2026 COMSAE 114 – 176 LATEST QUESTIONS AND CORRECT SOLUTIONS JUST RELEASED THIS YEAR………
Core Domains:
Osteopathic Principles and Practice
Anatomy and Embryology
Biochemistry and Molecular Biology
Microbiology and Immunology
Pathology and Pathophysiology
Pharmacology and Toxicology
Behavioral Health and Ethics
Preventive Medicine and Public Health
Clinical Medicine and Diagnostic Reasoning
Introduction:
This comprehensive practice examination is designed to assess the foundational and applied scientific knowledge
required for success on the COMSAE 114 – 176. It evaluates a candidate's grasp of core medical principles,
including normal structure and function, disease mechanisms, therapeutic interventions, and diagnostic
methodologies. The examination consists of 100 multiple-choice questions, many of which are presented in a
scenario-based format that tests critical thinking and clinical decision-making skills. Emphasis is placed on the
application of scientific knowledge to real-world clinical situations, osteopathic principles, ethical considerations,
and regulatory compliance to ensure the highest standards of patient care and public safety.
,SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male presents with progressive dyspnea on exertion and a nonproductive cough. Chest
auscultation reveals fine end-inspiratory crackles at the lung bases. Pulmonary function tests show a restrictive
pattern with a reduced diffusing capacity for carbon monoxide (DLCO). Which of the following is the most likely
diagnosis?
A. Chronic obstructive pulmonary disease
B. Idiopathic pulmonary fibrosis
C. Asthma
D. Congestive heart failure
🟢 B. Idiopathic pulmonary fibrosis
🔴 RATIONALE: Idiopathic pulmonary fibrosis is characterized by progressive dyspnea, nonproductive cough,
and fine crackles. It presents with a restrictive pattern on PFTs and a decreased DLCO due to alveolar-capillary
membrane thickening. COPD shows an obstructive pattern, asthma is obstructive and reversible, and CHF
typically presents with orthopnea and peripheral edema.
2. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Laboratory
studies reveal an elevated TSH and low free T4. Anti-thyroid peroxidase antibodies are positive. Which of the
following is the most appropriate initial treatment?
A. Levothyroxine replacement
B. Methimazole
C. Radioactive iodine ablation
D. Propylthiouracil
,🟢 A. Levothyroxine replacement
🔴 RATIONALE: The patient has primary hypothyroidism, likely due to Hashimoto's thyroiditis (positive anti-TPO
antibodies). The standard treatment is thyroid hormone replacement with levothyroxine. Methimazole,
radioactive iodine, and propylthiouracil are treatments for hyperthyroidism.
3. A 28-year-old man presents with acute onset of severe, tearing chest pain radiating to the back. On
examination, he is hypertensive, and there is a difference in blood pressure between the upper extremities.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
🟢 C. Aortic dissection
🔴 RATIONALE: Aortic dissection classically presents with sudden, severe, tearing chest pain radiating to the
back, along with a difference in blood pressure between arms. Myocardial infarction pain is more pressure-like,
pulmonary embolism presents with pleuritic pain and dyspnea, and pericarditis pain is often sharp and
positional.
4. A 55-year-old male with a history of hypertension and type 2 diabetes presents with a complaint of
progressive visual loss in the left eye over the past month. Fundoscopic examination reveals macular edema and
exudates. Which of the following is the most likely cause?
A. Open-angle glaucoma
B. Retinal vein occlusion
, C. Diabetic retinopathy
D. Optic neuritis
🟢 C. Diabetic retinopathy
🔴 RATIONALE: Macular edema and exudates in a patient with type 2 diabetes are characteristic of diabetic
retinopathy. Glaucoma is associated with optic nerve cupping, retinal vein occlusion presents with a "blood and
thunder" fundus, and optic neuritis is associated with pain on eye movement.
5. A 72-year-old woman is brought to the emergency department with confusion and fever. She has a history of
recurrent urinary tract infections. Urinalysis reveals leukocyte esterase and nitrites. Which of the following is the
most appropriate empirical antibiotic?
A. Amoxicillin
B. Nitrofurantoin
C. Ciprofloxacin
D. Ceftriaxone
🟢 D. Ceftriaxone
🔴 RATIONALE: In a febrile, elderly patient with suspected pyelonephritis, empirical antibiotics should cover
gram-negative organisms and be administered parenterally. Ceftriaxone is a good choice for severe urinary tract
infections. Nitrofurantoin is not effective for pyelonephritis, and amoxicillin resistance is common.
6. A 32-year-old male presents with a 1-week history of a painful, vesicular rash on the right side of his forehead
and the tip of his nose. He also reports photophobia and eye pain. Which of the following is the most important
initial step?
Core Domains:
Osteopathic Principles and Practice
Anatomy and Embryology
Biochemistry and Molecular Biology
Microbiology and Immunology
Pathology and Pathophysiology
Pharmacology and Toxicology
Behavioral Health and Ethics
Preventive Medicine and Public Health
Clinical Medicine and Diagnostic Reasoning
Introduction:
This comprehensive practice examination is designed to assess the foundational and applied scientific knowledge
required for success on the COMSAE 114 – 176. It evaluates a candidate's grasp of core medical principles,
including normal structure and function, disease mechanisms, therapeutic interventions, and diagnostic
methodologies. The examination consists of 100 multiple-choice questions, many of which are presented in a
scenario-based format that tests critical thinking and clinical decision-making skills. Emphasis is placed on the
application of scientific knowledge to real-world clinical situations, osteopathic principles, ethical considerations,
and regulatory compliance to ensure the highest standards of patient care and public safety.
,SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male presents with progressive dyspnea on exertion and a nonproductive cough. Chest
auscultation reveals fine end-inspiratory crackles at the lung bases. Pulmonary function tests show a restrictive
pattern with a reduced diffusing capacity for carbon monoxide (DLCO). Which of the following is the most likely
diagnosis?
A. Chronic obstructive pulmonary disease
B. Idiopathic pulmonary fibrosis
C. Asthma
D. Congestive heart failure
🟢 B. Idiopathic pulmonary fibrosis
🔴 RATIONALE: Idiopathic pulmonary fibrosis is characterized by progressive dyspnea, nonproductive cough,
and fine crackles. It presents with a restrictive pattern on PFTs and a decreased DLCO due to alveolar-capillary
membrane thickening. COPD shows an obstructive pattern, asthma is obstructive and reversible, and CHF
typically presents with orthopnea and peripheral edema.
2. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Laboratory
studies reveal an elevated TSH and low free T4. Anti-thyroid peroxidase antibodies are positive. Which of the
following is the most appropriate initial treatment?
A. Levothyroxine replacement
B. Methimazole
C. Radioactive iodine ablation
D. Propylthiouracil
,🟢 A. Levothyroxine replacement
🔴 RATIONALE: The patient has primary hypothyroidism, likely due to Hashimoto's thyroiditis (positive anti-TPO
antibodies). The standard treatment is thyroid hormone replacement with levothyroxine. Methimazole,
radioactive iodine, and propylthiouracil are treatments for hyperthyroidism.
3. A 28-year-old man presents with acute onset of severe, tearing chest pain radiating to the back. On
examination, he is hypertensive, and there is a difference in blood pressure between the upper extremities.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
🟢 C. Aortic dissection
🔴 RATIONALE: Aortic dissection classically presents with sudden, severe, tearing chest pain radiating to the
back, along with a difference in blood pressure between arms. Myocardial infarction pain is more pressure-like,
pulmonary embolism presents with pleuritic pain and dyspnea, and pericarditis pain is often sharp and
positional.
4. A 55-year-old male with a history of hypertension and type 2 diabetes presents with a complaint of
progressive visual loss in the left eye over the past month. Fundoscopic examination reveals macular edema and
exudates. Which of the following is the most likely cause?
A. Open-angle glaucoma
B. Retinal vein occlusion
, C. Diabetic retinopathy
D. Optic neuritis
🟢 C. Diabetic retinopathy
🔴 RATIONALE: Macular edema and exudates in a patient with type 2 diabetes are characteristic of diabetic
retinopathy. Glaucoma is associated with optic nerve cupping, retinal vein occlusion presents with a "blood and
thunder" fundus, and optic neuritis is associated with pain on eye movement.
5. A 72-year-old woman is brought to the emergency department with confusion and fever. She has a history of
recurrent urinary tract infections. Urinalysis reveals leukocyte esterase and nitrites. Which of the following is the
most appropriate empirical antibiotic?
A. Amoxicillin
B. Nitrofurantoin
C. Ciprofloxacin
D. Ceftriaxone
🟢 D. Ceftriaxone
🔴 RATIONALE: In a febrile, elderly patient with suspected pyelonephritis, empirical antibiotics should cover
gram-negative organisms and be administered parenterally. Ceftriaxone is a good choice for severe urinary tract
infections. Nitrofurantoin is not effective for pyelonephritis, and amoxicillin resistance is common.
6. A 32-year-old male presents with a 1-week history of a painful, vesicular rash on the right side of his forehead
and the tip of his nose. He also reports photophobia and eye pain. Which of the following is the most important
initial step?
