone, naltrexone)), general anesthetics (inhaled (halothane, isoflurane,
sevoflurane), IV (propofol, etomidate, ketamine, thiopental)), local anesthetics (esters (procaine,
tetracaine, cocaine), amides (lidocaine, bupivacaine), vasoconstrictors (epinephrine)),
anti-Parkinson drugs (levodopa/carbidopa, dopamine agonists, MAO-B inhibitors, COMT
inhibitors, amantadine, anticholinergics)), cardiovascular pharmacology (antiarrhythmics (Class
I-IV), antihypertensives (ACE inhibitors, ARBs, calcium channel blockers, beta-blockers,
alpha-blockers, diuretics (thiazide, loop, potassium-sparing), vasodilators (hydralazine,
minoxidil, nitrates)), anticoagulants (heparin, low molecular weight heparin, warfarin, direct
thrombin inhibitors, factor Xa inhibitors), antiplatelets (aspirin, clopidogrel, prasugrel, ticagrelor,
dipyridamole, eptifibatide), thrombolytics (tPA, streptokinase)), endocrine pharmacology
(insulin and oral hypoglycemics (sulfonylureas, metformin, thiazolidinediones, GLP-1 agonists,
DPP-4 inhibitors.
, Page 3 of 100
Osteopathic Principles and Practice (OPP) – somatic dysfunction (TART criteria (Tenderness,
Asymmetry, Range of motion abnormality, Tissue texture changes)), musculoskeletal
examination and diagnosis (positioning, landmarks, motion testing, Chapman’s reflexes
(viscerosomatic reflexes), viscerosomatic reflexes, facilitated segment, myofascial release,
counterstrain, muscle energy, high velocity low amplitude (HVLA), osteopathic manipulative
treatment (OMT) for somatic dysfunction and visceral conditions, cranial osteopathy
(controversial, not always emphasized on COMLEX), lymphatic techniques (thoracic inlet, pedal
pump, splenic pump), ligamentous articular strain, functional technique, still technique,
balanced ligamentous tension, articulatory technique, and integration of OMT with
conventional medical management.
Biostatistics & Epidemiology – study designs (cross-sectional, case-control, cohort, randomized
controlled trial, meta-analysis), bias (selection, recall, measurement, observer, lead time, length
time, publication), confounding, effect modification, measures of disease frequency (incidence,
prevalence, mortality, case fatality), measures of association (relative risk, odds ratio,
attributable risk, number needed to treat/harm), diagnostic testing (sensitivity, specificity,
positive predictive value (PPV)screening (lead time bias, length time bias, overdiagnosis),
research ethics (informed consent, IRB, conflict of interest, fraud), statistical inference
(hypothesis testing (null vs. alternative hypothesis, p-values, alpha (type I error), beta (type II
error), power, confidence intervals), parametric vs. non-parametric tests (t-test, ANOVA,
chi-square, Fisher’s exact, Mann-Whitney U, Wilcoxon signed-rank, Kruskal-Wallis), correlation
(Pearson, Spearman), regression (linear, logistic), survival analysis (Kaplan-Meier, log-rank test,
Cox proportional hazards)), epidemiology of infectious diseases (transmission (direct, indirect,
airborne, droplet, vector-borne, fomite), incubation period, communicability period, herd
immunity, outbreak investigation (descriptive (person, place, time), analytic (cohort,
case-control), interventions)), public health and preventive medicine (levels of prevention
(primary, secondary, tertiary), screening recommendations (USPSTF), immunizations,
environmental health (air, water, food, occupational hazards), global health, health disparities,
quality improvement (PDSA, root cause analysis)).
200 Randomized, Scenario-Based MCQs for COMSAE Phase 1 Form 115
1. A 28-year-old woman presents with a several-day history of fever, chills, and a productive
cough with greenish sputum. A chest X-ray shows a dense consolidation in the right lower lobe
with air bronchograms. The most likely causative organism is most effectively treated by which
of the following antibiotic classes?
A) Penicillins (e.g., amoxicillin) or macrolides/fluoroquinolones (depending on local resistance
patterns)
, Page 4 of 100
B) Tetracyclines
C) Aminoglycosides
D) Vancomycin
Answer: A
RATIONALE: Community-acquired pneumonia (CAP) with lobar consolidation is often caused
by Streptococcus pneumoniae, which is generally treated with beta-lactams, macrolides, or
respiratory fluoroquinolones.
2. A newborn with respiratory distress and a history of polyhydramnios has a chest X-ray
showing a radiolucent, hyperexpanded left upper lobe with mediastinal shift to the right. Which
embryologic malformation is most likely?
A) Congenital diaphragmatic hernia (Bochdalek)
B) Congenital cystic adenomatoid malformation (CCAM)
C) Congenital lobar emphysema
D) Pulmonary sequestration
Answer: C
RATIONALE: Congenital lobar emphysema presents with overinflation of a lobe (often left
upper) due to bronchial cartilage abnormality or external compression, causing respiratory
distress and mediastinal shift.
3. A 65-year-old man with a history of hypertension and diabetes presents with acute onset of
left-sided weakness and facial droop. A non-contrast head CT shows no acute hemorrhage.
Symptoms began 2 hours ago. Which intervention is most urgent?
