COMSAE PHASE 1 FORM 115 EXAM 2026/2027
| PRACTICE QUESTIONS & VERIFIED
ANSWERS
COMSAE PHASE 1 FORM 115 EXAM 2026/2027 | PRACTICE QUESTIONS &
VERIFIED ANSWERS
• This document contains 200 rigorously verified practice questions designed to
simulate actual COMSAE Phase 1 Form 115 examination format and difficulty,
providing comprehensive self-assessment across all major clinical and basic science
domains.
• Study this material by completing questions in sections, reviewing detailed
rationales for both correct and incorrect options, and using areas of weakness to
guide targeted review of core concepts and principles.
1. A 45-year-old male presents with acute onset of substernal chest pain
radiating to the left arm. Which of the following is the most likely diagnosis?
A) Gastroesophageal reflux disease
B) Musculoskeletal chest wall pain
C) Acute myocardial infarction
D) Pulmonary embolism
E) Aortic dissection
CORRECT ANSWER: C) Acute myocardial infarction ✓
The clinical presentation of substernal chest pain radiating to the left arm with
acute onset is classic for acute myocardial infarction. The radiation to the arm
(brachialgia) and the substernal location are hallmark features of coronary artery
insufficiency. While other conditions like aortic dissection and pulmonary embolism
can present with chest pain, the specific pattern of radiation to the left arm is most
characteristic of MI. GERD typically presents with burning quality and postprandial
onset, while musculoskeletal pain is reproducible with palpation.
,2. Which osteopathic technique is most appropriate for treating a somatic
dysfunction of the thoracic spine with restriction of extension?
A) High-velocity low-amplitude thrust (HVLAT) in the direction of the restriction
B) Soft tissue mobilization away from the restriction
C) High-velocity low-amplitude thrust (HVLAT) in the direction opposite to the
restriction
D) Isometric contraction in the direction of ease
E) Gentle oscillations within the painful arc
CORRECT ANSWER: C) High-velocity low-amplitude thrust (HVLAT) in the
direction opposite to the restriction ✓
In osteopathic manipulative treatment, when addressing a somatic dysfunction
with restriction of extension, the HVLAT should be applied in the direction opposite
to the restriction (toward extension in this case). This is the foundational principle
of direct technique application—moving the dysfunctional segment toward
freedom of motion. Option A is incorrect because thrusting into the restriction can
cause tissue damage. Options D and E describe indirect and mobilization
techniques which are less definitive for somatic dysfunction resolution.
3. A 22-year-old female presents with severe dysmenorrhea and pelvic pain.
Examination reveals fixed pelvic organs and nodular lesions in the cul-de-sac.
What is the most likely diagnosis?
A) Uterine fibroids
B) Endometriosis
C) Pelvic inflammatory disease
D) Ovarian cysts
E) Adenomyosis
CORRECT ANSWER: B) Endometriosis ✓
,Endometriosis is characterized by ectopic endometrial tissue with fixed pelvic
organs, nodular lesions (particularly in the cul-de-sac), severe dysmenorrhea, and
chronic pelvic pain. The nodular lesions and fixed organs are pathognomonic
findings. Adenomyosis causes dysmenorrhea but typically causes a boggy,
uniformly enlarged uterus rather than nodular lesions. Fibroids produce masses
but not typically nodular lesions in the cul-de-sac. PID causes acute pain but not the
chronic dysmenorrhea pattern seen here.
4. Which of the following represents the primary mechanism of action for ACE
inhibitors in hypertension management?
A) Beta-adrenergic receptor blockade
B) Inhibition of angiotensin II formation
C) Calcium channel antagonism
D) Direct vasodilation through nitric oxide release
E) Alpha-adrenergic receptor blockade
CORRECT ANSWER: B) Inhibition of angiotensin II formation ✓
ACE inhibitors work by blocking the angiotensin-converting enzyme, which prevents
the conversion of angiotensin I to angiotensin II. This reduces peripheral
vasoconstriction and aldosterone secretion, leading to decreased blood pressure.
This is their primary mechanism distinct from other antihypertensive classes. Beta-
blockers, calcium channel antagonists, direct vasodilators, and alpha-blockers work
through entirely different mechanisms.
5. A patient presents with a large left pleural effusion. Thoracentesis is
performed and the fluid analysis shows protein 3.2 g/dL, LDH 280 U/L, and
serum protein 6.0 g/dL. Which classification best describes this effusion?
A) Transudate
B) Exudate
, C) Hemothorax
D) Chylothorax
E) Empyema
CORRECT ANSWER: B) Exudate ✓
Using Light's criteria, an exudate is identified when: pleural fluid protein/serum
protein ratio >0.5, pleural LDH/serum LDH ratio >0.6, or pleural LDH >two-thirds
upper limit of normal serum LDH. In this case, the protein ratio is 3.2/6.0 = 0.53
(>0.5), confirming an exudate. Transudates have ratios <0.5 and are typically caused
by systemic conditions like CHF or cirrhosis, whereas exudates suggest localized
pathology such as infection, malignancy, or inflammation.
6. A 34-year-old male with type 1 diabetes presents with polyuria, polydipsia,
and altered mental status. Laboratory values show glucose 580 mg/dL, pH
7.22, and positive serum ketones. What is the primary acid-base disturbance?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Metabolic acidosis
D) Respiratory alkalosis
E) Mixed acidosis-alkalosis
CORRECT ANSWER: C) Metabolic acidosis ✓
Diabetic ketoacidosis (DKA) produces metabolic acidosis due to the accumulation of
ketoacids (beta-hydroxybutyrate and acetoacetate). The low pH (7.22), positive
serum ketones, and elevated glucose with glycosuria are diagnostic. While
respiratory compensatory mechanisms (Kussmaul breathing) may lower PaCO2
secondarily, the primary disturbance is metabolic acidosis from ketone
accumulation. The other options do not match this clinical scenario.
| PRACTICE QUESTIONS & VERIFIED
ANSWERS
COMSAE PHASE 1 FORM 115 EXAM 2026/2027 | PRACTICE QUESTIONS &
VERIFIED ANSWERS
• This document contains 200 rigorously verified practice questions designed to
simulate actual COMSAE Phase 1 Form 115 examination format and difficulty,
providing comprehensive self-assessment across all major clinical and basic science
domains.
• Study this material by completing questions in sections, reviewing detailed
rationales for both correct and incorrect options, and using areas of weakness to
guide targeted review of core concepts and principles.
1. A 45-year-old male presents with acute onset of substernal chest pain
radiating to the left arm. Which of the following is the most likely diagnosis?
A) Gastroesophageal reflux disease
B) Musculoskeletal chest wall pain
C) Acute myocardial infarction
D) Pulmonary embolism
E) Aortic dissection
CORRECT ANSWER: C) Acute myocardial infarction ✓
The clinical presentation of substernal chest pain radiating to the left arm with
acute onset is classic for acute myocardial infarction. The radiation to the arm
(brachialgia) and the substernal location are hallmark features of coronary artery
insufficiency. While other conditions like aortic dissection and pulmonary embolism
can present with chest pain, the specific pattern of radiation to the left arm is most
characteristic of MI. GERD typically presents with burning quality and postprandial
onset, while musculoskeletal pain is reproducible with palpation.
,2. Which osteopathic technique is most appropriate for treating a somatic
dysfunction of the thoracic spine with restriction of extension?
A) High-velocity low-amplitude thrust (HVLAT) in the direction of the restriction
B) Soft tissue mobilization away from the restriction
C) High-velocity low-amplitude thrust (HVLAT) in the direction opposite to the
restriction
D) Isometric contraction in the direction of ease
E) Gentle oscillations within the painful arc
CORRECT ANSWER: C) High-velocity low-amplitude thrust (HVLAT) in the
direction opposite to the restriction ✓
In osteopathic manipulative treatment, when addressing a somatic dysfunction
with restriction of extension, the HVLAT should be applied in the direction opposite
to the restriction (toward extension in this case). This is the foundational principle
of direct technique application—moving the dysfunctional segment toward
freedom of motion. Option A is incorrect because thrusting into the restriction can
cause tissue damage. Options D and E describe indirect and mobilization
techniques which are less definitive for somatic dysfunction resolution.
3. A 22-year-old female presents with severe dysmenorrhea and pelvic pain.
Examination reveals fixed pelvic organs and nodular lesions in the cul-de-sac.
What is the most likely diagnosis?
A) Uterine fibroids
B) Endometriosis
C) Pelvic inflammatory disease
D) Ovarian cysts
E) Adenomyosis
CORRECT ANSWER: B) Endometriosis ✓
,Endometriosis is characterized by ectopic endometrial tissue with fixed pelvic
organs, nodular lesions (particularly in the cul-de-sac), severe dysmenorrhea, and
chronic pelvic pain. The nodular lesions and fixed organs are pathognomonic
findings. Adenomyosis causes dysmenorrhea but typically causes a boggy,
uniformly enlarged uterus rather than nodular lesions. Fibroids produce masses
but not typically nodular lesions in the cul-de-sac. PID causes acute pain but not the
chronic dysmenorrhea pattern seen here.
4. Which of the following represents the primary mechanism of action for ACE
inhibitors in hypertension management?
A) Beta-adrenergic receptor blockade
B) Inhibition of angiotensin II formation
C) Calcium channel antagonism
D) Direct vasodilation through nitric oxide release
E) Alpha-adrenergic receptor blockade
CORRECT ANSWER: B) Inhibition of angiotensin II formation ✓
ACE inhibitors work by blocking the angiotensin-converting enzyme, which prevents
the conversion of angiotensin I to angiotensin II. This reduces peripheral
vasoconstriction and aldosterone secretion, leading to decreased blood pressure.
This is their primary mechanism distinct from other antihypertensive classes. Beta-
blockers, calcium channel antagonists, direct vasodilators, and alpha-blockers work
through entirely different mechanisms.
5. A patient presents with a large left pleural effusion. Thoracentesis is
performed and the fluid analysis shows protein 3.2 g/dL, LDH 280 U/L, and
serum protein 6.0 g/dL. Which classification best describes this effusion?
A) Transudate
B) Exudate
, C) Hemothorax
D) Chylothorax
E) Empyema
CORRECT ANSWER: B) Exudate ✓
Using Light's criteria, an exudate is identified when: pleural fluid protein/serum
protein ratio >0.5, pleural LDH/serum LDH ratio >0.6, or pleural LDH >two-thirds
upper limit of normal serum LDH. In this case, the protein ratio is 3.2/6.0 = 0.53
(>0.5), confirming an exudate. Transudates have ratios <0.5 and are typically caused
by systemic conditions like CHF or cirrhosis, whereas exudates suggest localized
pathology such as infection, malignancy, or inflammation.
6. A 34-year-old male with type 1 diabetes presents with polyuria, polydipsia,
and altered mental status. Laboratory values show glucose 580 mg/dL, pH
7.22, and positive serum ketones. What is the primary acid-base disturbance?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Metabolic acidosis
D) Respiratory alkalosis
E) Mixed acidosis-alkalosis
CORRECT ANSWER: C) Metabolic acidosis ✓
Diabetic ketoacidosis (DKA) produces metabolic acidosis due to the accumulation of
ketoacids (beta-hydroxybutyrate and acetoacetate). The low pH (7.22), positive
serum ketones, and elevated glucose with glycosuria are diagnostic. While
respiratory compensatory mechanisms (Kussmaul breathing) may lower PaCO2
secondarily, the primary disturbance is metabolic acidosis from ketone
accumulation. The other options do not match this clinical scenario.
