COMSAE PHASE 1 FORM 115 REAL EXAM
2026: HIGH-YIELD QUESTIONS WITH
ANSWERS & DETAILED RATIONALES —
COMPLETE NBOME OSTEOPATHIC BOARD
REVIEW FOR CARDIOLOGY,
PULMONOLOGY, NEUROLOGY, OMM,
MICROBIOLOGY & ENDOCRINOLOGY |
COMLEX-USA LEVEL 1 PREP QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Osteopathic Principles and Practice (OPP/OMT)
Cardiovascular System
Pulmonary System
Neurology and Neuroscience
Microbiology and Immunology
Endocrinology and Metabolism
Pharmacology
Pathology
Behavioral Science, Biostatistics, and Ethics
Multisystem and Interdisciplinary Topics
Introduction
,The COMSAE Phase 1 Form 115 is a comprehensive self-assessment
examination designed to evaluate osteopathic medical students'
readiness for COMLEX-USA Level 1. This examination assesses
foundational biomedical sciences, clinical systems, osteopathic
principles and practice, behavioral science, biostatistics, ethics, and
multisystem interdisciplinary topics. The test structure incorporates
multiple-choice, vignette-based, and osteopathic clinical reasoning
questions that emphasize real-world application and clinical
decision-making. Candidates are expected to demonstrate critical
thinking, integration of basic science mechanisms with clinical
presentations, and application of osteopathic principles. This
assessment ensures that successful examinees possess the knowledge
and clinical judgment necessary for progression to clinical rotations
and future licensure.
Section One: Questions 1–100
Cardiology
A 64-year-old male with a history of hypertension and
hyperlipidemia presents with sudden onset of severe tearing chest
pain radiating to the back. Blood pressure is 180/100 mm Hg in the
right arm and 140/80 mm Hg in the left arm. Which finding is most
likely on imaging?
A. Wide mediastinum on chest X-ray
B. ST-elevation in leads II, III, and aVF
C. Left ventricular hypertrophy on echocardiogram
D. Bilateral pleural effusions
Correct answer: A
, RATIONALE: The presentation of sudden tearing chest pain
with unequal blood pressures in the arms is classic for aortic
dissection. A widened mediastinum on chest X-ray is the most
common initial finding. ST-elevation in leads II, III, and aVF
indicates inferior myocardial infarction, not dissection.
A 55-year-old male presents with exertional chest pain relieved by
rest. ECG shows T-wave inversions in leads V4–V6. Which coronary
artery is most likely stenosed?
A. Right coronary artery
B. Left anterior descending artery
C. Left circumflex artery
D. Posterior descending artery
Correct answer: C
RATIONALE: T-wave inversions in leads V4–V6 (lateral leads)
suggest ischemia in the territory of the left circumflex artery. The
right coronary artery supplies the inferior wall (leads II, III, aVF).
The left anterior descending artery supplies the anterior wall and
septum (leads V1–V4).
A 72-year-old female with a history of atrial fibrillation presents
with sudden onset of right-sided weakness and aphasia. She is
within the 4.5-hour window. Which intervention is indicated?
A. Aspirin 325 mg orally
B. Intravenous tissue plasminogen activator
C. Heparin infusion
D. Warfarin 5 mg orally
, Correct answer: B
RATIONALE: Intravenous tPA is indicated for acute ischemic
stroke within 4.5 hours of symptom onset, provided there are no
contraindications. Aspirin is given after tPA or when tPA is
contraindicated. Heparin and warfarin are not acute interventions.
A 45-year-old male presents with palpitations and lightheadedness.
ECG shows a regular rhythm at 180 bpm with narrow QRS
complexes and no visible P waves. Which maneuver is most
appropriate for initial management?
A. Valsalva maneuver
B. Synchronized cardioversion
C. Adenosine administration
D. Defibrillation
Correct answer: A
RATIONALE: The rhythm is consistent with paroxysmal
supraventricular tachycardia (PSVT). Vagal maneuvers, such as the
Valsalva maneuver, are the first-line intervention. Adenosine is used
if vagal maneuvers fail. Cardioversion is for unstable patients.
A 58-year-old male presents with progressive dyspnea and bilateral
lower extremity edema. Echocardiogram shows an ejection fraction
of 30%. Which medication has a mortality benefit in this condition?
A. Amlodipine
B. Metoprolol succinate
C. Digoxin
D. Furosemide
2026: HIGH-YIELD QUESTIONS WITH
ANSWERS & DETAILED RATIONALES —
COMPLETE NBOME OSTEOPATHIC BOARD
REVIEW FOR CARDIOLOGY,
PULMONOLOGY, NEUROLOGY, OMM,
MICROBIOLOGY & ENDOCRINOLOGY |
COMLEX-USA LEVEL 1 PREP QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Osteopathic Principles and Practice (OPP/OMT)
Cardiovascular System
Pulmonary System
Neurology and Neuroscience
Microbiology and Immunology
Endocrinology and Metabolism
Pharmacology
Pathology
Behavioral Science, Biostatistics, and Ethics
Multisystem and Interdisciplinary Topics
Introduction
,The COMSAE Phase 1 Form 115 is a comprehensive self-assessment
examination designed to evaluate osteopathic medical students'
readiness for COMLEX-USA Level 1. This examination assesses
foundational biomedical sciences, clinical systems, osteopathic
principles and practice, behavioral science, biostatistics, ethics, and
multisystem interdisciplinary topics. The test structure incorporates
multiple-choice, vignette-based, and osteopathic clinical reasoning
questions that emphasize real-world application and clinical
decision-making. Candidates are expected to demonstrate critical
thinking, integration of basic science mechanisms with clinical
presentations, and application of osteopathic principles. This
assessment ensures that successful examinees possess the knowledge
and clinical judgment necessary for progression to clinical rotations
and future licensure.
Section One: Questions 1–100
Cardiology
A 64-year-old male with a history of hypertension and
hyperlipidemia presents with sudden onset of severe tearing chest
pain radiating to the back. Blood pressure is 180/100 mm Hg in the
right arm and 140/80 mm Hg in the left arm. Which finding is most
likely on imaging?
A. Wide mediastinum on chest X-ray
B. ST-elevation in leads II, III, and aVF
C. Left ventricular hypertrophy on echocardiogram
D. Bilateral pleural effusions
Correct answer: A
, RATIONALE: The presentation of sudden tearing chest pain
with unequal blood pressures in the arms is classic for aortic
dissection. A widened mediastinum on chest X-ray is the most
common initial finding. ST-elevation in leads II, III, and aVF
indicates inferior myocardial infarction, not dissection.
A 55-year-old male presents with exertional chest pain relieved by
rest. ECG shows T-wave inversions in leads V4–V6. Which coronary
artery is most likely stenosed?
A. Right coronary artery
B. Left anterior descending artery
C. Left circumflex artery
D. Posterior descending artery
Correct answer: C
RATIONALE: T-wave inversions in leads V4–V6 (lateral leads)
suggest ischemia in the territory of the left circumflex artery. The
right coronary artery supplies the inferior wall (leads II, III, aVF).
The left anterior descending artery supplies the anterior wall and
septum (leads V1–V4).
A 72-year-old female with a history of atrial fibrillation presents
with sudden onset of right-sided weakness and aphasia. She is
within the 4.5-hour window. Which intervention is indicated?
A. Aspirin 325 mg orally
B. Intravenous tissue plasminogen activator
C. Heparin infusion
D. Warfarin 5 mg orally
, Correct answer: B
RATIONALE: Intravenous tPA is indicated for acute ischemic
stroke within 4.5 hours of symptom onset, provided there are no
contraindications. Aspirin is given after tPA or when tPA is
contraindicated. Heparin and warfarin are not acute interventions.
A 45-year-old male presents with palpitations and lightheadedness.
ECG shows a regular rhythm at 180 bpm with narrow QRS
complexes and no visible P waves. Which maneuver is most
appropriate for initial management?
A. Valsalva maneuver
B. Synchronized cardioversion
C. Adenosine administration
D. Defibrillation
Correct answer: A
RATIONALE: The rhythm is consistent with paroxysmal
supraventricular tachycardia (PSVT). Vagal maneuvers, such as the
Valsalva maneuver, are the first-line intervention. Adenosine is used
if vagal maneuvers fail. Cardioversion is for unstable patients.
A 58-year-old male presents with progressive dyspnea and bilateral
lower extremity edema. Echocardiogram shows an ejection fraction
of 30%. Which medication has a mortality benefit in this condition?
A. Amlodipine
B. Metoprolol succinate
C. Digoxin
D. Furosemide
