COMSAE PHASE 1 FORM 116 EXAM TEST BANK is
designed as a comprehensive self-assessment tool
for osteopathic medical students preparing for
COMLEX-USA Level – NEWEST 2026 EDITION |
COMPREHENSIVE 160-QUESTION SET WITH
VERIFIED ANSWERS & DETAILED RATIONALES
CORE DOMAINS
• Osteopathic Principles and Manipulative Medicine
(OMM/OPP)
• Human Anatomy and Embryology
• Physiology and Pathophysiology
• Pathology and Laboratory Medicine
, • Pharmacology and Pharmacotherapeutics
• Microbiology and Immunology
• Biochemistry, Genetics, and Molecular Biology
• Behavioral Science, Ethics, and Biostatistics
• Clinical Integration and Systems-Based Practice
• High-Yield Multi-System Clinical Vignettes
INTRODUCTION
The COMSAE Phase 1 Form 116 examination is designed as a
comprehensive self-assessment tool for osteopathic medical
students preparing for COMLEX-USA Level 1. This assessment
evaluates foundational biomedical sciences integrated with
osteopathic principles and clinical reasoning. The examination
consists of single-best-answer multiple-choice questions, including
clinical vignettes that mirror the COMLEX-USA blueprint. Questions
emphasize application of basic science knowledge to clinical
scenarios, interpretation of laboratory and imaging findings, and
demonstration of competency in osteopathic manipulative
medicine. Success requires mastery of anatomy, physiology,
pathology, pharmacology, and the osteopathic approach to whole-
person care.
Question 1
A 24-year-old man presents with fever, headache, and neck stiffness.
Lumbar puncture shows elevated opening pressure, low glucose, and
high protein. Which organism is most likely responsible?
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Listeria monocytogenes
D. Escherichia coli
B. Streptococcus pneumoniae
, RATIONALE: Bacterial meningitis in adults is most commonly caused
by Streptococcus pneumoniae. The CSF findings (elevated opening
pressure, low glucose, high protein) are classic for bacterial meningitis.
While N. meningitidis (A) is also a common cause, S. pneumoniae is the
most frequent pathogen overall in adults .
Question 2
A 65-year-old smoker presents with hematuria and flank pain. CT
reveals a renal mass. Which is the most likely diagnosis?
A. Wilms tumor
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Angiomyolipoma
B. Renal cell carcinoma
RATIONALE: Renal cell carcinoma is the most common malignant
renal tumor in adults, strongly associated with smoking and typically
presenting with hematuria, flank pain, and a palpable mass. Wilms
tumor (A) occurs in children. Transitional cell carcinoma (C) arises from
the urothelium of the renal pelvis/ureter. Angiomyolipoma (D) is benign
and often contains fat on imaging .
Question 3
Which electrolyte abnormality is most associated with ECG showing
peaked T waves?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hyponatremia
B. Hyperkalemia
, RATIONALE: Hyperkalemia causes peaked ("tented") T waves due to
altered cardiac repolarization. Other ECG changes include widened
QRS, prolonged PR interval, and eventually sine wave pattern and
asystole. Hypokalemia (A) causes flat T waves and prominent U waves.
Hypercalcemia (C) shortens the QT interval .
Question 4
A child presents with barking cough and inspiratory stridor. What is the
most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
B. Croup
RATIONALE: Croup (laryngotracheobronchitis) classically presents
with a barking cough, inspiratory stridor, and respiratory distress in
young children. Epiglottitis (A) presents with high fever, drooling, and
tripod positioning, often without barking cough. Bronchiolitis (C)
presents with wheezing and respiratory distress in infants; asthma (D)
presents with wheezing .
Question 5
Which hormone is produced by the posterior pituitary?
A. ACTH
B. TSH
C. Oxytocin
D. GH
C. Oxytocin
designed as a comprehensive self-assessment tool
for osteopathic medical students preparing for
COMLEX-USA Level – NEWEST 2026 EDITION |
COMPREHENSIVE 160-QUESTION SET WITH
VERIFIED ANSWERS & DETAILED RATIONALES
CORE DOMAINS
• Osteopathic Principles and Manipulative Medicine
(OMM/OPP)
• Human Anatomy and Embryology
• Physiology and Pathophysiology
• Pathology and Laboratory Medicine
, • Pharmacology and Pharmacotherapeutics
• Microbiology and Immunology
• Biochemistry, Genetics, and Molecular Biology
• Behavioral Science, Ethics, and Biostatistics
• Clinical Integration and Systems-Based Practice
• High-Yield Multi-System Clinical Vignettes
INTRODUCTION
The COMSAE Phase 1 Form 116 examination is designed as a
comprehensive self-assessment tool for osteopathic medical
students preparing for COMLEX-USA Level 1. This assessment
evaluates foundational biomedical sciences integrated with
osteopathic principles and clinical reasoning. The examination
consists of single-best-answer multiple-choice questions, including
clinical vignettes that mirror the COMLEX-USA blueprint. Questions
emphasize application of basic science knowledge to clinical
scenarios, interpretation of laboratory and imaging findings, and
demonstration of competency in osteopathic manipulative
medicine. Success requires mastery of anatomy, physiology,
pathology, pharmacology, and the osteopathic approach to whole-
person care.
Question 1
A 24-year-old man presents with fever, headache, and neck stiffness.
Lumbar puncture shows elevated opening pressure, low glucose, and
high protein. Which organism is most likely responsible?
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Listeria monocytogenes
D. Escherichia coli
B. Streptococcus pneumoniae
, RATIONALE: Bacterial meningitis in adults is most commonly caused
by Streptococcus pneumoniae. The CSF findings (elevated opening
pressure, low glucose, high protein) are classic for bacterial meningitis.
While N. meningitidis (A) is also a common cause, S. pneumoniae is the
most frequent pathogen overall in adults .
Question 2
A 65-year-old smoker presents with hematuria and flank pain. CT
reveals a renal mass. Which is the most likely diagnosis?
A. Wilms tumor
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Angiomyolipoma
B. Renal cell carcinoma
RATIONALE: Renal cell carcinoma is the most common malignant
renal tumor in adults, strongly associated with smoking and typically
presenting with hematuria, flank pain, and a palpable mass. Wilms
tumor (A) occurs in children. Transitional cell carcinoma (C) arises from
the urothelium of the renal pelvis/ureter. Angiomyolipoma (D) is benign
and often contains fat on imaging .
Question 3
Which electrolyte abnormality is most associated with ECG showing
peaked T waves?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hyponatremia
B. Hyperkalemia
, RATIONALE: Hyperkalemia causes peaked ("tented") T waves due to
altered cardiac repolarization. Other ECG changes include widened
QRS, prolonged PR interval, and eventually sine wave pattern and
asystole. Hypokalemia (A) causes flat T waves and prominent U waves.
Hypercalcemia (C) shortens the QT interval .
Question 4
A child presents with barking cough and inspiratory stridor. What is the
most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
B. Croup
RATIONALE: Croup (laryngotracheobronchitis) classically presents
with a barking cough, inspiratory stridor, and respiratory distress in
young children. Epiglottitis (A) presents with high fever, drooling, and
tripod positioning, often without barking cough. Bronchiolitis (C)
presents with wheezing and respiratory distress in infants; asthma (D)
presents with wheezing .
Question 5
Which hormone is produced by the posterior pituitary?
A. ACTH
B. TSH
C. Oxytocin
D. GH
C. Oxytocin
