COMSAE ASA 107i Comprehensive
Osteopathic Medical Practice Exam
with Verified Questions, Detailed
Answers a 2026 editon
1. A 67-year-old man presents with crushing substernal
chest pain radiating to his left arm for 45 minutes. 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. Posterior descending artery
E. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions produce ST-
segment elevations in leads II, III, and aVF. The right
coronary artery supplies the inferior wall in the majority of
patients. LAD occlusion causes anterior MI, while circumflex
occlusion commonly affects the lateral wall. Recognition of
lead distributions is essential for COMLEX and COMSAE
examinations.
,2. A patient develops fever, hypotension, and diffuse
erythematous rash after prolonged tampon use. Which
organism is most likely responsible?
A. Streptococcus pyogenes
B. Escherichia coli
C. Staphylococcus aureus
D. Clostridium difficile
E. Pseudomonas aeruginosa
Answer: C. Staphylococcus aureus
Rationale: Toxic shock syndrome classically occurs due to
toxin-producing Staphylococcus aureus. Toxic shock toxin-1
acts as a superantigen, causing massive T-cell activation and
cytokine release. Hallmark findings include fever,
hypotension, diffuse rash, and multiorgan involvement.
3. Which electrolyte abnormality is most commonly
associated with prolonged QT interval?
A. Hypercalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
E. Hypermagnesemia
Answer: C. Hypokalemia
Rationale: Hypokalemia delays ventricular repolarization
and can prolong the QT interval, increasing risk for torsades
,de pointes. Additional ECG findings include flattened T
waves and prominent U waves.
4. A newborn presents with continuous machinery-like
murmur at the left infraclavicular area. What is the
diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Tetralogy of Fallot
E. Coarctation of the aorta
Answer: C. Patent ductus arteriosus
Rationale: PDA classically produces a continuous machinery
murmur. Persistence of the fetal connection between the
pulmonary artery and aorta results in a left-to-right shunt.
Indomethacin may facilitate closure in premature infants.
5. Which vitamin deficiency causes megaloblastic anemia
and neurologic deficits?
A. Vitamin B1
B. Vitamin B6
C. Vitamin B12
D. Vitamin C
E. Vitamin K
Answer: C. Vitamin B12
, Rationale: Vitamin B12 deficiency causes impaired DNA
synthesis resulting in megaloblastic anemia. Neurologic
manifestations include peripheral neuropathy, loss of
vibration sense, and subacute combined degeneration of the
spinal cord. Folate deficiency causes megaloblastic anemia
but lacks neurologic findings.
6. A patient with chronic alcohol use develops confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is
present?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Thiamine
E. Riboflavin
Answer: D. Thiamine
Rationale: Wernicke encephalopathy consists of confusion,
ophthalmoplegia, and ataxia due to thiamine deficiency.
Chronic alcohol use impairs thiamine absorption and
utilization. Immediate thiamine administration is required
before glucose.
7. Which nephron segment is the primary site of action of
loop diuretics?
A. Proximal convoluted tubule
B. Descending loop of Henle
Osteopathic Medical Practice Exam
with Verified Questions, Detailed
Answers a 2026 editon
1. A 67-year-old man presents with crushing substernal
chest pain radiating to his left arm for 45 minutes. 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. Posterior descending artery
E. Obtuse marginal artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarctions produce ST-
segment elevations in leads II, III, and aVF. The right
coronary artery supplies the inferior wall in the majority of
patients. LAD occlusion causes anterior MI, while circumflex
occlusion commonly affects the lateral wall. Recognition of
lead distributions is essential for COMLEX and COMSAE
examinations.
,2. A patient develops fever, hypotension, and diffuse
erythematous rash after prolonged tampon use. Which
organism is most likely responsible?
A. Streptococcus pyogenes
B. Escherichia coli
C. Staphylococcus aureus
D. Clostridium difficile
E. Pseudomonas aeruginosa
Answer: C. Staphylococcus aureus
Rationale: Toxic shock syndrome classically occurs due to
toxin-producing Staphylococcus aureus. Toxic shock toxin-1
acts as a superantigen, causing massive T-cell activation and
cytokine release. Hallmark findings include fever,
hypotension, diffuse rash, and multiorgan involvement.
3. Which electrolyte abnormality is most commonly
associated with prolonged QT interval?
A. Hypercalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
E. Hypermagnesemia
Answer: C. Hypokalemia
Rationale: Hypokalemia delays ventricular repolarization
and can prolong the QT interval, increasing risk for torsades
,de pointes. Additional ECG findings include flattened T
waves and prominent U waves.
4. A newborn presents with continuous machinery-like
murmur at the left infraclavicular area. What is the
diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Tetralogy of Fallot
E. Coarctation of the aorta
Answer: C. Patent ductus arteriosus
Rationale: PDA classically produces a continuous machinery
murmur. Persistence of the fetal connection between the
pulmonary artery and aorta results in a left-to-right shunt.
Indomethacin may facilitate closure in premature infants.
5. Which vitamin deficiency causes megaloblastic anemia
and neurologic deficits?
A. Vitamin B1
B. Vitamin B6
C. Vitamin B12
D. Vitamin C
E. Vitamin K
Answer: C. Vitamin B12
, Rationale: Vitamin B12 deficiency causes impaired DNA
synthesis resulting in megaloblastic anemia. Neurologic
manifestations include peripheral neuropathy, loss of
vibration sense, and subacute combined degeneration of the
spinal cord. Folate deficiency causes megaloblastic anemia
but lacks neurologic findings.
6. A patient with chronic alcohol use develops confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is
present?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Thiamine
E. Riboflavin
Answer: D. Thiamine
Rationale: Wernicke encephalopathy consists of confusion,
ophthalmoplegia, and ataxia due to thiamine deficiency.
Chronic alcohol use impairs thiamine absorption and
utilization. Immediate thiamine administration is required
before glucose.
7. Which nephron segment is the primary site of action of
loop diuretics?
A. Proximal convoluted tubule
B. Descending loop of Henle
