COMSAE PHASE 1 FORM 114 EXAM AND PRACTICE
EXAM NEWEST 2026/ 2027 TEST BANK /
COMPREHENSIVE OSTEOPATHIC MEDICAL SELF-
ASSESSMENT EXAMINATION PHASE 1 EXAM PREP
WITH COMPLETE 300 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED
A+ (MOST RECENT!!)
A 19-year-old college student develops fever, severe headache, and neck
stiffness. Cerebrospinal fluid shows elevated opening pressure,
neutrophilic pleocytosis, low glucose, and elevated protein. Gram stain
reveals gram-negative diplococci. Which virulence factor primarily
allows this organism to evade phagocytosis?
A. M protein
B. Polysaccharide capsule
C. Protein A
D. IgA protease - Correct answer - B
The polysaccharide capsule inhibits phagocytosis and is a major
virulence factor of Neisseria meningitidis. IgA protease facilitates
mucosal colonization but does not directly provide the same
antiphagocytic protection.
A patient with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. MRI demonstrates abnormalities around the
periaqueductal gray matter. Deficiency of which cofactor most directly
impairs the affected metabolic pathways?
A. Pyridoxal phosphate
B. Biotin
pg. 1
,C. Tetrahydrofolate
D. Thiamine pyrophosphate - Correct answer - D
Thiamine pyrophosphate is required by pyruvate dehydrogenase, α-
ketoglutarate dehydrogenase, and transketolase. Thiamine deficiency
causes Wernicke encephalopathy and disrupts cerebral energy
metabolism.
A 42-year-old woman develops progressive proximal muscle weakness.
Laboratory studies show elevated creatine kinase, and muscle biopsy
reveals endomysial inflammation with CD8-positive lymphocytes
invading nonnecrotic muscle fibers. Which mechanism best explains the
tissue injury?
A. Complement-mediated microangiopathy
B. Immune-complex deposition
C. Cytotoxic T-cell activity
D. Antibody blockade of acetylcholine receptors - Correct answer - C
Polymyositis is associated with CD8-positive cytotoxic T cells attacking
muscle fibers. Dermatomyositis, by contrast, is associated with
perifascicular atrophy and complement-mediated injury involving the
microvasculature.
A newborn develops vomiting, lethargy, and tachypnea shortly after
starting protein-containing feeds. Laboratory results show elevated
ammonia, decreased blood urea nitrogen, and increased urinary orotic
acid. Which enzyme deficiency is most likely?
A. Ornithine transcarbamylase
B. Argininosuccinate lyase
C. Carbamoyl phosphate synthetase I
pg. 2
,D. Arginase - Correct answer - A
Ornithine transcarbamylase deficiency causes X-linked
hyperammonemia. Excess mitochondrial carbamoyl phosphate enters the
pyrimidine synthesis pathway, increasing orotic acid. Carbamoyl
phosphate synthetase I deficiency also causes hyperammonemia but
typically does not elevate urinary orotic acid.
A patient with a rapidly growing lung mass develops confusion and a
serum sodium concentration of 119 mEq/L. Serum osmolality is low,
urine osmolality is inappropriately elevated, and the patient appears
euvolemic. Which tumor is most strongly associated with this
presentation?
A. Lung adenocarcinoma
B. Small-cell lung carcinoma
C. Pulmonary squamous cell carcinoma
D. Typical pulmonary carcinoid - Correct answer - B
Small-cell lung carcinoma can secrete ectopic antidiuretic hormone,
producing syndrome of inappropriate antidiuretic hormone secretion
(SIADH). The resulting water retention causes dilutional hyponatremia
with concentrated urine despite low serum osmolality.
A 56-year-old man develops sudden right-sided weakness and expressive
aphasia. Imaging identifies an infarct involving the dominant inferior
frontal gyrus. Which arterial branch is most likely occluded?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Lenticulostriate artery
D. Superior division of the middle cerebral artery - Correct answer - D
pg. 3
, Broca area lies in the dominant inferior frontal gyrus and is supplied
primarily by the superior division of the middle cerebral artery. Its injury
produces nonfluent speech with relatively preserved comprehension.
A 35-year-old woman experiences episodic palpitations, diaphoresis, and
severe headaches. Plasma metanephrines are elevated. During surgical
preparation, which medication sequence is most appropriate?
A. Alpha blockade followed by beta blockade
B. Beta blockade followed by alpha blockade
C. Calcium-channel blockade followed by beta blockade
D. Beta blockade alone - Correct answer - A
In pheochromocytoma, alpha-adrenergic blockade must precede beta
blockade. Giving a beta blocker first can leave alpha-mediated
vasoconstriction unopposed, precipitating a hypertensive crisis.
A 27-year-old man develops jaundice and dark urine after taking an
oxidant medication. Blood smear reveals bite cells, and supravital
staining demonstrates Heinz bodies. Which biochemical defect is
responsible?
A. Impaired heme synthesis
B. Reduced lysosomal degradation
C. Decreased NADPH generation
D. Defective globin-chain assembly - Correct answer - C
Glucose-6-phosphate dehydrogenase deficiency reduces NADPH
production through the pentose phosphate pathway. Without sufficient
NADPH, erythrocytes cannot adequately regenerate reduced glutathione,
making them vulnerable to oxidative injury.
pg. 4
EXAM NEWEST 2026/ 2027 TEST BANK /
COMPREHENSIVE OSTEOPATHIC MEDICAL SELF-
ASSESSMENT EXAMINATION PHASE 1 EXAM PREP
WITH COMPLETE 300 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED
A+ (MOST RECENT!!)
A 19-year-old college student develops fever, severe headache, and neck
stiffness. Cerebrospinal fluid shows elevated opening pressure,
neutrophilic pleocytosis, low glucose, and elevated protein. Gram stain
reveals gram-negative diplococci. Which virulence factor primarily
allows this organism to evade phagocytosis?
A. M protein
B. Polysaccharide capsule
C. Protein A
D. IgA protease - Correct answer - B
The polysaccharide capsule inhibits phagocytosis and is a major
virulence factor of Neisseria meningitidis. IgA protease facilitates
mucosal colonization but does not directly provide the same
antiphagocytic protection.
A patient with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. MRI demonstrates abnormalities around the
periaqueductal gray matter. Deficiency of which cofactor most directly
impairs the affected metabolic pathways?
A. Pyridoxal phosphate
B. Biotin
pg. 1
,C. Tetrahydrofolate
D. Thiamine pyrophosphate - Correct answer - D
Thiamine pyrophosphate is required by pyruvate dehydrogenase, α-
ketoglutarate dehydrogenase, and transketolase. Thiamine deficiency
causes Wernicke encephalopathy and disrupts cerebral energy
metabolism.
A 42-year-old woman develops progressive proximal muscle weakness.
Laboratory studies show elevated creatine kinase, and muscle biopsy
reveals endomysial inflammation with CD8-positive lymphocytes
invading nonnecrotic muscle fibers. Which mechanism best explains the
tissue injury?
A. Complement-mediated microangiopathy
B. Immune-complex deposition
C. Cytotoxic T-cell activity
D. Antibody blockade of acetylcholine receptors - Correct answer - C
Polymyositis is associated with CD8-positive cytotoxic T cells attacking
muscle fibers. Dermatomyositis, by contrast, is associated with
perifascicular atrophy and complement-mediated injury involving the
microvasculature.
A newborn develops vomiting, lethargy, and tachypnea shortly after
starting protein-containing feeds. Laboratory results show elevated
ammonia, decreased blood urea nitrogen, and increased urinary orotic
acid. Which enzyme deficiency is most likely?
A. Ornithine transcarbamylase
B. Argininosuccinate lyase
C. Carbamoyl phosphate synthetase I
pg. 2
,D. Arginase - Correct answer - A
Ornithine transcarbamylase deficiency causes X-linked
hyperammonemia. Excess mitochondrial carbamoyl phosphate enters the
pyrimidine synthesis pathway, increasing orotic acid. Carbamoyl
phosphate synthetase I deficiency also causes hyperammonemia but
typically does not elevate urinary orotic acid.
A patient with a rapidly growing lung mass develops confusion and a
serum sodium concentration of 119 mEq/L. Serum osmolality is low,
urine osmolality is inappropriately elevated, and the patient appears
euvolemic. Which tumor is most strongly associated with this
presentation?
A. Lung adenocarcinoma
B. Small-cell lung carcinoma
C. Pulmonary squamous cell carcinoma
D. Typical pulmonary carcinoid - Correct answer - B
Small-cell lung carcinoma can secrete ectopic antidiuretic hormone,
producing syndrome of inappropriate antidiuretic hormone secretion
(SIADH). The resulting water retention causes dilutional hyponatremia
with concentrated urine despite low serum osmolality.
A 56-year-old man develops sudden right-sided weakness and expressive
aphasia. Imaging identifies an infarct involving the dominant inferior
frontal gyrus. Which arterial branch is most likely occluded?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Lenticulostriate artery
D. Superior division of the middle cerebral artery - Correct answer - D
pg. 3
, Broca area lies in the dominant inferior frontal gyrus and is supplied
primarily by the superior division of the middle cerebral artery. Its injury
produces nonfluent speech with relatively preserved comprehension.
A 35-year-old woman experiences episodic palpitations, diaphoresis, and
severe headaches. Plasma metanephrines are elevated. During surgical
preparation, which medication sequence is most appropriate?
A. Alpha blockade followed by beta blockade
B. Beta blockade followed by alpha blockade
C. Calcium-channel blockade followed by beta blockade
D. Beta blockade alone - Correct answer - A
In pheochromocytoma, alpha-adrenergic blockade must precede beta
blockade. Giving a beta blocker first can leave alpha-mediated
vasoconstriction unopposed, precipitating a hypertensive crisis.
A 27-year-old man develops jaundice and dark urine after taking an
oxidant medication. Blood smear reveals bite cells, and supravital
staining demonstrates Heinz bodies. Which biochemical defect is
responsible?
A. Impaired heme synthesis
B. Reduced lysosomal degradation
C. Decreased NADPH generation
D. Defective globin-chain assembly - Correct answer - C
Glucose-6-phosphate dehydrogenase deficiency reduces NADPH
production through the pentose phosphate pathway. Without sufficient
NADPH, erythrocytes cannot adequately regenerate reduced glutathione,
making them vulnerable to oxidative injury.
pg. 4
