COMSAE PHASE 1 ASA 116 – THE COMPLETE
176 QUESTION TEST BANK ALL QUESTIONS
WITH CORRECT VERIFIED ANSWERS &
DETAILED RATIONALES – GRADED A+ FOR
THE NEWEST 2026 ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Osteopathic Principles and Practice (OMM)
Cardiology
Pulmonology
Neurology
Endocrinology
Microbiology and Immunology
Pharmacology
Biostatistics and Epidemiology
Pathology and Pathophysiology
Behavioral Science and Ethics
Introduction
This comprehensive assessment evaluates the osteopathic medical
knowledge and clinical reasoning skills required for COMLEX-USA Level
1 readiness. The examination systematically assesses foundational
biomedical sciences, osteopathic manipulative medicine, and clinical
,presentation across multiple organ systems. Comprising multiple-choice
and scenario-based items, the test mirrors the integrated cognitive
demands of the NBOME COMSAE Phase 1 examination. Special
emphasis is placed on viscerosomatic reflexes, somatic dysfunction
diagnosis, and real-world application of clinical decision-making,
ensuring candidates demonstrate the foundational readiness for
osteopathic medical licensure.
Section One: Questions 1–176
1. 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
B. Streptococcus pneumoniae
RATIONALE: Bacterial meningitis in adults is most commonly caused
by Streptococcus pneumoniae. The CSF findings (elevated opening
pressure, low glucose, high protein) are classic for bacterial meningitis.
While N. meningitidis (A) is also a common cause, S. pneumoniae is the
most frequent pathogen overall in adults.
2. 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
B. Renal cell carcinoma
RATIONALE: Renal cell carcinoma is the most common malignant
renal tumor in adults, strongly associated with smoking and typically
presenting with hematuria, flank pain, and a palpable mass. Wilms tumor
(A) occurs in children. Transitional cell carcinoma (C) arises from the
urothelium of the renal pelvis/ureter. Angiomyolipoma (D) is benign and
often contains fat on imaging.
3. Which electrolyte abnormality is most associated with ECG
showing peaked T waves?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hyponatremia
B. Hyperkalemia
RATIONALE: Hyperkalemia causes peaked ("tented") T waves due to
altered cardiac repolarization. Other ECG changes include widened QRS,
prolonged PR interval, and eventually sine wave pattern and asystole.
Hypokalemia (A) causes flat T waves and prominent U waves.
Hypercalcemia (C) shortens the QT interval.
4. A child presents with barking cough and inspiratory stridor. What is
the most likely diagnosis?
A. Epiglottitis
B. Croup
, C. Bronchiolitis
D. Asthma
B. Croup
RATIONALE: Croup (laryngotracheobronchitis) classically presents
with a barking cough, inspiratory stridor, and respiratory distress in young
children. Epiglottitis (A) presents with high fever, drooling, and tripod
positioning, often without barking cough. Bronchiolitis (C) presents with
wheezing and respiratory distress in infants; asthma (D) presents with
wheezing.
5. Which hormone is produced by the posterior pituitary?
A. ACTH
B. TSH
C. Oxytocin
D. GH
C. Oxytocin
RATIONALE: The posterior pituitary stores and releases oxytocin and
antidiuretic hormone (ADH, vasopressin), which are synthesized in the
hypothalamus. ACTH (A), TSH (B), and GH (D) are produced by the
anterior pituitary.
6. A 25-year-old man develops fever, headache, and a petechial rash.
Cerebrospinal fluid demonstrates gram-negative diplococci. Which
virulence factor allows this organism to evade phagocytosis?
A. Endospore formation
B. Lipoteichoic acid
C. M protein
176 QUESTION TEST BANK ALL QUESTIONS
WITH CORRECT VERIFIED ANSWERS &
DETAILED RATIONALES – GRADED A+ FOR
THE NEWEST 2026 ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Osteopathic Principles and Practice (OMM)
Cardiology
Pulmonology
Neurology
Endocrinology
Microbiology and Immunology
Pharmacology
Biostatistics and Epidemiology
Pathology and Pathophysiology
Behavioral Science and Ethics
Introduction
This comprehensive assessment evaluates the osteopathic medical
knowledge and clinical reasoning skills required for COMLEX-USA Level
1 readiness. The examination systematically assesses foundational
biomedical sciences, osteopathic manipulative medicine, and clinical
,presentation across multiple organ systems. Comprising multiple-choice
and scenario-based items, the test mirrors the integrated cognitive
demands of the NBOME COMSAE Phase 1 examination. Special
emphasis is placed on viscerosomatic reflexes, somatic dysfunction
diagnosis, and real-world application of clinical decision-making,
ensuring candidates demonstrate the foundational readiness for
osteopathic medical licensure.
Section One: Questions 1–176
1. 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
B. Streptococcus pneumoniae
RATIONALE: Bacterial meningitis in adults is most commonly caused
by Streptococcus pneumoniae. The CSF findings (elevated opening
pressure, low glucose, high protein) are classic for bacterial meningitis.
While N. meningitidis (A) is also a common cause, S. pneumoniae is the
most frequent pathogen overall in adults.
2. 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
B. Renal cell carcinoma
RATIONALE: Renal cell carcinoma is the most common malignant
renal tumor in adults, strongly associated with smoking and typically
presenting with hematuria, flank pain, and a palpable mass. Wilms tumor
(A) occurs in children. Transitional cell carcinoma (C) arises from the
urothelium of the renal pelvis/ureter. Angiomyolipoma (D) is benign and
often contains fat on imaging.
3. Which electrolyte abnormality is most associated with ECG
showing peaked T waves?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hyponatremia
B. Hyperkalemia
RATIONALE: Hyperkalemia causes peaked ("tented") T waves due to
altered cardiac repolarization. Other ECG changes include widened QRS,
prolonged PR interval, and eventually sine wave pattern and asystole.
Hypokalemia (A) causes flat T waves and prominent U waves.
Hypercalcemia (C) shortens the QT interval.
4. A child presents with barking cough and inspiratory stridor. What is
the most likely diagnosis?
A. Epiglottitis
B. Croup
, C. Bronchiolitis
D. Asthma
B. Croup
RATIONALE: Croup (laryngotracheobronchitis) classically presents
with a barking cough, inspiratory stridor, and respiratory distress in young
children. Epiglottitis (A) presents with high fever, drooling, and tripod
positioning, often without barking cough. Bronchiolitis (C) presents with
wheezing and respiratory distress in infants; asthma (D) presents with
wheezing.
5. Which hormone is produced by the posterior pituitary?
A. ACTH
B. TSH
C. Oxytocin
D. GH
C. Oxytocin
RATIONALE: The posterior pituitary stores and releases oxytocin and
antidiuretic hormone (ADH, vasopressin), which are synthesized in the
hypothalamus. ACTH (A), TSH (B), and GH (D) are produced by the
anterior pituitary.
6. A 25-year-old man develops fever, headache, and a petechial rash.
Cerebrospinal fluid demonstrates gram-negative diplococci. Which
virulence factor allows this organism to evade phagocytosis?
A. Endospore formation
B. Lipoteichoic acid
C. M protein
