COMSAE PHASE 1 ASA 115 – THE
COMPLETE 176 QUESTION TEST
BANK ALL QUESTIONS WITH
CORRECT VERIFIED ANSWERS &
DETAILED RATIONALES – GRADED
A+ FOR THE NEWEST 2026 ACTUAL
EXAM
Core Domains
Anatomy & Neuroanatomy
Physiology & Pathophysiology
Pharmacology
Microbiology & Immunology
Biochemistry & Genetics
Osteopathic Principles & Practice
Clinical Medicine & Diagnosis
Behavioral Science & Ethics
Introduction
This comprehensive examination assesses the foundational
biomedical and clinical knowledge required of osteopathic medical
students preparing for 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 6-year-old boy presents with recurrent epistaxis.
Physical exam shows telangiectasias on the lips and
mucosa. Which inheritance pattern best explains this
condition?
A. X-linked recessive
B. Autosomal recessive
C. Mitochondrial
D. Autosomal dominant
D. Autosomal dominant
RATIONALE: Telangiectasias with recurrent nosebleeds
suggest hereditary hemorrhagic telangiectasia (Osler-Weber-
Rendu syndrome), which is inherited in an autosomal dominant
pattern. It is characterized by vascular malformations affecting
skin, mucous membranes, and internal organs.
2. Which enzyme deficiency causes phenylketonuria
(PKU)?
A. Phenylalanine hydroxylase
B. Tyrosine aminotransferase
C. Homogentisate 1,2-dioxygenase
D. Branched-chain alpha-keto acid dehydrogenase
A. Phenylalanine hydroxylase
, RATIONALE: Phenylketonuria (PKU) is caused by deficiency of
phenylalanine hydroxylase, which converts phenylalanine to
tyrosine. This leads to accumulation of phenylalanine, causing
intellectual disability if untreated. Newborn screening and dietary
restriction prevent complications.
3. A 45-year-old male with a history of alcohol use
disorder presents with jaundice, ascites, and confusion.
Laboratory studies show elevated AST and ALT with
AST:ALT ratio >2. Which is the most likely diagnosis?
A. Viral hepatitis
B. Wilson's disease
C. Alcoholic liver disease
D. Hemochromatosis
C. Alcoholic liver disease
RATIONALE: AST:ALT ratio >2 (often >3) is characteristic of
alcoholic liver disease. Viral hepatitis typically has ALT > AST.
Wilson's disease presents with neurological symptoms and
Kayser-Fleischer rings. Hemochromatosis presents with bronze
skin, diabetes, and cardiomyopathy.
4. A 32-year-old pregnant woman presents with painless
vaginal bleeding at 32 weeks gestation. Ultrasound reveals
the placenta covering the internal cervical os. Which is the
most appropriate next step?
A. Digital cervical examination
B. Immediate cesarean section
C. Expectant management with hospitalization
D. Oxytocin induction
, C. Expectant management with hospitalization
RATIONALE: Placenta previa is managed expectantly with
hospitalization if bleeding is resolved. Digital cervical examination
is contraindicated as it can provoke severe hemorrhage. Cesarean
section is performed at 36-37 weeks or earlier for recurrent
bleeding.
5. A 55-year-old male with a 40-pack-year smoking history
presents with hemoptysis, weight loss, and a chest X-ray
showing a right hilar mass. Which paraneoplastic
syndrome is most commonly associated with small cell
lung cancer?
A. Hypercalcemia
B. Syndrome of inappropriate antidiuretic hormone (SIADH)
C. Hypertrophic osteoarthropathy
D. Erythema gyratum repens
B. Syndrome of inappropriate antidiuretic hormone (SIADH)
RATIONALE: SIADH (causing hyponatremia) is most
commonly associated with small cell lung cancer. Hypercalcemia
is associated with squamous cell lung cancer (via PTHrP).
Hypertrophic osteoarthropathy is associated with non-small cell
lung cancer, particularly adenocarcinoma.
6. A 25-year-old female presents with cyclic pelvic pain,
dysmenorrhea, and dyspareunia. Laparoscopy reveals
endometrial-like tissue implants on the pelvic peritoneum
and ovaries. Which is the most appropriate first-line
medical treatment?
A. Leuprolide acetate
B. Combined oral contraceptives
COMPLETE 176 QUESTION TEST
BANK ALL QUESTIONS WITH
CORRECT VERIFIED ANSWERS &
DETAILED RATIONALES – GRADED
A+ FOR THE NEWEST 2026 ACTUAL
EXAM
Core Domains
Anatomy & Neuroanatomy
Physiology & Pathophysiology
Pharmacology
Microbiology & Immunology
Biochemistry & Genetics
Osteopathic Principles & Practice
Clinical Medicine & Diagnosis
Behavioral Science & Ethics
Introduction
This comprehensive examination assesses the foundational
biomedical and clinical knowledge required of osteopathic medical
students preparing for 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 6-year-old boy presents with recurrent epistaxis.
Physical exam shows telangiectasias on the lips and
mucosa. Which inheritance pattern best explains this
condition?
A. X-linked recessive
B. Autosomal recessive
C. Mitochondrial
D. Autosomal dominant
D. Autosomal dominant
RATIONALE: Telangiectasias with recurrent nosebleeds
suggest hereditary hemorrhagic telangiectasia (Osler-Weber-
Rendu syndrome), which is inherited in an autosomal dominant
pattern. It is characterized by vascular malformations affecting
skin, mucous membranes, and internal organs.
2. Which enzyme deficiency causes phenylketonuria
(PKU)?
A. Phenylalanine hydroxylase
B. Tyrosine aminotransferase
C. Homogentisate 1,2-dioxygenase
D. Branched-chain alpha-keto acid dehydrogenase
A. Phenylalanine hydroxylase
, RATIONALE: Phenylketonuria (PKU) is caused by deficiency of
phenylalanine hydroxylase, which converts phenylalanine to
tyrosine. This leads to accumulation of phenylalanine, causing
intellectual disability if untreated. Newborn screening and dietary
restriction prevent complications.
3. A 45-year-old male with a history of alcohol use
disorder presents with jaundice, ascites, and confusion.
Laboratory studies show elevated AST and ALT with
AST:ALT ratio >2. Which is the most likely diagnosis?
A. Viral hepatitis
B. Wilson's disease
C. Alcoholic liver disease
D. Hemochromatosis
C. Alcoholic liver disease
RATIONALE: AST:ALT ratio >2 (often >3) is characteristic of
alcoholic liver disease. Viral hepatitis typically has ALT > AST.
Wilson's disease presents with neurological symptoms and
Kayser-Fleischer rings. Hemochromatosis presents with bronze
skin, diabetes, and cardiomyopathy.
4. A 32-year-old pregnant woman presents with painless
vaginal bleeding at 32 weeks gestation. Ultrasound reveals
the placenta covering the internal cervical os. Which is the
most appropriate next step?
A. Digital cervical examination
B. Immediate cesarean section
C. Expectant management with hospitalization
D. Oxytocin induction
, C. Expectant management with hospitalization
RATIONALE: Placenta previa is managed expectantly with
hospitalization if bleeding is resolved. Digital cervical examination
is contraindicated as it can provoke severe hemorrhage. Cesarean
section is performed at 36-37 weeks or earlier for recurrent
bleeding.
5. A 55-year-old male with a 40-pack-year smoking history
presents with hemoptysis, weight loss, and a chest X-ray
showing a right hilar mass. Which paraneoplastic
syndrome is most commonly associated with small cell
lung cancer?
A. Hypercalcemia
B. Syndrome of inappropriate antidiuretic hormone (SIADH)
C. Hypertrophic osteoarthropathy
D. Erythema gyratum repens
B. Syndrome of inappropriate antidiuretic hormone (SIADH)
RATIONALE: SIADH (causing hyponatremia) is most
commonly associated with small cell lung cancer. Hypercalcemia
is associated with squamous cell lung cancer (via PTHrP).
Hypertrophic osteoarthropathy is associated with non-small cell
lung cancer, particularly adenocarcinoma.
6. A 25-year-old female presents with cyclic pelvic pain,
dysmenorrhea, and dyspareunia. Laparoscopy reveals
endometrial-like tissue implants on the pelvic peritoneum
and ovaries. Which is the most appropriate first-line
medical treatment?
A. Leuprolide acetate
B. Combined oral contraceptives
