NBOME COMSAE Phase 1 Form 115 High-Yield
Prep Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Master the NBOME COMSAE Phase 1 Form 115 with this comprehensive, high-yield practice
resource. Features high-density multiple-choice questions mapping directly to official exam
trends, including critical neurology pathways, reproductive pathology, complex cranial/sacral
OMM mechanics, and autonomic pharmacology. Each item includes precise diagnostic
rationales designed to maximize your study efficiency, boost retention, and confidently clear
the 400+ threshold for COMLEX Level 1 success
Question 1
A 24-year-old medical student presents to the clinic complaining of recurrent
nosebleeds and small, red, blanching spots on her lips and oral mucosa. She
mentions that her father has a history of severe gastrointestinal bleeding of unknown
origin. Which of the following is the most likely mode of inheritance for this patient's
underlying condition?
A) Autosomal recessive
B) X-linked recessive
C) X-linked dominant
D) Autosomal dominant
D) Autosomal dominant
Rationale: This patient presents with signs and symptoms highly characteristic of
Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu
syndrome. This condition is characterized by localized malformations of vascular
tissue, leading to telangiectasias on the skin and mucous membranes (such as the
lips and tongue) and recurrent epistaxis. It is inherited in an autosomal dominant
fashion. Autosomal recessive, X-linked recessive, and X-linked dominant inheritance
patterns are incorrect because HHT is caused by mutations in genes like ENG or
ACVRL1, which follow an autosomal dominant pattern with variable expressivity.
Question 2
A 45-year-old male is brought to the emergency department after a high-speed motor
vehicle collision. On physical examination, the physician notes bilateral periorbital
ecchymosis ("raccoon eyes") and mastoid ecchymosis (Battle's sign). Clear fluid is
also seen leaking from his right ear canal. A fracture of which of the following bones
is most strongly associated with these clinical findings?
A) Frontal bone
,B) Temporal bone
C) Zygomatic bone
D) Mandible
B) Temporal bone
Rationale: "Raccoon eyes," Battle's sign, and cerebrospinal fluid (CSF) otorrhea are
classic clinical signs of a basilar skull fracture. The base of the skull consists of parts
of the temporal bone, occipital bone, sphenoid bone, ethmoid bone, and frontal
bone. Among the options, fractures involving the petrous portion of the temporal
bone are the most common source of Battle's sign and CSF leaks through the ear
canal. Frontal, zygomatic, and mandible fractures do not typically produce this
specific constellation of basilar skull signs.
Question 3
An osteopathic physician evaluates a patient with mid-back pain. Structural
examination reveals that T6 rotates preferredly to the right and sidebends preferredly
to the right. When the patient extends their spine, the asymmetry worsens, but when
the patient flexes their spine, the asymmetry resolves completely. Which of the
following represents the correct structural diagnosis for this spinal segment?
A) T6 Neutral S R R L
B) T6 Flexed S R R R
C) T6 Extended S L R L
D) T6 Flexed S R R L
B) T6 Flexed S R R R
Rationale: Type II somatic dysfunctions involve a single vertebral segment, show
asymmetry that worsens in either flexion or extension, and display sidebending and
rotation to the same side. Because this segment improves in flexion, it is a "Flexed"
dysfunction. Because it worsens in extension, the restriction is in extension. It rotates
right and sidebends right. Therefore, the standard somatic dysfunction notation is T6
Flexed, Sidebent Right, Rotated Right (T6 F S R R R). The other options incorrectly
list neutral mechanics (Type I) or the incorrect direction of sidebending and rotation.
,Question 4
A 52-year-old postmenopausal female presents with progressive abdominal
distension and pelvic discomfort. An ultrasound reveals a large, fluid-filled adnexal
mass. Following a surgical resection, histological evaluation of the tissue reveals
psammoma bodies (concentric laminated calcifications) within a malignant epithelial
tumor. Which of the following is the most likely diagnosis?
A) Mucinous cystadenocarcinoma
B) Granulosa cell tumor
C) Serous cystadenocarcinoma
D) Brenner tumor
C) Serous cystadenocarcinoma
Rationale: Serous cystadenocarcinoma is the most common malignant ovarian
epithelial tumor. It frequently presents bilaterally and characteristically exhibits
psammoma bodies on histological examination. Mucinous cystadenoccinomas are
lined by mucus-secreting epithelial cells and do not typically feature psammoma
bodies. Granulosa cell tumors show Call-Exner bodies and secrete estrogen.
Brenner tumors are usually benign and resemble transitional bladder epithelium
("coffee bean" nuclei).
Question 5
A 65-year-old male with a history of chronic heart failure presents to his physician for
a routine follow-up. He is currently taking a medication to manage his volume status.
Laboratory evaluation reveals a serum potassium level of 5.6 mEq/L (normal: 3.5–
5.0 mEq/L) and an elevated serum creatinine level. Which of the following
medications is most likely responsible for this patient's laboratory findings?
A) Furosemide
B) Spironolactone
C) Hydrochlorothiazide
D) Metolazone
B) Spironolactone
Rationale: Spironolactone is a potassium-sparing diuretic that acts as a competitive
antagonist of the aldosterone receptor in the cortical collecting tubule. By blocking
, aldosterone, it prevents sodium reabsorption and potassium excretion, which can
lead to hyperkalemia, especially in patients with baseline renal impairment.
Furosemide, hydrochlorothiazide, and metolazone are potassium-wasting diuretics
that typically cause hypokalemia rather than hyperkalemia.
Question 6
A 19-year-old male presents with sudden onset weakness in his right upper extremity
after a falling injury during a football game. Physical examination reveals a loss of
the biceps tendon reflex and an inability to supinate the right forearm. His arm is held
in an adducted, internally rotated position with an extended elbow. Which of the
following nerve roots are most likely damaged in this patient?
A) C5-C6
B) C7-C8
C) C8-T1
D) T1-T2
A) C5-C6
Rationale: This presentation describes Erb-Duchenne palsy ("waiter's tip" deformity),
which results from an injury to the upper trunk of the brachial plexus involving the C5
and C6 nerve roots. This injury typically occurs due to an excessive increase in the
angle between the neck and the shoulder. It paralyzes the deltoid, biceps brachii,
and brachialis muscles. C8-T1 injury results in Klumpke palsy, which presents with a
"claw hand" deformity due to loss of intrinsic hand muscles.
Question 7
A 31-year-old female presents to the physician with a 3-month history of fatigue,
unexpected weight gain, and generalized muscle aches. Physical examination
reveals slow relaxation of her deep tendon reflexes and mild, diffuse enlargement of
the thyroid gland. Laboratory studies demonstrate an elevated thyroid-stimulating
hormone (TSH) and a decreased free T4 level. Which of the following autoantibodies
is most specific for diagnosing the underlying cause of this patient's presentation?
Prep Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Master the NBOME COMSAE Phase 1 Form 115 with this comprehensive, high-yield practice
resource. Features high-density multiple-choice questions mapping directly to official exam
trends, including critical neurology pathways, reproductive pathology, complex cranial/sacral
OMM mechanics, and autonomic pharmacology. Each item includes precise diagnostic
rationales designed to maximize your study efficiency, boost retention, and confidently clear
the 400+ threshold for COMLEX Level 1 success
Question 1
A 24-year-old medical student presents to the clinic complaining of recurrent
nosebleeds and small, red, blanching spots on her lips and oral mucosa. She
mentions that her father has a history of severe gastrointestinal bleeding of unknown
origin. Which of the following is the most likely mode of inheritance for this patient's
underlying condition?
A) Autosomal recessive
B) X-linked recessive
C) X-linked dominant
D) Autosomal dominant
D) Autosomal dominant
Rationale: This patient presents with signs and symptoms highly characteristic of
Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu
syndrome. This condition is characterized by localized malformations of vascular
tissue, leading to telangiectasias on the skin and mucous membranes (such as the
lips and tongue) and recurrent epistaxis. It is inherited in an autosomal dominant
fashion. Autosomal recessive, X-linked recessive, and X-linked dominant inheritance
patterns are incorrect because HHT is caused by mutations in genes like ENG or
ACVRL1, which follow an autosomal dominant pattern with variable expressivity.
Question 2
A 45-year-old male is brought to the emergency department after a high-speed motor
vehicle collision. On physical examination, the physician notes bilateral periorbital
ecchymosis ("raccoon eyes") and mastoid ecchymosis (Battle's sign). Clear fluid is
also seen leaking from his right ear canal. A fracture of which of the following bones
is most strongly associated with these clinical findings?
A) Frontal bone
,B) Temporal bone
C) Zygomatic bone
D) Mandible
B) Temporal bone
Rationale: "Raccoon eyes," Battle's sign, and cerebrospinal fluid (CSF) otorrhea are
classic clinical signs of a basilar skull fracture. The base of the skull consists of parts
of the temporal bone, occipital bone, sphenoid bone, ethmoid bone, and frontal
bone. Among the options, fractures involving the petrous portion of the temporal
bone are the most common source of Battle's sign and CSF leaks through the ear
canal. Frontal, zygomatic, and mandible fractures do not typically produce this
specific constellation of basilar skull signs.
Question 3
An osteopathic physician evaluates a patient with mid-back pain. Structural
examination reveals that T6 rotates preferredly to the right and sidebends preferredly
to the right. When the patient extends their spine, the asymmetry worsens, but when
the patient flexes their spine, the asymmetry resolves completely. Which of the
following represents the correct structural diagnosis for this spinal segment?
A) T6 Neutral S R R L
B) T6 Flexed S R R R
C) T6 Extended S L R L
D) T6 Flexed S R R L
B) T6 Flexed S R R R
Rationale: Type II somatic dysfunctions involve a single vertebral segment, show
asymmetry that worsens in either flexion or extension, and display sidebending and
rotation to the same side. Because this segment improves in flexion, it is a "Flexed"
dysfunction. Because it worsens in extension, the restriction is in extension. It rotates
right and sidebends right. Therefore, the standard somatic dysfunction notation is T6
Flexed, Sidebent Right, Rotated Right (T6 F S R R R). The other options incorrectly
list neutral mechanics (Type I) or the incorrect direction of sidebending and rotation.
,Question 4
A 52-year-old postmenopausal female presents with progressive abdominal
distension and pelvic discomfort. An ultrasound reveals a large, fluid-filled adnexal
mass. Following a surgical resection, histological evaluation of the tissue reveals
psammoma bodies (concentric laminated calcifications) within a malignant epithelial
tumor. Which of the following is the most likely diagnosis?
A) Mucinous cystadenocarcinoma
B) Granulosa cell tumor
C) Serous cystadenocarcinoma
D) Brenner tumor
C) Serous cystadenocarcinoma
Rationale: Serous cystadenocarcinoma is the most common malignant ovarian
epithelial tumor. It frequently presents bilaterally and characteristically exhibits
psammoma bodies on histological examination. Mucinous cystadenoccinomas are
lined by mucus-secreting epithelial cells and do not typically feature psammoma
bodies. Granulosa cell tumors show Call-Exner bodies and secrete estrogen.
Brenner tumors are usually benign and resemble transitional bladder epithelium
("coffee bean" nuclei).
Question 5
A 65-year-old male with a history of chronic heart failure presents to his physician for
a routine follow-up. He is currently taking a medication to manage his volume status.
Laboratory evaluation reveals a serum potassium level of 5.6 mEq/L (normal: 3.5–
5.0 mEq/L) and an elevated serum creatinine level. Which of the following
medications is most likely responsible for this patient's laboratory findings?
A) Furosemide
B) Spironolactone
C) Hydrochlorothiazide
D) Metolazone
B) Spironolactone
Rationale: Spironolactone is a potassium-sparing diuretic that acts as a competitive
antagonist of the aldosterone receptor in the cortical collecting tubule. By blocking
, aldosterone, it prevents sodium reabsorption and potassium excretion, which can
lead to hyperkalemia, especially in patients with baseline renal impairment.
Furosemide, hydrochlorothiazide, and metolazone are potassium-wasting diuretics
that typically cause hypokalemia rather than hyperkalemia.
Question 6
A 19-year-old male presents with sudden onset weakness in his right upper extremity
after a falling injury during a football game. Physical examination reveals a loss of
the biceps tendon reflex and an inability to supinate the right forearm. His arm is held
in an adducted, internally rotated position with an extended elbow. Which of the
following nerve roots are most likely damaged in this patient?
A) C5-C6
B) C7-C8
C) C8-T1
D) T1-T2
A) C5-C6
Rationale: This presentation describes Erb-Duchenne palsy ("waiter's tip" deformity),
which results from an injury to the upper trunk of the brachial plexus involving the C5
and C6 nerve roots. This injury typically occurs due to an excessive increase in the
angle between the neck and the shoulder. It paralyzes the deltoid, biceps brachii,
and brachialis muscles. C8-T1 injury results in Klumpke palsy, which presents with a
"claw hand" deformity due to loss of intrinsic hand muscles.
Question 7
A 31-year-old female presents to the physician with a 3-month history of fatigue,
unexpected weight gain, and generalized muscle aches. Physical examination
reveals slow relaxation of her deep tendon reflexes and mild, diffuse enlargement of
the thyroid gland. Laboratory studies demonstrate an elevated thyroid-stimulating
hormone (TSH) and a decreased free T4 level. Which of the following autoantibodies
is most specific for diagnosing the underlying cause of this patient's presentation?
