COMSAE Phase 1 Form 114 Practice Exam:
High-Yield Concepts and Sample Questions
Examination 2026–2027 | Comprehensive
Question Practice Test with Answers &
Rationales| Free Pdf Access
1. A 28-year-old woman presents with chronic low back pain. On examination, you
find a tender point at the right superior medial angle of the scapula. Compression
of this point reproduces her symptoms. Which Chapman's reflex point is most
likely being palpated?
A) Gallbladder
B) Stomach
C) Liver
D) Duodenum
Answer: A) Gallbladder
Explanation: The right superior medial angle of the scapula corresponds to the
Chapman's reflex point for the gallbladder. Chapman's points are anterior and posterior
fascial tender points that reflect visceral dysfunction. The gallbladder reflex is located on
the right between the 6th and 7th ribs anteriorly and at the right superior medial scapular
border posteriorly.
2. A 55-year-old male with a history of hypertension presents with sudden, severe
"tearing" chest pain that radiates to his back. His blood pressure is 190/110 mmHg
in the right arm and 140/80 mmHg in the left arm. Which of the following is the
most appropriate initial imaging study?
A) Chest X-ray
B) Echocardiogram
C) CT angiography
, D) MRI
Answer: C) CT angiography
Explanation: This patient presents with classic findings of acute aortic dissection: tearing
chest pain, hypertension, and pulse/blood pressure differential between arms. CT
angiography is the most rapid and sensitive imaging modality for diagnosing aortic
dissection in the emergency setting. While chest X-ray may show a widened mediastinum,
it is not diagnostic.
3. A 45-year-old obese woman presents with right upper quadrant pain that
worsens after meals. Ultrasound reveals gallstones. She undergoes laparoscopic
cholecystectomy. During the procedure, which structure is at greatest risk of injury
due to its anatomical relationship with the cystic duct and common hepatic duct?
A) Portal vein
B) Right hepatic artery
C) Cystic artery
D) Common bile duct
Answer: B) Right hepatic artery
Explanation: The right hepatic artery is a branch of the proper hepatic artery and runs
posterior to the common hepatic duct. During cholecystectomy, it can be mistaken for the
cystic artery and inadvertently ligated, leading to hepatic ischemia. The "triangle of Calot"
is bounded by the cystic duct, common hepatic duct, and inferior liver edge, and contains
the cystic artery.
4. A 32-year-old man with cystic fibrosis presents with worsening cough and thick
sputum. Which of the following pathophysiological mechanisms best explains his
pulmonary manifestations?
A) Increased sodium reabsorption in airway epithelium
B) Decreased chloride secretion leading to reduced water in airway lumen
C) Increased ATP production in alveolar macrophages
D) Overexpression of surfactant proteins
, Answer: B) Decreased chloride secretion leading to reduced water in airway lumen
Explanation: Cystic fibrosis results from a mutation in the CFTR gene encoding a chloride
channel. Defective CFTR leads to decreased chloride secretion and increased sodium and
water reabsorption, resulting in dehydrated, thick mucus that obstructs airways and
predisposes to chronic infections. This is the fundamental mechanism behind the
pulmonary disease.
5. According to Fryette's principles, which of the following best describes Type I
somatic dysfunction?
A) Flexed or extended spine with sidebending and rotation to the same side
B) Neutral spine with sidebending and rotation to opposite sides
C) Non-neutral spine with sidebending and rotation to opposite sides
D) Neutral spine with sidebending and rotation to the same side
Answer: B) Neutral spine with sidebending and rotation to opposite sides
Explanation: Fryette's Type I (neutral) mechanics occur when the spine is in neutral
position. In this state, sidebending and rotation occur to opposite sides and typically
involve multiple vertebrae. Type II (non-neutral) mechanics occur in flexion or extension
with rotation and sidebending to the same side, affecting single segments.
6. A 68-year-old man presents with progressive difficulty initiating urination, weak
stream, and nocturia. Digital rectal exam reveals a firm, enlarged, non-tender
prostate. Laboratory studies show elevated PSA. A biopsy confirms
adenocarcinoma. Which of the following is the most common site of metastasis
for this cancer?
A) Brain
B) Liver
C) Bones
D) Lungs
Answer: C) Bones
Explanation: Prostate adenocarcinoma commonly metastasizes to bone, particularly the
axial skeleton (vertebrae, pelvis, ribs). Osteoblastic metastases are characteristic. While
, liver and lung metastases can occur, bone is the most frequent site. Brain metastases are
rare in prostate cancer.
7. A 22-year-old woman presents with a 3-day history of fever, sore throat, and
cervical lymphadenopathy. She reports fatigue and a mild headache. On
examination, she has pharyngeal erythema and tonsillar exudates. Rapid strep test
is negative, but a Monospot test is positive. Which of the following is the most
appropriate management?
A) Amoxicillin
B) Azithromycin
C) Supportive care with rest and hydration
D) Corticosteroids
Answer: C) Supportive care with rest and hydration
Explanation: This patient has infectious mononucleosis caused by Epstein-Barr virus
(EBV), as indicated by positive Monospot, fever, pharyngitis, and lymphadenopathy.
Treatment is supportive with rest, hydration, and analgesics. Amoxicillin is contraindicated
because it can cause a maculopapular rash in patients with EBV. Corticosteroids are
reserved for complications like airway obstruction or severe hemolytic anemia.
8. A 60-year-old woman with a history of GERD presents with progressive
dysphagia to solids. She reports food getting stuck in her chest. Barium swallow
shows a "bird's beak" appearance. Which of the following is the most likely
diagnosis?
A) Diffuse esophageal spasm
B) Achalasia
C) Esophageal stricture
D) Esophageal cancer
Answer: B) Achalasia
Explanation: Achalasia presents with progressive dysphagia to both solids and liquids,
regurgitation, and chest pain. Barium swallow classically demonstrates a "bird's beak"
appearance due to incomplete relaxation of the lower esophageal sphincter and loss of
High-Yield Concepts and Sample Questions
Examination 2026–2027 | Comprehensive
Question Practice Test with Answers &
Rationales| Free Pdf Access
1. A 28-year-old woman presents with chronic low back pain. On examination, you
find a tender point at the right superior medial angle of the scapula. Compression
of this point reproduces her symptoms. Which Chapman's reflex point is most
likely being palpated?
A) Gallbladder
B) Stomach
C) Liver
D) Duodenum
Answer: A) Gallbladder
Explanation: The right superior medial angle of the scapula corresponds to the
Chapman's reflex point for the gallbladder. Chapman's points are anterior and posterior
fascial tender points that reflect visceral dysfunction. The gallbladder reflex is located on
the right between the 6th and 7th ribs anteriorly and at the right superior medial scapular
border posteriorly.
2. A 55-year-old male with a history of hypertension presents with sudden, severe
"tearing" chest pain that radiates to his back. His blood pressure is 190/110 mmHg
in the right arm and 140/80 mmHg in the left arm. Which of the following is the
most appropriate initial imaging study?
A) Chest X-ray
B) Echocardiogram
C) CT angiography
, D) MRI
Answer: C) CT angiography
Explanation: This patient presents with classic findings of acute aortic dissection: tearing
chest pain, hypertension, and pulse/blood pressure differential between arms. CT
angiography is the most rapid and sensitive imaging modality for diagnosing aortic
dissection in the emergency setting. While chest X-ray may show a widened mediastinum,
it is not diagnostic.
3. A 45-year-old obese woman presents with right upper quadrant pain that
worsens after meals. Ultrasound reveals gallstones. She undergoes laparoscopic
cholecystectomy. During the procedure, which structure is at greatest risk of injury
due to its anatomical relationship with the cystic duct and common hepatic duct?
A) Portal vein
B) Right hepatic artery
C) Cystic artery
D) Common bile duct
Answer: B) Right hepatic artery
Explanation: The right hepatic artery is a branch of the proper hepatic artery and runs
posterior to the common hepatic duct. During cholecystectomy, it can be mistaken for the
cystic artery and inadvertently ligated, leading to hepatic ischemia. The "triangle of Calot"
is bounded by the cystic duct, common hepatic duct, and inferior liver edge, and contains
the cystic artery.
4. A 32-year-old man with cystic fibrosis presents with worsening cough and thick
sputum. Which of the following pathophysiological mechanisms best explains his
pulmonary manifestations?
A) Increased sodium reabsorption in airway epithelium
B) Decreased chloride secretion leading to reduced water in airway lumen
C) Increased ATP production in alveolar macrophages
D) Overexpression of surfactant proteins
, Answer: B) Decreased chloride secretion leading to reduced water in airway lumen
Explanation: Cystic fibrosis results from a mutation in the CFTR gene encoding a chloride
channel. Defective CFTR leads to decreased chloride secretion and increased sodium and
water reabsorption, resulting in dehydrated, thick mucus that obstructs airways and
predisposes to chronic infections. This is the fundamental mechanism behind the
pulmonary disease.
5. According to Fryette's principles, which of the following best describes Type I
somatic dysfunction?
A) Flexed or extended spine with sidebending and rotation to the same side
B) Neutral spine with sidebending and rotation to opposite sides
C) Non-neutral spine with sidebending and rotation to opposite sides
D) Neutral spine with sidebending and rotation to the same side
Answer: B) Neutral spine with sidebending and rotation to opposite sides
Explanation: Fryette's Type I (neutral) mechanics occur when the spine is in neutral
position. In this state, sidebending and rotation occur to opposite sides and typically
involve multiple vertebrae. Type II (non-neutral) mechanics occur in flexion or extension
with rotation and sidebending to the same side, affecting single segments.
6. A 68-year-old man presents with progressive difficulty initiating urination, weak
stream, and nocturia. Digital rectal exam reveals a firm, enlarged, non-tender
prostate. Laboratory studies show elevated PSA. A biopsy confirms
adenocarcinoma. Which of the following is the most common site of metastasis
for this cancer?
A) Brain
B) Liver
C) Bones
D) Lungs
Answer: C) Bones
Explanation: Prostate adenocarcinoma commonly metastasizes to bone, particularly the
axial skeleton (vertebrae, pelvis, ribs). Osteoblastic metastases are characteristic. While
, liver and lung metastases can occur, bone is the most frequent site. Brain metastases are
rare in prostate cancer.
7. A 22-year-old woman presents with a 3-day history of fever, sore throat, and
cervical lymphadenopathy. She reports fatigue and a mild headache. On
examination, she has pharyngeal erythema and tonsillar exudates. Rapid strep test
is negative, but a Monospot test is positive. Which of the following is the most
appropriate management?
A) Amoxicillin
B) Azithromycin
C) Supportive care with rest and hydration
D) Corticosteroids
Answer: C) Supportive care with rest and hydration
Explanation: This patient has infectious mononucleosis caused by Epstein-Barr virus
(EBV), as indicated by positive Monospot, fever, pharyngitis, and lymphadenopathy.
Treatment is supportive with rest, hydration, and analgesics. Amoxicillin is contraindicated
because it can cause a maculopapular rash in patients with EBV. Corticosteroids are
reserved for complications like airway obstruction or severe hemolytic anemia.
8. A 60-year-old woman with a history of GERD presents with progressive
dysphagia to solids. She reports food getting stuck in her chest. Barium swallow
shows a "bird's beak" appearance. Which of the following is the most likely
diagnosis?
A) Diffuse esophageal spasm
B) Achalasia
C) Esophageal stricture
D) Esophageal cancer
Answer: B) Achalasia
Explanation: Achalasia presents with progressive dysphagia to both solids and liquids,
regurgitation, and chest pain. Barium swallow classically demonstrates a "bird's beak"
appearance due to incomplete relaxation of the lower esophageal sphincter and loss of
