COMSAE PHASE 1 FORM 116 REAL
EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
CORE DOMAINS
Osteopathic Principles and Practice (OMM)
Cardiology
Pulmonology
Neurology
Endocrinology
Microbiology
Pharmacology
Biostatistics and Epidemiology
INTRODUCTION
The purpose of this comprehensive assessment is to evaluate the osteopathic
medical knowledge and clinical reasoning skills required for COMLEX-USA
Level 1 readiness. The examination systematically assesses foundational
biomedical sciences, osteopathic manipulative medicine, and clinical
presentation across multiple organ systems. Comprising multiple-choice and
scenario-based items, the test mirrors the integrated cognitive demands of the
NBOME COMSAE Phase 1 examination. Special emphasis is placed on
viscerosomatic reflexes, somatic dysfunction diagnosis, and real-world
application of clinical decision-making, ensuring candidates demonstrate the
foundational readiness for osteopathic medical licensure.
SECTION ONE: QUESTIONS 1–176
,Question 1
A 24-year-old woman presents with episodic flank pain, hypertension, and
gross hematuria after mild trauma. Imaging reveals bilaterally enlarged
kidneys with multiple cysts. Which inheritance pattern is most likely?
A. Autosomal recessive
B. X-linked dominant
C. Autosomal dominant
D. Mitochondrial
C. Autosomal dominant
RATIONALE: Autosomal dominant polycystic kidney disease (ADPKD)
presents with hypertension, hematuria, flank pain, and bilaterally enlarged
cystic kidneys. It is the most common inherited kidney disorder.
Question 2
A 45-year-old with chronic alcoholism is found to have asterixis, confusion,
and abdominal distension. Which medication directly lowers ammonia by
enhancing nitrogen excretion as hippurate?
A. Lactulose
B. Rifaximin
C. Sodium benzoate
D. Spironolactone
C. Sodium benzoate
RATIONALE: Sodium benzoate conjugates glycine to form hippurate,
which is renally excreted, directly lowering ammonia levels. Lactulose
acidifies the colon to trap ammonium.
Question 3
A 60-year-old with a 40-pack-year smoking history presents with new
hoarseness and a left supraclavicular mass. Biopsy shows small blue cells with
scant cytoplasm. Which immunohistochemical stain would be positive?
,A. Cytokeratin 7
B. Chromogranin
C. TTF-1
D. S-100
B. Chromogranin
RATIONALE: Small cell lung cancer is a neuroendocrine tumor that stains
positive for chromogranin, synaptophysin, and CD56.
Question 4
A 25-year-old man has an acute psychotic episode with auditory
hallucinations and delusions after using methamphetamine. Which receptor
is primarily involved in the reinforcing effects?
A. Dopamine D2
B. NMDA
C. GABA-A
D. Serotonin 5-HT2A
A. Dopamine D2
RATIONALE: The dopamine D2 receptor in the mesolimbic reward
pathway mediates the reinforcing effects of psychostimulants like
methamphetamine.
Question 5
A 55-year-old with cirrhosis presents with hematemesis. Endoscopy shows
esophageal varices. What is the immediate target for pharmacologic therapy?
A. Portal vein pressure
B. Splanchnic vasodilation
C. Hepatic venous pressure gradient reduction via octreotide
D. Intrinsic coagulation cascade
C. Hepatic venous pressure gradient reduction via octreotide
, RATIONALE: Octreotide, a somatostatin analogue, reduces splanchnic
blood flow and portal pressure. Initial management includes band ligation
and vasoactive drugs.
Question 6
A 19-year-old college student has fever, pharyngitis, and lymphadenopathy.
Monospot is positive. Which cell is infected by the causative virus?
A. CD4+ T cells
B. B cells
C. Hepatocytes
D. Endothelial cells
B. B cells
RATIONALE: Epstein-Barr virus infects B cells via the CD21 receptor,
causing infectious mononucleosis. Atypical lymphocytes are activated CD8+
T cells.
Question 7
A 6-month-old is brought in for "spells" of sudden head drop and arm flexion
lasting seconds. EEG shows hypsarrhythmia. What is the first-line therapy?
A. Valproate
B. ACTH
C. Levetiracetam
D. Ketogenic diet
B. ACTH
RATIONALE: Infantile spasms (West syndrome) is treated first-line with
ACTH or vigabatrin. Hypsarrhythmia is pathognomonic.
Question 8
A 62-year-old male with a history of hypertension presents with progressive
dyspnea on exertion. Echocardiogram shows left ventricular hypertrophy with
EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
CORE DOMAINS
Osteopathic Principles and Practice (OMM)
Cardiology
Pulmonology
Neurology
Endocrinology
Microbiology
Pharmacology
Biostatistics and Epidemiology
INTRODUCTION
The purpose of this comprehensive assessment is to evaluate the osteopathic
medical knowledge and clinical reasoning skills required for COMLEX-USA
Level 1 readiness. The examination systematically assesses foundational
biomedical sciences, osteopathic manipulative medicine, and clinical
presentation across multiple organ systems. Comprising multiple-choice and
scenario-based items, the test mirrors the integrated cognitive demands of the
NBOME COMSAE Phase 1 examination. Special emphasis is placed on
viscerosomatic reflexes, somatic dysfunction diagnosis, and real-world
application of clinical decision-making, ensuring candidates demonstrate the
foundational readiness for osteopathic medical licensure.
SECTION ONE: QUESTIONS 1–176
,Question 1
A 24-year-old woman presents with episodic flank pain, hypertension, and
gross hematuria after mild trauma. Imaging reveals bilaterally enlarged
kidneys with multiple cysts. Which inheritance pattern is most likely?
A. Autosomal recessive
B. X-linked dominant
C. Autosomal dominant
D. Mitochondrial
C. Autosomal dominant
RATIONALE: Autosomal dominant polycystic kidney disease (ADPKD)
presents with hypertension, hematuria, flank pain, and bilaterally enlarged
cystic kidneys. It is the most common inherited kidney disorder.
Question 2
A 45-year-old with chronic alcoholism is found to have asterixis, confusion,
and abdominal distension. Which medication directly lowers ammonia by
enhancing nitrogen excretion as hippurate?
A. Lactulose
B. Rifaximin
C. Sodium benzoate
D. Spironolactone
C. Sodium benzoate
RATIONALE: Sodium benzoate conjugates glycine to form hippurate,
which is renally excreted, directly lowering ammonia levels. Lactulose
acidifies the colon to trap ammonium.
Question 3
A 60-year-old with a 40-pack-year smoking history presents with new
hoarseness and a left supraclavicular mass. Biopsy shows small blue cells with
scant cytoplasm. Which immunohistochemical stain would be positive?
,A. Cytokeratin 7
B. Chromogranin
C. TTF-1
D. S-100
B. Chromogranin
RATIONALE: Small cell lung cancer is a neuroendocrine tumor that stains
positive for chromogranin, synaptophysin, and CD56.
Question 4
A 25-year-old man has an acute psychotic episode with auditory
hallucinations and delusions after using methamphetamine. Which receptor
is primarily involved in the reinforcing effects?
A. Dopamine D2
B. NMDA
C. GABA-A
D. Serotonin 5-HT2A
A. Dopamine D2
RATIONALE: The dopamine D2 receptor in the mesolimbic reward
pathway mediates the reinforcing effects of psychostimulants like
methamphetamine.
Question 5
A 55-year-old with cirrhosis presents with hematemesis. Endoscopy shows
esophageal varices. What is the immediate target for pharmacologic therapy?
A. Portal vein pressure
B. Splanchnic vasodilation
C. Hepatic venous pressure gradient reduction via octreotide
D. Intrinsic coagulation cascade
C. Hepatic venous pressure gradient reduction via octreotide
, RATIONALE: Octreotide, a somatostatin analogue, reduces splanchnic
blood flow and portal pressure. Initial management includes band ligation
and vasoactive drugs.
Question 6
A 19-year-old college student has fever, pharyngitis, and lymphadenopathy.
Monospot is positive. Which cell is infected by the causative virus?
A. CD4+ T cells
B. B cells
C. Hepatocytes
D. Endothelial cells
B. B cells
RATIONALE: Epstein-Barr virus infects B cells via the CD21 receptor,
causing infectious mononucleosis. Atypical lymphocytes are activated CD8+
T cells.
Question 7
A 6-month-old is brought in for "spells" of sudden head drop and arm flexion
lasting seconds. EEG shows hypsarrhythmia. What is the first-line therapy?
A. Valproate
B. ACTH
C. Levetiracetam
D. Ketogenic diet
B. ACTH
RATIONALE: Infantile spasms (West syndrome) is treated first-line with
ACTH or vigabatrin. Hypsarrhythmia is pathognomonic.
Question 8
A 62-year-old male with a history of hypertension presents with progressive
dyspnea on exertion. Echocardiogram shows left ventricular hypertrophy with
