COMSAE EXAM REVIEW 2026/2027 – 150
COMPLETE PRACTICE QUESTIONS WITH
CORRECT VERIFIED ANSWERS WITH
CLEASR EXPLANATIONS FOR LEVEL 1, 2,
AND 3 COVERING THE RECENT TESTED
QUESTIONS
EXAM STRUCTURE OVERVIEW
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment
Examination) is administered by the NBOME and mirrors the COMLEX-
USA blueprint across all three levels. This review covers:
Level Focus Area Questions
Basic sciences, osteopathic principles, foundational
Level 1 Questions 1-50
knowledge
Level 2- Clinical knowledge, diagnosis, management, Questions 51-
CE OMM/OPP 100
Advanced clinical reasoning, patient management, Questions 101-
Level 3
synthesis 150
,LEVEL 1 — FOUNDATIONAL & BASIC SCIENCES
Questions 1-50
Question 1
A 45-year-old male presents with acute low back pain after lifting a
heavy object. He reports the pain radiates down the posterior aspect of
his right leg. On examination, straight leg raise is positive at 30 degrees
on the right. Which nerve root is most likely affected?
A. L3
B. L4
C. L5
D. S1
Correct Answer: D — S1
Rationale: S1 radiculopathy typically causes pain radiating down the
posterior leg to the lateral foot. Straight leg raise positive at less than 60
degrees suggests nerve root irritation. S1 involvement is associated with
decreased ankle reflex and weakness in plantar flexion.
Question 2
A 28-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory studies reveal elevated TSH
and low free T4. Which of the following is the most likely diagnosis?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Subacute thyroiditis
D. Pituitary adenoma
,Correct Answer: B — Hashimoto's thyroiditis
Rationale: The clinical presentation (fatigue, weight gain, cold
intolerance) with elevated TSH and low free T4 indicates primary
hypothyroidism. Hashimoto's thyroiditis is the most common cause of
hypothyroidism in the United States and is an autoimmune disorder
characterized by anti-thyroid peroxidase antibodies.
Question 3
A 62-year-old man with a 40-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. Chest X-ray shows a
right hilar mass. Which of the following is the most likely cell type?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Large cell carcinoma
Correct Answer: B — Squamous cell carcinoma
Rationale: Squamous cell carcinoma is strongly associated with smoking
and typically presents as a central/hilar mass. It is the most common
lung cancer in men and is strongly linked to tobacco exposure. It can
cavitate and is associated with hypercalcemia due to ectopic PTHrP
production.
Question 4
A patient with a history of alcohol use disorder is admitted with
confusion, ataxia, and ophthalmoplegia. Which vitamin deficiency is
, most likely responsible?
A. Vitamin B1 (Thiamine)
B. Vitamin B3 (Niacin)
C. Vitamin B6 (Pyridoxine)
D. Vitamin B12 (Cobalamin)
Correct Answer: A — Vitamin B1 (Thiamine)
Rationale: Wernicke encephalopathy presents with the triad of
confusion, ataxia, and ophthalmoplegia. It is caused by thiamine (vitamin
B1) deficiency, most commonly seen in patients with alcohol use
disorder. Immediate thiamine replacement is essential to prevent
progression to Korsakoff syndrome.
Question 5
A 55-year-old woman presents with progressive weakness in her
proximal muscles, difficulty rising from a chair, and a heliotrope rash on
her eyelids. Laboratory studies show elevated creatine kinase. Which of
the following is the most likely diagnosis?
A. Polymyositis
B. Dermatomyositis
C. Inclusion body myositis
D. Systemic lupus erythematosus
Correct Answer: B — Dermatomyositis
Rationale: Dermatomyositis is an inflammatory myopathy characterized
by proximal muscle weakness and characteristic skin findings, including
a heliotrope (purple) rash on the eyelids and Gottron's papules over the
knuckles. Elevated creatine kinase indicates muscle inflammation.
COMPLETE PRACTICE QUESTIONS WITH
CORRECT VERIFIED ANSWERS WITH
CLEASR EXPLANATIONS FOR LEVEL 1, 2,
AND 3 COVERING THE RECENT TESTED
QUESTIONS
EXAM STRUCTURE OVERVIEW
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment
Examination) is administered by the NBOME and mirrors the COMLEX-
USA blueprint across all three levels. This review covers:
Level Focus Area Questions
Basic sciences, osteopathic principles, foundational
Level 1 Questions 1-50
knowledge
Level 2- Clinical knowledge, diagnosis, management, Questions 51-
CE OMM/OPP 100
Advanced clinical reasoning, patient management, Questions 101-
Level 3
synthesis 150
,LEVEL 1 — FOUNDATIONAL & BASIC SCIENCES
Questions 1-50
Question 1
A 45-year-old male presents with acute low back pain after lifting a
heavy object. He reports the pain radiates down the posterior aspect of
his right leg. On examination, straight leg raise is positive at 30 degrees
on the right. Which nerve root is most likely affected?
A. L3
B. L4
C. L5
D. S1
Correct Answer: D — S1
Rationale: S1 radiculopathy typically causes pain radiating down the
posterior leg to the lateral foot. Straight leg raise positive at less than 60
degrees suggests nerve root irritation. S1 involvement is associated with
decreased ankle reflex and weakness in plantar flexion.
Question 2
A 28-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory studies reveal elevated TSH
and low free T4. Which of the following is the most likely diagnosis?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Subacute thyroiditis
D. Pituitary adenoma
,Correct Answer: B — Hashimoto's thyroiditis
Rationale: The clinical presentation (fatigue, weight gain, cold
intolerance) with elevated TSH and low free T4 indicates primary
hypothyroidism. Hashimoto's thyroiditis is the most common cause of
hypothyroidism in the United States and is an autoimmune disorder
characterized by anti-thyroid peroxidase antibodies.
Question 3
A 62-year-old man with a 40-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. Chest X-ray shows a
right hilar mass. Which of the following is the most likely cell type?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Large cell carcinoma
Correct Answer: B — Squamous cell carcinoma
Rationale: Squamous cell carcinoma is strongly associated with smoking
and typically presents as a central/hilar mass. It is the most common
lung cancer in men and is strongly linked to tobacco exposure. It can
cavitate and is associated with hypercalcemia due to ectopic PTHrP
production.
Question 4
A patient with a history of alcohol use disorder is admitted with
confusion, ataxia, and ophthalmoplegia. Which vitamin deficiency is
, most likely responsible?
A. Vitamin B1 (Thiamine)
B. Vitamin B3 (Niacin)
C. Vitamin B6 (Pyridoxine)
D. Vitamin B12 (Cobalamin)
Correct Answer: A — Vitamin B1 (Thiamine)
Rationale: Wernicke encephalopathy presents with the triad of
confusion, ataxia, and ophthalmoplegia. It is caused by thiamine (vitamin
B1) deficiency, most commonly seen in patients with alcohol use
disorder. Immediate thiamine replacement is essential to prevent
progression to Korsakoff syndrome.
Question 5
A 55-year-old woman presents with progressive weakness in her
proximal muscles, difficulty rising from a chair, and a heliotrope rash on
her eyelids. Laboratory studies show elevated creatine kinase. Which of
the following is the most likely diagnosis?
A. Polymyositis
B. Dermatomyositis
C. Inclusion body myositis
D. Systemic lupus erythematosus
Correct Answer: B — Dermatomyositis
Rationale: Dermatomyositis is an inflammatory myopathy characterized
by proximal muscle weakness and characteristic skin findings, including
a heliotrope (purple) rash on the eyelids and Gottron's papules over the
knuckles. Elevated creatine kinase indicates muscle inflammation.
