COMSAE 114 Exam Prep Document | 2026/2027 Edition | 200
Verified Questions
COMSAE 114 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions |
Updated Per Latest Guidelines | Graded A+
This comprehensive study guide is meticulously crafted for osteopathic medical students preparing for
the 2026 COMSAE 114. It features 200 verified questions with detailed rationales, covering all core
basic science and clinical concepts. The content is aligned with the latest NBOME blueprint, ensuring
high-yield, exam-relevant material. Trusted by DO students, this resource is your key to a guaranteed
pass.
Key Features:
200 verified questions with detailed answer rationales
Comprehensive coverage of foundational biomedical sciences
Clinical vignettes mirroring actual COMSAE 114 format
High-yield topic summaries for rapid review
Updated to reflect 2026/2027 NBOME guidelines
Expertly curated by top-performing osteopathic students
Updates for 2026:
- Aligned with the latest 2026 NBOME content blueprint
- Incorporated new clinical presentation patterns from recent exams
- Enhanced rationales with evidence-based explanations
- Added more integrative and cross-disciplinary questions
- Refined answer explanations to address common student misconceptions
Abstract:
The 2026 COMSAE 114 is a pivotal assessment for osteopathic medical students, evaluating their mastery of
foundational biomedical sciences and clinical reasoning. This study guide provides a comprehensive collection of
200 verified questions, each accompanied by detailed rationales that explain both correct and incorrect options.
The content is systematically organized to mirror the exam's blueprint, covering key areas such as anatomy,
physiology, biochemistry, microbiology, immunology, pathology, pharmacology, and osteopathic principles. Each
question is designed to challenge critical thinking and application of knowledge to clinical scenarios. Additionally,
the guide includes high-yield summaries, test-taking strategies, and performance analytics to help students identify
strengths and weaknesses. Updated for the 2026/2027 academic year, this resource is trusted by DO students for its
accuracy, relevance, and effectiveness in securing a passing score. Whether used for comprehensive review or
targeted practice, this guide is an indispensable tool for success on COMSAE 114.
Keywords:
COMSAE 114, COMLEX preparation, Osteopathic medical exam, Basic sciences review, Clinical vignettes,
NBOME blueprint, Verified questions, Study guide 2026
Answer Format:
Each question is followed by the correct answer, a detailed rationale explaining the underlying concept, and an
analysis of why the other options are incorrect. Rationales are concise yet comprehensive, referencing key
physiological and pathological mechanisms. This format reinforces learning and helps students understand the
'why' behind each answer.
Compliance Checklist:
Aligned with NBOME 2026/2027 content specifications
Page 1
, All questions verified for accuracy by content experts
Includes evidence-based rationales and references
Covers all major disciplines tested on COMSAE 114
Format mirrors the actual exam interface and question style
Content Area Overview:
Content Area Questions Key Topics Weight
Anatomy 1-30 Gross anatomy, Embryology, 15%
Neuroanatomy, Histology
Physiology 31-60 Cardiovascular, Renal, Respiratory, 15%
Endocrine, Gastrointestinal
Biochemistry & Genetics 61-80 Metabolism, Molecular biology, Genetic 10%
disorders, Nutrition
Microbiology & Immunology 81-110 Bacteriology, Virology, Mycology, 15%
Parasitology, Immune response
Pathology 111-140 General pathology, Systemic pathology, 15%
Neoplasia, Inflammation
Pharmacology 141-160 Autonomic, Cardiovascular, CNS, 10%
Antimicrobials, Chemotherapy
Osteopathic Principles & 161-180 OMT techniques, Palpatory diagnosis, 10%
Practice Cranial concepts, Visceral manipulation
Clinical Integration & Ethics 181-200 Patient communication, Medical ethics, 10%
Biostatistics, Epidemiology
Page 2
,Q1. A 45-year-old with cirrhosis and refractory ascites is being considered for
transjugular intrahepatic portosystemic shunt (TIPS). Which hemodynamic
parameter most strongly predicts poor post-TIPS survival and thus contraindicates
the procedure?
A. Mean pulmonary artery pressure (mPAP) of 30 mm Hg
B. Hepatic venous pressure gradient (HVPG) of 12 mm Hg
C. Right atrial pressure of 8 mm Hg
D. Cardiac output of 9 L/min
Correct Answer: A. Mean pulmonary artery pressure (mPAP) of 30 mm Hg
Rationale: A mPAP >45 mm Hg is an absolute contraindication to TIPS due to high
perioperative mortality; values 30-45 mm Hg are relative contraindications. HVPG of 12
mm Hg is a threshold for variceal bleeding risk but not a contraindication. Right atrial
pressure and cardiac output are not primary contraindications.
Why Wrong:
B - HVPG of 12 mm Hg indicates portal hypertension but does not preclude TIPS; it
is actually a target for reducing bleeding risk.
C - Right atrial pressure alone is not a contraindication; it may affect volume status
but is not a definitive TIPS exclusion criterion.
D - High cardiac output is common in cirrhosis and not a contraindication; severe
pulmonary hypertension is the key concern.
Reference: García-Pagán JC, et al. (2020). TIPS for portal hypertension. Hepatology.
Q2. In a patient with suspected acute coronary syndrome, which ECG finding is most
specific for acute occlusion of the left circumflex artery (LCx) and is often missed on
standard 12-lead ECG?
A. ST-segment depression in leads V1-V3 with upright T waves
B. Isolated ST-segment elevation in leads II, III, and aVF
C. ST-segment elevation in leads V5-V6 and I with reciprocal changes in aVR
D. Prominent R wave and ST-segment depression in lead V1
Correct Answer: A. ST-segment depression in leads V1-V3 with upright T waves
Rationale: LCx occlusion often presents as posterior MI, which manifests as ST
depression in V1-V3 (posterior leads) with upright T waves. This is frequently missed
because standard ECG lacks posterior leads (V7-V9). ST elevation in inferior leads
suggests RCA occlusion, and lateral leads (V5-V6, I) suggest LCx but are less specific than
posterior changes.
Why Wrong:
B - ST elevation in inferior leads (II, III, aVF) is more typical of right coronary artery
occlusion, not LCx.
C - Lateral ST elevation (V5-V6, I) can occur with LCx but is not the most specific or
Page 3
, commonly missed pattern; posterior leads are key.
D - Prominent R wave and ST depression in V1 can occur in posterior MI but this
pattern is not the most specific for LCx; it may also be seen in right ventricular
hypertrophy or bundle branch block.
Reference: O'Gara PT, et al. (2013). ACCF/AHA guideline for STEMI. Circulation.
Q3. A 30-year-old female with a history of recurrent urinary tract infections presents
with acute flank pain and fever. CT shows a 6 mm stone at the ureteropelvic junction
with moderate hydronephrosis. Urine culture grows Proteus mirabilis. Which
combination of factors most increases the risk of developing staghorn calculi?
A. Urease production and alkaline urine
B. Hyperoxaluria and acidic urine
C. Hyperuricosuria and low urine pH
D. Hypocitraturia and acidic urine
Correct Answer: A. Urease production and alkaline urine
Rationale: Proteus mirabilis produces urease, which hydrolyzes urea to ammonia,
alkalinizing urine and promoting struvite (magnesium ammonium phosphate) stone
formation. Staghorn calculi are typically struvite stones associated with urease-producing
organisms and alkaline urine. Hyperoxaluria, hyperuricosuria, and hypocitraturia are risk
factors for calcium or uric acid stones, not struvite staghorns.
Why Wrong:
B - Hyperoxaluria and acidic urine predispose to calcium oxalate stones, not struvite
staghorn calculi.
C - Hyperuricosuria and low urine pH lead to uric acid stones, which do not form
staghorn calculi as commonly as struvite.
D - Hypocitraturia and acidic urine increase risk for calcium stones, not struvite.
Reference: Pearle MS, et al. (2014). Medical management of kidney stones. AUA
Guideline.
Q4. During a musculoskeletal ultrasound-guided injection, the needle is advanced
under the distal third of the clavicle. Which of the following structures is at greatest
risk of injury?
A. Subclavian artery
B. Brachial plexus trunks
C. Long thoracic nerve
D. Suprascapular nerve
Correct Answer: A. Subclavian artery
Rationale: The subclavian artery lies directly posterior to the distal third of the clavicle
and is vulnerable during infraclavicular approaches. The brachial plexus is more medial
Page 4
Verified Questions
COMSAE 114 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions |
Updated Per Latest Guidelines | Graded A+
This comprehensive study guide is meticulously crafted for osteopathic medical students preparing for
the 2026 COMSAE 114. It features 200 verified questions with detailed rationales, covering all core
basic science and clinical concepts. The content is aligned with the latest NBOME blueprint, ensuring
high-yield, exam-relevant material. Trusted by DO students, this resource is your key to a guaranteed
pass.
Key Features:
200 verified questions with detailed answer rationales
Comprehensive coverage of foundational biomedical sciences
Clinical vignettes mirroring actual COMSAE 114 format
High-yield topic summaries for rapid review
Updated to reflect 2026/2027 NBOME guidelines
Expertly curated by top-performing osteopathic students
Updates for 2026:
- Aligned with the latest 2026 NBOME content blueprint
- Incorporated new clinical presentation patterns from recent exams
- Enhanced rationales with evidence-based explanations
- Added more integrative and cross-disciplinary questions
- Refined answer explanations to address common student misconceptions
Abstract:
The 2026 COMSAE 114 is a pivotal assessment for osteopathic medical students, evaluating their mastery of
foundational biomedical sciences and clinical reasoning. This study guide provides a comprehensive collection of
200 verified questions, each accompanied by detailed rationales that explain both correct and incorrect options.
The content is systematically organized to mirror the exam's blueprint, covering key areas such as anatomy,
physiology, biochemistry, microbiology, immunology, pathology, pharmacology, and osteopathic principles. Each
question is designed to challenge critical thinking and application of knowledge to clinical scenarios. Additionally,
the guide includes high-yield summaries, test-taking strategies, and performance analytics to help students identify
strengths and weaknesses. Updated for the 2026/2027 academic year, this resource is trusted by DO students for its
accuracy, relevance, and effectiveness in securing a passing score. Whether used for comprehensive review or
targeted practice, this guide is an indispensable tool for success on COMSAE 114.
Keywords:
COMSAE 114, COMLEX preparation, Osteopathic medical exam, Basic sciences review, Clinical vignettes,
NBOME blueprint, Verified questions, Study guide 2026
Answer Format:
Each question is followed by the correct answer, a detailed rationale explaining the underlying concept, and an
analysis of why the other options are incorrect. Rationales are concise yet comprehensive, referencing key
physiological and pathological mechanisms. This format reinforces learning and helps students understand the
'why' behind each answer.
Compliance Checklist:
Aligned with NBOME 2026/2027 content specifications
Page 1
, All questions verified for accuracy by content experts
Includes evidence-based rationales and references
Covers all major disciplines tested on COMSAE 114
Format mirrors the actual exam interface and question style
Content Area Overview:
Content Area Questions Key Topics Weight
Anatomy 1-30 Gross anatomy, Embryology, 15%
Neuroanatomy, Histology
Physiology 31-60 Cardiovascular, Renal, Respiratory, 15%
Endocrine, Gastrointestinal
Biochemistry & Genetics 61-80 Metabolism, Molecular biology, Genetic 10%
disorders, Nutrition
Microbiology & Immunology 81-110 Bacteriology, Virology, Mycology, 15%
Parasitology, Immune response
Pathology 111-140 General pathology, Systemic pathology, 15%
Neoplasia, Inflammation
Pharmacology 141-160 Autonomic, Cardiovascular, CNS, 10%
Antimicrobials, Chemotherapy
Osteopathic Principles & 161-180 OMT techniques, Palpatory diagnosis, 10%
Practice Cranial concepts, Visceral manipulation
Clinical Integration & Ethics 181-200 Patient communication, Medical ethics, 10%
Biostatistics, Epidemiology
Page 2
,Q1. A 45-year-old with cirrhosis and refractory ascites is being considered for
transjugular intrahepatic portosystemic shunt (TIPS). Which hemodynamic
parameter most strongly predicts poor post-TIPS survival and thus contraindicates
the procedure?
A. Mean pulmonary artery pressure (mPAP) of 30 mm Hg
B. Hepatic venous pressure gradient (HVPG) of 12 mm Hg
C. Right atrial pressure of 8 mm Hg
D. Cardiac output of 9 L/min
Correct Answer: A. Mean pulmonary artery pressure (mPAP) of 30 mm Hg
Rationale: A mPAP >45 mm Hg is an absolute contraindication to TIPS due to high
perioperative mortality; values 30-45 mm Hg are relative contraindications. HVPG of 12
mm Hg is a threshold for variceal bleeding risk but not a contraindication. Right atrial
pressure and cardiac output are not primary contraindications.
Why Wrong:
B - HVPG of 12 mm Hg indicates portal hypertension but does not preclude TIPS; it
is actually a target for reducing bleeding risk.
C - Right atrial pressure alone is not a contraindication; it may affect volume status
but is not a definitive TIPS exclusion criterion.
D - High cardiac output is common in cirrhosis and not a contraindication; severe
pulmonary hypertension is the key concern.
Reference: García-Pagán JC, et al. (2020). TIPS for portal hypertension. Hepatology.
Q2. In a patient with suspected acute coronary syndrome, which ECG finding is most
specific for acute occlusion of the left circumflex artery (LCx) and is often missed on
standard 12-lead ECG?
A. ST-segment depression in leads V1-V3 with upright T waves
B. Isolated ST-segment elevation in leads II, III, and aVF
C. ST-segment elevation in leads V5-V6 and I with reciprocal changes in aVR
D. Prominent R wave and ST-segment depression in lead V1
Correct Answer: A. ST-segment depression in leads V1-V3 with upright T waves
Rationale: LCx occlusion often presents as posterior MI, which manifests as ST
depression in V1-V3 (posterior leads) with upright T waves. This is frequently missed
because standard ECG lacks posterior leads (V7-V9). ST elevation in inferior leads
suggests RCA occlusion, and lateral leads (V5-V6, I) suggest LCx but are less specific than
posterior changes.
Why Wrong:
B - ST elevation in inferior leads (II, III, aVF) is more typical of right coronary artery
occlusion, not LCx.
C - Lateral ST elevation (V5-V6, I) can occur with LCx but is not the most specific or
Page 3
, commonly missed pattern; posterior leads are key.
D - Prominent R wave and ST depression in V1 can occur in posterior MI but this
pattern is not the most specific for LCx; it may also be seen in right ventricular
hypertrophy or bundle branch block.
Reference: O'Gara PT, et al. (2013). ACCF/AHA guideline for STEMI. Circulation.
Q3. A 30-year-old female with a history of recurrent urinary tract infections presents
with acute flank pain and fever. CT shows a 6 mm stone at the ureteropelvic junction
with moderate hydronephrosis. Urine culture grows Proteus mirabilis. Which
combination of factors most increases the risk of developing staghorn calculi?
A. Urease production and alkaline urine
B. Hyperoxaluria and acidic urine
C. Hyperuricosuria and low urine pH
D. Hypocitraturia and acidic urine
Correct Answer: A. Urease production and alkaline urine
Rationale: Proteus mirabilis produces urease, which hydrolyzes urea to ammonia,
alkalinizing urine and promoting struvite (magnesium ammonium phosphate) stone
formation. Staghorn calculi are typically struvite stones associated with urease-producing
organisms and alkaline urine. Hyperoxaluria, hyperuricosuria, and hypocitraturia are risk
factors for calcium or uric acid stones, not struvite staghorns.
Why Wrong:
B - Hyperoxaluria and acidic urine predispose to calcium oxalate stones, not struvite
staghorn calculi.
C - Hyperuricosuria and low urine pH lead to uric acid stones, which do not form
staghorn calculi as commonly as struvite.
D - Hypocitraturia and acidic urine increase risk for calcium stones, not struvite.
Reference: Pearle MS, et al. (2014). Medical management of kidney stones. AUA
Guideline.
Q4. During a musculoskeletal ultrasound-guided injection, the needle is advanced
under the distal third of the clavicle. Which of the following structures is at greatest
risk of injury?
A. Subclavian artery
B. Brachial plexus trunks
C. Long thoracic nerve
D. Suprascapular nerve
Correct Answer: A. Subclavian artery
Rationale: The subclavian artery lies directly posterior to the distal third of the clavicle
and is vulnerable during infraclavicular approaches. The brachial plexus is more medial
Page 4
