Ultimate COMSAE Phase 1 (Form 114)
Practice Set |250+ High-Yield Questions
& Detailed Rationales (2026 Edition)
This comprehensive study resource is specifically designed for
osteopathic medical students preparing for the COMSAE Phase 1
(Form 114) and the COMLEX-USA Level 1. It contains meticulously
crafted multiple-choice questions (MCQs) that mirror the style,
difficulty, and content distribution of the actual NBOME assessment.
What’s Included?
• Practice Questions: Covering all major systems (Cardiovascular,
GI, Renal, Respiratory, Reproductive, etc.).
• Heavy OMM Focus: Detailed questions on Cranial strains,
Sacral torsions, Chapman points, Viscerosomatic reflexes, and
Fryette’s Laws.
• Bolded Answers: For quick-review and self-testing.
• In-Depth Rationales: Every answer includes an italicized
rationale explaining the underlying physiology, pathology, or
osteopathic principle to ensure deep conceptual understanding.
• High-Yield Topics: Focused on the most “testable” concepts for
Form 114, including Microbiology (gram stains/spores),
Pharmacology (MOAs/Antidotes), and Biochemistry (rate-
limiting enzymes).
,1.A 65-year-old male with a history of hypertension and smoking
presents with sudden onset “tearing” chest pain radiating to his back.
His blood pressure is 180/100 mmHg in the right arm and 140/90
mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Tension pneumothorax
E) Pericarditis
Answer: C
Rationale: Aortic dissection typically presents with sudden, tearing
chest pain radiating to the back and a blood pressure discrepancy
between the arms.
2.A 24-year-old female presents with a “velvety” patch of darkened
skin on the back of her neck. She has a BMI of 34. This skin finding is
most commonly associated with which of the following?
A) Vitamin B12 deficiency
B) Hypothyroidism
C) Insulin resistance
D) Excess sun exposure
E) Iron deficiency anemia
Answer: C
Rationale: Acanthosis nigricans is a clinical sign of insulin resistance,
often seen in Type 2 Diabetes or PCOS.
,3.During a structural exam, a patient’s T4 vertebrae is found to be
rotated right and sidebent right. The dysfunction improves in
extension and worsens in flexion. What is the diagnosis?
A) T4 Neutral Sidebent Left Rotated Right
B) T4 Flexed Sidebent Right Rotated Right
C) T4 Extended Sidebent Right Rotated Right
D) T4 Neutral Sidebent Right Rotated Right
E) T4 Extended Sidebent Left Rotated Left
Answer: C
Rationale: Improvement in extension makes it “Extended” (E). Same-
side rotation/sidebending (RRSR) follows Fryette Type II mechanics
(ESRR).
4.Which of the following Chapman points is located on the lateral
aspect of the middle-to-lower humerus?
A) Bladder
B) Eye
C) Ear
D) Sinuses
E) Thyroid
Answer: B
Rationale: The anterior Chapman point for the eye is located on the
surgical neck/lateral humerus.
, 5.A 4-year-old boy presents with a “barking” cough and inspiratory
stridor. A neck X-ray shows subglottic narrowing (Steeple sign). What
is the most likely causative agent?
A) Respiratory syncytial virus (RSV)
B) Haemophilus influenzae type b
C) Parainfluenza virus
D) Bordetella pertussis
E) Mycoplasma pneumoniae
Answer: C
Rationale: Laryngotracheobronchitis (Croup) is most commonly caused
by the Parainfluenza virus and shows the “Steeple sign” on X-ray.
6.A patient with long-standing rheumatoid arthritis is undergoing
elective surgery. Which of the following must be evaluated pre-
operatively to prevent neurological injury during intubation?
A) Lumbar spine
B) Sacroiliac joints
C) Cervical spine (C1-C2)
D) Temporomandibular joint
E) Thoracic inlet
Answer: C
Rationale: RA can cause atlantoaxial subluxation; intubation can lead to
spinal cord compression if not screened.
Practice Set |250+ High-Yield Questions
& Detailed Rationales (2026 Edition)
This comprehensive study resource is specifically designed for
osteopathic medical students preparing for the COMSAE Phase 1
(Form 114) and the COMLEX-USA Level 1. It contains meticulously
crafted multiple-choice questions (MCQs) that mirror the style,
difficulty, and content distribution of the actual NBOME assessment.
What’s Included?
• Practice Questions: Covering all major systems (Cardiovascular,
GI, Renal, Respiratory, Reproductive, etc.).
• Heavy OMM Focus: Detailed questions on Cranial strains,
Sacral torsions, Chapman points, Viscerosomatic reflexes, and
Fryette’s Laws.
• Bolded Answers: For quick-review and self-testing.
• In-Depth Rationales: Every answer includes an italicized
rationale explaining the underlying physiology, pathology, or
osteopathic principle to ensure deep conceptual understanding.
• High-Yield Topics: Focused on the most “testable” concepts for
Form 114, including Microbiology (gram stains/spores),
Pharmacology (MOAs/Antidotes), and Biochemistry (rate-
limiting enzymes).
,1.A 65-year-old male with a history of hypertension and smoking
presents with sudden onset “tearing” chest pain radiating to his back.
His blood pressure is 180/100 mmHg in the right arm and 140/90
mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Tension pneumothorax
E) Pericarditis
Answer: C
Rationale: Aortic dissection typically presents with sudden, tearing
chest pain radiating to the back and a blood pressure discrepancy
between the arms.
2.A 24-year-old female presents with a “velvety” patch of darkened
skin on the back of her neck. She has a BMI of 34. This skin finding is
most commonly associated with which of the following?
A) Vitamin B12 deficiency
B) Hypothyroidism
C) Insulin resistance
D) Excess sun exposure
E) Iron deficiency anemia
Answer: C
Rationale: Acanthosis nigricans is a clinical sign of insulin resistance,
often seen in Type 2 Diabetes or PCOS.
,3.During a structural exam, a patient’s T4 vertebrae is found to be
rotated right and sidebent right. The dysfunction improves in
extension and worsens in flexion. What is the diagnosis?
A) T4 Neutral Sidebent Left Rotated Right
B) T4 Flexed Sidebent Right Rotated Right
C) T4 Extended Sidebent Right Rotated Right
D) T4 Neutral Sidebent Right Rotated Right
E) T4 Extended Sidebent Left Rotated Left
Answer: C
Rationale: Improvement in extension makes it “Extended” (E). Same-
side rotation/sidebending (RRSR) follows Fryette Type II mechanics
(ESRR).
4.Which of the following Chapman points is located on the lateral
aspect of the middle-to-lower humerus?
A) Bladder
B) Eye
C) Ear
D) Sinuses
E) Thyroid
Answer: B
Rationale: The anterior Chapman point for the eye is located on the
surgical neck/lateral humerus.
, 5.A 4-year-old boy presents with a “barking” cough and inspiratory
stridor. A neck X-ray shows subglottic narrowing (Steeple sign). What
is the most likely causative agent?
A) Respiratory syncytial virus (RSV)
B) Haemophilus influenzae type b
C) Parainfluenza virus
D) Bordetella pertussis
E) Mycoplasma pneumoniae
Answer: C
Rationale: Laryngotracheobronchitis (Croup) is most commonly caused
by the Parainfluenza virus and shows the “Steeple sign” on X-ray.
6.A patient with long-standing rheumatoid arthritis is undergoing
elective surgery. Which of the following must be evaluated pre-
operatively to prevent neurological injury during intubation?
A) Lumbar spine
B) Sacroiliac joints
C) Cervical spine (C1-C2)
D) Temporomandibular joint
E) Thoracic inlet
Answer: C
Rationale: RA can cause atlantoaxial subluxation; intubation can lead to
spinal cord compression if not screened.
