COMSAE FORM 113 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
,Osteopathic Principles, Practice, and Manipulative Treatment
Foundational Biomedical Sciences (Anatomy, Biochemistry, Microbiology, Pathology)
Physiology and Pharmacology
Musculoskeletal System and Somatic Pain
Nervous System and Mental Health
Circulatory and Hematologic Systems
Gastrointestinal System and Nutritional Health
Respiratory System
Professionalism, Ethics, and Regulatory Compliance
,Public Health, Behavioral Science, and Systems-Based Practice Core Domains: Osteopathic Principles,
Practice, and Manipulative Treatment; Foundational Biomedical Sciences (Anatomy, Biochemistry,
Microbiology, Pathology); Physiology and Pharmacology; Musculoskeletal System and Somatic Pain;
Nervous System and Mental Health; Circulatory and Hematologic Systems; Gastrointestinal System and
Nutritional Health; Respiratory System; Professionalism, Ethics, and Regulatory Compliance; Public
Health, Behavioral Science, and Systems-Based Practice This comprehensive practice exam is designed to
assess mastery of osteopathic medical knowledge at the Level 1 level. The exam evaluates foundational
biomedical sciences, osteopathic principles, clinical application, and professional standards essential for safe
medical practice. Questions are presented in multiple-choice and scenario-based formats that emphasize
real-world clinical decision-making, diagnostic reasoning, and evidence-based management. Candidates
will encounter questions covering anatomical relationships, pathophysiological mechanisms,
pharmacological interventions, osteopathic manipulative treatment techniques, regulatory requirements,
ethical principles, and public health considerations. The exam mirrors the structure and difficulty of the
actual COMSAE assessment, preparing students for clinical competency and board examination success.
SECTION ONE: QUESTIONS 1–100
Question 1
A 28-year-old male presents with acute low back pain following lifting a heavy box. He reports pain radiating to
the right posterior thigh but no numbness or weakness. Palpation reveals increased tone and warmth in the
right lumbar paraspinals. Which osteopathic finding best describes this presentation?
A. Soft tissue edema with decreased temperature
B. Tissue texture abnormality with increased temperature and tone
C. bony deformity with decreased mobility
D. Asymmetry with normal tissue texture
, 🟢 Correct answer: B
🔴 RATIONALE: The patient presents with acute somatic dysfunction characterized by tissue texture
abnormalities (increased tone, warmth) indicating increased temperature and soft tissue edema. This is
consistent with the TART criteria (Tissue texture, Asymmetry, Range of motion, Temperature) for identifying
somatic dysfunction. Acute dysfunction typically presents with increased temperature, edema, and
hypertonicity.
Question 2
Which vitamin is essential for the conversion of homocysteine to methionine and serves as a cofactor in DNA
synthesis?
A. Vitamin B6
B. Vitamin B12
C. Vitamin B1
D. Vitamin B3
🟢 Correct answer: B
🔴 RATIONALE: Vitamin B12 (cobalamin) is required for the methionine synthase reaction that converts
homocysteine to methionine. This reaction is critical for DNA synthesis and methylation reactions. Deficiency
leads to elevated homocysteine and megaloblastic anemia. Vitamin B6 is involved in transamination, B1 in
pyruvate dehydrogenase, and B3 in NAD/NADP synthesis.
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
,Osteopathic Principles, Practice, and Manipulative Treatment
Foundational Biomedical Sciences (Anatomy, Biochemistry, Microbiology, Pathology)
Physiology and Pharmacology
Musculoskeletal System and Somatic Pain
Nervous System and Mental Health
Circulatory and Hematologic Systems
Gastrointestinal System and Nutritional Health
Respiratory System
Professionalism, Ethics, and Regulatory Compliance
,Public Health, Behavioral Science, and Systems-Based Practice Core Domains: Osteopathic Principles,
Practice, and Manipulative Treatment; Foundational Biomedical Sciences (Anatomy, Biochemistry,
Microbiology, Pathology); Physiology and Pharmacology; Musculoskeletal System and Somatic Pain;
Nervous System and Mental Health; Circulatory and Hematologic Systems; Gastrointestinal System and
Nutritional Health; Respiratory System; Professionalism, Ethics, and Regulatory Compliance; Public
Health, Behavioral Science, and Systems-Based Practice This comprehensive practice exam is designed to
assess mastery of osteopathic medical knowledge at the Level 1 level. The exam evaluates foundational
biomedical sciences, osteopathic principles, clinical application, and professional standards essential for safe
medical practice. Questions are presented in multiple-choice and scenario-based formats that emphasize
real-world clinical decision-making, diagnostic reasoning, and evidence-based management. Candidates
will encounter questions covering anatomical relationships, pathophysiological mechanisms,
pharmacological interventions, osteopathic manipulative treatment techniques, regulatory requirements,
ethical principles, and public health considerations. The exam mirrors the structure and difficulty of the
actual COMSAE assessment, preparing students for clinical competency and board examination success.
SECTION ONE: QUESTIONS 1–100
Question 1
A 28-year-old male presents with acute low back pain following lifting a heavy box. He reports pain radiating to
the right posterior thigh but no numbness or weakness. Palpation reveals increased tone and warmth in the
right lumbar paraspinals. Which osteopathic finding best describes this presentation?
A. Soft tissue edema with decreased temperature
B. Tissue texture abnormality with increased temperature and tone
C. bony deformity with decreased mobility
D. Asymmetry with normal tissue texture
, 🟢 Correct answer: B
🔴 RATIONALE: The patient presents with acute somatic dysfunction characterized by tissue texture
abnormalities (increased tone, warmth) indicating increased temperature and soft tissue edema. This is
consistent with the TART criteria (Tissue texture, Asymmetry, Range of motion, Temperature) for identifying
somatic dysfunction. Acute dysfunction typically presents with increased temperature, edema, and
hypertonicity.
Question 2
Which vitamin is essential for the conversion of homocysteine to methionine and serves as a cofactor in DNA
synthesis?
A. Vitamin B6
B. Vitamin B12
C. Vitamin B1
D. Vitamin B3
🟢 Correct answer: B
🔴 RATIONALE: Vitamin B12 (cobalamin) is required for the methionine synthase reaction that converts
homocysteine to methionine. This reaction is critical for DNA synthesis and methylation reactions. Deficiency
leads to elevated homocysteine and megaloblastic anemia. Vitamin B6 is involved in transamination, B1 in
pyruvate dehydrogenase, and B3 in NAD/NADP synthesis.
