1 | Page
COMSAE Phase 1 Form 113 Exam Questions
and Verified Answers 2026–2027 | COMLEX
Level 1 Osteopathic Medical Comprehensive
Assessment | Actual Form 113 Exam | Graded A+
| 100% Pass Guaranteed
Description: This comprehensive examination is designed for
osteopathic medical students preparing for the COMLEX Level 1 and
COMSAE Phase 1 assessment. The exam covers foundational
biomedical sciences, clinical presentations, osteopathic principles and
practice, and patient management scenarios essential for success on the
COMSAE Form 113. Questions reflect the integrated format of the
actual COMSAE examination, testing the application of basic science
knowledge to clinical situations, osteopathic manipulative treatment, and
clinical decision-making expected of a competent osteopathic medical
student.
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SECTION 1: QUESTIONS 1-50
Question 1
A 45-year-old male presents with progressive weakness in his lower
extremities, urinary incontinence, and a sensory level at T4. Which of
the following is the most appropriate initial imaging study?
A) Computed tomography (CT) of the spine without contrast
B) Magnetic resonance imaging (MRI) of the spine with and without
contrast
C) Plain radiographs of the spine
D) Myelography with CT
Verified Answer: B
Rationale: MRI with and without contrast is the imaging modality of
choice for suspected spinal cord compression or intramedullary
pathology. It provides excellent soft tissue visualization and can identify
lesions such as epidural abscess, tumor, or disc herniation. CT without
contrast provides limited soft tissue detail, plain radiographs lack
sensitivity for soft tissue pathology, and myelography with CT is
invasive and typically reserved for cases where MRI is contraindicated.
---
Question 2
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A 28-year-old female 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) Toxic multinodular goiter
Verified Answer: B
Rationale: Hashimoto's thyroiditis is the most common cause of
hypothyroidism in iodine-sufficient areas. It is an autoimmune disorder
characterized by elevated TSH and low free T4 levels. Graves' disease
and toxic multinodular goiter cause hyperthyroidism with low TSH and
elevated T4 levels. Subacute thyroiditis presents with a painful, tender
thyroid and often follows a viral illness.
---
Question 3
A 55-year-old male with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. Which of the following vitamin
deficiencies is most likely responsible for this presentation?
A) Vitamin B1 (Thiamine)
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B) Vitamin B3 (Niacin)
C) Vitamin B6 (Pyridoxine)
D) Vitamin B12
Verified Answer: A
Rationale: Wernicke's encephalopathy, characterized by the classic triad
of confusion, ataxia, and ophthalmoplegia, is caused by thiamine
(vitamin B1) deficiency. This condition is commonly seen in patients
with alcohol use disorder but can also occur in other states of
malnutrition. Prompt thiamine replacement is essential to prevent
progression to Korsakoff syndrome, a chronic neuropsychiatric
condition.
---
Question 4
A 60-year-old female presents with acute onset of severe headache,
photophobia, and neck stiffness. Lumbar puncture reveals elevated
opening pressure, high protein, low glucose, and numerous neutrophils.
Gram stain shows gram-negative diplococci. Which of the following
organisms is most likely responsible?
A) Streptococcus pneumoniae
B) Neisseria meningitidis
C) Listeria monocytogenes
COMSAE Phase 1 Form 113 Exam Questions
and Verified Answers 2026–2027 | COMLEX
Level 1 Osteopathic Medical Comprehensive
Assessment | Actual Form 113 Exam | Graded A+
| 100% Pass Guaranteed
Description: This comprehensive examination is designed for
osteopathic medical students preparing for the COMLEX Level 1 and
COMSAE Phase 1 assessment. The exam covers foundational
biomedical sciences, clinical presentations, osteopathic principles and
practice, and patient management scenarios essential for success on the
COMSAE Form 113. Questions reflect the integrated format of the
actual COMSAE examination, testing the application of basic science
knowledge to clinical situations, osteopathic manipulative treatment, and
clinical decision-making expected of a competent osteopathic medical
student.
,2 | Page
SECTION 1: QUESTIONS 1-50
Question 1
A 45-year-old male presents with progressive weakness in his lower
extremities, urinary incontinence, and a sensory level at T4. Which of
the following is the most appropriate initial imaging study?
A) Computed tomography (CT) of the spine without contrast
B) Magnetic resonance imaging (MRI) of the spine with and without
contrast
C) Plain radiographs of the spine
D) Myelography with CT
Verified Answer: B
Rationale: MRI with and without contrast is the imaging modality of
choice for suspected spinal cord compression or intramedullary
pathology. It provides excellent soft tissue visualization and can identify
lesions such as epidural abscess, tumor, or disc herniation. CT without
contrast provides limited soft tissue detail, plain radiographs lack
sensitivity for soft tissue pathology, and myelography with CT is
invasive and typically reserved for cases where MRI is contraindicated.
---
Question 2
,3 | Page
A 28-year-old female 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) Toxic multinodular goiter
Verified Answer: B
Rationale: Hashimoto's thyroiditis is the most common cause of
hypothyroidism in iodine-sufficient areas. It is an autoimmune disorder
characterized by elevated TSH and low free T4 levels. Graves' disease
and toxic multinodular goiter cause hyperthyroidism with low TSH and
elevated T4 levels. Subacute thyroiditis presents with a painful, tender
thyroid and often follows a viral illness.
---
Question 3
A 55-year-old male with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. Which of the following vitamin
deficiencies is most likely responsible for this presentation?
A) Vitamin B1 (Thiamine)
, 4 | Page
B) Vitamin B3 (Niacin)
C) Vitamin B6 (Pyridoxine)
D) Vitamin B12
Verified Answer: A
Rationale: Wernicke's encephalopathy, characterized by the classic triad
of confusion, ataxia, and ophthalmoplegia, is caused by thiamine
(vitamin B1) deficiency. This condition is commonly seen in patients
with alcohol use disorder but can also occur in other states of
malnutrition. Prompt thiamine replacement is essential to prevent
progression to Korsakoff syndrome, a chronic neuropsychiatric
condition.
---
Question 4
A 60-year-old female presents with acute onset of severe headache,
photophobia, and neck stiffness. Lumbar puncture reveals elevated
opening pressure, high protein, low glucose, and numerous neutrophils.
Gram stain shows gram-negative diplococci. Which of the following
organisms is most likely responsible?
A) Streptococcus pneumoniae
B) Neisseria meningitidis
C) Listeria monocytogenes
