COMSAE LEVEL 1 FORM C PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
* Osteopathic Principles and Practice
* Cardiovascular System
* Respiratory System
* Musculoskeletal System
* Gastrointestinal and Nutrition
* Renal and Urinary Systems
* Neurology and Behavioral Health
* Hematology and Oncology
* Ethics and Professionalism
Introduction
*The purpose of this assessment is to provide a comprehensive review of clinical knowledge requi
SECTION ONE: QUESTIONS 1–100
A 55-year-old male presents with acute crushing substernal chest pain radiating to the left arm.
Electrocardiogram shows ST-segment elevation in leads V2-V4. Which coronary artery is most likely
occluded?
A. Right coronary artery
B. Left circumflex artery
,C. Left anterior descending artery
D. Posterior descending artery
🟢C
🔴 RATIONALE: The left anterior descending (LAD) artery supplies the anterior wall of the left
ventricle and the anterior two-thirds of the septum. ST-segment elevation in leads V2-V4
corresponds to an anterior wall myocardial infarction.
A patient with chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea.
Arterial blood gas shows pH 7.25, PaCO2 60 mmHg, and PaO2 55 mmHg. What is the primary
acid-base disturbance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
🟢A
🔴 RATIONALE: Respiratory acidosis is characterized by a low pH and an elevated PaCO2. In
patients with COPD, the inability to adequately ventilate leads to carbon dioxide retention, causing a
decrease in pH.
An osteopathic physician performs a structural exam on a patient with chronic lower back pain and
identifies a T10-T12 segment dysfunction. This segment corresponds to the sympathetic innervation
of which organ?
A. Stomach
B. Small intestine
C. Kidneys
D. Bladder
🟢C
,🔴 RATIONALE: The sympathetic levels for the kidneys are T10-T11. T5-T9 typically innervates the
upper gastrointestinal tract, while T12-L2 often relates to the lower GI tract and bladder.
A 28-year-old female presents with a butterfly rash on her face and joint pain. Serologic testing
reveals a positive anti-double-stranded DNA antibody. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Dermatomyositis
🟢B
🔴 RATIONALE: Systemic lupus erythematosus (SLE) is classically associated with a malar
(butterfly) rash and positive anti-dsDNA antibodies, which are highly specific for the condition.
Which of the following cranial nerves is responsible for the motor innervation of the muscles of
mastication?
A. Trigeminal nerve (CN V)
B. Facial nerve (CN VII)
C. Glossopharyngeal nerve (CN IX)
D. Vagus nerve (CN X)
🟢A
🔴 RATIONALE: The mandibular branch of the trigeminal nerve (CN V3) provides motor innervation
to the muscles of mastication, including the masseter, temporalis, and pterygoids.
A patient is prescribed a medication that acts as a selective serotonin reuptake inhibitor (SSRI).
Which neurotransmitter level is primarily increased in the synaptic cleft?
A. Dopamine
B. Norepinephrine
C. Serotonin
, D. Acetylcholine
🟢C
🔴 RATIONALE: SSRIs work by inhibiting the reuptake of serotonin (5-HT) into the presynaptic
neuron, thereby increasing the concentration of serotonin available in the synaptic cleft to bind to
postsynaptic receptors.
A patient presents with signs of hypovolemic shock. Which compensatory mechanism is activated
first to maintain mean arterial pressure?
A. Renin-angiotensin-aldosterone system
B. Baroreceptor reflex
C. Antidiuretic hormone release
D. Atrial natriuretic peptide secretion
🟢B
🔴 RATIONALE: The baroreceptor reflex is an immediate response to drops in blood pressure,
occurring within seconds to increase heart rate and systemic vascular resistance.
In the context of osteopathic medicine, which of the following best describes the "Fryette’s First
Law"?
A. Occurs in the thoracic and lumbar spine in a neutral position
B. Occurs in the cervical spine during flexion or extension
C. Involves non-neutral mechanics in the lumbar spine
D. Describes rotation occurring in the same direction as sidebending
🟢A
🔴 RATIONALE: Fryette’s First Law states that in neutral spinal mechanics (when the spine is not
significantly flexed or extended), sidebending and rotation occur in opposite directions.
A patient with type 1 diabetes mellitus presents with fruity-smelling breath and Kussmaul
respirations. What is the most appropriate initial management?
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
* Osteopathic Principles and Practice
* Cardiovascular System
* Respiratory System
* Musculoskeletal System
* Gastrointestinal and Nutrition
* Renal and Urinary Systems
* Neurology and Behavioral Health
* Hematology and Oncology
* Ethics and Professionalism
Introduction
*The purpose of this assessment is to provide a comprehensive review of clinical knowledge requi
SECTION ONE: QUESTIONS 1–100
A 55-year-old male presents with acute crushing substernal chest pain radiating to the left arm.
Electrocardiogram shows ST-segment elevation in leads V2-V4. Which coronary artery is most likely
occluded?
A. Right coronary artery
B. Left circumflex artery
,C. Left anterior descending artery
D. Posterior descending artery
🟢C
🔴 RATIONALE: The left anterior descending (LAD) artery supplies the anterior wall of the left
ventricle and the anterior two-thirds of the septum. ST-segment elevation in leads V2-V4
corresponds to an anterior wall myocardial infarction.
A patient with chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea.
Arterial blood gas shows pH 7.25, PaCO2 60 mmHg, and PaO2 55 mmHg. What is the primary
acid-base disturbance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
🟢A
🔴 RATIONALE: Respiratory acidosis is characterized by a low pH and an elevated PaCO2. In
patients with COPD, the inability to adequately ventilate leads to carbon dioxide retention, causing a
decrease in pH.
An osteopathic physician performs a structural exam on a patient with chronic lower back pain and
identifies a T10-T12 segment dysfunction. This segment corresponds to the sympathetic innervation
of which organ?
A. Stomach
B. Small intestine
C. Kidneys
D. Bladder
🟢C
,🔴 RATIONALE: The sympathetic levels for the kidneys are T10-T11. T5-T9 typically innervates the
upper gastrointestinal tract, while T12-L2 often relates to the lower GI tract and bladder.
A 28-year-old female presents with a butterfly rash on her face and joint pain. Serologic testing
reveals a positive anti-double-stranded DNA antibody. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Dermatomyositis
🟢B
🔴 RATIONALE: Systemic lupus erythematosus (SLE) is classically associated with a malar
(butterfly) rash and positive anti-dsDNA antibodies, which are highly specific for the condition.
Which of the following cranial nerves is responsible for the motor innervation of the muscles of
mastication?
A. Trigeminal nerve (CN V)
B. Facial nerve (CN VII)
C. Glossopharyngeal nerve (CN IX)
D. Vagus nerve (CN X)
🟢A
🔴 RATIONALE: The mandibular branch of the trigeminal nerve (CN V3) provides motor innervation
to the muscles of mastication, including the masseter, temporalis, and pterygoids.
A patient is prescribed a medication that acts as a selective serotonin reuptake inhibitor (SSRI).
Which neurotransmitter level is primarily increased in the synaptic cleft?
A. Dopamine
B. Norepinephrine
C. Serotonin
, D. Acetylcholine
🟢C
🔴 RATIONALE: SSRIs work by inhibiting the reuptake of serotonin (5-HT) into the presynaptic
neuron, thereby increasing the concentration of serotonin available in the synaptic cleft to bind to
postsynaptic receptors.
A patient presents with signs of hypovolemic shock. Which compensatory mechanism is activated
first to maintain mean arterial pressure?
A. Renin-angiotensin-aldosterone system
B. Baroreceptor reflex
C. Antidiuretic hormone release
D. Atrial natriuretic peptide secretion
🟢B
🔴 RATIONALE: The baroreceptor reflex is an immediate response to drops in blood pressure,
occurring within seconds to increase heart rate and systemic vascular resistance.
In the context of osteopathic medicine, which of the following best describes the "Fryette’s First
Law"?
A. Occurs in the thoracic and lumbar spine in a neutral position
B. Occurs in the cervical spine during flexion or extension
C. Involves non-neutral mechanics in the lumbar spine
D. Describes rotation occurring in the same direction as sidebending
🟢A
🔴 RATIONALE: Fryette’s First Law states that in neutral spinal mechanics (when the spine is not
significantly flexed or extended), sidebending and rotation occur in opposite directions.
A patient with type 1 diabetes mellitus presents with fruity-smelling breath and Kussmaul
respirations. What is the most appropriate initial management?
