COMSAE Phase 1 Form 114 Test Bank | 200 NBOME-Style
Practice Questions with Bold Italic Answers & Detailed
Rationales
Introduction
This COMSAE Phase 1 Form 114 Test Bank provides 200 multiple-choice practice questions designed to mirror
the NBOME Osteopathic Medical Knowledge Self-Assessment (COMSAE) exam. Each question includes a clinical
vignette or fundamental science concept, four answer choices (A–D), a bold italic correct answer with the
corresponding letter and text and a brief rationale Use this bank to assess your readiness for COMLEX-USA Level
1, focusing on osteopathic principles, basic medical sciences and clinical presentation.
Key Topics Covered
• Osteopathic Principles & Practice (OMM/OMT, somatic dysfunction, viscerosomatic reflexes)
• Anatomy (gross, neuroanatomy, embryology)
• Physiology (cardiovascular, respiratory, renal, endocrine)
• Pathology (inflammation, neoplasia, systemic disorders)
• Pharmacology (autonomics, antibiotics, cardiovascular drugs)
• Microbiology (bacteria, viruses, fungi, parasites)
• Immunology (hypersensitivity, autoimmunity, immunodeficiency)
• Behavioral Science (ethics, patient communication, development)
• Biochemistry (metabolism, genetics, molecular biology)
• Biostatistics & Epidemiology (study designs, probability, screening)
1. A 45-year-old male presents with chronic low back pain worsened by prolonged sitting. On osteopathic
examination, you find a restricted, tender L5 vertebral segment that is less mobile in flexion compared to
extension. This somatic dysfunction is best described as:
A) Type I dysfunction
B) Type II dysfunction
C) Neutral dysfunction
D) Non-neutral dysfunction
Answer B: Type II dysfunction
Rationale: Type II dysfunction occurs when a vertebral segment is more restricted in one direction (often
flexion) with less restriction in the opposite; it is typically non-neutral and responds well to direct thrust
techniques.
, 2. Which arm reflex tests the C6 nerve root?
A) Biceps reflex
B) Brachioradialis reflex
C) Triceps reflex
D) Pronator teres reflex
Answer B: Brachioradialis reflex
Rationale: Brachioradialis reflex is primarily mediated by C6. Biceps is C5–C6, triceps is C7, and pronator teres is
C6–C7 but classically C6.
3. A 32-year-old woman with SLE develops pleuritic chest pain and dyspnea. ECG shows diffuse ST elevations
and PR depression. What is the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Costochondritis
Answer B: Pericarditis
Rationale: SLE commonly causes serositis including pericarditis. Diffuse ST elevations and PR depression are
classic for acute pericarditis, not MI or PE.
4. In a patient with metabolic acidosis, an increased anion gap is most likely due to:
A) Diarrhea
B) Renal tubular acidosis
C) Lactic acidosis
D) Acetazolamide use
Answer C: Lactic acidosis
Rationale: Increased anion gap metabolic acidosis results from unmeasured anions (e.g., lactate, ketones,
toxins). Diarrhea and RTA are non‑gap, as is acetazolamide.
5. A 68-year-old man with heart failure is started on spironolactone. Which electrolyte abnormality requires
immediate discontinuation?
A) Hyponatremia 130 mEq/L
B) Hypokalemia 3.2 mEq/L
C) Hyperkalemia 6.1 mEq/L
D) Hypocalcemia 7.8 mg/dL
Answer C: Hyperkalemia 6.1 mEq/L
Rationale: Spironolactone (aldosterone antagonist) reduces potassium excretion; severe hyperkalemia (>6.0)
risks cardiac arrhythmias and mandates stopping the drug.
Practice Questions with Bold Italic Answers & Detailed
Rationales
Introduction
This COMSAE Phase 1 Form 114 Test Bank provides 200 multiple-choice practice questions designed to mirror
the NBOME Osteopathic Medical Knowledge Self-Assessment (COMSAE) exam. Each question includes a clinical
vignette or fundamental science concept, four answer choices (A–D), a bold italic correct answer with the
corresponding letter and text and a brief rationale Use this bank to assess your readiness for COMLEX-USA Level
1, focusing on osteopathic principles, basic medical sciences and clinical presentation.
Key Topics Covered
• Osteopathic Principles & Practice (OMM/OMT, somatic dysfunction, viscerosomatic reflexes)
• Anatomy (gross, neuroanatomy, embryology)
• Physiology (cardiovascular, respiratory, renal, endocrine)
• Pathology (inflammation, neoplasia, systemic disorders)
• Pharmacology (autonomics, antibiotics, cardiovascular drugs)
• Microbiology (bacteria, viruses, fungi, parasites)
• Immunology (hypersensitivity, autoimmunity, immunodeficiency)
• Behavioral Science (ethics, patient communication, development)
• Biochemistry (metabolism, genetics, molecular biology)
• Biostatistics & Epidemiology (study designs, probability, screening)
1. A 45-year-old male presents with chronic low back pain worsened by prolonged sitting. On osteopathic
examination, you find a restricted, tender L5 vertebral segment that is less mobile in flexion compared to
extension. This somatic dysfunction is best described as:
A) Type I dysfunction
B) Type II dysfunction
C) Neutral dysfunction
D) Non-neutral dysfunction
Answer B: Type II dysfunction
Rationale: Type II dysfunction occurs when a vertebral segment is more restricted in one direction (often
flexion) with less restriction in the opposite; it is typically non-neutral and responds well to direct thrust
techniques.
, 2. Which arm reflex tests the C6 nerve root?
A) Biceps reflex
B) Brachioradialis reflex
C) Triceps reflex
D) Pronator teres reflex
Answer B: Brachioradialis reflex
Rationale: Brachioradialis reflex is primarily mediated by C6. Biceps is C5–C6, triceps is C7, and pronator teres is
C6–C7 but classically C6.
3. A 32-year-old woman with SLE develops pleuritic chest pain and dyspnea. ECG shows diffuse ST elevations
and PR depression. What is the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Costochondritis
Answer B: Pericarditis
Rationale: SLE commonly causes serositis including pericarditis. Diffuse ST elevations and PR depression are
classic for acute pericarditis, not MI or PE.
4. In a patient with metabolic acidosis, an increased anion gap is most likely due to:
A) Diarrhea
B) Renal tubular acidosis
C) Lactic acidosis
D) Acetazolamide use
Answer C: Lactic acidosis
Rationale: Increased anion gap metabolic acidosis results from unmeasured anions (e.g., lactate, ketones,
toxins). Diarrhea and RTA are non‑gap, as is acetazolamide.
5. A 68-year-old man with heart failure is started on spironolactone. Which electrolyte abnormality requires
immediate discontinuation?
A) Hyponatremia 130 mEq/L
B) Hypokalemia 3.2 mEq/L
C) Hyperkalemia 6.1 mEq/L
D) Hypocalcemia 7.8 mg/dL
Answer C: Hyperkalemia 6.1 mEq/L
Rationale: Spironolactone (aldosterone antagonist) reduces potassium excretion; severe hyperkalemia (>6.0)
risks cardiac arrhythmias and mandates stopping the drug.
