Page 1 of 139
COMSAE Phase 1 Form 116 — exam COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR-JUST RELEASED
1. Osteopathic Principles & OMM (High Weight): Viscerosomatic/somatovisceral reflexes,
autonomic levels, Chapman points, muscle energy/counterstrain/MFR, HVLA contraindications,
Fryette laws, rib dysfunctions, sacral torsions/innominates, cranial strain patterns, lymphatic
OMM and contraindications.
2. Anatomy (Clinically Applied): Brachial plexus lesions, dermatomes/myotomes, cranial nerve
deficits, spinal cord syndromes, pelvic and reproductive anatomy, abdominal blood supply,
hernias, coronary territories, orthopedic nerve injuries.
3. Physiology (Major Core): Cardiac cycle and PV loops, Frank-Starling, pulmonary mechanics and
PFTs, V/Q mismatch, renal clearance and tubular transport, RAAS, acid-base compensation,
endocrine feedback axes, shock physiology.
4. Pathology (Mechanisms + Patterns): Cell injury, inflammation/wound healing, granulomas,
neoplasia genetics, thrombosis/embolism/infarction/edema, autoimmune disease patterns,
cardio/pulm/renal/hepatic pathology syndromes.
5. Microbiology: Gram ID, toxins/virulence, respiratory organisms, GI pathogens, STIs, CNS
infections by age, HIV opportunistic infections, fungi, parasites, DNA vs RNA viruses and
hepatitis.
6. Immunology: Innate/adaptive immunity, T/B cell markers, MHC presentation, cytokines,
hypersensitivity I–IV, immunodeficiencies, complement deficiencies, autoimmune mechanisms
and transplant rejection.
7. Pharmacology: Autonomic drugs, cholinergic drugs, antibiotics MOA/resistance/toxicities, CV
drugs, CNS drugs, endocrine drugs, chemotherapy adverse effects, CYP450 interactions,
teratogenic drugs.
8. Biochemistry & Genetics: Enzyme kinetics, metabolism pathways, fatty acid/ketone
metabolism, amino acid disorders, urea cycle defects, vitamin deficiencies, lysosomal storage
diseases, inheritance patterns.
9. Neurology & Psychiatry: Stroke territories, spinal cord lesions, neurotransmitters, seizures and
antiepileptics, movement disorders, demyelinating diseases, psychiatric disorders, substance
intoxication/withdrawal.
10. Cardiology: Murmurs, hypertension management, arrhythmias/blocks, heart failure
compensation, shock types, endocarditis/rheumatic fever, CAD and MI complications.
11. Pulmonary: Asthma vs COPD, PFT interpretation, PE vs pneumonia vs CHF, ARDS, pleural
effusions/pneumothorax, oxygen-hemoglobin curve shifts.
12. Renal & Electrolytes: AKI classification, nephritic vs nephrotic diseases, acid-base interpretation,
SIADH vs DI, potassium abnormalities/ECG, diuretic effects.
13. Endocrine & Reproductive: Diabetes emergencies, thyroid disorders, adrenal disorders,
pituitary dysfunctions, MEN syndromes, pregnancy hormones, contraception
pharmacology/complications.
14. GI & Hepatobiliary: Hepatitis serology/liver enzymes, cirrhosis complications, pancreatitis,
PUD/H. pylori, malabsorption/IBD, gallstones and biliary infections.
15. Hematology & Oncology: Anemia evaluation, coagulation testing, DIC vs TTP vs HUS,
leukemia/lymphoma patterns, multiple myeloma, metastasis/paraneoplastic syndromes.
, Page 2 of 139
16. Musculoskeletal & Rheumatology: OA vs RA, gout vs pseudogout, lupus
antibodies/manifestations, vasculitis patterns, bone tumors, osteomyelitis organisms.
17. Biostatistics & Epidemiology: Sensitivity/specificity/PPV/NPV, RR vs OR, likelihood ratios, study
designs, bias/confounding, p-values/CI/power.
18. Ethics & Medical Law: Ethical principles, informed consent/capacity, confidentiality/reporting,
surrogate decision hierarchy, end-of-life directives, professionalism/conflicts, error disclosure.
COMSAE Phase 1 Form 116
1.
A patient with peptic ulcer disease has tissue texture changes and hypertonicity at T5–T9 on the left.
These findings most likely represent which osteopathic concept?
A. Somatovisceral reflex
B. Viscerosomatic reflex
C. Chapman's reflex only
D. Counterstrain dysfunction
Answer: B. Viscerosomatic reflex
Rationale: GI pathology commonly produces viscerosomatic changes in sympathetic spinal segments
T5–T9.
2.
, Page 3 of 139
A newborn presents with arm adduction, internal rotation, and wrist flexion after difficult vaginal
delivery. Which nerve roots are most likely injured?
A. C8–T1
B. C5–C6
C. T1–T2
D. C7–C8
Answer: B. C5–C6
Rationale: Erb palsy involves upper trunk injury affecting C5–C6 roots.
3.
A patient with heart failure demonstrates increased ventricular end-diastolic volume leading to stronger
contraction. Which physiologic principle explains this response?
A. Laplace law
B. Frank-Starling mechanism
, Page 4 of 139
C. Fick principle
D. Bernoulli principle
Answer: B. Frank-Starling mechanism
Rationale: Increased preload stretches myocardial fibers, increasing contractile force.
4.
A patient develops coagulative necrosis after myocardial infarction. Which cellular change most likely
occurs first?
A. Nuclear hyperplasia
B. ATP depletion
C. Fibrosis formation
D. Collagen synthesis
Answer: B. ATP depletion
Rationale: Ischemia rapidly impairs oxidative phosphorylation, reducing ATP production.
COMSAE Phase 1 Form 116 — exam COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR-JUST RELEASED
1. Osteopathic Principles & OMM (High Weight): Viscerosomatic/somatovisceral reflexes,
autonomic levels, Chapman points, muscle energy/counterstrain/MFR, HVLA contraindications,
Fryette laws, rib dysfunctions, sacral torsions/innominates, cranial strain patterns, lymphatic
OMM and contraindications.
2. Anatomy (Clinically Applied): Brachial plexus lesions, dermatomes/myotomes, cranial nerve
deficits, spinal cord syndromes, pelvic and reproductive anatomy, abdominal blood supply,
hernias, coronary territories, orthopedic nerve injuries.
3. Physiology (Major Core): Cardiac cycle and PV loops, Frank-Starling, pulmonary mechanics and
PFTs, V/Q mismatch, renal clearance and tubular transport, RAAS, acid-base compensation,
endocrine feedback axes, shock physiology.
4. Pathology (Mechanisms + Patterns): Cell injury, inflammation/wound healing, granulomas,
neoplasia genetics, thrombosis/embolism/infarction/edema, autoimmune disease patterns,
cardio/pulm/renal/hepatic pathology syndromes.
5. Microbiology: Gram ID, toxins/virulence, respiratory organisms, GI pathogens, STIs, CNS
infections by age, HIV opportunistic infections, fungi, parasites, DNA vs RNA viruses and
hepatitis.
6. Immunology: Innate/adaptive immunity, T/B cell markers, MHC presentation, cytokines,
hypersensitivity I–IV, immunodeficiencies, complement deficiencies, autoimmune mechanisms
and transplant rejection.
7. Pharmacology: Autonomic drugs, cholinergic drugs, antibiotics MOA/resistance/toxicities, CV
drugs, CNS drugs, endocrine drugs, chemotherapy adverse effects, CYP450 interactions,
teratogenic drugs.
8. Biochemistry & Genetics: Enzyme kinetics, metabolism pathways, fatty acid/ketone
metabolism, amino acid disorders, urea cycle defects, vitamin deficiencies, lysosomal storage
diseases, inheritance patterns.
9. Neurology & Psychiatry: Stroke territories, spinal cord lesions, neurotransmitters, seizures and
antiepileptics, movement disorders, demyelinating diseases, psychiatric disorders, substance
intoxication/withdrawal.
10. Cardiology: Murmurs, hypertension management, arrhythmias/blocks, heart failure
compensation, shock types, endocarditis/rheumatic fever, CAD and MI complications.
11. Pulmonary: Asthma vs COPD, PFT interpretation, PE vs pneumonia vs CHF, ARDS, pleural
effusions/pneumothorax, oxygen-hemoglobin curve shifts.
12. Renal & Electrolytes: AKI classification, nephritic vs nephrotic diseases, acid-base interpretation,
SIADH vs DI, potassium abnormalities/ECG, diuretic effects.
13. Endocrine & Reproductive: Diabetes emergencies, thyroid disorders, adrenal disorders,
pituitary dysfunctions, MEN syndromes, pregnancy hormones, contraception
pharmacology/complications.
14. GI & Hepatobiliary: Hepatitis serology/liver enzymes, cirrhosis complications, pancreatitis,
PUD/H. pylori, malabsorption/IBD, gallstones and biliary infections.
15. Hematology & Oncology: Anemia evaluation, coagulation testing, DIC vs TTP vs HUS,
leukemia/lymphoma patterns, multiple myeloma, metastasis/paraneoplastic syndromes.
, Page 2 of 139
16. Musculoskeletal & Rheumatology: OA vs RA, gout vs pseudogout, lupus
antibodies/manifestations, vasculitis patterns, bone tumors, osteomyelitis organisms.
17. Biostatistics & Epidemiology: Sensitivity/specificity/PPV/NPV, RR vs OR, likelihood ratios, study
designs, bias/confounding, p-values/CI/power.
18. Ethics & Medical Law: Ethical principles, informed consent/capacity, confidentiality/reporting,
surrogate decision hierarchy, end-of-life directives, professionalism/conflicts, error disclosure.
COMSAE Phase 1 Form 116
1.
A patient with peptic ulcer disease has tissue texture changes and hypertonicity at T5–T9 on the left.
These findings most likely represent which osteopathic concept?
A. Somatovisceral reflex
B. Viscerosomatic reflex
C. Chapman's reflex only
D. Counterstrain dysfunction
Answer: B. Viscerosomatic reflex
Rationale: GI pathology commonly produces viscerosomatic changes in sympathetic spinal segments
T5–T9.
2.
, Page 3 of 139
A newborn presents with arm adduction, internal rotation, and wrist flexion after difficult vaginal
delivery. Which nerve roots are most likely injured?
A. C8–T1
B. C5–C6
C. T1–T2
D. C7–C8
Answer: B. C5–C6
Rationale: Erb palsy involves upper trunk injury affecting C5–C6 roots.
3.
A patient with heart failure demonstrates increased ventricular end-diastolic volume leading to stronger
contraction. Which physiologic principle explains this response?
A. Laplace law
B. Frank-Starling mechanism
, Page 4 of 139
C. Fick principle
D. Bernoulli principle
Answer: B. Frank-Starling mechanism
Rationale: Increased preload stretches myocardial fibers, increasing contractile force.
4.
A patient develops coagulative necrosis after myocardial infarction. Which cellular change most likely
occurs first?
A. Nuclear hyperplasia
B. ATP depletion
C. Fibrosis formation
D. Collagen synthesis
Answer: B. ATP depletion
Rationale: Ischemia rapidly impairs oxidative phosphorylation, reducing ATP production.
