COMSAE PHASE 1 FORM 114 QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026/2027
Q&A | INSTANT DOWNLOAD PDF.
Core Domains
• Behavioral Science
• Biochemistry
• Microbiology
• Immunology
• Pathology
• Pharmacology
• Physiology
• Public Health
Introduction
The COMSAE Phase 1 Form 114 examination is designed to assess foundational medical knowledge and
clinical reasoning skills required for osteopathic medical students. It evaluates comprehension of basic
biomedical sciences, systems-based pathophysiology, and principles of patient care. The assessment uses
multiple-choice and scenario-based questions to simulate real-world clinical decision-making. Emphasis
is placed on application of knowledge, integration of concepts, and ethical professional standards. This
exam preparation tool provides comprehensive practice to identify strengths and areas requiring further
study, ensuring readiness for licensure examinations and clinical rotations. It promotes critical thinking
and evidence-based practice across all core domains.
Section One: Questions 1–100
Question 1
A 24-year-old medical student is studying the role of the sodium-potassium pump in maintaining cellular
resting membrane potential. Which of the following best describes the direct effect of inhibiting this
pump?
A. Increased intracellular sodium and decreased intracellular potassium
B. Decreased intracellular sodium and increased intracellular potassium
C. Increased intracellular calcium and decreased intracellular sodium
D. Decreased intracellular chloride and increased intracellular potassium
, Correct answer
A. Increased intracellular sodium and decreased intracellular potassium
RATIONALE: The sodium-potassium pump normally moves three sodium ions out of the cell and two
potassium ions into the cell. Inhibition leads to sodium accumulation inside the cell and potassium loss
from the cell, disrupting the resting membrane potential.
Question 2
A 45-year-old male presents with severe chest pain and is diagnosed with an acute myocardial
infarction. Which of the following laboratory findings would be most specific for myocardial injury?
A. Elevated creatine kinase-MB
B. Elevated troponin I
C. Elevated lactate dehydrogenase
D. Elevated aspartate aminotransferase
Correct answer
B. Elevated troponin I
RATIONALE: Troponin I is highly specific to cardiac muscle and is the preferred biomarker for
diagnosing myocardial infarction due to its high sensitivity and specificity.
Question 3
A 32-year-old female is prescribed a drug that inhibits the enzyme cyclooxygenase. Which of the
following therapeutic effects is most directly attributed to this mechanism?
A. Reduced fever and inflammation
B. Increased blood clotting
C. Enhanced gastric mucosal protection
D. Bronchodilation
Correct answer
A. Reduced fever and inflammation
RATIONALE: Cyclooxygenase inhibition decreases prostaglandin synthesis, which reduces fever, pain,
and inflammation. It does not enhance gastric protection or bronchodilation.
Question 4
A 60-year-old male with a history of alcohol abuse presents with confusion and ataxia. Which vitamin
deficiency is most likely responsible for his symptoms?
A. Vitamin C
B. Vitamin B1
C. Vitamin D
D. Vitamin K
Correct answer
B. Vitamin B1
RATIONALE: Thiamine deficiency is common in chronic alcohol abuse and can lead to Wernicke
encephalopathy, characterized by confusion, ataxia, and ophthalmoplegia.
, Question 5
A 28-year-old female presents with a malar rash, photosensitivity, and joint pain. Which of the following
autoantibodies is most specific for her likely diagnosis?
A. Anti-dsDNA
B. Rheumatoid factor
C. Anti-histone
D. Anti-Scl-70
Correct answer
A. Anti-dsDNA
RATIONALE: Anti-double-stranded DNA antibodies are highly specific for systemic lupus
erythematosus, which presents with malar rash, photosensitivity, and arthralgias.
Question 6
A 55-year-old male with a history of smoking presents with hemoptysis and weight loss. A lung biopsy
reveals malignant cells with keratin pearls. Which type of lung cancer is most likely?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Large cell carcinoma
Correct answer
B. Squamous cell carcinoma
RATIONALE: Squamous cell carcinoma of the lung is strongly associated with smoking and is
characterized by keratin pearl formation on histology.
Question 7
A 70-year-old female is diagnosed with osteoporosis. Which of the following mechanisms best explains
the therapeutic effect of bisphosphonates?
A. Stimulation of osteoblast activity
B. Inhibition of osteoclast-mediated bone resorption
C. Increased calcium absorption in the gut
D. Enhanced renal calcium reabsorption
Correct answer
B. Inhibition of osteoclast-mediated bone resorption
RATIONALE: Bisphosphonates bind to hydroxyapatite and are internalized by osteoclasts, leading to
apoptosis and reduced bone resorption, thereby increasing bone mineral density.
Question 8
A 40-year-old male presents with a duodenal ulcer. Which of the following is the most common cause?
A. Helicobacter pylori infection
B. Chronic use of NSAIDs
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026/2027
Q&A | INSTANT DOWNLOAD PDF.
Core Domains
• Behavioral Science
• Biochemistry
• Microbiology
• Immunology
• Pathology
• Pharmacology
• Physiology
• Public Health
Introduction
The COMSAE Phase 1 Form 114 examination is designed to assess foundational medical knowledge and
clinical reasoning skills required for osteopathic medical students. It evaluates comprehension of basic
biomedical sciences, systems-based pathophysiology, and principles of patient care. The assessment uses
multiple-choice and scenario-based questions to simulate real-world clinical decision-making. Emphasis
is placed on application of knowledge, integration of concepts, and ethical professional standards. This
exam preparation tool provides comprehensive practice to identify strengths and areas requiring further
study, ensuring readiness for licensure examinations and clinical rotations. It promotes critical thinking
and evidence-based practice across all core domains.
Section One: Questions 1–100
Question 1
A 24-year-old medical student is studying the role of the sodium-potassium pump in maintaining cellular
resting membrane potential. Which of the following best describes the direct effect of inhibiting this
pump?
A. Increased intracellular sodium and decreased intracellular potassium
B. Decreased intracellular sodium and increased intracellular potassium
C. Increased intracellular calcium and decreased intracellular sodium
D. Decreased intracellular chloride and increased intracellular potassium
, Correct answer
A. Increased intracellular sodium and decreased intracellular potassium
RATIONALE: The sodium-potassium pump normally moves three sodium ions out of the cell and two
potassium ions into the cell. Inhibition leads to sodium accumulation inside the cell and potassium loss
from the cell, disrupting the resting membrane potential.
Question 2
A 45-year-old male presents with severe chest pain and is diagnosed with an acute myocardial
infarction. Which of the following laboratory findings would be most specific for myocardial injury?
A. Elevated creatine kinase-MB
B. Elevated troponin I
C. Elevated lactate dehydrogenase
D. Elevated aspartate aminotransferase
Correct answer
B. Elevated troponin I
RATIONALE: Troponin I is highly specific to cardiac muscle and is the preferred biomarker for
diagnosing myocardial infarction due to its high sensitivity and specificity.
Question 3
A 32-year-old female is prescribed a drug that inhibits the enzyme cyclooxygenase. Which of the
following therapeutic effects is most directly attributed to this mechanism?
A. Reduced fever and inflammation
B. Increased blood clotting
C. Enhanced gastric mucosal protection
D. Bronchodilation
Correct answer
A. Reduced fever and inflammation
RATIONALE: Cyclooxygenase inhibition decreases prostaglandin synthesis, which reduces fever, pain,
and inflammation. It does not enhance gastric protection or bronchodilation.
Question 4
A 60-year-old male with a history of alcohol abuse presents with confusion and ataxia. Which vitamin
deficiency is most likely responsible for his symptoms?
A. Vitamin C
B. Vitamin B1
C. Vitamin D
D. Vitamin K
Correct answer
B. Vitamin B1
RATIONALE: Thiamine deficiency is common in chronic alcohol abuse and can lead to Wernicke
encephalopathy, characterized by confusion, ataxia, and ophthalmoplegia.
, Question 5
A 28-year-old female presents with a malar rash, photosensitivity, and joint pain. Which of the following
autoantibodies is most specific for her likely diagnosis?
A. Anti-dsDNA
B. Rheumatoid factor
C. Anti-histone
D. Anti-Scl-70
Correct answer
A. Anti-dsDNA
RATIONALE: Anti-double-stranded DNA antibodies are highly specific for systemic lupus
erythematosus, which presents with malar rash, photosensitivity, and arthralgias.
Question 6
A 55-year-old male with a history of smoking presents with hemoptysis and weight loss. A lung biopsy
reveals malignant cells with keratin pearls. Which type of lung cancer is most likely?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Large cell carcinoma
Correct answer
B. Squamous cell carcinoma
RATIONALE: Squamous cell carcinoma of the lung is strongly associated with smoking and is
characterized by keratin pearl formation on histology.
Question 7
A 70-year-old female is diagnosed with osteoporosis. Which of the following mechanisms best explains
the therapeutic effect of bisphosphonates?
A. Stimulation of osteoblast activity
B. Inhibition of osteoclast-mediated bone resorption
C. Increased calcium absorption in the gut
D. Enhanced renal calcium reabsorption
Correct answer
B. Inhibition of osteoclast-mediated bone resorption
RATIONALE: Bisphosphonates bind to hydroxyapatite and are internalized by osteoclasts, leading to
apoptosis and reduced bone resorption, thereby increasing bone mineral density.
Question 8
A 40-year-old male presents with a duodenal ulcer. Which of the following is the most common cause?
A. Helicobacter pylori infection
B. Chronic use of NSAIDs
