COMSAE Form ASA 114
Comprehensive Osteopathic Medical
Self-Assessment Examination
(COMSAE)-Style Practice Test Exam
with Verified Questions, Detailed
Answers a 2026 editon
1. A 67-year-old man presents with progressive exertional
dyspnea and angina. Physical examination reveals a harsh
crescendo-decrescendo systolic murmur best heard at the
right upper sternal border and radiating to the carotids.
What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Pulmonic stenosis
D. Tricuspid regurgitation
Answer: B. Aortic stenosis
Rationale: Aortic stenosis classically presents with the triad
of angina, syncope, and heart failure symptoms. The
murmur is a harsh systolic ejection murmur heard best at
the right upper sternal border with radiation to the carotid
arteries. Mitral regurgitation radiates to the axilla, while
right-sided valvular lesions are heard best along the left
sternal border.
,2. A 23-year-old woman develops fever, malar rash, oral
ulcers, and proteinuria. Which antibody is most specific for
her condition?
A. Anti-Ro
B. Anti-Smith
C. Rheumatoid factor
D. Anti-centromere
Answer: B. Anti-Smith
Rationale: The patient has systemic lupus erythematosus
(SLE). Anti-Smith antibodies are highly specific for SLE,
although less sensitive than ANA. Anti-dsDNA correlates
with disease activity and nephritis, while anti-Ro is
associated with Sjögren syndrome and neonatal lupus.
3. A patient develops severe chest pain radiating to the
back. Blood pressure differs significantly between the two
arms. Which diagnosis is most likely?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Sudden tearing chest pain radiating to the back
combined with unequal arm blood pressures strongly
suggests aortic dissection. The condition results from an
,intimal tear allowing blood to track within the aortic wall.
Immediate diagnosis and management are critical because
mortality rises rapidly.
4. A 6-year-old boy presents with honey-colored crusted
lesions around the mouth. Which organism is most
commonly responsible?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Neisseria meningitidis
D. Corynebacterium diphtheriae
Answer: B. Staphylococcus aureus
Rationale: Impetigo commonly presents as honey-colored
crusted lesions, especially in children. Staphylococcus aureus
is the most common cause, although Streptococcus
pyogenes may also be involved.
5. Which electrolyte abnormality is most commonly
associated with peaked T waves on ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Answer: B. Hyperkalemia
Rationale: Hyperkalemia causes characteristic ECG changes
including peaked T waves, prolonged PR interval, widening
, of the QRS complex, and eventually a sine-wave pattern.
These changes can progress to fatal arrhythmias if
untreated.
6. A patient with COPD has an arterial blood gas showing pH
7.36, PaCO₂ 58 mm Hg, and elevated bicarbonate. This
represents:
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with compensation
C. Metabolic alkalosis
D. Mixed respiratory alkalosis and metabolic acidosis
Answer: B. Chronic respiratory acidosis with compensation
Rationale: COPD causes chronic CO₂ retention. Renal
compensation increases bicarbonate reabsorption over
time, helping normalize pH. Near-normal pH with elevated
PaCO₂ and bicarbonate indicates chronic compensated
respiratory acidosis.
7. Which cranial nerve mediates the afferent limb of the
corneal reflex?
A. CN II
B. CN III
C. CN V1
D. CN VII
Answer: C. CN V1
Comprehensive Osteopathic Medical
Self-Assessment Examination
(COMSAE)-Style Practice Test Exam
with Verified Questions, Detailed
Answers a 2026 editon
1. A 67-year-old man presents with progressive exertional
dyspnea and angina. Physical examination reveals a harsh
crescendo-decrescendo systolic murmur best heard at the
right upper sternal border and radiating to the carotids.
What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Pulmonic stenosis
D. Tricuspid regurgitation
Answer: B. Aortic stenosis
Rationale: Aortic stenosis classically presents with the triad
of angina, syncope, and heart failure symptoms. The
murmur is a harsh systolic ejection murmur heard best at
the right upper sternal border with radiation to the carotid
arteries. Mitral regurgitation radiates to the axilla, while
right-sided valvular lesions are heard best along the left
sternal border.
,2. A 23-year-old woman develops fever, malar rash, oral
ulcers, and proteinuria. Which antibody is most specific for
her condition?
A. Anti-Ro
B. Anti-Smith
C. Rheumatoid factor
D. Anti-centromere
Answer: B. Anti-Smith
Rationale: The patient has systemic lupus erythematosus
(SLE). Anti-Smith antibodies are highly specific for SLE,
although less sensitive than ANA. Anti-dsDNA correlates
with disease activity and nephritis, while anti-Ro is
associated with Sjögren syndrome and neonatal lupus.
3. A patient develops severe chest pain radiating to the
back. Blood pressure differs significantly between the two
arms. Which diagnosis is most likely?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Sudden tearing chest pain radiating to the back
combined with unequal arm blood pressures strongly
suggests aortic dissection. The condition results from an
,intimal tear allowing blood to track within the aortic wall.
Immediate diagnosis and management are critical because
mortality rises rapidly.
4. A 6-year-old boy presents with honey-colored crusted
lesions around the mouth. Which organism is most
commonly responsible?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Neisseria meningitidis
D. Corynebacterium diphtheriae
Answer: B. Staphylococcus aureus
Rationale: Impetigo commonly presents as honey-colored
crusted lesions, especially in children. Staphylococcus aureus
is the most common cause, although Streptococcus
pyogenes may also be involved.
5. Which electrolyte abnormality is most commonly
associated with peaked T waves on ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Answer: B. Hyperkalemia
Rationale: Hyperkalemia causes characteristic ECG changes
including peaked T waves, prolonged PR interval, widening
, of the QRS complex, and eventually a sine-wave pattern.
These changes can progress to fatal arrhythmias if
untreated.
6. A patient with COPD has an arterial blood gas showing pH
7.36, PaCO₂ 58 mm Hg, and elevated bicarbonate. This
represents:
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with compensation
C. Metabolic alkalosis
D. Mixed respiratory alkalosis and metabolic acidosis
Answer: B. Chronic respiratory acidosis with compensation
Rationale: COPD causes chronic CO₂ retention. Renal
compensation increases bicarbonate reabsorption over
time, helping normalize pH. Near-normal pH with elevated
PaCO₂ and bicarbonate indicates chronic compensated
respiratory acidosis.
7. Which cranial nerve mediates the afferent limb of the
corneal reflex?
A. CN II
B. CN III
C. CN V1
D. CN VII
Answer: C. CN V1
