National Board of Osteopathic Medical Examiners | COMSAE Comprehensive Examination
COMSAE Comprehensive Self-Assessment Examination
Bundle 2026/2027 | Verified Questions
National Board of Osteopathic Medical Examiners | COMSAE Comprehensive Examination | Professional
Osteopathic Medical Candidates
150 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
National Board of Osteopathic Medical Examiners | COMSAE Comprehensive Examination
Comprehensive Self-Assessment Examination Bundle Actual Exam | Academic Year
2026/2027
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
,Introduction
This document presents 150 original, professional-level items developed for the COMSAE Comprehensive
Self-Assessment Examination Bundle administered by the National Board of Osteopathic Medical Examiners
for the 2026/2027 academic year. The 150 items span the full scope of the comprehensive examination
bundle and are allocated across four core domains drawn from the official content outline: Domain 1: Health
Maintenance and Disease Prevention, with 38 items; Domain 2: History and Physical Examination, with 38
items; Domain 3: Diagnostic Studies and Pharmacologic Therapeutics, with 37 items; and Domain 4: Clinical
Interventions and Professional Ethics, with 37 items. Every stem, option set, and rationale is original work
composed specifically for this document rather than reproduced from any administered instrument. Each
item is mapped to a distinct clinical concept, diagnostic criterion, pharmacologic principle, osteopathic
technique, or ethical standard, so that no two items assess the same calculation, rule, or data interpretation,
and each rationale shows the diagnostic and therapeutic logic supporting the correct option. The set is
designed to reinforce the official COMSAE Comprehensive Self-Assessment Examination Bundle objectives,
supporting actual exam readiness, diagnostic accuracy, and clinical proficiency for the 2026/2027 academic
year.
Actual Questions
Domain 1: Health Maintenance and Disease Prevention
Question 1. An asymptomatic 45-year-old patient of average risk asks when colorectal cancer
screening should begin. What is the most appropriate recommendation?
A. Defer screening until age 60 regardless of risk
B. Begin screening now, with colonoscopy every 10 years as one acceptable strategy
C. Screen only if a first-degree relative is affected
D. Begin screening at age 75 with annual imaging
Correct Answer: B
Rationale: Current preventive care guidance lowers the starting age for average-risk adults to 45 years
because incidence in younger adults has risen. Colonoscopy every ten years, annual fecal immunochemical
sampling, or stool DNA every one to three years are all acceptable strategies, with the choice driven by
shared decision making.
Question 2. Cervical cancer screening in an immunocompetent woman should begin at what
age and with what initial modality?
A. Age 21 with cervical cytology alone every three years
B. Age 16 with cytology plus human papillomavirus co-screening annually
C. Age 30 with human papillomavirus typing alone every five years only
D. Age 18 with colposcopy every two years
Correct Answer: A
Rationale: Screening begins at 21 regardless of sexual history because cervical cancer is rare before that
age and most human papillomavirus infections in adolescents clear spontaneously. Cytology alone is used
every three years from 21 to 29, after which co-screening or primary human papillomavirus screening
every five years becomes an option.
Question 3. A 52-year-old woman with no family history of breast cancer asks about
mammography. Which schedule is most consistent with preventive guidance?
A. Annual screening magnetic resonance imaging beginning immediately
B. No imaging until age 65 unless symptoms develop
C. A single baseline study at 52 with no further imaging
D. Biennial screening mammography through age 74
Correct Answer: D
Rationale: For average-risk women, biennial mammography between roughly 50 and 74 years yields the
most favorable balance of mortality reduction against false-positive findings and overdiagnosis. Magnetic
resonance imaging is added only for high lifetime risk, such as a known deleterious BRCA variant or prior
chest irradiation.
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
,Question 4. Which patient meets criteria for annual low-dose computed tomography
screening for lung cancer?
A. A 42-year-old with a 30 pack-year history who currently smokes
B. A 70-year-old who never smoked but has chronic cough
C. A 58-year-old with a 25 pack-year smoking history who quit 4 years ago
D. A 62-year-old with a 10 pack-year history who quit 20 years ago
Correct Answer: C
Rationale: Eligibility requires an age of roughly 50 to 80 years, at least a 20 pack-year history, and
current smoking or cessation within the past 15 years. The 58-year-old satisfies all three criteria, whereas
the others fail on age, absent tobacco exposure, or insufficient pack-years.
Question 5. One-time abdominal ultrasonography to screen for abdominal aortic aneurysm is
indicated for which group?
A. All women aged 40 to 50 years
B. All adults over age 30 with hypertension
C. Men under age 45 with a normal body mass index
D. Men aged 65 to 75 years who have ever smoked
Correct Answer: D
Rationale: The prevalence of clinically important aneurysm is high enough in older male smokers that a
single ultrasound reduces aneurysm-related mortality. Screening is not recommended for women who
have never smoked, and selective screening may be considered in men 65 to 75 who never smoked.
Question 6. At what age should bone mineral density screening with dual-energy x-ray
absorptiometry routinely begin in women without additional risk factors?
A. Age 40
B. Age 50 at menopause
C. Age 65
D. Age 80
Correct Answer: C
Rationale: Fracture risk rises sharply after 65, making population screening cost-effective at that
threshold. Younger postmenopausal women are screened only when a validated fracture-risk instrument
indicates a ten-year major osteoporotic fracture risk equivalent to that of a 65-year-old, or when
glucocorticoid exposure or prior fragility fracture is present.
Question 7. A 60-year-old man asks about prostate-specific antigen screening. What is the
most appropriate approach?
A. Screen automatically without discussion because he is over 55
B. Refuse screening in all men regardless of preference
C. Proceed directly to prostate biopsy for baseline staging
D. Engage in shared decision making about potential benefit and harm before screening
Correct Answer: D
Rationale: For men aged 55 to 69 the small absolute reduction in prostate cancer mortality must be
weighed against overdiagnosis, biopsy complications, and treatment-related incontinence and erectile
dysfunction. Guidance therefore calls for an individualized discussion rather than routine or universal
screening, and against screening after age 70.
Question 8. How frequently should blood pressure be measured in a healthy normotensive
adult aged 40 years or older?
A. At least annually, with confirmation outside the office before diagnosis
B. Once every ten years with no confirmation
C. Only when symptoms such as headache occur
D. Continuously by ambulatory monitoring in all adults
Correct Answer: A
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
, Rationale: Adults 40 and older, and younger adults with elevated readings or increased risk, warrant
yearly measurement. Because white-coat elevation is common, ambulatory or home monitoring should
confirm an elevated office reading before hypertension is diagnosed and pharmacotherapy is begun.
Question 9. A 55-year-old man has a calculated 10-year atherosclerotic cardiovascular disease
risk of 12 percent and a low-density lipoprotein level of 150 mg/dL. What is the most
appropriate preventive intervention?
A. Initiate high-dose niacin as monotherapy
B. Initiate a moderate-intensity statin along with lifestyle modification
C. Withhold pharmacotherapy until risk exceeds 30 percent
D. Begin anticoagulation with warfarin
Correct Answer: B
Rationale: A ten-year risk of 7.5 percent or greater in an adult aged 40 to 75 with a low-density lipoprotein
above 70 mg/dL supports statin therapy for primary prevention. Statins reduce events by lowering
atherogenic particles and stabilizing plaque, whereas niacin has not shown outcome benefit when added to
statin therapy.
Question 10. Screening for type 2 diabetes mellitus with a fasting glucose or hemoglobin A1c is
recommended for which asymptomatic adult?
A. A 20-year-old with a body mass index of 20 kg/m2
B. A 30-year-old marathon runner with no risk factors
C. A 25-year-old with well-controlled asthma only
D. A 40-year-old with a body mass index of 31 kg/m2
Correct Answer: D
Rationale: Screening is advised for adults aged roughly 35 to 70 years who are overweight or obese,
because early detection permits intensive lifestyle intervention or metformin to delay progression from
prediabetes. Younger screening is reserved for those with additional risks such as gestational diabetes or a
strong family history.
Question 11. Universal one-time screening for human immunodeficiency virus infection is
recommended for which population?
A. Only patients reporting injection drug use
B. All adolescents and adults aged 15 to 65 years
C. Only pregnant women in the third trimester
D. Only adults older than 65 years
Correct Answer: B
Rationale: Opt-out screening of everyone from 15 to 65 identifies infections that risk-based strategies miss,
allows earlier antiretroviral therapy, and lowers transmission. Repeat screening is added for ongoing risk,
and all pregnant women are screened at the first prenatal encounter regardless of prior status.
Question 12. Which statement correctly describes hepatitis C virus screening for the general
adult population?
A. Screening is limited to persons born in the baby boom birth cohort
B. Screening is indicated only after transaminase elevation
C. Screening requires liver biopsy confirmation before antibody assay
D. One-time antibody screening is recommended for all adults aged 18 to 79 years
Correct Answer: D
Rationale: Because highly effective direct-acting antiviral regimens can cure most infections and prevent
cirrhosis and hepatocellular carcinoma, one-time antibody screening is now advised for all adults in this
age range. A reactive antibody result is confirmed with a nucleic acid assay for viral RNA before
treatment.
Question 13. Annual screening for chlamydial infection is most strongly indicated in which
patient?
A. A 45-year-old woman in a mutually monogamous relationship
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
COMSAE Comprehensive Self-Assessment Examination
Bundle 2026/2027 | Verified Questions
National Board of Osteopathic Medical Examiners | COMSAE Comprehensive Examination | Professional
Osteopathic Medical Candidates
150 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
National Board of Osteopathic Medical Examiners | COMSAE Comprehensive Examination
Comprehensive Self-Assessment Examination Bundle Actual Exam | Academic Year
2026/2027
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
,Introduction
This document presents 150 original, professional-level items developed for the COMSAE Comprehensive
Self-Assessment Examination Bundle administered by the National Board of Osteopathic Medical Examiners
for the 2026/2027 academic year. The 150 items span the full scope of the comprehensive examination
bundle and are allocated across four core domains drawn from the official content outline: Domain 1: Health
Maintenance and Disease Prevention, with 38 items; Domain 2: History and Physical Examination, with 38
items; Domain 3: Diagnostic Studies and Pharmacologic Therapeutics, with 37 items; and Domain 4: Clinical
Interventions and Professional Ethics, with 37 items. Every stem, option set, and rationale is original work
composed specifically for this document rather than reproduced from any administered instrument. Each
item is mapped to a distinct clinical concept, diagnostic criterion, pharmacologic principle, osteopathic
technique, or ethical standard, so that no two items assess the same calculation, rule, or data interpretation,
and each rationale shows the diagnostic and therapeutic logic supporting the correct option. The set is
designed to reinforce the official COMSAE Comprehensive Self-Assessment Examination Bundle objectives,
supporting actual exam readiness, diagnostic accuracy, and clinical proficiency for the 2026/2027 academic
year.
Actual Questions
Domain 1: Health Maintenance and Disease Prevention
Question 1. An asymptomatic 45-year-old patient of average risk asks when colorectal cancer
screening should begin. What is the most appropriate recommendation?
A. Defer screening until age 60 regardless of risk
B. Begin screening now, with colonoscopy every 10 years as one acceptable strategy
C. Screen only if a first-degree relative is affected
D. Begin screening at age 75 with annual imaging
Correct Answer: B
Rationale: Current preventive care guidance lowers the starting age for average-risk adults to 45 years
because incidence in younger adults has risen. Colonoscopy every ten years, annual fecal immunochemical
sampling, or stool DNA every one to three years are all acceptable strategies, with the choice driven by
shared decision making.
Question 2. Cervical cancer screening in an immunocompetent woman should begin at what
age and with what initial modality?
A. Age 21 with cervical cytology alone every three years
B. Age 16 with cytology plus human papillomavirus co-screening annually
C. Age 30 with human papillomavirus typing alone every five years only
D. Age 18 with colposcopy every two years
Correct Answer: A
Rationale: Screening begins at 21 regardless of sexual history because cervical cancer is rare before that
age and most human papillomavirus infections in adolescents clear spontaneously. Cytology alone is used
every three years from 21 to 29, after which co-screening or primary human papillomavirus screening
every five years becomes an option.
Question 3. A 52-year-old woman with no family history of breast cancer asks about
mammography. Which schedule is most consistent with preventive guidance?
A. Annual screening magnetic resonance imaging beginning immediately
B. No imaging until age 65 unless symptoms develop
C. A single baseline study at 52 with no further imaging
D. Biennial screening mammography through age 74
Correct Answer: D
Rationale: For average-risk women, biennial mammography between roughly 50 and 74 years yields the
most favorable balance of mortality reduction against false-positive findings and overdiagnosis. Magnetic
resonance imaging is added only for high lifetime risk, such as a known deleterious BRCA variant or prior
chest irradiation.
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
,Question 4. Which patient meets criteria for annual low-dose computed tomography
screening for lung cancer?
A. A 42-year-old with a 30 pack-year history who currently smokes
B. A 70-year-old who never smoked but has chronic cough
C. A 58-year-old with a 25 pack-year smoking history who quit 4 years ago
D. A 62-year-old with a 10 pack-year history who quit 20 years ago
Correct Answer: C
Rationale: Eligibility requires an age of roughly 50 to 80 years, at least a 20 pack-year history, and
current smoking or cessation within the past 15 years. The 58-year-old satisfies all three criteria, whereas
the others fail on age, absent tobacco exposure, or insufficient pack-years.
Question 5. One-time abdominal ultrasonography to screen for abdominal aortic aneurysm is
indicated for which group?
A. All women aged 40 to 50 years
B. All adults over age 30 with hypertension
C. Men under age 45 with a normal body mass index
D. Men aged 65 to 75 years who have ever smoked
Correct Answer: D
Rationale: The prevalence of clinically important aneurysm is high enough in older male smokers that a
single ultrasound reduces aneurysm-related mortality. Screening is not recommended for women who
have never smoked, and selective screening may be considered in men 65 to 75 who never smoked.
Question 6. At what age should bone mineral density screening with dual-energy x-ray
absorptiometry routinely begin in women without additional risk factors?
A. Age 40
B. Age 50 at menopause
C. Age 65
D. Age 80
Correct Answer: C
Rationale: Fracture risk rises sharply after 65, making population screening cost-effective at that
threshold. Younger postmenopausal women are screened only when a validated fracture-risk instrument
indicates a ten-year major osteoporotic fracture risk equivalent to that of a 65-year-old, or when
glucocorticoid exposure or prior fragility fracture is present.
Question 7. A 60-year-old man asks about prostate-specific antigen screening. What is the
most appropriate approach?
A. Screen automatically without discussion because he is over 55
B. Refuse screening in all men regardless of preference
C. Proceed directly to prostate biopsy for baseline staging
D. Engage in shared decision making about potential benefit and harm before screening
Correct Answer: D
Rationale: For men aged 55 to 69 the small absolute reduction in prostate cancer mortality must be
weighed against overdiagnosis, biopsy complications, and treatment-related incontinence and erectile
dysfunction. Guidance therefore calls for an individualized discussion rather than routine or universal
screening, and against screening after age 70.
Question 8. How frequently should blood pressure be measured in a healthy normotensive
adult aged 40 years or older?
A. At least annually, with confirmation outside the office before diagnosis
B. Once every ten years with no confirmation
C. Only when symptoms such as headache occur
D. Continuously by ambulatory monitoring in all adults
Correct Answer: A
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
, Rationale: Adults 40 and older, and younger adults with elevated readings or increased risk, warrant
yearly measurement. Because white-coat elevation is common, ambulatory or home monitoring should
confirm an elevated office reading before hypertension is diagnosed and pharmacotherapy is begun.
Question 9. A 55-year-old man has a calculated 10-year atherosclerotic cardiovascular disease
risk of 12 percent and a low-density lipoprotein level of 150 mg/dL. What is the most
appropriate preventive intervention?
A. Initiate high-dose niacin as monotherapy
B. Initiate a moderate-intensity statin along with lifestyle modification
C. Withhold pharmacotherapy until risk exceeds 30 percent
D. Begin anticoagulation with warfarin
Correct Answer: B
Rationale: A ten-year risk of 7.5 percent or greater in an adult aged 40 to 75 with a low-density lipoprotein
above 70 mg/dL supports statin therapy for primary prevention. Statins reduce events by lowering
atherogenic particles and stabilizing plaque, whereas niacin has not shown outcome benefit when added to
statin therapy.
Question 10. Screening for type 2 diabetes mellitus with a fasting glucose or hemoglobin A1c is
recommended for which asymptomatic adult?
A. A 20-year-old with a body mass index of 20 kg/m2
B. A 30-year-old marathon runner with no risk factors
C. A 25-year-old with well-controlled asthma only
D. A 40-year-old with a body mass index of 31 kg/m2
Correct Answer: D
Rationale: Screening is advised for adults aged roughly 35 to 70 years who are overweight or obese,
because early detection permits intensive lifestyle intervention or metformin to delay progression from
prediabetes. Younger screening is reserved for those with additional risks such as gestational diabetes or a
strong family history.
Question 11. Universal one-time screening for human immunodeficiency virus infection is
recommended for which population?
A. Only patients reporting injection drug use
B. All adolescents and adults aged 15 to 65 years
C. Only pregnant women in the third trimester
D. Only adults older than 65 years
Correct Answer: B
Rationale: Opt-out screening of everyone from 15 to 65 identifies infections that risk-based strategies miss,
allows earlier antiretroviral therapy, and lowers transmission. Repeat screening is added for ongoing risk,
and all pregnant women are screened at the first prenatal encounter regardless of prior status.
Question 12. Which statement correctly describes hepatitis C virus screening for the general
adult population?
A. Screening is limited to persons born in the baby boom birth cohort
B. Screening is indicated only after transaminase elevation
C. Screening requires liver biopsy confirmation before antibody assay
D. One-time antibody screening is recommended for all adults aged 18 to 79 years
Correct Answer: D
Rationale: Because highly effective direct-acting antiviral regimens can cure most infections and prevent
cirrhosis and hepatocellular carcinoma, one-time antibody screening is now advised for all adults in this
age range. A reactive antibody result is confirmed with a nucleic acid assay for viral RNA before
treatment.
Question 13. Annual screening for chlamydial infection is most strongly indicated in which
patient?
A. A 45-year-old woman in a mutually monogamous relationship
COMSAE Comprehensive Self-Assessment Examination Bundle 2026/2027 | Verified Questions
