COMSAE PHASE 1 FORM 116 EXAM
TEST BANK – NEWEST 2026 EDITION |
COMPREHENSIVE -QUESTION SET
WITH VERIFIED ANSWERS &
DETAILED RATIONALES
Core Domains
• Osteopathic Principles and Manipulative Medicine
• Anatomy and Embryology
• Physiology and Pathophysiology
• Biochemistry and Molecular Biology
• Pharmacology and Pharmacotherapeutics
• Microbiology and Immunology
• Pathology and Laboratory Medicine
• Behavioral Science and Ethics
• Clinical Integration and Systems-Based Practice
Introduction
This comprehensive assessment evaluates the osteopathic medical
student’s readiness for COMLEX-USA Level 1. The examination
integrates foundational biomedical sciences with osteopathic
principles and clinical reasoning. Questions are presented as single-
best-answer multiple-choice items that reflect the content and
,difficulty of the official COMSAE Phase 1. Emphasis is placed on
applying basic science knowledge to clinical vignettes, interpreting
laboratory and imaging findings, and demonstrating competency in
osteopathic manipulative medicine. Success requires mastery of
anatomy, physiology, pathology, pharmacology, and the osteopathic
approach to whole-person care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old man presents with chest pain radiating to his left arm.
ECG shows ST elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
RATIONALE: Inferior wall myocardial infarction is indicated by
ST elevation in leads II, III, and aVF. The right coronary artery
commonly supplies the inferior wall of the heart in most
individuals. Therefore, occlusion of the RCA is the most likely
cause.
Question 2
A patient experiences sudden chest pain and dyspnea. Imaging
reveals a pulmonary embolism. The embolus most likely originated
from which location?
,A. Left atrium
B. Coronary arteries
C. Deep veins of the lower extremities
D. Pulmonary veins
RATIONALE: Most pulmonary emboli arise from deep venous
thromboses in the legs and travel through the venous circulation to
the lungs.
Question 3
A patient with Graves disease has antibodies directed against which
receptor?
A. Insulin receptor
B. ACTH receptor
C. TSH receptor
D. Growth hormone receptor
RATIONALE: Graves disease involves stimulating
autoantibodies against the TSH receptor, causing hyperthyroidism.
Question 4
A patient has elevated serum calcium and elevated parathyroid
hormone levels. Which diagnosis is most likely?
A. Vitamin D deficiency
B. Hypoparathyroidism
C. Primary hyperparathyroidism
D. Chronic renal failure
, RATIONALE: Primary hyperparathyroidism presents with
elevated calcium and inappropriately elevated PTH levels, typically
due to a parathyroid adenoma.
Question 5
A 24-year-old man presents with fever, headache, and neck
stiffness. Lumbar puncture shows elevated opening pressure, low
glucose, and high protein. Which organism is most likely
responsible?
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Listeria monocytogenes
D. Escherichia coli
RATIONALE: Bacterial meningitis in adults is most commonly
caused by Streptococcus pneumoniae. The CSF findings of elevated
opening pressure, low glucose, and high protein are classic for
bacterial meningitis.
Question 6
A 65-year-old smoker presents with hematuria and flank pain. CT
reveals a renal mass. Which is the most likely diagnosis?
A. Wilms tumor
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Angiomyolipoma
RATIONALE: Renal cell carcinoma is the most common
malignant renal tumor in adults, strongly associated with smoking
TEST BANK – NEWEST 2026 EDITION |
COMPREHENSIVE -QUESTION SET
WITH VERIFIED ANSWERS &
DETAILED RATIONALES
Core Domains
• Osteopathic Principles and Manipulative Medicine
• Anatomy and Embryology
• Physiology and Pathophysiology
• Biochemistry and Molecular Biology
• Pharmacology and Pharmacotherapeutics
• Microbiology and Immunology
• Pathology and Laboratory Medicine
• Behavioral Science and Ethics
• Clinical Integration and Systems-Based Practice
Introduction
This comprehensive assessment evaluates the osteopathic medical
student’s readiness for COMLEX-USA Level 1. The examination
integrates foundational biomedical sciences with osteopathic
principles and clinical reasoning. Questions are presented as single-
best-answer multiple-choice items that reflect the content and
,difficulty of the official COMSAE Phase 1. Emphasis is placed on
applying basic science knowledge to clinical vignettes, interpreting
laboratory and imaging findings, and demonstrating competency in
osteopathic manipulative medicine. Success requires mastery of
anatomy, physiology, pathology, pharmacology, and the osteopathic
approach to whole-person care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old man presents with chest pain radiating to his left arm.
ECG shows ST elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
RATIONALE: Inferior wall myocardial infarction is indicated by
ST elevation in leads II, III, and aVF. The right coronary artery
commonly supplies the inferior wall of the heart in most
individuals. Therefore, occlusion of the RCA is the most likely
cause.
Question 2
A patient experiences sudden chest pain and dyspnea. Imaging
reveals a pulmonary embolism. The embolus most likely originated
from which location?
,A. Left atrium
B. Coronary arteries
C. Deep veins of the lower extremities
D. Pulmonary veins
RATIONALE: Most pulmonary emboli arise from deep venous
thromboses in the legs and travel through the venous circulation to
the lungs.
Question 3
A patient with Graves disease has antibodies directed against which
receptor?
A. Insulin receptor
B. ACTH receptor
C. TSH receptor
D. Growth hormone receptor
RATIONALE: Graves disease involves stimulating
autoantibodies against the TSH receptor, causing hyperthyroidism.
Question 4
A patient has elevated serum calcium and elevated parathyroid
hormone levels. Which diagnosis is most likely?
A. Vitamin D deficiency
B. Hypoparathyroidism
C. Primary hyperparathyroidism
D. Chronic renal failure
, RATIONALE: Primary hyperparathyroidism presents with
elevated calcium and inappropriately elevated PTH levels, typically
due to a parathyroid adenoma.
Question 5
A 24-year-old man presents with fever, headache, and neck
stiffness. Lumbar puncture shows elevated opening pressure, low
glucose, and high protein. Which organism is most likely
responsible?
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Listeria monocytogenes
D. Escherichia coli
RATIONALE: Bacterial meningitis in adults is most commonly
caused by Streptococcus pneumoniae. The CSF findings of elevated
opening pressure, low glucose, and high protein are classic for
bacterial meningitis.
Question 6
A 65-year-old smoker presents with hematuria and flank pain. CT
reveals a renal mass. Which is the most likely diagnosis?
A. Wilms tumor
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Angiomyolipoma
RATIONALE: Renal cell carcinoma is the most common
malignant renal tumor in adults, strongly associated with smoking
