COMSAE PHASE 1 ASA 114 – THE COMPLETE
176 QUESTION TEST BANK ALL QUESTIONS
WITH CORRECT VERIFIED ANSWERS &
DETAILED RATIONALES – GRADED A+ FOR
THE NEWEST 2026 ACTUAL EXAM
Core Domains
Osteopathic Principles & Practice (OPP)
Anatomy & Embryology
Physiology & Pathophysiology
Biochemistry & Molecular Biology
Microbiology & Immunology
Pharmacology
Pathology
Clinical Medicine & Diagnosis
Behavioral Science & Ethics
Introduction
This comprehensive examination assesses the foundational biomedical
and clinical knowledge required of osteopathic medical students
preparing for COMSAE Phase 1 Form ASA 114 and COMLEX-USA Level
1. It evaluates anatomy, physiology, pathology, pharmacology,
microbiology, immunology, biochemistry, genetics, osteopathic
principles, and clinical reasoning. The examination employs multiple-
,choice and scenario-based questions to simulate realistic clinical
encounters. Emphasis is placed on critical thinking, mechanism-based
reasoning, diagnostic accuracy, and the application of osteopathic
principles in patient care. This assessment prepares candidates for the
rigor of COMSAE Phase 1 and the COMLEX-USA Level 1 examination.
SECTION ONE: QUESTIONS 1–176
1. A 28-year-old female presents with a distinct, migratory, butterfly-
shaped rash across her cheeks and nasal bridge that worsens after
sun exposure. Laboratory testing reveals positive antinuclear
antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA)
antibodies. What is the most likely diagnosis?
A. Systemic lupus erythematosus
B. Dermatomyositis
C. Rosacea
D. Seborrheic dermatitis
A. Systemic lupus erythematosus
RATIONALE: Systemic lupus erythematosus (SLE) is a chronic
autoimmune disease characterized by a malar (butterfly) rash that
exhibits photosensitivity. The presence of highly specific antibodies like
anti-dsDNA confirms the diagnosis. Dermatomyositis presents with a
heliotrope rash and proximal muscle weakness. Rosacea lacks systemic
autoantibodies. Seborrheic dermatitis presents with greasy scales in the
nasolabial folds.
2. A 45-year-old male undergoes a physical examination. The
physician notes a somatic dysfunction of the T5 thoracic vertebra.
,Palpation reveals that the T5 spinous process rotates preferentially
to the right and sidebends preferentially to the right. When the
patient flexes his spine, the asymmetry worsens, but it improves
significantly when he extends his spine. According to Fryette's
principles, how should this somatic dysfunction be named?
A. T5 Neutral R(R) S(L)
B. T5 Extended R(R) S(R)
C. T5 Flexed R(L) S(L)
D. T5 Extended R(L) S(R)
B. T5 Extended R(R) S(R)
RATIONALE: Under Fryette's Principle II, non-neutral thoracic
dysfunctions occur at a single vertebral segment where rotation and
sidebending occur to the same side. Because the asymmetry improves in
extension, the restriction is in flexion, meaning the vertebra is trapped in
an extended position. The positional diagnosis is named for its directional
preferences: Extended, Rotated Right, and Sidebent Right.
3. A 62-year-old male with a history of chronic smoking presents with
an emergency onset of severe, tearing chest pain that radiates
directly to his back between his scapulae. His blood pressure is
180/100 mmHg in the right arm and 140/85 mmHg in the left arm.
What is the most immediate life-threatening condition to suspect?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
, D. Tension pneumothorax
B. Acute aortic dissection
RATIONALE: A tearing or ripping chest pain radiating to the back,
coupled with an asymmetric blood pressure differential between the
upper extremities (>20 mmHg variation), is highly indicative of an acute
aortic dissection. Acute myocardial infarction typically features crushing
retrosternal pain radiating to the jaw or left arm. Pulmonary embolism
presents with pleuritic chest pain and dyspnea. Tension pneumothorax
causes absent breath sounds on the affected side.
4. A 34-year-old patient presents with symptoms highly suggestive of
acute appendicitis. During an osteopathic structural exam, the
physician looks for a viscerosomatic reflex. At which spinal level
would sympathetic innervation from the appendix be expected?
A. T5-T9
B. T10-T11
C. T12-L2
D. L3-L5
B. T10-T11
RATIONALE: The appendix receives sympathetic innervation from the
T10-T11 spinal segments. Viscerosomatic reflexes from the appendix
would be expected at these levels. Foregut structures (stomach,
pancreas, liver) refer to T5-T9, while hindgut structures (descending
colon, rectum) refer to T12-L2.
176 QUESTION TEST BANK ALL QUESTIONS
WITH CORRECT VERIFIED ANSWERS &
DETAILED RATIONALES – GRADED A+ FOR
THE NEWEST 2026 ACTUAL EXAM
Core Domains
Osteopathic Principles & Practice (OPP)
Anatomy & Embryology
Physiology & Pathophysiology
Biochemistry & Molecular Biology
Microbiology & Immunology
Pharmacology
Pathology
Clinical Medicine & Diagnosis
Behavioral Science & Ethics
Introduction
This comprehensive examination assesses the foundational biomedical
and clinical knowledge required of osteopathic medical students
preparing for COMSAE Phase 1 Form ASA 114 and COMLEX-USA Level
1. It evaluates anatomy, physiology, pathology, pharmacology,
microbiology, immunology, biochemistry, genetics, osteopathic
principles, and clinical reasoning. The examination employs multiple-
,choice and scenario-based questions to simulate realistic clinical
encounters. Emphasis is placed on critical thinking, mechanism-based
reasoning, diagnostic accuracy, and the application of osteopathic
principles in patient care. This assessment prepares candidates for the
rigor of COMSAE Phase 1 and the COMLEX-USA Level 1 examination.
SECTION ONE: QUESTIONS 1–176
1. A 28-year-old female presents with a distinct, migratory, butterfly-
shaped rash across her cheeks and nasal bridge that worsens after
sun exposure. Laboratory testing reveals positive antinuclear
antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA)
antibodies. What is the most likely diagnosis?
A. Systemic lupus erythematosus
B. Dermatomyositis
C. Rosacea
D. Seborrheic dermatitis
A. Systemic lupus erythematosus
RATIONALE: Systemic lupus erythematosus (SLE) is a chronic
autoimmune disease characterized by a malar (butterfly) rash that
exhibits photosensitivity. The presence of highly specific antibodies like
anti-dsDNA confirms the diagnosis. Dermatomyositis presents with a
heliotrope rash and proximal muscle weakness. Rosacea lacks systemic
autoantibodies. Seborrheic dermatitis presents with greasy scales in the
nasolabial folds.
2. A 45-year-old male undergoes a physical examination. The
physician notes a somatic dysfunction of the T5 thoracic vertebra.
,Palpation reveals that the T5 spinous process rotates preferentially
to the right and sidebends preferentially to the right. When the
patient flexes his spine, the asymmetry worsens, but it improves
significantly when he extends his spine. According to Fryette's
principles, how should this somatic dysfunction be named?
A. T5 Neutral R(R) S(L)
B. T5 Extended R(R) S(R)
C. T5 Flexed R(L) S(L)
D. T5 Extended R(L) S(R)
B. T5 Extended R(R) S(R)
RATIONALE: Under Fryette's Principle II, non-neutral thoracic
dysfunctions occur at a single vertebral segment where rotation and
sidebending occur to the same side. Because the asymmetry improves in
extension, the restriction is in flexion, meaning the vertebra is trapped in
an extended position. The positional diagnosis is named for its directional
preferences: Extended, Rotated Right, and Sidebent Right.
3. A 62-year-old male with a history of chronic smoking presents with
an emergency onset of severe, tearing chest pain that radiates
directly to his back between his scapulae. His blood pressure is
180/100 mmHg in the right arm and 140/85 mmHg in the left arm.
What is the most immediate life-threatening condition to suspect?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
, D. Tension pneumothorax
B. Acute aortic dissection
RATIONALE: A tearing or ripping chest pain radiating to the back,
coupled with an asymmetric blood pressure differential between the
upper extremities (>20 mmHg variation), is highly indicative of an acute
aortic dissection. Acute myocardial infarction typically features crushing
retrosternal pain radiating to the jaw or left arm. Pulmonary embolism
presents with pleuritic chest pain and dyspnea. Tension pneumothorax
causes absent breath sounds on the affected side.
4. A 34-year-old patient presents with symptoms highly suggestive of
acute appendicitis. During an osteopathic structural exam, the
physician looks for a viscerosomatic reflex. At which spinal level
would sympathetic innervation from the appendix be expected?
A. T5-T9
B. T10-T11
C. T12-L2
D. L3-L5
B. T10-T11
RATIONALE: The appendix receives sympathetic innervation from the
T10-T11 spinal segments. Viscerosomatic reflexes from the appendix
would be expected at these levels. Foregut structures (stomach,
pancreas, liver) refer to T5-T9, while hindgut structures (descending
colon, rectum) refer to T12-L2.
