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COMSAE Exam 2025 – Comprehensive Osteopathic Medical Self-
Assessment Exam Study Guide and Practice Questions
Prepare for the COMSAE Exam 2025 with this complete study and practice guide. Includes
COMLEX-style questions, OMM review, systems-based practice content, and performance
strategies to help you score high on your osteopathic board assessments.
• COMSAE Exam
• COMSAE practice test
• COMLEX practice exam
Man presents to the office with complaint of dizziness when he stands up. PMH symptomatic BPH which
he takes terazosin (alpha-1 adrenergic antagonist that relaxes smooth muscles) for. Most common cause
of dizziness is - ANSWER-impaired responsiveness of sympathetic vasculature. Terazosin inhibits
sympathetic vasoconstriction in the periphery resulting in decreased vascular tone=dizzy.
70 yr old Man presents for an annual visit and reports 25 pack history for smoking. He quit 15 years ago.
What screening should you offer - ANSWER-abdominal aortic aneurysm. Don't screen for asymptomatic
CAD, always screen for AAA if they are 65-75 who have ever smoked.
2yr old has 2 week history of vomiting and contipatio. Appears pale and in distress. Lab studies reveal
hemoglobin low and serum lead level high. TX is - ANSWER-sodium edetate. Ferrous sulfate would be to
correct iron deficiency anemia in a small child.
53 yr old women presents with polyuria. PMH T2DM. Consumes 15 L of water daily to cleanse toxins in
her system. Labs show sodium ↓,creatinine ↑, BUN normal. Most likely cause - ANSWER-osmotic
suppression of vasopressin release. primary polydipsia (compulsive water drinking), leading to osmotic
suppression of vasopressin.
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47 yr old man has 6 month history of anxiety. He is employed as a taxi driver. Anxiety doesn't fluctuate
through the day. Tx is - ANSWER-buspirone (5-HT1A partial agonist) "bus drivers take buspirone" , benzos
are too sedating.
3 month history of pelvic pain, a sense of pelvic fullness, diarrhea. Physical exam reveals pelvic mass.
Ultrasound reveals an ovarian mass. Initial Mets of tumor cells from this mass via lymphatics will most
likely involve which nodes - ANSWER-lumbar. Primary lymph node drainage for ovarian cancer is lumbar
and (para-aortic) and preaortic nodes.
5o yr old present with 6 month fatigue, lethargy, constipation, decreased libido. Erectile dysfunction, and
lightheadedness. PMH 2 week episode of severe headache and blurred vision 6 months ago. Orthostatic
BP present. Most likely dx - ANSWER-panhypopituitarism. Sudden with vision changes and low FSH/LH
leading to low testosterone sx. Addisons would not affect sex hormones.
2 weeks history of severe pain across her face. Intense pain while chewing and applying her makeup.
Unilateral hypersensitivity across the region of the lower face involving the upper lip. Which nerve is
responsible - ANSWER-mandibular. (v3) of trigeminal branch causing trigeminal neuralgia. Facial nerve
would be responsible for movement, not sensation.
42 yr old presents with 1 month history of erectile dysfunction. Able to achieve erection but is not able
to achieve orgasm and ejaculation. PMH T1DM. mechanism for his sexual dysfunction is - ANSWER-
decreased sympathetic tone. "point and shoot"
28 yr old man presents with sudden onset of several headaches. He complains of stick neck, vomits,
loses consciousness. Bilateral abdominal masses are noted in the flanks. A lumbar puncture reveals
increases pressure and blood. Which is the abnormal proteins most likely present - ANSWER-polycystin
1. ADPKD is present
7 month old male in the early fall presents with fever, irritability, lethargy. Temp is 103 w/ diffuse
maculopapular rash. LP reveals ↑ leukocytes(with predominant lymphocytes), ↑ protein. No organism
found on gram stain. Etiology - ANSWER-coxsackievirus.
42 yr old presents w/ 1 day history of odynophagia, chest pain, fever, nausea, vomiting. Bone marrow
transplant occurred 1 week ago. Deep ulcers in the distal ½ of the esophagus are present.
Multinucleated giant cells and prominent intranuclear Cowdry type A inclusion bodies are present. DX -
ANSWER-herpesvirus type1. HSV creates deep discrete ulcers. VZV creates shallow ulcers and vesicular
rash.
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43 yr old man presents to the office with 2 week history of fever, dyspnea, dry hacking couch. Farmer
that has the same sx every year after he takes in the hay. Sputum sample is positive for environmental
mold. Which is the following mechanism most likely occurring - ANSWER-deposition of immune
complexes in the lungs. Thermophilic actinomyces. Type 3 HSN.
18 yr old women presents with 3 day history of yellow sclerae. She is anxious about the appearance. Her
hepatic bilirubin UDP glucuronosyltransferase activity is 30% normal. Recommendation should be -
ANSWER-avoid worrying because her condition is benign. Gilbert Syndrome.
32 yr old man is brought to ED in a disoriented and extremely agitated state. He is restrained after
several attempt to bite first responders. He is vomiting, hallucinations, not oriented to time or place.
Physical exam reveals several extremely painful bite marks which have been cleaned by the patient. His
companion reports that the injuries occurred when he was attacked by a raccoon 3 weeks ago.
Cytoplasmic inclusion bodies(Negri bodies) associated with this patients disorder are most likely to be
found in - ANSWER-the hippocampus. Rabies. Neurotopic RNA virus that infects the hippocampal
pyramidal neurons that lead to hallucinations and cerebellum for motor ataxia.
13 yr old boy is brought to the office for visible breast growth. Breast size is 3cm and symmetrical and a
ridge of glandular tissue can be palpated around the nipple areolar complex. The patient has - ANSWER-
normal pubertal development. transient imbalance of estrogen > androgens, appears around Tanner
stage 2-4. Palpable subareolar tissue = true gynecomastia.
pt presents with 24 hr history of intense, throbbing pain in his R index finger after he inadvertently
touched a hot stove. Exam revels swollen, inflamed, blistered area at the distal end. What transmitters
are most likely to account for the patient's pain - ANSWER-substance P. Nociceptic neuron that does
perception, sensitization, inflammation. GABA would modulate pain signals.
40 yr old woman present for annual visit. PMH hysterectomy with bilateral oophorectomy 10 yrs ago to
treat dysfunction uterine bleeding. She east processed foods and smokes fewer than 5 cigs per day.
What should she get screening for - ANSWER-mammography. 40+= mammography, 45+ =colonoscopy.
40 yr old presents with 2 day history of hematuria. PMH is prostatitis. Enlarged, tender prostate. 2+
blood on urine dipstick. Most likely source of bleeding - ANSWER-inferior vesical artery. Branch from the
internal iliac artery for the prostate, lower bladder, and seminal vesicles.
COMSAE Exam 2025 – Comprehensive Osteopathic Medical Self-
Assessment Exam Study Guide and Practice Questions
Prepare for the COMSAE Exam 2025 with this complete study and practice guide. Includes
COMLEX-style questions, OMM review, systems-based practice content, and performance
strategies to help you score high on your osteopathic board assessments.
• COMSAE Exam
• COMSAE practice test
• COMLEX practice exam
Man presents to the office with complaint of dizziness when he stands up. PMH symptomatic BPH which
he takes terazosin (alpha-1 adrenergic antagonist that relaxes smooth muscles) for. Most common cause
of dizziness is - ANSWER-impaired responsiveness of sympathetic vasculature. Terazosin inhibits
sympathetic vasoconstriction in the periphery resulting in decreased vascular tone=dizzy.
70 yr old Man presents for an annual visit and reports 25 pack history for smoking. He quit 15 years ago.
What screening should you offer - ANSWER-abdominal aortic aneurysm. Don't screen for asymptomatic
CAD, always screen for AAA if they are 65-75 who have ever smoked.
2yr old has 2 week history of vomiting and contipatio. Appears pale and in distress. Lab studies reveal
hemoglobin low and serum lead level high. TX is - ANSWER-sodium edetate. Ferrous sulfate would be to
correct iron deficiency anemia in a small child.
53 yr old women presents with polyuria. PMH T2DM. Consumes 15 L of water daily to cleanse toxins in
her system. Labs show sodium ↓,creatinine ↑, BUN normal. Most likely cause - ANSWER-osmotic
suppression of vasopressin release. primary polydipsia (compulsive water drinking), leading to osmotic
suppression of vasopressin.
,2|Page
47 yr old man has 6 month history of anxiety. He is employed as a taxi driver. Anxiety doesn't fluctuate
through the day. Tx is - ANSWER-buspirone (5-HT1A partial agonist) "bus drivers take buspirone" , benzos
are too sedating.
3 month history of pelvic pain, a sense of pelvic fullness, diarrhea. Physical exam reveals pelvic mass.
Ultrasound reveals an ovarian mass. Initial Mets of tumor cells from this mass via lymphatics will most
likely involve which nodes - ANSWER-lumbar. Primary lymph node drainage for ovarian cancer is lumbar
and (para-aortic) and preaortic nodes.
5o yr old present with 6 month fatigue, lethargy, constipation, decreased libido. Erectile dysfunction, and
lightheadedness. PMH 2 week episode of severe headache and blurred vision 6 months ago. Orthostatic
BP present. Most likely dx - ANSWER-panhypopituitarism. Sudden with vision changes and low FSH/LH
leading to low testosterone sx. Addisons would not affect sex hormones.
2 weeks history of severe pain across her face. Intense pain while chewing and applying her makeup.
Unilateral hypersensitivity across the region of the lower face involving the upper lip. Which nerve is
responsible - ANSWER-mandibular. (v3) of trigeminal branch causing trigeminal neuralgia. Facial nerve
would be responsible for movement, not sensation.
42 yr old presents with 1 month history of erectile dysfunction. Able to achieve erection but is not able
to achieve orgasm and ejaculation. PMH T1DM. mechanism for his sexual dysfunction is - ANSWER-
decreased sympathetic tone. "point and shoot"
28 yr old man presents with sudden onset of several headaches. He complains of stick neck, vomits,
loses consciousness. Bilateral abdominal masses are noted in the flanks. A lumbar puncture reveals
increases pressure and blood. Which is the abnormal proteins most likely present - ANSWER-polycystin
1. ADPKD is present
7 month old male in the early fall presents with fever, irritability, lethargy. Temp is 103 w/ diffuse
maculopapular rash. LP reveals ↑ leukocytes(with predominant lymphocytes), ↑ protein. No organism
found on gram stain. Etiology - ANSWER-coxsackievirus.
42 yr old presents w/ 1 day history of odynophagia, chest pain, fever, nausea, vomiting. Bone marrow
transplant occurred 1 week ago. Deep ulcers in the distal ½ of the esophagus are present.
Multinucleated giant cells and prominent intranuclear Cowdry type A inclusion bodies are present. DX -
ANSWER-herpesvirus type1. HSV creates deep discrete ulcers. VZV creates shallow ulcers and vesicular
rash.
, 3|Page
43 yr old man presents to the office with 2 week history of fever, dyspnea, dry hacking couch. Farmer
that has the same sx every year after he takes in the hay. Sputum sample is positive for environmental
mold. Which is the following mechanism most likely occurring - ANSWER-deposition of immune
complexes in the lungs. Thermophilic actinomyces. Type 3 HSN.
18 yr old women presents with 3 day history of yellow sclerae. She is anxious about the appearance. Her
hepatic bilirubin UDP glucuronosyltransferase activity is 30% normal. Recommendation should be -
ANSWER-avoid worrying because her condition is benign. Gilbert Syndrome.
32 yr old man is brought to ED in a disoriented and extremely agitated state. He is restrained after
several attempt to bite first responders. He is vomiting, hallucinations, not oriented to time or place.
Physical exam reveals several extremely painful bite marks which have been cleaned by the patient. His
companion reports that the injuries occurred when he was attacked by a raccoon 3 weeks ago.
Cytoplasmic inclusion bodies(Negri bodies) associated with this patients disorder are most likely to be
found in - ANSWER-the hippocampus. Rabies. Neurotopic RNA virus that infects the hippocampal
pyramidal neurons that lead to hallucinations and cerebellum for motor ataxia.
13 yr old boy is brought to the office for visible breast growth. Breast size is 3cm and symmetrical and a
ridge of glandular tissue can be palpated around the nipple areolar complex. The patient has - ANSWER-
normal pubertal development. transient imbalance of estrogen > androgens, appears around Tanner
stage 2-4. Palpable subareolar tissue = true gynecomastia.
pt presents with 24 hr history of intense, throbbing pain in his R index finger after he inadvertently
touched a hot stove. Exam revels swollen, inflamed, blistered area at the distal end. What transmitters
are most likely to account for the patient's pain - ANSWER-substance P. Nociceptic neuron that does
perception, sensitization, inflammation. GABA would modulate pain signals.
40 yr old woman present for annual visit. PMH hysterectomy with bilateral oophorectomy 10 yrs ago to
treat dysfunction uterine bleeding. She east processed foods and smokes fewer than 5 cigs per day.
What should she get screening for - ANSWER-mammography. 40+= mammography, 45+ =colonoscopy.
40 yr old presents with 2 day history of hematuria. PMH is prostatitis. Enlarged, tender prostate. 2+
blood on urine dipstick. Most likely source of bleeding - ANSWER-inferior vesical artery. Branch from the
internal iliac artery for the prostate, lower bladder, and seminal vesicles.
