COMSAE Phase 1 Form 116 Exam Test Bank
– Newest2026 Edition | Comprehensive 160-
Question Set withVerified Answers &
Detailed Rationales
original
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 examination assesses the osteopathic medical
student's readiness for COMLEX-USA Level 1. It integrates foundational
biomedical sciences with osteopathic principles and clinical reasoning.
The structure uses single-best-answer, scenario-based questions with
detailed rationales to test clinical judgment and real-world decision-
making. 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. This exam serves as a
,rigorous benchmark for professional competency and readiness for
COMLEX-USA Level 1.
SECTION ONE: QUESTIONS 1-100
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
B. Right coronary 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.
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
C. Deep veins of the lower extremities
RATIONALE: Most pulmonary emboli arise from deep venous
thromboses in the legs and travel through the venous circulation to the
lungs.
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
C. TSH receptor
RATIONALE: Graves disease involves stimulating autoantibodies
against the TSH receptor, causing hyperthyroidism.
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
C. Primary hyperparathyroidism
RATIONALE: Primary hyperparathyroidism presents with elevated
calcium and inappropriately elevated PTH levels, typically due to a
parathyroid adenoma.
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
B. Streptococcus pneumoniae
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.
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
B. Renal cell carcinoma
RATIONALE: Renal cell carcinoma is the most common malignant
renal tumor in adults, strongly associated with smoking and typically
presenting with hematuria, flank pain, and a palpable mass.
7. A 22-year-old man develops severe diarrhea after returning from a
camping trip. Stool studies demonstrate an organism that produces
a toxin causing increased intracellular cAMP by ADP-ribosylating
Gs. Which organism is most likely responsible?
A. Shigella dysenteriae
B. Salmonella enterica
C. Campylobacter jejuni
D. Vibrio cholerae
D. Vibrio cholerae
RATIONALE: The cholera toxin ADP-ribosylates Gs, locking it in its
active state and increasing adenylate cyclase activity. The resulting
increase in cAMP causes chloride and water secretion into the intestinal
lumen.
8. A patient with a history of chronic alcohol use presents with
confusion, ophthalmoplegia, and ataxia. Which deficiency is most
likely responsible?
– Newest2026 Edition | Comprehensive 160-
Question Set withVerified Answers &
Detailed Rationales
original
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 examination assesses the osteopathic medical
student's readiness for COMLEX-USA Level 1. It integrates foundational
biomedical sciences with osteopathic principles and clinical reasoning.
The structure uses single-best-answer, scenario-based questions with
detailed rationales to test clinical judgment and real-world decision-
making. 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. This exam serves as a
,rigorous benchmark for professional competency and readiness for
COMLEX-USA Level 1.
SECTION ONE: QUESTIONS 1-100
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
B. Right coronary 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.
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
C. Deep veins of the lower extremities
RATIONALE: Most pulmonary emboli arise from deep venous
thromboses in the legs and travel through the venous circulation to the
lungs.
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
C. TSH receptor
RATIONALE: Graves disease involves stimulating autoantibodies
against the TSH receptor, causing hyperthyroidism.
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
C. Primary hyperparathyroidism
RATIONALE: Primary hyperparathyroidism presents with elevated
calcium and inappropriately elevated PTH levels, typically due to a
parathyroid adenoma.
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
B. Streptococcus pneumoniae
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.
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
B. Renal cell carcinoma
RATIONALE: Renal cell carcinoma is the most common malignant
renal tumor in adults, strongly associated with smoking and typically
presenting with hematuria, flank pain, and a palpable mass.
7. A 22-year-old man develops severe diarrhea after returning from a
camping trip. Stool studies demonstrate an organism that produces
a toxin causing increased intracellular cAMP by ADP-ribosylating
Gs. Which organism is most likely responsible?
A. Shigella dysenteriae
B. Salmonella enterica
C. Campylobacter jejuni
D. Vibrio cholerae
D. Vibrio cholerae
RATIONALE: The cholera toxin ADP-ribosylates Gs, locking it in its
active state and increasing adenylate cyclase activity. The resulting
increase in cAMP causes chloride and water secretion into the intestinal
lumen.
8. A patient with a history of chronic alcohol use presents with
confusion, ophthalmoplegia, and ataxia. Which deficiency is most
likely responsible?
