COMSAE phase 1/ COMLEX-USA Level 1 form 114 Practice Exam
COMSAE phase 1/COMLEX-USA Level 1 form
114 Practice Exam 2026 Edition 100
Advanced Questions with Answers and
Detailed Rationales
Part 1 (Questions 1–25)
Disclaimer: The following questions are original and designed to resemble the style, scope, and
reasoning expected on COMSAE Phase 1 and COMLEX-USA Level 1. They are not reproduced
from any official COMSAE form.
Question 1
A 22-year-old man presents with fever, sore throat, and generalized fatigue for 5 days.
Examination reveals posterior cervical lymphadenopathy and mild splenomegaly. Laboratory
studies show atypical lymphocytosis. A heterophile antibody test is positive.
Which organism is responsible?
A. Cytomegalovirus
B. Epstein-Barr virus
C. Adenovirus
D. Human herpesvirus 6
E. Toxoplasma gondii
Answer: B. Epstein-Barr virus
Rationale
The patient's presentation is classic for infectious mononucleosis due to Epstein-Barr virus
(EBV).
Key features:
Fever
, COMSAE phase 1/ COMLEX-USA Level 1 form 114 Practice Exam
Pharyngitis
Posterior cervical lymphadenopathy
Splenomegaly
Atypical lymphocytes
Positive heterophile (Monospot) test
Incorrect answers
A: CMV causes a mononucleosis-like illness but heterophile test is negative.
C: Adenovirus commonly causes pharyngitis and conjunctivitis.
D: HHV-6 causes roseola.
E: Toxoplasmosis may mimic mono but heterophile testing is negative.
High-yield pearl: Avoid contact sports for at least 3–4 weeks because of splenic rupture risk.
Question 2
A 68-year-old woman presents with exertional dyspnea and chest pain. Cardiac examination
reveals a crescendo-decrescendo systolic murmur best heard at the right upper sternal border that
radiates to the carotids.
Which pathology most likely explains her symptoms?
A. Myxomatous degeneration
B. Calcific degeneration
C. Rheumatic fever
D. Infective endocarditis
E. Carcinoid syndrome
Answer: B. Calcific degeneration
Rationale
Elderly patients most commonly develop calcific aortic stenosis.
Classic findings:
Systolic ejection murmur
Carotid radiation
Pulsus parvus et tardus
, COMSAE phase 1/ COMLEX-USA Level 1 form 114 Practice Exam
Angina
Syncope
Heart failure
Incorrect answers
A: Causes mitral valve prolapse.
C: More commonly causes mitral stenosis.
D: Produces vegetations.
E: Primarily affects right-sided valves.
High-yield pearl: The triad of angina, syncope, and heart failure strongly suggests severe
aortic stenosis.
Question 3
A patient with diabetic ketoacidosis is started on intravenous insulin.
Which electrolyte should be monitored most closely during treatment?
A. Calcium
B. Sodium
C. Potassium
D. Magnesium
E. Chloride
Answer: C. Potassium
Rationale
Insulin drives potassium into cells, causing serum potassium to decrease rapidly. Even when
initial potassium appears elevated, total body potassium is depleted.
High-yield pearl: If potassium is <3.3 mEq/L, replace potassium before starting insulin.
Question 4
, COMSAE phase 1/ COMLEX-USA Level 1 form 114 Practice Exam
A patient presents with unilateral facial paralysis involving both the forehead and lower face.
The lesion most likely affects which structure?
A. Left corticobulbar tract
B. Right corticobulbar tract
C. Facial nerve
D. Trigeminal nerve
E. Oculomotor nerve
Answer: C. Facial nerve
Rationale
Lower motor neuron facial lesions affect the entire ipsilateral face, including the forehead.
Upper motor neuron lesions spare the forehead due to bilateral cortical innervation.
Question 5
A patient develops severe diarrhea after completing clindamycin therapy.
Which organism is the most likely cause?
A. Salmonella enterica
B. Shigella sonnei
C. Clostridioides difficile
D. Campylobacter jejuni
E. Vibrio cholerae
Answer: C. Clostridioides difficile
Rationale
Risk factors:
COMSAE phase 1/COMLEX-USA Level 1 form
114 Practice Exam 2026 Edition 100
Advanced Questions with Answers and
Detailed Rationales
Part 1 (Questions 1–25)
Disclaimer: The following questions are original and designed to resemble the style, scope, and
reasoning expected on COMSAE Phase 1 and COMLEX-USA Level 1. They are not reproduced
from any official COMSAE form.
Question 1
A 22-year-old man presents with fever, sore throat, and generalized fatigue for 5 days.
Examination reveals posterior cervical lymphadenopathy and mild splenomegaly. Laboratory
studies show atypical lymphocytosis. A heterophile antibody test is positive.
Which organism is responsible?
A. Cytomegalovirus
B. Epstein-Barr virus
C. Adenovirus
D. Human herpesvirus 6
E. Toxoplasma gondii
Answer: B. Epstein-Barr virus
Rationale
The patient's presentation is classic for infectious mononucleosis due to Epstein-Barr virus
(EBV).
Key features:
Fever
, COMSAE phase 1/ COMLEX-USA Level 1 form 114 Practice Exam
Pharyngitis
Posterior cervical lymphadenopathy
Splenomegaly
Atypical lymphocytes
Positive heterophile (Monospot) test
Incorrect answers
A: CMV causes a mononucleosis-like illness but heterophile test is negative.
C: Adenovirus commonly causes pharyngitis and conjunctivitis.
D: HHV-6 causes roseola.
E: Toxoplasmosis may mimic mono but heterophile testing is negative.
High-yield pearl: Avoid contact sports for at least 3–4 weeks because of splenic rupture risk.
Question 2
A 68-year-old woman presents with exertional dyspnea and chest pain. Cardiac examination
reveals a crescendo-decrescendo systolic murmur best heard at the right upper sternal border that
radiates to the carotids.
Which pathology most likely explains her symptoms?
A. Myxomatous degeneration
B. Calcific degeneration
C. Rheumatic fever
D. Infective endocarditis
E. Carcinoid syndrome
Answer: B. Calcific degeneration
Rationale
Elderly patients most commonly develop calcific aortic stenosis.
Classic findings:
Systolic ejection murmur
Carotid radiation
Pulsus parvus et tardus
, COMSAE phase 1/ COMLEX-USA Level 1 form 114 Practice Exam
Angina
Syncope
Heart failure
Incorrect answers
A: Causes mitral valve prolapse.
C: More commonly causes mitral stenosis.
D: Produces vegetations.
E: Primarily affects right-sided valves.
High-yield pearl: The triad of angina, syncope, and heart failure strongly suggests severe
aortic stenosis.
Question 3
A patient with diabetic ketoacidosis is started on intravenous insulin.
Which electrolyte should be monitored most closely during treatment?
A. Calcium
B. Sodium
C. Potassium
D. Magnesium
E. Chloride
Answer: C. Potassium
Rationale
Insulin drives potassium into cells, causing serum potassium to decrease rapidly. Even when
initial potassium appears elevated, total body potassium is depleted.
High-yield pearl: If potassium is <3.3 mEq/L, replace potassium before starting insulin.
Question 4
, COMSAE phase 1/ COMLEX-USA Level 1 form 114 Practice Exam
A patient presents with unilateral facial paralysis involving both the forehead and lower face.
The lesion most likely affects which structure?
A. Left corticobulbar tract
B. Right corticobulbar tract
C. Facial nerve
D. Trigeminal nerve
E. Oculomotor nerve
Answer: C. Facial nerve
Rationale
Lower motor neuron facial lesions affect the entire ipsilateral face, including the forehead.
Upper motor neuron lesions spare the forehead due to bilateral cortical innervation.
Question 5
A patient develops severe diarrhea after completing clindamycin therapy.
Which organism is the most likely cause?
A. Salmonella enterica
B. Shigella sonnei
C. Clostridioides difficile
D. Campylobacter jejuni
E. Vibrio cholerae
Answer: C. Clostridioides difficile
Rationale
Risk factors:
