COMSAE LEVEL 1 FORM A PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
* Biomedical Sciences Foundations
* Osteopathic Principles and Practice
* Clinical Physiology and Pathophysiology
* Pharmacology and Therapeutics
* Ethics, Legal, and Professional Standards
* Behavioral Health and Patient Communication
* Preventive Medicine and Public Health
* Evidence-Based Practice and Research
INTRODUCTION
*The purpose of this assessment is to evaluate foundational clinical knowledge and the ability to
SECTION ONE: QUESTIONS 1–100
A 45-year-old male presents with persistent mid-thoracic back pain. Physical examination reveals a
Type II somatic dysfunction at T6. Which of the following findings is most consistent with this
diagnosis?
A. The dysfunction involves a group of segments.
B. The segment is rotated and sidebent to the same side.
,C. The segmental rotation is significantly more limited in flexion.
D. The dysfunction is primarily caused by long restrictor muscles.
🟢B
🔴 RATIONALE: Type II somatic dysfunctions typically involve a single segment, have a traumatic or
postural onset, and involve rotation and sidebending to the same side. They often demonstrate
asymmetry in flexion or extension.
A 22-year-old medical student is studying the mechanism of action of SSRIs. Which
neurotransmitter is primarily modulated to produce the therapeutic effect in depression?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
🟢C
🔴 RATIONALE: Selective serotonin reuptake inhibitors (SSRIs) primarily work by inhibiting the reuptake
of serotonin (5-HT) into the presynaptic neuron, increasing its availability in the synaptic cleft.
An ethics committee is reviewing a case where a physician bypassed surrogate consent during an
emergency. Which ethical principle allows for this action?
A. Autonomy
B. Beneficence
C. Justice
D. Non-maleficence
🟢B
🔴 RATIONALE: Beneficence involves acting in the best interest of the patient. In life-threatening
emergencies where consent cannot be obtained, the principle of beneficence (often paired with implied
consent) justifies immediate intervention.
A 60-year-old patient with hypertension is started on an ACE inhibitor. Which side effect is most
likely to cause the patient to discontinue the medication?
,A. Peripheral edema
B. Dry cough
C. Bradycardia
D. Hypokalemia
🟢B
🔴 RATIONALE: ACE inhibitors are frequently associated with a persistent, dry cough caused by the
accumulation of bradykinin in the lungs.
During an OMM treatment, a physician performs a muscle energy technique on a patient’s right
anterior innominate. Where should the physician place their contact for the barrier?
A. Right ASIS
B. Right PSIS
C. Left ASIS
D. Left PSIS
🟢A
🔴 RATIONALE: To treat an anterior innominate rotation, the physician typically engages the restrictive
barrier by rotating the innominate posteriorly, which involves applying force to the ASIS while the patient’s
leg is extended.
A patient presents with a deficiency in Vitamin B12. Which hematologic finding is most likely?
A. Microcytic, hypochromic anemia
B. Megaloblastic anemia
C. Hemolytic anemia
D. Aplastic anemia
🟢B
🔴 RATIONALE: Vitamin B12 (cobalamin) deficiency impairs DNA synthesis, leading to megaloblastic
anemia characterized by macrocytic red blood cells and hypersegmented neutrophils.
Which of the following best describes the principle of "First, do no harm"?
, A. Autonomy
B. Beneficence
C. Justice
D. Non-maleficence
🟢D
🔴 RATIONALE: Non-maleficence is the ethical principle defined by the obligation to avoid inflicting harm
on patients.
A 30-year-old female presents with signs of Graves' disease. Which lab finding is expected?
A. Elevated TSH, low T3/T4
B. Low TSH, elevated T3/T4
C. Elevated TSH, elevated T3/T4
D. Low TSH, low T3/T4
🟢B
🔴 RATIONALE: In primary hyperthyroidism like Graves' disease, the thyroid produces excess hormones,
which provides negative feedback to the pituitary, resulting in low TSH levels.
A patient with pneumonia is treated with a cephalosporin. How does this drug exert its bactericidal
effect?
A. Inhibiting protein synthesis
B. Inhibiting cell wall synthesis
C. Inhibiting DNA gyrase
D. Inhibiting folic acid synthesis
🟢B
🔴 RATIONALE: Cephalosporins, like penicillins, are beta-lactam antibiotics that inhibit the synthesis of
bacterial cell walls by binding to penicillin-binding proteins.
A physician notes a patient has a "short leg" syndrome. What is the minimum difference in leg length
usually required to justify a heel lift?
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
* Biomedical Sciences Foundations
* Osteopathic Principles and Practice
* Clinical Physiology and Pathophysiology
* Pharmacology and Therapeutics
* Ethics, Legal, and Professional Standards
* Behavioral Health and Patient Communication
* Preventive Medicine and Public Health
* Evidence-Based Practice and Research
INTRODUCTION
*The purpose of this assessment is to evaluate foundational clinical knowledge and the ability to
SECTION ONE: QUESTIONS 1–100
A 45-year-old male presents with persistent mid-thoracic back pain. Physical examination reveals a
Type II somatic dysfunction at T6. Which of the following findings is most consistent with this
diagnosis?
A. The dysfunction involves a group of segments.
B. The segment is rotated and sidebent to the same side.
,C. The segmental rotation is significantly more limited in flexion.
D. The dysfunction is primarily caused by long restrictor muscles.
🟢B
🔴 RATIONALE: Type II somatic dysfunctions typically involve a single segment, have a traumatic or
postural onset, and involve rotation and sidebending to the same side. They often demonstrate
asymmetry in flexion or extension.
A 22-year-old medical student is studying the mechanism of action of SSRIs. Which
neurotransmitter is primarily modulated to produce the therapeutic effect in depression?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
🟢C
🔴 RATIONALE: Selective serotonin reuptake inhibitors (SSRIs) primarily work by inhibiting the reuptake
of serotonin (5-HT) into the presynaptic neuron, increasing its availability in the synaptic cleft.
An ethics committee is reviewing a case where a physician bypassed surrogate consent during an
emergency. Which ethical principle allows for this action?
A. Autonomy
B. Beneficence
C. Justice
D. Non-maleficence
🟢B
🔴 RATIONALE: Beneficence involves acting in the best interest of the patient. In life-threatening
emergencies where consent cannot be obtained, the principle of beneficence (often paired with implied
consent) justifies immediate intervention.
A 60-year-old patient with hypertension is started on an ACE inhibitor. Which side effect is most
likely to cause the patient to discontinue the medication?
,A. Peripheral edema
B. Dry cough
C. Bradycardia
D. Hypokalemia
🟢B
🔴 RATIONALE: ACE inhibitors are frequently associated with a persistent, dry cough caused by the
accumulation of bradykinin in the lungs.
During an OMM treatment, a physician performs a muscle energy technique on a patient’s right
anterior innominate. Where should the physician place their contact for the barrier?
A. Right ASIS
B. Right PSIS
C. Left ASIS
D. Left PSIS
🟢A
🔴 RATIONALE: To treat an anterior innominate rotation, the physician typically engages the restrictive
barrier by rotating the innominate posteriorly, which involves applying force to the ASIS while the patient’s
leg is extended.
A patient presents with a deficiency in Vitamin B12. Which hematologic finding is most likely?
A. Microcytic, hypochromic anemia
B. Megaloblastic anemia
C. Hemolytic anemia
D. Aplastic anemia
🟢B
🔴 RATIONALE: Vitamin B12 (cobalamin) deficiency impairs DNA synthesis, leading to megaloblastic
anemia characterized by macrocytic red blood cells and hypersegmented neutrophils.
Which of the following best describes the principle of "First, do no harm"?
, A. Autonomy
B. Beneficence
C. Justice
D. Non-maleficence
🟢D
🔴 RATIONALE: Non-maleficence is the ethical principle defined by the obligation to avoid inflicting harm
on patients.
A 30-year-old female presents with signs of Graves' disease. Which lab finding is expected?
A. Elevated TSH, low T3/T4
B. Low TSH, elevated T3/T4
C. Elevated TSH, elevated T3/T4
D. Low TSH, low T3/T4
🟢B
🔴 RATIONALE: In primary hyperthyroidism like Graves' disease, the thyroid produces excess hormones,
which provides negative feedback to the pituitary, resulting in low TSH levels.
A patient with pneumonia is treated with a cephalosporin. How does this drug exert its bactericidal
effect?
A. Inhibiting protein synthesis
B. Inhibiting cell wall synthesis
C. Inhibiting DNA gyrase
D. Inhibiting folic acid synthesis
🟢B
🔴 RATIONALE: Cephalosporins, like penicillins, are beta-lactam antibiotics that inhibit the synthesis of
bacterial cell walls by binding to penicillin-binding proteins.
A physician notes a patient has a "short leg" syndrome. What is the minimum difference in leg length
usually required to justify a heel lift?
