2026/2027 COMSAE PHASE 1 FORM 113 ACTUAL
EXAM QUESTIONS AND DETAILED SOLUTIONS JUST
RELEASED.PDF QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Foundational Biomedical Sciences (Anatomy, Physiology, Biochemistry,
Microbiology, Pathology, Pharmacology)
Osteopathic Principles and Practice (OMM, Somatic Dysfunction, Viscerosomatic
Reflexes)
Cardiovascular System Disorders
Respiratory System Disorders
Gastrointestinal and Hepatobiliary Disorders
Renal and Electrolyte Disorders
Endocrine and Metabolic Disorders
Infectious Diseases
Hematology and Oncology
Neurologic Disorders
Behavioral Health and Ethics
Musculoskeletal and Rheumatologic Disorders
Introduction
The COMSAE Phase 1 Form 113 examination is a comprehensive osteopathic
medical self-assessment designed to evaluate readiness for COMLEX-USA Level 1.
This assessment integrates foundational biomedical sciences with clinical
,reasoning through vignette-based multiple-choice questions. Content spans
anatomy, physiology, pathology, pharmacology, microbiology, biochemistry, and
osteopathic principles, emphasizing applied decision-making and diagnostic
accuracy. The exam evaluates candidates' ability to synthesize multidisciplinary
knowledge in clinical scenarios, interpret laboratory and imaging findings, and apply
osteopathic manipulative medicine principles. Successful performance
demonstrates the foundational biomedical understanding and clinical reasoning
skills required for progression to clinical training and COMLEX-USA Level 1
success.
SECTION ONE: QUESTIONS 1–100
1. A 24-year-old woman presents with fatigue, weight loss, heat intolerance,
palpitations, and a fine tremor. Examination reveals a diffusely enlarged thyroid
and bilateral exophthalmos. Laboratory studies show decreased TSH and
increased free T4. Which mechanism best explains her condition?
A. Destruction of thyroid follicles by cytotoxic T cells
B. Activation of the TSH receptor by stimulating immunoglobulin
C. Autonomous secretion of TSH by a pituitary adenoma
D. Inhibition of thyroid peroxidase by circulating antibodies
B. Activation of the TSH receptor by stimulating immunoglobulin
RATIONALE: Graves disease is caused by thyroid-stimulating immunoglobulin
that binds and activates the TSH receptor, resulting in increased thyroid hormone
synthesis, diffuse thyroid enlargement, and characteristic ophthalmopathy .
2. A 67-year-old man with hypertension develops sudden right-sided weakness
and difficulty speaking. He is found to have atrial fibrillation. MRI demonstrates
an acute infarction involving the left middle cerebral artery territory. Which
vascular structure is most likely occluded?
A. Left anterior cerebral artery
B. Left posterior cerebral artery
,C. Left middle cerebral artery
D. Basilar artery
C. Left middle cerebral artery
RATIONALE: The middle cerebral artery supplies much of the lateral cerebral
hemisphere. A dominant-hemisphere MCA infarction commonly produces
contralateral weakness, sensory deficits, and aphasia. Atrial fibrillation increases
the risk of embolic ischemic stroke .
3. A 5-year-old child presents with fever, sore throat, tender anterior cervical
lymphadenopathy, and tonsillar exudates without cough. Which organism is
the most likely cause?
A. Corynebacterium diphtheriae
B. Epstein-Barr virus
C. Streptococcus pyogenes
D. Haemophilus influenzae
C. Streptococcus pyogenes
RATIONALE: Streptococcus pyogenes causes group A streptococcal
pharyngitis, which classically presents with fever, tonsillar exudates, tender anterior
cervical nodes, and absence of cough .
4. A 58-year-old man experiences crushing substernal chest pain radiating to
his left arm. ECG demonstrates ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
, C. Right coronary artery
RATIONALE: ST-segment elevation in leads II, III, and aVF indicates an inferior
myocardial infarction. The right coronary artery is the most common culprit vessel
in inferior STEMI .
5. A patient with chronic obstructive pulmonary disease develops worsening
dyspnea and increased sputum production. Which pulmonary finding is most
consistent with emphysema?
A. Decreased total lung capacity
B. Decreased residual volume
C. Increased lung compliance
D. Increased elastic recoil
C. Increased lung compliance
RATIONALE: Emphysema involves destruction of alveolar walls and elastic
tissue, causing increased lung compliance and decreased elastic recoil. Air trapping
leads to increased residual volume and total lung capacity .
6. A 32-year-old woman develops painful swelling of the left calf 1 week after
surgery. Doppler ultrasonography confirms a deep venous thrombosis. Which
component of Virchow triad most directly explains her postoperative risk?
A. Hypercalcemia
B. Venous stasis
C. Increased arterial flow
D. Thrombocytopenia
B. Venous stasis
RATIONALE: Virchow triad consists of endothelial injury, abnormal blood flow
such as stasis, and hypercoagulability. Immobilization after surgery promotes
venous stasis and increases the risk of DVT .
EXAM QUESTIONS AND DETAILED SOLUTIONS JUST
RELEASED.PDF QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Foundational Biomedical Sciences (Anatomy, Physiology, Biochemistry,
Microbiology, Pathology, Pharmacology)
Osteopathic Principles and Practice (OMM, Somatic Dysfunction, Viscerosomatic
Reflexes)
Cardiovascular System Disorders
Respiratory System Disorders
Gastrointestinal and Hepatobiliary Disorders
Renal and Electrolyte Disorders
Endocrine and Metabolic Disorders
Infectious Diseases
Hematology and Oncology
Neurologic Disorders
Behavioral Health and Ethics
Musculoskeletal and Rheumatologic Disorders
Introduction
The COMSAE Phase 1 Form 113 examination is a comprehensive osteopathic
medical self-assessment designed to evaluate readiness for COMLEX-USA Level 1.
This assessment integrates foundational biomedical sciences with clinical
,reasoning through vignette-based multiple-choice questions. Content spans
anatomy, physiology, pathology, pharmacology, microbiology, biochemistry, and
osteopathic principles, emphasizing applied decision-making and diagnostic
accuracy. The exam evaluates candidates' ability to synthesize multidisciplinary
knowledge in clinical scenarios, interpret laboratory and imaging findings, and apply
osteopathic manipulative medicine principles. Successful performance
demonstrates the foundational biomedical understanding and clinical reasoning
skills required for progression to clinical training and COMLEX-USA Level 1
success.
SECTION ONE: QUESTIONS 1–100
1. A 24-year-old woman presents with fatigue, weight loss, heat intolerance,
palpitations, and a fine tremor. Examination reveals a diffusely enlarged thyroid
and bilateral exophthalmos. Laboratory studies show decreased TSH and
increased free T4. Which mechanism best explains her condition?
A. Destruction of thyroid follicles by cytotoxic T cells
B. Activation of the TSH receptor by stimulating immunoglobulin
C. Autonomous secretion of TSH by a pituitary adenoma
D. Inhibition of thyroid peroxidase by circulating antibodies
B. Activation of the TSH receptor by stimulating immunoglobulin
RATIONALE: Graves disease is caused by thyroid-stimulating immunoglobulin
that binds and activates the TSH receptor, resulting in increased thyroid hormone
synthesis, diffuse thyroid enlargement, and characteristic ophthalmopathy .
2. A 67-year-old man with hypertension develops sudden right-sided weakness
and difficulty speaking. He is found to have atrial fibrillation. MRI demonstrates
an acute infarction involving the left middle cerebral artery territory. Which
vascular structure is most likely occluded?
A. Left anterior cerebral artery
B. Left posterior cerebral artery
,C. Left middle cerebral artery
D. Basilar artery
C. Left middle cerebral artery
RATIONALE: The middle cerebral artery supplies much of the lateral cerebral
hemisphere. A dominant-hemisphere MCA infarction commonly produces
contralateral weakness, sensory deficits, and aphasia. Atrial fibrillation increases
the risk of embolic ischemic stroke .
3. A 5-year-old child presents with fever, sore throat, tender anterior cervical
lymphadenopathy, and tonsillar exudates without cough. Which organism is
the most likely cause?
A. Corynebacterium diphtheriae
B. Epstein-Barr virus
C. Streptococcus pyogenes
D. Haemophilus influenzae
C. Streptococcus pyogenes
RATIONALE: Streptococcus pyogenes causes group A streptococcal
pharyngitis, which classically presents with fever, tonsillar exudates, tender anterior
cervical nodes, and absence of cough .
4. A 58-year-old man experiences crushing substernal chest pain radiating to
his left arm. ECG demonstrates ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
, C. Right coronary artery
RATIONALE: ST-segment elevation in leads II, III, and aVF indicates an inferior
myocardial infarction. The right coronary artery is the most common culprit vessel
in inferior STEMI .
5. A patient with chronic obstructive pulmonary disease develops worsening
dyspnea and increased sputum production. Which pulmonary finding is most
consistent with emphysema?
A. Decreased total lung capacity
B. Decreased residual volume
C. Increased lung compliance
D. Increased elastic recoil
C. Increased lung compliance
RATIONALE: Emphysema involves destruction of alveolar walls and elastic
tissue, causing increased lung compliance and decreased elastic recoil. Air trapping
leads to increased residual volume and total lung capacity .
6. A 32-year-old woman develops painful swelling of the left calf 1 week after
surgery. Doppler ultrasonography confirms a deep venous thrombosis. Which
component of Virchow triad most directly explains her postoperative risk?
A. Hypercalcemia
B. Venous stasis
C. Increased arterial flow
D. Thrombocytopenia
B. Venous stasis
RATIONALE: Virchow triad consists of endothelial injury, abnormal blood flow
such as stasis, and hypercoagulability. Immobilization after surgery promotes
venous stasis and increases the risk of DVT .
