COMSAE PHASE 1 ASA 114 – THE COMPLETE 176
QUESTION TEST BANK ALL QUESTIONS WITH CORRECT
VERIFIED ANSWERS & DETAILED RATIONALES – GRADED
A+ FOR THE NEWEST 2026 ACTUAL 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 and Immunology
Pharmacology
Biostatistics and Epidemiology
Pathology and Pathophysiology
Behavioral Science and Ethics
Introduction
This comprehensive assessment evaluates 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
1. A 28-year-old female presents with a distinct, migratory,
butterfly-shaped rash across her cheeks and nasal bridge
that worsens after sun exposure. Laboratory testing
reveals positive antinuclear antibodies (ANA) and anti-
double-stranded DNA (anti-dsDNA) antibodies. What is
the most likely diagnosis?
A. Systemic lupus erythematosus
B. Dermatomyositis
C. Rosacea
D. Seborrheic dermatitis
🟢 A. Systemic lupus erythematosus
🔴 RATIONALE: Systemic lupus erythematosus (SLE) is a
chronic autoimmune disease characterized by a malar
,(butterfly) rash that exhibits photosensitivity. The presence
of highly specific antibodies like anti-dsDNA confirms the
diagnosis. Dermatomyositis presents with a heliotrope rash
and proximal muscle weakness. Rosacea lacks systemic
autoantibodies. Seborrheic dermatitis presents with greasy
scales in the nasolabial folds.
2. A 45-year-old male undergoes a physical examination.
The physician notes a somatic dysfunction of the T5
thoracic vertebra. Palpation reveals that the T5 spinous
process rotates preferentially to the right and sidebends
preferentially to the right. When the patient flexes his
spine, the asymmetry worsens, but it improves
significantly when he extends his spine. According to
Fryette's principles, how should this somatic dysfunction
be named?
A. T5 Neutral R(R) S(L)
B. T5 Extended R(R) S(R)
C. T5 Flexed R(L) S(L)
D. T5 Extended R(L) S(R)
🟢 B. T5 Extended R(R) S(R)
🔴 RATIONALE: Under Fryette's Principle II, non-neutral
thoracic dysfunctions occur at a single vertebral segment
where rotation and sidebending occur to the same side.
, Because the asymmetry improves in extension, the
restriction is in flexion, meaning the vertebra is trapped in
an extended position. The positional diagnosis is named for
its directional preferences: Extended, Rotated Right, and
Sidebent Right.
3. A 62-year-old male with a history of chronic smoking
presents with an emergency onset of severe, tearing chest
pain that radiates directly to his back between his
scapulae. His blood pressure is 180/100 mmHg in the
right arm and 140/85 mmHg in the left arm. What is the
most immediate life-threatening condition to suspect?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
D. Tension pneumothorax
🟢 B. Acute aortic dissection
🔴 RATIONALE: A tearing or ripping chest pain radiating to
the back, coupled with an asymmetric blood pressure
differential between the upper extremities (>20 mmHg
variation), is highly indicative of an acute aortic dissection.
Acute myocardial infarction typically features crushing
retrosternal pain radiating to the jaw or left arm. Pulmonary
embolism presents with pleuritic chest pain and dyspnea.
QUESTION TEST BANK ALL QUESTIONS WITH CORRECT
VERIFIED ANSWERS & DETAILED RATIONALES – GRADED
A+ FOR THE NEWEST 2026 ACTUAL 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 and Immunology
Pharmacology
Biostatistics and Epidemiology
Pathology and Pathophysiology
Behavioral Science and Ethics
Introduction
This comprehensive assessment evaluates 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
1. A 28-year-old female presents with a distinct, migratory,
butterfly-shaped rash across her cheeks and nasal bridge
that worsens after sun exposure. Laboratory testing
reveals positive antinuclear antibodies (ANA) and anti-
double-stranded DNA (anti-dsDNA) antibodies. What is
the most likely diagnosis?
A. Systemic lupus erythematosus
B. Dermatomyositis
C. Rosacea
D. Seborrheic dermatitis
🟢 A. Systemic lupus erythematosus
🔴 RATIONALE: Systemic lupus erythematosus (SLE) is a
chronic autoimmune disease characterized by a malar
,(butterfly) rash that exhibits photosensitivity. The presence
of highly specific antibodies like anti-dsDNA confirms the
diagnosis. Dermatomyositis presents with a heliotrope rash
and proximal muscle weakness. Rosacea lacks systemic
autoantibodies. Seborrheic dermatitis presents with greasy
scales in the nasolabial folds.
2. A 45-year-old male undergoes a physical examination.
The physician notes a somatic dysfunction of the T5
thoracic vertebra. Palpation reveals that the T5 spinous
process rotates preferentially to the right and sidebends
preferentially to the right. When the patient flexes his
spine, the asymmetry worsens, but it improves
significantly when he extends his spine. According to
Fryette's principles, how should this somatic dysfunction
be named?
A. T5 Neutral R(R) S(L)
B. T5 Extended R(R) S(R)
C. T5 Flexed R(L) S(L)
D. T5 Extended R(L) S(R)
🟢 B. T5 Extended R(R) S(R)
🔴 RATIONALE: Under Fryette's Principle II, non-neutral
thoracic dysfunctions occur at a single vertebral segment
where rotation and sidebending occur to the same side.
, Because the asymmetry improves in extension, the
restriction is in flexion, meaning the vertebra is trapped in
an extended position. The positional diagnosis is named for
its directional preferences: Extended, Rotated Right, and
Sidebent Right.
3. A 62-year-old male with a history of chronic smoking
presents with an emergency onset of severe, tearing chest
pain that radiates directly to his back between his
scapulae. His blood pressure is 180/100 mmHg in the
right arm and 140/85 mmHg in the left arm. What is the
most immediate life-threatening condition to suspect?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
D. Tension pneumothorax
🟢 B. Acute aortic dissection
🔴 RATIONALE: A tearing or ripping chest pain radiating to
the back, coupled with an asymmetric blood pressure
differential between the upper extremities (>20 mmHg
variation), is highly indicative of an acute aortic dissection.
Acute myocardial infarction typically features crushing
retrosternal pain radiating to the jaw or left arm. Pulmonary
embolism presents with pleuritic chest pain and dyspnea.
