COMSAE 111 EXAM STUDY GUIDE 2026 – COMPLETE
CONCEPT REVIEW & PRACTICE MATERIALS (LATEST
EDITION)
A comprehensive review guide for the COMSAE Phase 1 exam, focusing on high-
yield concepts across all disciplines tested in the COMLEX Level 1. It integrates
osteopathic principles with clinical sciences, emphasizing application-based
questions, patient presentations, and OMM integration for effective board
preparation.
Keywords: Osteopathic Principles, Clinical Application, Board Preparation, OMM
Integration, Systems-Based Practice
1. A 65-year-old patient with a history of CHF presents with worsening dyspnea and edema.
On cardiac exam, you hear a third heart sound (S3). What is the most likely pathophysiological
mechanism for this finding?
A) Early, rapid ventricular filling
B) Atrial contraction against a stiff ventricle
C) Turbulent flow across the aortic valve
D) Closure of the mitral and tricuspid valves
A) Early, rapid ventricular filling *(An S3 gallop is a low-frequency sound occurring in early
diastole due to rapid deceleration of blood flow against a non-compliant, often volume-
overloaded, ventricle. It is common in conditions like systolic heart failure.)*
2. During an OMM session, you plan to use Muscle Energy Technique (MET) for a patient with
a restricted sacral sulcus. Which initial positioning is most appropriate for a unilateral sacral
flexion dysfunction?
A) Patient supine, physician side-bends the patient towards the dysfunctional side
B) Patient prone, physician extends the leg on the dysfunctional side
C) Patient side-lying with the dysfunctional side up, hips and knees flexed
D) Patient seated, physician rotates the torso away from the dysfunctional side
C) Patient side-lying with the dysfunctional side up, hips and knees flexed (For MET on a
unilateral sacral flexion dysfunction (e.g., left-on-left forward torsion), the patient is positioned
side-lying with the affected side up. Flexing the hips and knees helps localize forces to the
sacroiliac joint.)
,3. A 24-year-old female presents with amenorrhea, galactorrhea, and bitemporal
hemianopsia. What is the most likely location of the underlying lesion?
A) Anterior pituitary
B) Hypothalamus
C) Optic chiasm
D) Posterior pituitary
C) Optic chiasm (The triad suggests a prolactin-secreting pituitary adenoma (prolactinoma).
Bitemporal hemianopsia localizes the mass effect to the optic chiasm, where crossing fibers from
the nasal retinas are compressed.)
4. Which of the following findings is most consistent with a diagnosis of Nephrotic Syndrome?
A) Hematuria with red cell casts
B) Proteinuria >3.5 g/day, hypoalbuminemia, edema
C) Oliguria, hypertension, elevated BUN/Cr
D) Sterile pyuria with white cell casts
B) Proteinuria >3.5 g/day, hypoalbuminemia, edema (Nephrotic syndrome is characterized
by massive proteinuria leading to hypoalbuminemia, edema, hyperlipidemia, and lipiduria.
Hematuria and casts are more typical of nephritic syndrome.)
5. A patient presents with acute onset of right lower quadrant pain, anorexia, and fever.
McBurney's point tenderness is noted. Which autonomic nervous system level primarily
mediates the visceral pain component initially felt as periumbilical discomfort?
A) T8-T9
B) T10
C) L1-L2
D) S2-S4
B) T10 (Early appendicitis pain is often referred to the periumbilical region (T10 dermatome)
due to visceral afferent fibers traveling with sympathetic nerves from the midgut. Somatic pain
later localizes to McBurney's point.)
(Questions 6-100 would follow in a similar format, covering Biochemistry, Microbiology,
Pharmacology, Pathology, OPP, and all other systems. Each question would be application-
based, integrate foundational science with clinical reasoning or OMM, and have one clearly
correct answer marked with . The total would build to 100 unique Q&A pairs.)
6-100
Of course. Here are questions 6 through 100, continuing in the required format for the COMSAE
111 Study Guide.
, 6. A 32-year-old woman with systemic lupus erythematosus (SLE) is found to have a positive
direct Coombs test. What is the most likely type of anemia she has developed?
A) Iron deficiency anemia
B) Aplastic anemia
C) Autoimmune hemolytic anemia
D) Anemia of chronic disease
C) Autoimmune hemolytic anemia (A positive direct Coombs test indicates antibodies or
complement are coating red blood cells, leading to their premature destruction. This is a
common complication of SLE and defines autoimmune hemolytic anemia.)
7. During a structural exam, you note that when the patient is seated, the right shoulder is
lower than the left. When the patient stands, the right iliac crest is higher. These findings are
most consistent with:
A) A right anatomic leg length discrepancy
B) A left anatomic leg length discrepancy
C) A right functional leg length discrepancy
D) A pelvic shear dysfunction
C) A right functional leg length discrepancy (A functional discrepancy is postural and
changes with position. A lower shoulder with a higher ipsilateral pelvis suggests unleveling due
to pelvic dysfunction or muscle hypertonicity, not a true anatomic bone length difference.)
8. Inhibition of which enzyme is the primary mechanism of action for aspirin's antiplatelet
effect?
A) Phospholipase A2
B) Cyclooxygenase-1 (COX-1)
C) Thromboxane synthase
D) Cyclooxygenase-2 (COX-2)
B) Cyclooxygenase-1 (COX-1) *(Aspirin irreversibly acetylates COX-1 in platelets, inhibiting
thromboxane A2 synthesis for the lifespan of the platelet (7-10 days). This prevents platelet
aggregation, providing its antithrombotic effect.)*
9. A patient presents with diplopia, ptosis, and a "down and out" eye. Pupillary reflexes are
intact. Which cranial nerve is most likely affected?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
B) CN III (Oculomotor) (A "down and out" eye is the resting position due to unopposed
CONCEPT REVIEW & PRACTICE MATERIALS (LATEST
EDITION)
A comprehensive review guide for the COMSAE Phase 1 exam, focusing on high-
yield concepts across all disciplines tested in the COMLEX Level 1. It integrates
osteopathic principles with clinical sciences, emphasizing application-based
questions, patient presentations, and OMM integration for effective board
preparation.
Keywords: Osteopathic Principles, Clinical Application, Board Preparation, OMM
Integration, Systems-Based Practice
1. A 65-year-old patient with a history of CHF presents with worsening dyspnea and edema.
On cardiac exam, you hear a third heart sound (S3). What is the most likely pathophysiological
mechanism for this finding?
A) Early, rapid ventricular filling
B) Atrial contraction against a stiff ventricle
C) Turbulent flow across the aortic valve
D) Closure of the mitral and tricuspid valves
A) Early, rapid ventricular filling *(An S3 gallop is a low-frequency sound occurring in early
diastole due to rapid deceleration of blood flow against a non-compliant, often volume-
overloaded, ventricle. It is common in conditions like systolic heart failure.)*
2. During an OMM session, you plan to use Muscle Energy Technique (MET) for a patient with
a restricted sacral sulcus. Which initial positioning is most appropriate for a unilateral sacral
flexion dysfunction?
A) Patient supine, physician side-bends the patient towards the dysfunctional side
B) Patient prone, physician extends the leg on the dysfunctional side
C) Patient side-lying with the dysfunctional side up, hips and knees flexed
D) Patient seated, physician rotates the torso away from the dysfunctional side
C) Patient side-lying with the dysfunctional side up, hips and knees flexed (For MET on a
unilateral sacral flexion dysfunction (e.g., left-on-left forward torsion), the patient is positioned
side-lying with the affected side up. Flexing the hips and knees helps localize forces to the
sacroiliac joint.)
,3. A 24-year-old female presents with amenorrhea, galactorrhea, and bitemporal
hemianopsia. What is the most likely location of the underlying lesion?
A) Anterior pituitary
B) Hypothalamus
C) Optic chiasm
D) Posterior pituitary
C) Optic chiasm (The triad suggests a prolactin-secreting pituitary adenoma (prolactinoma).
Bitemporal hemianopsia localizes the mass effect to the optic chiasm, where crossing fibers from
the nasal retinas are compressed.)
4. Which of the following findings is most consistent with a diagnosis of Nephrotic Syndrome?
A) Hematuria with red cell casts
B) Proteinuria >3.5 g/day, hypoalbuminemia, edema
C) Oliguria, hypertension, elevated BUN/Cr
D) Sterile pyuria with white cell casts
B) Proteinuria >3.5 g/day, hypoalbuminemia, edema (Nephrotic syndrome is characterized
by massive proteinuria leading to hypoalbuminemia, edema, hyperlipidemia, and lipiduria.
Hematuria and casts are more typical of nephritic syndrome.)
5. A patient presents with acute onset of right lower quadrant pain, anorexia, and fever.
McBurney's point tenderness is noted. Which autonomic nervous system level primarily
mediates the visceral pain component initially felt as periumbilical discomfort?
A) T8-T9
B) T10
C) L1-L2
D) S2-S4
B) T10 (Early appendicitis pain is often referred to the periumbilical region (T10 dermatome)
due to visceral afferent fibers traveling with sympathetic nerves from the midgut. Somatic pain
later localizes to McBurney's point.)
(Questions 6-100 would follow in a similar format, covering Biochemistry, Microbiology,
Pharmacology, Pathology, OPP, and all other systems. Each question would be application-
based, integrate foundational science with clinical reasoning or OMM, and have one clearly
correct answer marked with . The total would build to 100 unique Q&A pairs.)
6-100
Of course. Here are questions 6 through 100, continuing in the required format for the COMSAE
111 Study Guide.
, 6. A 32-year-old woman with systemic lupus erythematosus (SLE) is found to have a positive
direct Coombs test. What is the most likely type of anemia she has developed?
A) Iron deficiency anemia
B) Aplastic anemia
C) Autoimmune hemolytic anemia
D) Anemia of chronic disease
C) Autoimmune hemolytic anemia (A positive direct Coombs test indicates antibodies or
complement are coating red blood cells, leading to their premature destruction. This is a
common complication of SLE and defines autoimmune hemolytic anemia.)
7. During a structural exam, you note that when the patient is seated, the right shoulder is
lower than the left. When the patient stands, the right iliac crest is higher. These findings are
most consistent with:
A) A right anatomic leg length discrepancy
B) A left anatomic leg length discrepancy
C) A right functional leg length discrepancy
D) A pelvic shear dysfunction
C) A right functional leg length discrepancy (A functional discrepancy is postural and
changes with position. A lower shoulder with a higher ipsilateral pelvis suggests unleveling due
to pelvic dysfunction or muscle hypertonicity, not a true anatomic bone length difference.)
8. Inhibition of which enzyme is the primary mechanism of action for aspirin's antiplatelet
effect?
A) Phospholipase A2
B) Cyclooxygenase-1 (COX-1)
C) Thromboxane synthase
D) Cyclooxygenase-2 (COX-2)
B) Cyclooxygenase-1 (COX-1) *(Aspirin irreversibly acetylates COX-1 in platelets, inhibiting
thromboxane A2 synthesis for the lifespan of the platelet (7-10 days). This prevents platelet
aggregation, providing its antithrombotic effect.)*
9. A patient presents with diplopia, ptosis, and a "down and out" eye. Pupillary reflexes are
intact. Which cranial nerve is most likely affected?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
B) CN III (Oculomotor) (A "down and out" eye is the resting position due to unopposed
