COMSAE Phase 1 – Form ASA 116 (Non-
Secure Browser Format for Self-Pacing) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
Question 1
A 25-year-old man develops fever, headache, and a petechial
rash. Cerebrospinal fluid demonstrates gram-negative
diplococci. Which virulence factor allows this organism to
evade phagocytosis?
A. Endospore formation
B. Lipoteichoic acid
C. M protein
D. Polysaccharide capsule
E. Protein A
Answer: D. Polysaccharide capsule
The polysaccharide capsule of Neisseria meningitidis inhibits
phagocytosis and is a major virulence factor. M protein is
associated with Streptococcus pyogenes, while Protein A is
produced by Staphylococcus aureus.
Question 2
,A patient presents with fatigue and pallor. Laboratory studies
reveal a mean corpuscular volume of 70 fL. Which condition
is most likely responsible?
A. Folate deficiency
B. Vitamin B12 deficiency
C. Iron deficiency anemia
D. Liver disease
E. Alcoholism
Answer: C. Iron deficiency anemia
Iron deficiency anemia classically produces a microcytic,
hypochromic anemia. Folate deficiency, B12 deficiency, liver
disease, and alcoholism typically result in macrocytic anemia.
Question 3
A researcher observes a hormone that increases blood
glucose levels by stimulating glycogen breakdown. Which
hormone is responsible?
A. Insulin
B. Cortisol
C. Growth hormone
D. Epinephrine
E. Glucagon
Answer: E. Glucagon
Glucagon acts primarily on the liver to stimulate
glycogenolysis and gluconeogenesis, increasing blood glucose
concentrations during fasting.
,Question 4
A patient develops weakness after a lesion affecting the
lateral corticospinal tract. Which finding is expected?
A. Flaccid paralysis
B. Fasciculations
C. Hyporeflexia
D. Hyperreflexia
E. Muscle atrophy early in disease
Answer: D. Hyperreflexia
Upper motor neuron lesions produce hyperreflexia, spasticity,
and increased muscle tone. Fasciculations and marked
atrophy are lower motor neuron findings.
Question 5
A newborn exhibits cyanosis that improves with crying.
Examination reveals choanal atresia. Failure of which
embryologic structure caused this defect?
A. First pharyngeal pouch
B. Third pharyngeal pouch
C. Buccopharyngeal membrane
D. Oronasal membrane
E. Neural tube
Answer: D. Oronasal membrane
, Persistence of the oronasal membrane prevents
communication between the nasal cavity and nasopharynx,
resulting in choanal atresia.
Question 6
A patient has elevated serum calcium and elevated
parathyroid hormone levels. Which diagnosis is most likely?
A. Vitamin D deficiency
B. Hypoparathyroidism
C. Secondary hyperparathyroidism
D. Primary hyperparathyroidism
E. Osteomalacia
Answer: D. Primary hyperparathyroidism
Primary hyperparathyroidism causes excessive PTH secretion,
resulting in hypercalcemia through increased bone resorption
and renal calcium reabsorption.
Question 7
A woman develops autoimmune destruction of thyroid tissue.
Which histologic finding is most characteristic?
A. Reed-Sternberg cells
B. Caseating granulomas
C. Psammoma bodies
D. Aschoff bodies
E. Hürthle cells
Secure Browser Format for Self-Pacing) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
Question 1
A 25-year-old man develops fever, headache, and a petechial
rash. Cerebrospinal fluid demonstrates gram-negative
diplococci. Which virulence factor allows this organism to
evade phagocytosis?
A. Endospore formation
B. Lipoteichoic acid
C. M protein
D. Polysaccharide capsule
E. Protein A
Answer: D. Polysaccharide capsule
The polysaccharide capsule of Neisseria meningitidis inhibits
phagocytosis and is a major virulence factor. M protein is
associated with Streptococcus pyogenes, while Protein A is
produced by Staphylococcus aureus.
Question 2
,A patient presents with fatigue and pallor. Laboratory studies
reveal a mean corpuscular volume of 70 fL. Which condition
is most likely responsible?
A. Folate deficiency
B. Vitamin B12 deficiency
C. Iron deficiency anemia
D. Liver disease
E. Alcoholism
Answer: C. Iron deficiency anemia
Iron deficiency anemia classically produces a microcytic,
hypochromic anemia. Folate deficiency, B12 deficiency, liver
disease, and alcoholism typically result in macrocytic anemia.
Question 3
A researcher observes a hormone that increases blood
glucose levels by stimulating glycogen breakdown. Which
hormone is responsible?
A. Insulin
B. Cortisol
C. Growth hormone
D. Epinephrine
E. Glucagon
Answer: E. Glucagon
Glucagon acts primarily on the liver to stimulate
glycogenolysis and gluconeogenesis, increasing blood glucose
concentrations during fasting.
,Question 4
A patient develops weakness after a lesion affecting the
lateral corticospinal tract. Which finding is expected?
A. Flaccid paralysis
B. Fasciculations
C. Hyporeflexia
D. Hyperreflexia
E. Muscle atrophy early in disease
Answer: D. Hyperreflexia
Upper motor neuron lesions produce hyperreflexia, spasticity,
and increased muscle tone. Fasciculations and marked
atrophy are lower motor neuron findings.
Question 5
A newborn exhibits cyanosis that improves with crying.
Examination reveals choanal atresia. Failure of which
embryologic structure caused this defect?
A. First pharyngeal pouch
B. Third pharyngeal pouch
C. Buccopharyngeal membrane
D. Oronasal membrane
E. Neural tube
Answer: D. Oronasal membrane
, Persistence of the oronasal membrane prevents
communication between the nasal cavity and nasopharynx,
resulting in choanal atresia.
Question 6
A patient has elevated serum calcium and elevated
parathyroid hormone levels. Which diagnosis is most likely?
A. Vitamin D deficiency
B. Hypoparathyroidism
C. Secondary hyperparathyroidism
D. Primary hyperparathyroidism
E. Osteomalacia
Answer: D. Primary hyperparathyroidism
Primary hyperparathyroidism causes excessive PTH secretion,
resulting in hypercalcemia through increased bone resorption
and renal calcium reabsorption.
Question 7
A woman develops autoimmune destruction of thyroid tissue.
Which histologic finding is most characteristic?
A. Reed-Sternberg cells
B. Caseating granulomas
C. Psammoma bodies
D. Aschoff bodies
E. Hürthle cells
