COMSAE Form ASA 110i Osteopathic
Medical Comprehensive Practice Exam
with Verified Questions, Detailed
Answers a 2026 editon
1. A 68-year-old man presents with crushing substernal
chest pain radiating to his left arm. ECG demonstrates ST-
segment elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Diagonal branch
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions produce ST-
segment elevations in leads II, III, and aVF. The right
coronary artery supplies the inferior wall in the majority of
individuals. Occlusion commonly causes inferior STEMI and
may also result in bradyarrhythmias due to SA or AV nodal
ischemia.
,2. A patient with chronic alcohol use develops confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is
responsible?
A. Vitamin B12
B. Niacin
C. Folate
D. Thiamine
E. Pyridoxine
Answer: D. Thiamine
Rationale: Wernicke encephalopathy is characterized by the
triad of confusion, ophthalmoplegia, and ataxia. It results
from thiamine deficiency, most commonly in patients with
alcohol use disorder. Immediate thiamine administration is
required before glucose to prevent worsening neurologic
injury.
3. Which cranial nerve innervates the lateral rectus muscle?
A. CN III
B. CN IV
C. CN V1
D. CN VI
E. CN VII
Answer: D. CN VI
Rationale: The abducens nerve (CN VI) innervates the lateral
rectus muscle, which abducts the eye. Injury results in
inability to move the eye laterally and horizontal diplopia.
,4. A patient presents with fever, productive cough, and rust-
colored sputum. Which organism is the most likely cause?
A. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
C. Legionella pneumophila
D. Chlamydia pneumoniae
E. Klebsiella pneumoniae
Answer: B. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is the most common
cause of community-acquired pneumonia. Classic findings
include fever, productive cough, lobar consolidation, and
rust-colored sputum due to blood-stained secretions.
5. Which electrolyte abnormality is most commonly
associated with flattened T waves and U waves on ECG?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hyponatremia
E. Hypermagnesemia
Answer: C. Hypokalemia
Rationale: Hypokalemia causes flattened T waves, ST
depression, and prominent U waves. Severe hypokalemia
increases risk of ventricular arrhythmias and muscle
weakness.
, 6. A 25-year-old woman develops heat intolerance, weight
loss, and palpitations. Laboratory testing shows suppressed
TSH and elevated free T4. What is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
E. Pituitary adenoma
Answer: B. Graves disease
Rationale: Graves disease is the most common cause of
hyperthyroidism in young women. Autoantibodies stimulate
the TSH receptor, causing increased thyroid hormone
production. Ophthalmopathy and pretibial myxedema are
characteristic findings.
7. Which acid-base disorder is expected in a patient with
prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
E. Mixed acidosis
Answer: D. Metabolic alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid,
leading to increased serum bicarbonate and metabolic
Medical Comprehensive Practice Exam
with Verified Questions, Detailed
Answers a 2026 editon
1. A 68-year-old man presents with crushing substernal
chest pain radiating to his left arm. ECG demonstrates ST-
segment elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
E. Diagonal branch
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions produce ST-
segment elevations in leads II, III, and aVF. The right
coronary artery supplies the inferior wall in the majority of
individuals. Occlusion commonly causes inferior STEMI and
may also result in bradyarrhythmias due to SA or AV nodal
ischemia.
,2. A patient with chronic alcohol use develops confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is
responsible?
A. Vitamin B12
B. Niacin
C. Folate
D. Thiamine
E. Pyridoxine
Answer: D. Thiamine
Rationale: Wernicke encephalopathy is characterized by the
triad of confusion, ophthalmoplegia, and ataxia. It results
from thiamine deficiency, most commonly in patients with
alcohol use disorder. Immediate thiamine administration is
required before glucose to prevent worsening neurologic
injury.
3. Which cranial nerve innervates the lateral rectus muscle?
A. CN III
B. CN IV
C. CN V1
D. CN VI
E. CN VII
Answer: D. CN VI
Rationale: The abducens nerve (CN VI) innervates the lateral
rectus muscle, which abducts the eye. Injury results in
inability to move the eye laterally and horizontal diplopia.
,4. A patient presents with fever, productive cough, and rust-
colored sputum. Which organism is the most likely cause?
A. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
C. Legionella pneumophila
D. Chlamydia pneumoniae
E. Klebsiella pneumoniae
Answer: B. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is the most common
cause of community-acquired pneumonia. Classic findings
include fever, productive cough, lobar consolidation, and
rust-colored sputum due to blood-stained secretions.
5. Which electrolyte abnormality is most commonly
associated with flattened T waves and U waves on ECG?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hyponatremia
E. Hypermagnesemia
Answer: C. Hypokalemia
Rationale: Hypokalemia causes flattened T waves, ST
depression, and prominent U waves. Severe hypokalemia
increases risk of ventricular arrhythmias and muscle
weakness.
, 6. A 25-year-old woman develops heat intolerance, weight
loss, and palpitations. Laboratory testing shows suppressed
TSH and elevated free T4. What is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
E. Pituitary adenoma
Answer: B. Graves disease
Rationale: Graves disease is the most common cause of
hyperthyroidism in young women. Autoantibodies stimulate
the TSH receptor, causing increased thyroid hormone
production. Ophthalmopathy and pretibial myxedema are
characteristic findings.
7. Which acid-base disorder is expected in a patient with
prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
E. Mixed acidosis
Answer: D. Metabolic alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid,
leading to increased serum bicarbonate and metabolic
