COMSAE Phase 1 Form 115 Practice Exam |
Questions & Verified Answers with
Rationales | 2026/2027 Edition | INSTANT
PDF DOWNLOAD
1. A 24-year-old male presents with a cough and night sweats. A chest X-ray
shows a cavitary lesion in the right upper lobe. Sputum culture grows acid-fast
bacilli. Which cytokine is primarily responsible for the formation of the
granulomas seen in this patient?
A) IL-4
B) IL-10
C) IFN-gamma
D) IL-5
Answer: C) IFN-gamma
Macrophages present antigen to CD4+ T-cells, which secrete IL-12 to induce Th1
differentiation. Th1 cells then secrete IFN-gamma to activate macrophages, leading to
granuloma formation in M. tuberculosis infection.
2. An osteopathic structural exam on a 30-year-old female reveals a restricted T5
segment. The segment prefers rotation right and sidebending right. It improves
when the patient slumps forward into spinal flexion. What is the correct
diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answer: C) T5 Flexed RR SR
,Since it improves in flexion, the dysfunction is Flexed (F). According to Fryette’s
Second Law (Type II), rotation and sidebending occur to the same side (RRSR).
3. A 45-year-old male is started on a medication for chronic gout. Two weeks
later, he develops a severe skin rash with epidermal detachment involving 35% of
his body surface area. Which medication was most likely started?
A) Colchicine
B) Probenecid
C) Allopurinol
D) Indomethacin
Answer: C) Allopurinol
Allopurinol is a frequent trigger for Stevens-Johnson Syndrome (SJS) and Toxic
Epidermal Necrolysis (TEN), especially in patients with the HLA-B*5801 allele.
4. During a cranial exam, the physician notes that the sphenoid base moves
superiorly during the inhalation phase of the primary respiratory mechanism.
What is this motion called?
A) Extension
B) Flexion
C) Torsion
D) Sidebending-Rotation
Answer: B) Flexion
In cranial flexion, the midline bones (sphenoid and occiput) rotate in opposite
directions, causing the sphenobasilar synchondrosis (SBS) to rise superiorly.
5. A 55-year-old woman with a history of breast cancer presents with severe back
pain. Imaging shows lytic lesions in the lumbar vertebrae. Labs show a Calcium
of 13.2 mg/dL. What is the initial best step in management?
A) Bisphosphonates
B) Calcitonin
C) Normal saline IV
D) Furosemide
Answer: C) Normal saline IV
The first priority in symptomatic hypercalcemia is volume expansion with normal saline
,to promote renal calcium excretion. Bisphosphonates are used later for long-term
control.
6. A researcher is studying a bacteria that is Gram-positive, catalase-negative,
and shows an "alpha-hemolysis" pattern on blood agar. It is also sensitive to
optochin. Which organism is this?
A) Streptococcus pyogenes
B) Streptococcus agalactiae
C) Streptococcus pneumoniae
D) Enterococcus faecalis
Answer: C) Streptococcus pneumoniae
S. pneumoniae is alpha-hemolytic and optochin-sensitive. Viridans streptococci are
also alpha-hemolytic but are optochin-resistant.
7. A 16-year-old female presents for a sports physical. Exam reveals a rib hump
on the right side when she bends forward. Her Cobb angle is measured at 15
degrees. What is the recommended management?
A) Observation and re-evaluation in 6 months
B) Bracing
C) Surgical consultation
D) OMM alone
Answer: A) Observation and re-evaluation in 6 months
For scoliosis, a Cobb angle <20° is managed with observation. Bracing is indicated for
20-45°, and surgery is generally considered for angles >45-50°.
8. Which of the following drugs acts by irreversibly inhibiting cyclooxygenase-1
and 2?
A) Ibuprofen
B) Celecoxib
C) Aspirin
D) Naproxen
Answer: C) Aspirin
Aspirin covalently acetylates COX enzymes, leading to irreversible inhibition. Other
NSAIDs like ibuprofen bind reversibly.
, 9. A 60-year-old male with a history of heavy alcohol use presents with
hematemesis. Endoscopy reveals enlarged veins in the lower esophagus. These
vessels represent an anastomosis between which two veins?
A) Superior mesenteric and Splenic
B) Left gastric and Azygos
C) Inferior mesenteric and Internal iliac
D) Paraumbilical and Superficial epigastric
Answer: B) Left gastric and Azygos
Esophageal varices occur due to portal hypertension, causing a backup of blood from
the left gastric vein (portal) into the azygos vein (systemic).
10. A patient presents with right-sided neck pain. Physical exam shows the C3
segment is rotated left and sidebent left. Which OMM technique would involve
moving the segment into rotation right and sidebending right?
A) Muscle Energy
B) Strain-Counterstrain
C) Cranial
D) Facilitated Positional Release
Answer: A) Muscle Energy
Muscle Energy is a direct technique, meaning the physician moves the patient into the
restrictive barrier (the side they don't like to go).
11. A 32-year-old female presents with a "butterfly" rash on her face and joint
pain in her hands. Laboratory testing shows a positive ANA and anti-double-
stranded DNA (dsDNA) antibodies. Which of the following renal findings is most
commonly associated with this condition?
A) Focal segmental glomerulosclerosis
B) Diffuse proliferative glomerulonephritis
C) Minimal change disease
D) Amyloidosis
Answer: B) Diffuse proliferative glomerulonephritis
Systemic Lupus Erythematosus (SLE) often presents with lupus nephritis. Type IV
(diffuse proliferative) is the most common and severe form, characterized by "wire-loop"
capillary lesions on light microscopy.
Questions & Verified Answers with
Rationales | 2026/2027 Edition | INSTANT
PDF DOWNLOAD
1. A 24-year-old male presents with a cough and night sweats. A chest X-ray
shows a cavitary lesion in the right upper lobe. Sputum culture grows acid-fast
bacilli. Which cytokine is primarily responsible for the formation of the
granulomas seen in this patient?
A) IL-4
B) IL-10
C) IFN-gamma
D) IL-5
Answer: C) IFN-gamma
Macrophages present antigen to CD4+ T-cells, which secrete IL-12 to induce Th1
differentiation. Th1 cells then secrete IFN-gamma to activate macrophages, leading to
granuloma formation in M. tuberculosis infection.
2. An osteopathic structural exam on a 30-year-old female reveals a restricted T5
segment. The segment prefers rotation right and sidebending right. It improves
when the patient slumps forward into spinal flexion. What is the correct
diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answer: C) T5 Flexed RR SR
,Since it improves in flexion, the dysfunction is Flexed (F). According to Fryette’s
Second Law (Type II), rotation and sidebending occur to the same side (RRSR).
3. A 45-year-old male is started on a medication for chronic gout. Two weeks
later, he develops a severe skin rash with epidermal detachment involving 35% of
his body surface area. Which medication was most likely started?
A) Colchicine
B) Probenecid
C) Allopurinol
D) Indomethacin
Answer: C) Allopurinol
Allopurinol is a frequent trigger for Stevens-Johnson Syndrome (SJS) and Toxic
Epidermal Necrolysis (TEN), especially in patients with the HLA-B*5801 allele.
4. During a cranial exam, the physician notes that the sphenoid base moves
superiorly during the inhalation phase of the primary respiratory mechanism.
What is this motion called?
A) Extension
B) Flexion
C) Torsion
D) Sidebending-Rotation
Answer: B) Flexion
In cranial flexion, the midline bones (sphenoid and occiput) rotate in opposite
directions, causing the sphenobasilar synchondrosis (SBS) to rise superiorly.
5. A 55-year-old woman with a history of breast cancer presents with severe back
pain. Imaging shows lytic lesions in the lumbar vertebrae. Labs show a Calcium
of 13.2 mg/dL. What is the initial best step in management?
A) Bisphosphonates
B) Calcitonin
C) Normal saline IV
D) Furosemide
Answer: C) Normal saline IV
The first priority in symptomatic hypercalcemia is volume expansion with normal saline
,to promote renal calcium excretion. Bisphosphonates are used later for long-term
control.
6. A researcher is studying a bacteria that is Gram-positive, catalase-negative,
and shows an "alpha-hemolysis" pattern on blood agar. It is also sensitive to
optochin. Which organism is this?
A) Streptococcus pyogenes
B) Streptococcus agalactiae
C) Streptococcus pneumoniae
D) Enterococcus faecalis
Answer: C) Streptococcus pneumoniae
S. pneumoniae is alpha-hemolytic and optochin-sensitive. Viridans streptococci are
also alpha-hemolytic but are optochin-resistant.
7. A 16-year-old female presents for a sports physical. Exam reveals a rib hump
on the right side when she bends forward. Her Cobb angle is measured at 15
degrees. What is the recommended management?
A) Observation and re-evaluation in 6 months
B) Bracing
C) Surgical consultation
D) OMM alone
Answer: A) Observation and re-evaluation in 6 months
For scoliosis, a Cobb angle <20° is managed with observation. Bracing is indicated for
20-45°, and surgery is generally considered for angles >45-50°.
8. Which of the following drugs acts by irreversibly inhibiting cyclooxygenase-1
and 2?
A) Ibuprofen
B) Celecoxib
C) Aspirin
D) Naproxen
Answer: C) Aspirin
Aspirin covalently acetylates COX enzymes, leading to irreversible inhibition. Other
NSAIDs like ibuprofen bind reversibly.
, 9. A 60-year-old male with a history of heavy alcohol use presents with
hematemesis. Endoscopy reveals enlarged veins in the lower esophagus. These
vessels represent an anastomosis between which two veins?
A) Superior mesenteric and Splenic
B) Left gastric and Azygos
C) Inferior mesenteric and Internal iliac
D) Paraumbilical and Superficial epigastric
Answer: B) Left gastric and Azygos
Esophageal varices occur due to portal hypertension, causing a backup of blood from
the left gastric vein (portal) into the azygos vein (systemic).
10. A patient presents with right-sided neck pain. Physical exam shows the C3
segment is rotated left and sidebent left. Which OMM technique would involve
moving the segment into rotation right and sidebending right?
A) Muscle Energy
B) Strain-Counterstrain
C) Cranial
D) Facilitated Positional Release
Answer: A) Muscle Energy
Muscle Energy is a direct technique, meaning the physician moves the patient into the
restrictive barrier (the side they don't like to go).
11. A 32-year-old female presents with a "butterfly" rash on her face and joint
pain in her hands. Laboratory testing shows a positive ANA and anti-double-
stranded DNA (dsDNA) antibodies. Which of the following renal findings is most
commonly associated with this condition?
A) Focal segmental glomerulosclerosis
B) Diffuse proliferative glomerulonephritis
C) Minimal change disease
D) Amyloidosis
Answer: B) Diffuse proliferative glomerulonephritis
Systemic Lupus Erythematosus (SLE) often presents with lupus nephritis. Type IV
(diffuse proliferative) is the most common and severe form, characterized by "wire-loop"
capillary lesions on light microscopy.
