1
COMSAE 115 EXAM ] (LATEST 2026 UPDATE) | COMPLETE ACCURATE
EXAM WITH REAL QUESTIONS AND CORRECT VERIFIED SOLUTIONS |
DETAILED RATIONALES INCLUDED | NEWEST UPDATED VERSION 2026
EDITION | GUARANTEED SUCCESS A+ | BRAND NEW STUDY GUIDE
Core Domains
• Osteopathic Principles and Practice (OPP)
• Anatomy and Embryology
• Physiology and Pathophysiology
• Microbiology and Immunology
• Pharmacology
• Biochemistry and Genetics
• Pathology and Histology
• Neurology and Psychiatry
• Cardiovascular and Respiratory Systems
• Gastrointestinal and Renal Systems
• Reproductive and Endocrine Systems
• Musculoskeletal and Integumentary Systems
• Clinical Decision-Making and Patient Safety
Introduction
This comprehensive examination simulates the COMSAE 115 Phase 1 assessment,
reflecting the most current blueprint and question formats used by the National
Board of Osteopathic Medical Examiners (NBOME). It integrates foundational
biomedical sciences with clinical application, emphasizing the distinctive
osteopathic principles that define COMLEX-USA. Questions are designed to test
your ability to apply knowledge of anatomy, physiology, pathology,
pharmacology, and microbiology to patient scenarios, while incorporating the
pg. 1
,2
osteopathic tenets of body unity, self-regulation, and structure-function
interdependence. The exam features clinical vignettes with laboratory data,
imaging, and physical examination findings that require interpretation. Each
question is accompanied by a detailed rationale that explains the correct answer
and addresses common distractors. Use this resource to assess your readiness,
identify knowledge gaps, and build confidence for the actual examination.
Mastery of this content will not only prepare you for COMSAE success but also for
competent, compassionate osteopathic medical practice.
SECTION ONE: QUESTIONS 1–150
1. A 45-year-old male presents with lower back pain that is worse with
extension and relieved with flexion. Physical examination reveals a step-off
deformity at the lumbosacral junction and tight hamstrings. Which
osteopathic manipulative treatment (OMT) technique is most appropriate
to address the underlying somatic dysfunction?
A. High-velocity, low-amplitude (HVLA) thrust to the sacrum
B. Counterstrain to the psoas muscle
C. Muscle energy technique to the iliopsoas and lumbar spine
D. Myofascial release of the thoracolumbar fascia
Correct answer: C. Muscle energy technique to the iliopsoas and lumbar spine
RATIONALE: The presentation suggests a hyperlordotic lumbar spine with
anterior innominate rotation or sacral base anterior dysfunction. Pain with
extension indicates facet joint irritation or stenosis. Muscle energy techniques
address hypertonic muscles (iliopsoas, erector spinae) and can correct sacral and
innominate somatic dysfunctions. HVLA is relatively contraindicated if there is
suspicion of spondylolisthesis (step-off). Counterstrain would be indirect but not
the first choice for a structural issue. Myofascial release alone is insufficient.
2. A 72-year-old female with a history of atrial fibrillation on warfarin presents
with acute onset of severe left lower quadrant abdominal pain. CT reveals a
thickened colonic wall with thumbprinting and pneumatosis. What is the
underlying pathophysiology?
A. Atherosclerotic plaque rupture in the superior mesenteric artery
B. Thrombotic occlusion of the inferior mesenteric vein
pg. 2
,3
C. Embolic occlusion of the inferior mesenteric artery
D. Vasospasm of the splanchnic circulation
Correct answer: C. Embolic occlusion of the inferior mesenteric artery
RATIONALE: Atrial fibrillation predisposes to embolic events. The left colon
(inferior mesenteric artery distribution) is a common site for emboli. Acute
mesenteric ischemia presents with severe pain out of proportion to physical
findings. Thumbprinting and pneumatosis indicate bowel wall ischemia and
necrosis.
3. A 2-day-old neonate born to a mother with no prenatal care presents with
jaundice, cataracts, and a heart murmur. Which maternal infection is most
likely responsible?
A. Cytomegalovirus
B. Toxoplasma gondii
C. Rubella virus
D. Herpes simplex virus
Correct answer: C. Rubella virus
RATIONALE: Congenital rubella syndrome classically presents with cataracts,
congenital heart disease (patent ductus arteriosus, pulmonary artery stenosis),
and sensorineural deafness. Jaundice and thrombocytopenia may also occur. CMV
causes periventricular calcifications. Toxoplasma causes hydrocephalus,
intracranial calcifications, and chorioretinitis. HSV causes vesicular lesions.
4. A 34-year-old male with HIV (CD4 count 45 cells/mm³) presents with
progressive dyspnea and a nonproductive cough. Chest X-ray shows diffuse
bilateral interstitial infiltrates. Silver stain of bronchoalveolar lavage reveals
cup-shaped organisms. What is the most likely diagnosis?
A. Pulmonary aspergillosis
B. Pneumocystis jirovecii pneumonia
C. Mycobacterium tuberculosis
D. Cytomegalovirus pneumonitis
Correct answer: B. Pneumocystis jirovecii pneumonia
RATIONALE: PJP is an AIDS-defining illness when CD4 counts drop below 200
cells/mm³. Symptoms include insidious onset dyspnea, dry cough, fever, and
pg. 3
, 4
hypoxemia. CXR shows bilateral interstitial infiltrates. Gomori methenamine silver
stain demonstrates cup-shaped cysts. Treatment is trimethoprim-
sulfamethoxazole.
5. A 55-year-old male smoker presents with hemoptysis, weight loss, and a
cavitary lesion on chest X-ray. Sputum culture on Löwenstein-Jensen
medium grows acid-fast bacilli. What virulence factor is most associated
with the organism's ability to survive within macrophages?
A. Mycolic acid cell wall
B. Cord factor (trehalose dimycolate)
C. Sulfatides
D. Lipoarabinomannan
Correct answer: B. Cord factor (trehalose dimycolate)
RATIONALE: Mycobacterium tuberculosis produces cord factor, which inhibits
phagolysosome fusion and allows survival within macrophages, leading to
granuloma formation. Mycolic acids provide the acid-fast property. Sulfatides
inhibit phagosome activation. LAM is immunomodulatory.
6. A 10-year-old boy with a history of recurrent otitis media presents with
nephrotic-range proteinuria. Renal biopsy is normal on light microscopy but
shows diffuse effacement of podocyte foot processes on electron
microscopy. What is the most likely diagnosis?
A. IgA nephropathy
B. Membranous nephropathy
C. Minimal change disease
D. Focal segmental glomerulosclerosis
Correct answer: C. Minimal change disease
RATIONALE: Minimal change disease is the most common cause of nephrotic
syndrome in children. It is characterized by selective proteinuria and normal
glomeruli on light microscopy. EM shows foot process effacement. It responds
well to corticosteroids. It can be associated with Hodgkin lymphoma, NSAIDs, and
recent infections.
7. A 45-year-old female presents with dysphagia to solids and liquids,
regurgitation, and halitosis. Barium swallow shows a dilated esophagus
pg. 4
COMSAE 115 EXAM ] (LATEST 2026 UPDATE) | COMPLETE ACCURATE
EXAM WITH REAL QUESTIONS AND CORRECT VERIFIED SOLUTIONS |
DETAILED RATIONALES INCLUDED | NEWEST UPDATED VERSION 2026
EDITION | GUARANTEED SUCCESS A+ | BRAND NEW STUDY GUIDE
Core Domains
• Osteopathic Principles and Practice (OPP)
• Anatomy and Embryology
• Physiology and Pathophysiology
• Microbiology and Immunology
• Pharmacology
• Biochemistry and Genetics
• Pathology and Histology
• Neurology and Psychiatry
• Cardiovascular and Respiratory Systems
• Gastrointestinal and Renal Systems
• Reproductive and Endocrine Systems
• Musculoskeletal and Integumentary Systems
• Clinical Decision-Making and Patient Safety
Introduction
This comprehensive examination simulates the COMSAE 115 Phase 1 assessment,
reflecting the most current blueprint and question formats used by the National
Board of Osteopathic Medical Examiners (NBOME). It integrates foundational
biomedical sciences with clinical application, emphasizing the distinctive
osteopathic principles that define COMLEX-USA. Questions are designed to test
your ability to apply knowledge of anatomy, physiology, pathology,
pharmacology, and microbiology to patient scenarios, while incorporating the
pg. 1
,2
osteopathic tenets of body unity, self-regulation, and structure-function
interdependence. The exam features clinical vignettes with laboratory data,
imaging, and physical examination findings that require interpretation. Each
question is accompanied by a detailed rationale that explains the correct answer
and addresses common distractors. Use this resource to assess your readiness,
identify knowledge gaps, and build confidence for the actual examination.
Mastery of this content will not only prepare you for COMSAE success but also for
competent, compassionate osteopathic medical practice.
SECTION ONE: QUESTIONS 1–150
1. A 45-year-old male presents with lower back pain that is worse with
extension and relieved with flexion. Physical examination reveals a step-off
deformity at the lumbosacral junction and tight hamstrings. Which
osteopathic manipulative treatment (OMT) technique is most appropriate
to address the underlying somatic dysfunction?
A. High-velocity, low-amplitude (HVLA) thrust to the sacrum
B. Counterstrain to the psoas muscle
C. Muscle energy technique to the iliopsoas and lumbar spine
D. Myofascial release of the thoracolumbar fascia
Correct answer: C. Muscle energy technique to the iliopsoas and lumbar spine
RATIONALE: The presentation suggests a hyperlordotic lumbar spine with
anterior innominate rotation or sacral base anterior dysfunction. Pain with
extension indicates facet joint irritation or stenosis. Muscle energy techniques
address hypertonic muscles (iliopsoas, erector spinae) and can correct sacral and
innominate somatic dysfunctions. HVLA is relatively contraindicated if there is
suspicion of spondylolisthesis (step-off). Counterstrain would be indirect but not
the first choice for a structural issue. Myofascial release alone is insufficient.
2. A 72-year-old female with a history of atrial fibrillation on warfarin presents
with acute onset of severe left lower quadrant abdominal pain. CT reveals a
thickened colonic wall with thumbprinting and pneumatosis. What is the
underlying pathophysiology?
A. Atherosclerotic plaque rupture in the superior mesenteric artery
B. Thrombotic occlusion of the inferior mesenteric vein
pg. 2
,3
C. Embolic occlusion of the inferior mesenteric artery
D. Vasospasm of the splanchnic circulation
Correct answer: C. Embolic occlusion of the inferior mesenteric artery
RATIONALE: Atrial fibrillation predisposes to embolic events. The left colon
(inferior mesenteric artery distribution) is a common site for emboli. Acute
mesenteric ischemia presents with severe pain out of proportion to physical
findings. Thumbprinting and pneumatosis indicate bowel wall ischemia and
necrosis.
3. A 2-day-old neonate born to a mother with no prenatal care presents with
jaundice, cataracts, and a heart murmur. Which maternal infection is most
likely responsible?
A. Cytomegalovirus
B. Toxoplasma gondii
C. Rubella virus
D. Herpes simplex virus
Correct answer: C. Rubella virus
RATIONALE: Congenital rubella syndrome classically presents with cataracts,
congenital heart disease (patent ductus arteriosus, pulmonary artery stenosis),
and sensorineural deafness. Jaundice and thrombocytopenia may also occur. CMV
causes periventricular calcifications. Toxoplasma causes hydrocephalus,
intracranial calcifications, and chorioretinitis. HSV causes vesicular lesions.
4. A 34-year-old male with HIV (CD4 count 45 cells/mm³) presents with
progressive dyspnea and a nonproductive cough. Chest X-ray shows diffuse
bilateral interstitial infiltrates. Silver stain of bronchoalveolar lavage reveals
cup-shaped organisms. What is the most likely diagnosis?
A. Pulmonary aspergillosis
B. Pneumocystis jirovecii pneumonia
C. Mycobacterium tuberculosis
D. Cytomegalovirus pneumonitis
Correct answer: B. Pneumocystis jirovecii pneumonia
RATIONALE: PJP is an AIDS-defining illness when CD4 counts drop below 200
cells/mm³. Symptoms include insidious onset dyspnea, dry cough, fever, and
pg. 3
, 4
hypoxemia. CXR shows bilateral interstitial infiltrates. Gomori methenamine silver
stain demonstrates cup-shaped cysts. Treatment is trimethoprim-
sulfamethoxazole.
5. A 55-year-old male smoker presents with hemoptysis, weight loss, and a
cavitary lesion on chest X-ray. Sputum culture on Löwenstein-Jensen
medium grows acid-fast bacilli. What virulence factor is most associated
with the organism's ability to survive within macrophages?
A. Mycolic acid cell wall
B. Cord factor (trehalose dimycolate)
C. Sulfatides
D. Lipoarabinomannan
Correct answer: B. Cord factor (trehalose dimycolate)
RATIONALE: Mycobacterium tuberculosis produces cord factor, which inhibits
phagolysosome fusion and allows survival within macrophages, leading to
granuloma formation. Mycolic acids provide the acid-fast property. Sulfatides
inhibit phagosome activation. LAM is immunomodulatory.
6. A 10-year-old boy with a history of recurrent otitis media presents with
nephrotic-range proteinuria. Renal biopsy is normal on light microscopy but
shows diffuse effacement of podocyte foot processes on electron
microscopy. What is the most likely diagnosis?
A. IgA nephropathy
B. Membranous nephropathy
C. Minimal change disease
D. Focal segmental glomerulosclerosis
Correct answer: C. Minimal change disease
RATIONALE: Minimal change disease is the most common cause of nephrotic
syndrome in children. It is characterized by selective proteinuria and normal
glomeruli on light microscopy. EM shows foot process effacement. It responds
well to corticosteroids. It can be associated with Hodgkin lymphoma, NSAIDs, and
recent infections.
7. A 45-year-old female presents with dysphagia to solids and liquids,
regurgitation, and halitosis. Barium swallow shows a dilated esophagus
pg. 4
