COMSAE PHASE 1 FORM 117 EXAM TEST
BANK QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
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Core Domains
• Osteopathic Principles and Manipulative Medicine
• Anatomy and Embryology
• Physiology and Pathophysiology
• Biochemistry and Molecular Biology
• Pharmacology and Pharmacotherapeutics
• Microbiology and Immunology
• Pathology and Laboratory Medicine
• Behavioral Science and Ethics
• Clinical Integration and Systems-Based Practice
• Biostatistics and Epidemiology
Introduction
The COMSAE Phase 1 Form 117 examination is a comprehensive
self-assessment tool designed for osteopathic medical students
preparing for COMLEX-USA Level 1. It evaluates foundational
biomedical sciences, systems-based pathology, pharmacology,
osteopathic clinical reasoning, and behavioral science. The exam
integrates basic science principles with clinical vignettes to test
critical thinking, application of knowledge to patient scenarios, and
competency in osteopathic manipulative medicine. Questions
emphasize real-world clinical decision-making, interpretation of
laboratory and imaging findings, and the osteopathic approach to
whole-person care. This assessment mirrors the format, difficulty,
and content domains of the official COMSAE Phase 1 examination
and is designed to identify knowledge gaps and strengthen test-
taking skills prior to licensure testing.
,Question 1
A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and menorrhagia. Labs show elevated TSH, low free T4, and
positive anti-TPO antibodies. Which is the most likely diagnosis?
A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Toxic multinodular goiter
B. Hashimoto thyroiditis
RATIONALE: Elevated TSH with low free T4 indicates primary
hypothyroidism. Positive anti-TPO antibodies confirm Hashimoto
thyroiditis, the most common cause of hypothyroidism in the United
States.
Question 2
A 60-year-old man presents with sudden severe tearing chest pain
radiating to the back. Chest X-ray shows a widened mediastinum. Which
is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
RATIONALE: Sudden tearing chest pain radiating to the back with a
widened mediastinum is classic for aortic dissection, a life-threatening
emergency requiring urgent imaging and surgical consultation.
Question 3
,Which vitamin deficiency causes megaloblastic anemia and neurologic
symptoms including paresthesias and ataxia?
A. Folate
B. Vitamin B12
C. Iron
D. Thiamine
B. Vitamin B12
RATIONALE: Vitamin B12 deficiency causes megaloblastic anemia
and neurologic symptoms due to impaired DNA synthesis and myelin
formation. Folate deficiency causes megaloblastic anemia without
neurologic symptoms.
Question 4
A 25-year-old man has recurrent infections with catalase-positive
organisms. The nitroblue tetrazolium test is abnormal. Which diagnosis
is most likely?
A. Chronic granulomatous disease
B. Severe combined immunodeficiency
C. Chediak-Higashi syndrome
D. Leukocyte adhesion deficiency
A. Chronic granulomatous disease
RATIONALE: Chronic granulomatous disease is caused by defective
NADPH oxidase, leading to impaired respiratory burst and recurrent
infections with catalase-positive organisms.
Question 5
Which immunoglobulin class is most abundant in secretions such as
saliva, tears, and breast milk?
, A. IgG
B. IgM
C. IgA
D. IgE
C. IgA
RATIONALE: IgA is the predominant immunoglobulin in mucosal
secretions and provides local immunity. IgG is most abundant in serum,
IgM is a marker of recent infection, and IgE mediates allergic reactions.
Question 6
A 55-year-old man with cirrhosis and ascites requires diuretic therapy.
Which medication is most appropriate as a first-line agent?
A. Furosemide
B. Spironolactone
C. Hydrochlorothiazide
D. Acetazolamide
B. Spironolactone
RATIONALE: Spironolactone, an aldosterone antagonist, is first-line
for ascites in cirrhosis because it counteracts secondary
hyperaldosteronism. Furosemide may be added if needed.
Question 7
A 30-year-old woman has recurrent panic attacks. Which medication is
considered first-line for long-term management?
A. Alprazolam
B. Propranolol
C. Sertraline
BANK QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
Core Domains
• Osteopathic Principles and Manipulative Medicine
• Anatomy and Embryology
• Physiology and Pathophysiology
• Biochemistry and Molecular Biology
• Pharmacology and Pharmacotherapeutics
• Microbiology and Immunology
• Pathology and Laboratory Medicine
• Behavioral Science and Ethics
• Clinical Integration and Systems-Based Practice
• Biostatistics and Epidemiology
Introduction
The COMSAE Phase 1 Form 117 examination is a comprehensive
self-assessment tool designed for osteopathic medical students
preparing for COMLEX-USA Level 1. It evaluates foundational
biomedical sciences, systems-based pathology, pharmacology,
osteopathic clinical reasoning, and behavioral science. The exam
integrates basic science principles with clinical vignettes to test
critical thinking, application of knowledge to patient scenarios, and
competency in osteopathic manipulative medicine. Questions
emphasize real-world clinical decision-making, interpretation of
laboratory and imaging findings, and the osteopathic approach to
whole-person care. This assessment mirrors the format, difficulty,
and content domains of the official COMSAE Phase 1 examination
and is designed to identify knowledge gaps and strengthen test-
taking skills prior to licensure testing.
,Question 1
A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and menorrhagia. Labs show elevated TSH, low free T4, and
positive anti-TPO antibodies. Which is the most likely diagnosis?
A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Toxic multinodular goiter
B. Hashimoto thyroiditis
RATIONALE: Elevated TSH with low free T4 indicates primary
hypothyroidism. Positive anti-TPO antibodies confirm Hashimoto
thyroiditis, the most common cause of hypothyroidism in the United
States.
Question 2
A 60-year-old man presents with sudden severe tearing chest pain
radiating to the back. Chest X-ray shows a widened mediastinum. Which
is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
RATIONALE: Sudden tearing chest pain radiating to the back with a
widened mediastinum is classic for aortic dissection, a life-threatening
emergency requiring urgent imaging and surgical consultation.
Question 3
,Which vitamin deficiency causes megaloblastic anemia and neurologic
symptoms including paresthesias and ataxia?
A. Folate
B. Vitamin B12
C. Iron
D. Thiamine
B. Vitamin B12
RATIONALE: Vitamin B12 deficiency causes megaloblastic anemia
and neurologic symptoms due to impaired DNA synthesis and myelin
formation. Folate deficiency causes megaloblastic anemia without
neurologic symptoms.
Question 4
A 25-year-old man has recurrent infections with catalase-positive
organisms. The nitroblue tetrazolium test is abnormal. Which diagnosis
is most likely?
A. Chronic granulomatous disease
B. Severe combined immunodeficiency
C. Chediak-Higashi syndrome
D. Leukocyte adhesion deficiency
A. Chronic granulomatous disease
RATIONALE: Chronic granulomatous disease is caused by defective
NADPH oxidase, leading to impaired respiratory burst and recurrent
infections with catalase-positive organisms.
Question 5
Which immunoglobulin class is most abundant in secretions such as
saliva, tears, and breast milk?
, A. IgG
B. IgM
C. IgA
D. IgE
C. IgA
RATIONALE: IgA is the predominant immunoglobulin in mucosal
secretions and provides local immunity. IgG is most abundant in serum,
IgM is a marker of recent infection, and IgE mediates allergic reactions.
Question 6
A 55-year-old man with cirrhosis and ascites requires diuretic therapy.
Which medication is most appropriate as a first-line agent?
A. Furosemide
B. Spironolactone
C. Hydrochlorothiazide
D. Acetazolamide
B. Spironolactone
RATIONALE: Spironolactone, an aldosterone antagonist, is first-line
for ascites in cirrhosis because it counteracts secondary
hyperaldosteronism. Furosemide may be added if needed.
Question 7
A 30-year-old woman has recurrent panic attacks. Which medication is
considered first-line for long-term management?
A. Alprazolam
B. Propranolol
C. Sertraline
