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CORE DOMAINS
Osteopathic Principles and Practice
Biochemistry and Cellular Biology
Anatomy and Embryology
Physiology and Pathophysiology
Microbiology and Immunology
Pharmacology and Therapeutics
Pathology and Disease Processes
Clinical Ethics and Professionalism
Public Health and Biostatistics
INTRODUCTION
The purpose of this practice exam is to provide a rigorous assessment environment for
candidates preparing for the COMSAE Phase 1 board examination. This test evaluates
,foundational knowledge, clinical integration, and the ability to apply osteopathic concepts
across diverse biomedical sciences. Featuring a combination of multiple-choice and
complex scenario-based questions, the assessment emphasizes critical thinking,
diagnostic reasoning, and evidence-based decision-making. By replicating the cognitive
demands of real-world clinical practice, this exam helps identify mastery of core curricular
standards, ensures competency in medical ethics, and refines the test-taking skills
necessary to succeed in a professional healthcare setting.
SECTION ONE: QUESTIONS 1–50
A 45-year-old male presents with acute lower back pain after lifting a heavy box. On
physical exam, there is a hypertonic muscle segment at T10–T11. Which nerve root
is most likely responsible for the sympathetic innervation to the organ associated
with these levels?
A. Greater splanchnic nerve
B. Lesser splanchnic nerve
C. Least splanchnic nerve
D. Lumbar splanchnic nerve
🟢 Correct Answer: B. Lesser splanchnic nerve
🔴 Explanation: The T10–T11 spinal levels provide sympathetic innervation to the mid-
gastrointestinal tract (small intestine, right colon, kidneys, and upper ureters) via the lesser
splanchnic nerve.
, A patient with a history of chronic alcoholism presents with peripheral neuropathy.
Which vitamin deficiency is the most likely cause?
A. Thiamine (B1)
B. Riboflavin (B2)
C. Niacin (B3)
D. Pyridoxine (B6)
🟢 Correct Answer: A. Thiamine (B1)
🔴 Explanation: Chronic alcohol use leads to poor dietary intake and impaired absorption
of B-vitamins, particularly thiamine, leading to conditions like Wernicke-Korsakoff
syndrome and peripheral neuropathy.
Which of the following cells is responsible for the secretion of surfactant in the lungs?
A. Type I pneumocytes
B. Type II pneumocytes
C. Clara cells
D. Macrophages
🟢 Correct Answer: B. Type II pneumocytes
🔴 Explanation: Type II pneumocytes are specialized epithelial cells that synthesize and
secrete pulmonary surfactant, which reduces alveolar surface tension to prevent collapse.
, A patient is diagnosed with a herniated disc at the L4–L5 level. Which reflex is most
likely to be diminished?
A. Patellar reflex
B. Achilles reflex
C. Triceps reflex
D. Biceps reflex
🟢 Correct Answer: A. Patellar reflex
🔴 Explanation: The patellar reflex is primarily mediated by the L4 nerve root. A herniation
at L4–L5 often affects the L4 nerve root, leading to diminished reflex response.
Which osteopathic technique is considered a direct, passive method?
A. Muscle Energy
B. High Velocity Low Amplitude (HVLA)
C. Counterstrain
D. Still Technique
🟢 Correct Answer: B. High Velocity Low Amplitude (HVLA)
🔴 Explanation: HVLA is a direct technique (moving the segment toward the restrictive
barrier) and passive (the physician performs the motion without patient muscle effort).