COMSAE 115 Exam - NBOME COMSAE | 2026/2027
Edition | 250 Verified Questions
COMSAE 115 Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions
| Updated Per Latest NBOME Guidelines | Graded A+
This comprehensive exam preparation guide for the COMSAE 115 (Comprehensive Osteopathic
Medical Self-Assessment Examination) by the National Board of Osteopathic Medical Examiners
(NBOME) features 250 meticulously verified questions. Designed for the 2026/2027 academic year,
this resource reflects the latest blueprint and competency domains. Each question is accompanied by
evidence-based rationales and detailed explanations to reinforce osteopathic principles and clinical
knowledge. Ideal for osteopathic medical students preparing for COMLEX-USA Level 1 and beyond.
Key Features:
Osteopathic Principles and Practice (OPP)
Biomedical Sciences (Anatomy, Physiology, Biochemistry, Microbiology, Pharmacology)
Clinical Presentations and Differential Diagnosis
Patient Management and Evidence-Based Medicine
Ethics, Professionalism, and Health Systems
Updates for 2026:
- Incorporated 2026 NBOME content outline revisions
- Added new questions on emerging infectious diseases and public health
- Enhanced rationales with step-by-step clinical reasoning
- Updated pharmacology and treatment guidelines per latest standards
- Expanded OMM/Osteopathic Manipulative Treatment scenarios
Abstract:
The COMSAE 115 Exam Preparation Guide for the 2026/2027 academic year is a meticulously curated collection
of 250 verified questions designed to assess and reinforce the foundational knowledge required for osteopathic
medical students. Aligned with the NBOME's comprehensive blueprint, this resource covers essential biomedical
sciences, osteopathic principles and practice, clinical presentations, and patient management. Each question is
paired with evidence-based answers and detailed rationales that elucidate correct and incorrect options, fostering
deeper understanding and clinical application. The guide emphasizes high-yield topics such as anatomy,
physiology, microbiology, pharmacology, and OPP, while integrating ethics and professionalism. Updated to
reflect the latest guidelines and emerging healthcare challenges, this document serves as an indispensable tool for
self-assessment and exam readiness. By simulating the actual exam format and difficulty, it helps students identify
strengths and areas for improvement, ultimately enhancing performance on the COMSAE 115 and subsequent
COMLEX-USA examinations.
Keywords:
COMSAE 115, NBOME, osteopathic medicine, COMLEX Level 1, osteopathic principles, biomedical sciences,
clinical reasoning, exam preparation
Answer Format:
Each question is followed by the correct answer and a comprehensive rationale explaining why it is correct, along
with analysis of incorrect options to clarify common misconceptions. Distractors are addressed with
evidence-based explanations to reinforce learning and clinical decision-making.
Compliance Checklist:
Aligned with NBOME 2026-2027 content specifications
Page 1
, All questions verified for accuracy by subject matter experts
Includes evidence-based rationales and references
Covers all core competency domains
Updated per latest medical guidelines and standards
Suitable for self-assessment and targeted review
Content Area Overview:
Content Area Questions Key Topics Weight
Osteopathic Principles and 1-50 OMM techniques, somatic dysfunction, 20%
Practice (OPP) viscerosomatic reflexes, cranial osteopathy,
lymphatic pump
Biomedical Sciences: Anatomy 51-100 Gross anatomy, neuroanatomy, embryology, 20%
& Physiology cell physiology, organ systems
Biomedical Sciences: 101-130 Metabolic pathways, molecular biology, 12%
Biochemistry & Genetics genetic disorders, nutrition
Biomedical Sciences: 131-160 Bacteriology, virology, mycology, 12%
Microbiology & Immunology parasitology, immune response, vaccines
Biomedical Sciences: 161-190 Pharmacokinetics, autonomic drugs, 12%
Pharmacology antimicrobials, chemotherapy, adverse
effects
Clinical Presentations & Patient 191-250 Differential diagnosis, diagnostic tests, 24%
Management treatment plans, evidence-based medicine,
ethics
Page 2
,Q1. A patient with a history of recurrent otitis media presents with a new-onset, painless,
pearly-white mass behind an intact tympanic membrane. Which of the following is the most likely
diagnosis?
A. Cholesteatoma
B. Glomus tympanicum tumor
C. Epidermoid cyst of the middle ear
D. Acute suppurative otitis media with effusion
Correct Answer: A. Cholesteatoma
Rationale: Cholesteatoma is a keratinizing squamous epithelial lesion that typically presents as a
painless, pearly-white mass behind the tympanic membrane, often in the setting of chronic Eustachian
tube dysfunction. Glomus tympanicum tumors are vascular and appear reddish-blue. Epidermoid cysts
are rare in this location. Acute suppurative otitis media would present with pain, fever, and purulent
effusion.
Why Wrong:
B - Glomus tympanicum tumors are vascular and appear reddish-blue, not pearly-white.
C - Epidermoid cysts of the middle ear are extremely rare and not typically associated with chronic
otitis media.
D - Acute suppurative otitis media presents with pain, fever, and purulent effusion, not a painless
white mass.
Reference: Cummings, C.W. (2026). Otolaryngology: Head and Neck Surgery, 7th Ed., Ch. 12
Q2. In a double-blind randomized trial, a new drug reduces systolic blood pressure by an average of
8 mmHg compared to placebo (p=0.03). The 95% confidence interval for the difference is 1.5 to 14.5
mmHg. Which of the following is the most appropriate interpretation?
A. There is a 97% probability that the true reduction is between 1.5 and 14.5 mmHg.
B. The drug is clinically significant because the p-value is less than 0.05.
C. The study has a high chance of a Type I error because the confidence interval is wide.
D. The null hypothesis of no difference is rejected, but clinical significance requires further
evaluation.
Correct Answer: D. The null hypothesis of no difference is rejected, but clinical significance requires
further evaluation.
Rationale: The p-value < 0.05 indicates statistical significance, allowing rejection of the null hypothesis.
However, clinical significance depends on the magnitude of effect and the patient population; a reduction
of 8 mmHg may be modest. The confidence interval does not provide a probability about the parameter (A
is incorrect). Clinical significance is not determined solely by p-value (B). A wide CI suggests imprecision
but does not directly indicate Type I error risk (C).
Why Wrong:
A - A 95% confidence interval does not imply a 97% probability; it means that if the study were
repeated many times, 95% of intervals would contain the true value.
B - Clinical significance requires consideration of effect size and clinical context, not just p-value.
C - A wide confidence interval reflects imprecision, not necessarily a high Type I error risk; Type I
error is controlled by alpha (0.05).
Reference: Guyatt, G. et al. (2026). Users' Guides to the Medical Literature, 4th Ed., Ch. 4
Page 3
, Q3. A medical student is performing a cranial nerve examination on a patient. The patient is asked
to clench their teeth and then move the jaw from side to side. Which nucleus is primarily
responsible for the motor component of this action?
A. Trigeminal motor nucleus
B. Facial motor nucleus
C. Hypoglossal nucleus
D. Accessory nucleus
Correct Answer: A. Trigeminal motor nucleus
Rationale: Clenching teeth and lateral jaw movement are functions of the muscles of mastication
(temporalis, masseter, pterygoids), which are innervated by the mandibular division of the trigeminal
nerve (CN V3). The motor nucleus of CN V is located in the pons. The facial motor nucleus controls facial
expression, the hypoglossal nucleus controls tongue movements, and the accessory nucleus controls
sternocleidomastoid and trapezius.
Why Wrong:
B - The facial motor nucleus innervates muscles of facial expression, not mastication.
C - The hypoglossal nucleus innervates intrinsic and extrinsic tongue muscles.
D - The accessory nucleus innervates sternocleidomastoid and trapezius.
Reference: Blumenfeld, H. (2026). Neuroanatomy through Clinical Cases, 3rd Ed., Ch. 8
Q4. A 45-year-old patient with no significant medical history presents with acute-onset severe
epigastric pain radiating to the back, nausea, and vomiting. Serum amylase is 1200 U/L, lipase 1500
U/L, and triglycerides are 2500 mg/dL. Which of the following is the most appropriate initial step in
management to prevent recurrence?
A. Initiate insulin infusion and intravenous fluids
B. Plasmapheresis
C. Start a low-fat diet and fibrate therapy
D. Administer intravenous heparin
Correct Answer: B. Plasmapheresis
Rationale: Severe hypertriglyceridemia (>1000 mg/dL) can cause acute pancreatitis. Plasmapheresis
rapidly lowers triglyceride levels and is indicated in severe cases to prevent recurrence and
complications. Insulin and heparin can help lower triglycerides but are slower; plasmapheresis is more
definitive in the acute setting. Long-term management includes fibrates and diet, but initial step for acute
severe hypertriglyceridemia is plasmapheresis.
Why Wrong:
A - Insulin infusion and fluids are used for diabetic ketoacidosis or general pancreatitis support, but
not as first-line for severe hypertriglyceridemia.
C - Low-fat diet and fibrates are long-term management, not appropriate for acute severe
hypertriglyceridemia.
D - Intravenous heparin is not standard for hypertriglyceridemia-induced pancreatitis; it may cause
bleeding risk.
Reference: Peery, A.F. et al. (2026). Gastroenterology, 160(3): 789-802
Page 4
Edition | 250 Verified Questions
COMSAE 115 Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions
| Updated Per Latest NBOME Guidelines | Graded A+
This comprehensive exam preparation guide for the COMSAE 115 (Comprehensive Osteopathic
Medical Self-Assessment Examination) by the National Board of Osteopathic Medical Examiners
(NBOME) features 250 meticulously verified questions. Designed for the 2026/2027 academic year,
this resource reflects the latest blueprint and competency domains. Each question is accompanied by
evidence-based rationales and detailed explanations to reinforce osteopathic principles and clinical
knowledge. Ideal for osteopathic medical students preparing for COMLEX-USA Level 1 and beyond.
Key Features:
Osteopathic Principles and Practice (OPP)
Biomedical Sciences (Anatomy, Physiology, Biochemistry, Microbiology, Pharmacology)
Clinical Presentations and Differential Diagnosis
Patient Management and Evidence-Based Medicine
Ethics, Professionalism, and Health Systems
Updates for 2026:
- Incorporated 2026 NBOME content outline revisions
- Added new questions on emerging infectious diseases and public health
- Enhanced rationales with step-by-step clinical reasoning
- Updated pharmacology and treatment guidelines per latest standards
- Expanded OMM/Osteopathic Manipulative Treatment scenarios
Abstract:
The COMSAE 115 Exam Preparation Guide for the 2026/2027 academic year is a meticulously curated collection
of 250 verified questions designed to assess and reinforce the foundational knowledge required for osteopathic
medical students. Aligned with the NBOME's comprehensive blueprint, this resource covers essential biomedical
sciences, osteopathic principles and practice, clinical presentations, and patient management. Each question is
paired with evidence-based answers and detailed rationales that elucidate correct and incorrect options, fostering
deeper understanding and clinical application. The guide emphasizes high-yield topics such as anatomy,
physiology, microbiology, pharmacology, and OPP, while integrating ethics and professionalism. Updated to
reflect the latest guidelines and emerging healthcare challenges, this document serves as an indispensable tool for
self-assessment and exam readiness. By simulating the actual exam format and difficulty, it helps students identify
strengths and areas for improvement, ultimately enhancing performance on the COMSAE 115 and subsequent
COMLEX-USA examinations.
Keywords:
COMSAE 115, NBOME, osteopathic medicine, COMLEX Level 1, osteopathic principles, biomedical sciences,
clinical reasoning, exam preparation
Answer Format:
Each question is followed by the correct answer and a comprehensive rationale explaining why it is correct, along
with analysis of incorrect options to clarify common misconceptions. Distractors are addressed with
evidence-based explanations to reinforce learning and clinical decision-making.
Compliance Checklist:
Aligned with NBOME 2026-2027 content specifications
Page 1
, All questions verified for accuracy by subject matter experts
Includes evidence-based rationales and references
Covers all core competency domains
Updated per latest medical guidelines and standards
Suitable for self-assessment and targeted review
Content Area Overview:
Content Area Questions Key Topics Weight
Osteopathic Principles and 1-50 OMM techniques, somatic dysfunction, 20%
Practice (OPP) viscerosomatic reflexes, cranial osteopathy,
lymphatic pump
Biomedical Sciences: Anatomy 51-100 Gross anatomy, neuroanatomy, embryology, 20%
& Physiology cell physiology, organ systems
Biomedical Sciences: 101-130 Metabolic pathways, molecular biology, 12%
Biochemistry & Genetics genetic disorders, nutrition
Biomedical Sciences: 131-160 Bacteriology, virology, mycology, 12%
Microbiology & Immunology parasitology, immune response, vaccines
Biomedical Sciences: 161-190 Pharmacokinetics, autonomic drugs, 12%
Pharmacology antimicrobials, chemotherapy, adverse
effects
Clinical Presentations & Patient 191-250 Differential diagnosis, diagnostic tests, 24%
Management treatment plans, evidence-based medicine,
ethics
Page 2
,Q1. A patient with a history of recurrent otitis media presents with a new-onset, painless,
pearly-white mass behind an intact tympanic membrane. Which of the following is the most likely
diagnosis?
A. Cholesteatoma
B. Glomus tympanicum tumor
C. Epidermoid cyst of the middle ear
D. Acute suppurative otitis media with effusion
Correct Answer: A. Cholesteatoma
Rationale: Cholesteatoma is a keratinizing squamous epithelial lesion that typically presents as a
painless, pearly-white mass behind the tympanic membrane, often in the setting of chronic Eustachian
tube dysfunction. Glomus tympanicum tumors are vascular and appear reddish-blue. Epidermoid cysts
are rare in this location. Acute suppurative otitis media would present with pain, fever, and purulent
effusion.
Why Wrong:
B - Glomus tympanicum tumors are vascular and appear reddish-blue, not pearly-white.
C - Epidermoid cysts of the middle ear are extremely rare and not typically associated with chronic
otitis media.
D - Acute suppurative otitis media presents with pain, fever, and purulent effusion, not a painless
white mass.
Reference: Cummings, C.W. (2026). Otolaryngology: Head and Neck Surgery, 7th Ed., Ch. 12
Q2. In a double-blind randomized trial, a new drug reduces systolic blood pressure by an average of
8 mmHg compared to placebo (p=0.03). The 95% confidence interval for the difference is 1.5 to 14.5
mmHg. Which of the following is the most appropriate interpretation?
A. There is a 97% probability that the true reduction is between 1.5 and 14.5 mmHg.
B. The drug is clinically significant because the p-value is less than 0.05.
C. The study has a high chance of a Type I error because the confidence interval is wide.
D. The null hypothesis of no difference is rejected, but clinical significance requires further
evaluation.
Correct Answer: D. The null hypothesis of no difference is rejected, but clinical significance requires
further evaluation.
Rationale: The p-value < 0.05 indicates statistical significance, allowing rejection of the null hypothesis.
However, clinical significance depends on the magnitude of effect and the patient population; a reduction
of 8 mmHg may be modest. The confidence interval does not provide a probability about the parameter (A
is incorrect). Clinical significance is not determined solely by p-value (B). A wide CI suggests imprecision
but does not directly indicate Type I error risk (C).
Why Wrong:
A - A 95% confidence interval does not imply a 97% probability; it means that if the study were
repeated many times, 95% of intervals would contain the true value.
B - Clinical significance requires consideration of effect size and clinical context, not just p-value.
C - A wide confidence interval reflects imprecision, not necessarily a high Type I error risk; Type I
error is controlled by alpha (0.05).
Reference: Guyatt, G. et al. (2026). Users' Guides to the Medical Literature, 4th Ed., Ch. 4
Page 3
, Q3. A medical student is performing a cranial nerve examination on a patient. The patient is asked
to clench their teeth and then move the jaw from side to side. Which nucleus is primarily
responsible for the motor component of this action?
A. Trigeminal motor nucleus
B. Facial motor nucleus
C. Hypoglossal nucleus
D. Accessory nucleus
Correct Answer: A. Trigeminal motor nucleus
Rationale: Clenching teeth and lateral jaw movement are functions of the muscles of mastication
(temporalis, masseter, pterygoids), which are innervated by the mandibular division of the trigeminal
nerve (CN V3). The motor nucleus of CN V is located in the pons. The facial motor nucleus controls facial
expression, the hypoglossal nucleus controls tongue movements, and the accessory nucleus controls
sternocleidomastoid and trapezius.
Why Wrong:
B - The facial motor nucleus innervates muscles of facial expression, not mastication.
C - The hypoglossal nucleus innervates intrinsic and extrinsic tongue muscles.
D - The accessory nucleus innervates sternocleidomastoid and trapezius.
Reference: Blumenfeld, H. (2026). Neuroanatomy through Clinical Cases, 3rd Ed., Ch. 8
Q4. A 45-year-old patient with no significant medical history presents with acute-onset severe
epigastric pain radiating to the back, nausea, and vomiting. Serum amylase is 1200 U/L, lipase 1500
U/L, and triglycerides are 2500 mg/dL. Which of the following is the most appropriate initial step in
management to prevent recurrence?
A. Initiate insulin infusion and intravenous fluids
B. Plasmapheresis
C. Start a low-fat diet and fibrate therapy
D. Administer intravenous heparin
Correct Answer: B. Plasmapheresis
Rationale: Severe hypertriglyceridemia (>1000 mg/dL) can cause acute pancreatitis. Plasmapheresis
rapidly lowers triglyceride levels and is indicated in severe cases to prevent recurrence and
complications. Insulin and heparin can help lower triglycerides but are slower; plasmapheresis is more
definitive in the acute setting. Long-term management includes fibrates and diet, but initial step for acute
severe hypertriglyceridemia is plasmapheresis.
Why Wrong:
A - Insulin infusion and fluids are used for diabetic ketoacidosis or general pancreatitis support, but
not as first-line for severe hypertriglyceridemia.
C - Low-fat diet and fibrates are long-term management, not appropriate for acute severe
hypertriglyceridemia.
D - Intravenous heparin is not standard for hypertriglyceridemia-induced pancreatitis; it may cause
bleeding risk.
Reference: Peery, A.F. et al. (2026). Gastroenterology, 160(3): 789-802
Page 4
