Page 1 of 129
COMSAE Phase 1 Form 116 exam QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 1 Form 116 exam
EXAM SUMMARIZED COMPRESSED POINT FORM CONTENT AREAS COVERED BY THE TITLE
• Osteopathic Principles & OMM (15%): viscerosomatic reflexes, Chapman points, Fryette's laws,
sacral/innominate diagnostics, HVLA, muscle energy, counterstrain, cranial, lymphatic
• Human Anatomy (15%): brachial plexus, cranial nerves, spinal cord syndromes, vascular supply,
pelvic anatomy, hernias, nerve injuries
• Pathology (18%): cell injury, inflammation, neoplasia, autoimmune diseases, organ-specific
pathology, shock, hemostasis
• Physiology (15%): cardiac cycle, renal function, acid-base, pulmonary mechanics, endocrine
axes, GI physiology, neurophysiology
• Pharmacology (12%): autonomic drugs, antibiotics, cardiovascular agents, CNS drugs,
chemotherapy, endocrine agents, adverse effects
• Microbiology / Immunology (10%): bacterial/viral/fungal identification, toxins, STIs, CNS
infections, HIV, hypersensitivity, immunodeficiencies
• Biochemistry / Genetics (8%): metabolic pathways, vitamin deficiencies, lysosomal storage
diseases, inheritance patterns, inborn errors
• Neurology / Psychiatry (7%): stroke localization, spinal cord syndromes, neurodegenerative
diseases, aphasias, psychiatric disorders
• Exam Format: 176 single-best-answer multiple-choice questions divided into 4 sections of 44
questions each
1. A 58-year-old man presents with chest pain radiating to his left arm. ECG shows ST elevation in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Posterior descending artery
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Answer: B
Rationale: Inferior wall MI (leads II, III, aVF) is most commonly caused by right coronary artery occlusion,
which supplies the inferior wall in most individuals .
2. A 24-year-old man presents with fever, headache, and neck stiffness. Lumbar puncture shows
elevated opening pressure, low glucose, and high protein. Which organism is most likely responsible?
A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Listeria monocytogenes
D) Escherichia coli
Answer: B
Rationale: Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults, with
classic CSF findings of low glucose and high protein .
3. A 35-year-old woman presents with episodic palpitations, anxiety, and diaphoresis. Blood pressure
during episodes is 200/110 mmHg. CT abdomen shows a 3-cm right adrenal mass. Which test is most
specific for diagnosis?
A) Urinary VMA
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B) Plasma fractionated metanephrines
C) Serum cortisol
D) Plasma renin activity
Answer: B
Rationale: Plasma free metanephrines have the highest sensitivity and specificity for diagnosing
pheochromocytoma .
4. A 48-year-old man with alcohol use disorder presents with confusion, ataxia, and bilateral nystagmus.
Which vitamin deficiency is most likely?
A) Vitamin B12
B) Thiamine
C) Niacin
D) Vitamin E
Answer: B
Rationale: Wernicke encephalopathy (confusion, ataxia, nystagmus) is caused by thiamine deficiency
and requires immediate parenteral thiamine replacement .
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5. Which neurotransmitter is primarily deficient in Parkinson disease?
A) Serotonin
B) Dopamine
C) Acetylcholine
D) GABA
Answer: B
Rationale: Parkinson disease is characterized by degeneration of dopaminergic neurons in the substantia
nigra pars compacta, leading to decreased dopamine levels .
6. A 65-year-old smoker presents with hematuria and flank pain. CT reveals a renal mass. Which is the
most likely diagnosis?
A) Wilms tumor
B) Renal cell carcinoma
C) Transitional cell carcinoma
D) Angiomyolipoma
Answer: B
COMSAE Phase 1 Form 116 exam QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 1 Form 116 exam
EXAM SUMMARIZED COMPRESSED POINT FORM CONTENT AREAS COVERED BY THE TITLE
• Osteopathic Principles & OMM (15%): viscerosomatic reflexes, Chapman points, Fryette's laws,
sacral/innominate diagnostics, HVLA, muscle energy, counterstrain, cranial, lymphatic
• Human Anatomy (15%): brachial plexus, cranial nerves, spinal cord syndromes, vascular supply,
pelvic anatomy, hernias, nerve injuries
• Pathology (18%): cell injury, inflammation, neoplasia, autoimmune diseases, organ-specific
pathology, shock, hemostasis
• Physiology (15%): cardiac cycle, renal function, acid-base, pulmonary mechanics, endocrine
axes, GI physiology, neurophysiology
• Pharmacology (12%): autonomic drugs, antibiotics, cardiovascular agents, CNS drugs,
chemotherapy, endocrine agents, adverse effects
• Microbiology / Immunology (10%): bacterial/viral/fungal identification, toxins, STIs, CNS
infections, HIV, hypersensitivity, immunodeficiencies
• Biochemistry / Genetics (8%): metabolic pathways, vitamin deficiencies, lysosomal storage
diseases, inheritance patterns, inborn errors
• Neurology / Psychiatry (7%): stroke localization, spinal cord syndromes, neurodegenerative
diseases, aphasias, psychiatric disorders
• Exam Format: 176 single-best-answer multiple-choice questions divided into 4 sections of 44
questions each
1. A 58-year-old man presents with chest pain radiating to his left arm. ECG shows ST elevation in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Posterior descending artery
, Page 2 of 129
Answer: B
Rationale: Inferior wall MI (leads II, III, aVF) is most commonly caused by right coronary artery occlusion,
which supplies the inferior wall in most individuals .
2. A 24-year-old man presents with fever, headache, and neck stiffness. Lumbar puncture shows
elevated opening pressure, low glucose, and high protein. Which organism is most likely responsible?
A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Listeria monocytogenes
D) Escherichia coli
Answer: B
Rationale: Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults, with
classic CSF findings of low glucose and high protein .
3. A 35-year-old woman presents with episodic palpitations, anxiety, and diaphoresis. Blood pressure
during episodes is 200/110 mmHg. CT abdomen shows a 3-cm right adrenal mass. Which test is most
specific for diagnosis?
A) Urinary VMA
, Page 3 of 129
B) Plasma fractionated metanephrines
C) Serum cortisol
D) Plasma renin activity
Answer: B
Rationale: Plasma free metanephrines have the highest sensitivity and specificity for diagnosing
pheochromocytoma .
4. A 48-year-old man with alcohol use disorder presents with confusion, ataxia, and bilateral nystagmus.
Which vitamin deficiency is most likely?
A) Vitamin B12
B) Thiamine
C) Niacin
D) Vitamin E
Answer: B
Rationale: Wernicke encephalopathy (confusion, ataxia, nystagmus) is caused by thiamine deficiency
and requires immediate parenteral thiamine replacement .
, Page 4 of 129
5. Which neurotransmitter is primarily deficient in Parkinson disease?
A) Serotonin
B) Dopamine
C) Acetylcholine
D) GABA
Answer: B
Rationale: Parkinson disease is characterized by degeneration of dopaminergic neurons in the substantia
nigra pars compacta, leading to decreased dopamine levels .
6. A 65-year-old smoker presents with hematuria and flank pain. CT reveals a renal mass. Which is the
most likely diagnosis?
A) Wilms tumor
B) Renal cell carcinoma
C) Transitional cell carcinoma
D) Angiomyolipoma
Answer: B
