COMSAE Form 110 — 200+ Practice Questions with
Detailed Answers and Rationales for
Comprehensive Osteopathic Board Review”
•
• 200 original COMLEX-style MCQs (mirroring COMSAE Form
110 difficulty & blueprint).
• Include correct answer & detailed rationale for each question.
• Cover all systems (cardio, resp, GI, MSK, neuro, etc.) and OPP
content.
Sample COMSAE/COMLEX-Style Questions
1. A 23-year-old man presents with severe right lower quadrant
abdominal pain, nausea, and fever. His pain started near the
umbilicus and migrated. On exam, he has rebound tenderness at
McBurney’s point. What is the most likely diagnosis?
A. Crohn’s disease
B. Appendicitis
C. Diverticulitis
D. Gastroenteritis
Answer: B. Appendicitis
Rationale: Migratory pain from periumbilical to RLQ with rebound
tenderness is classic for acute appendicitis. Crohn’s is chronic,
diverticulitis is LLQ, gastroenteritis has diffuse pain.
2. A 2-week-old infant has persistent vomiting and fails to gain
weight. Exam shows dehydration and a palpable olive-shaped mass
,in the RUQ. Labs reveal metabolic alkalosis. What is the next step in
management?
A. Begin oral feeding
B. Start IV fluids and schedule surgical pyloromyotomy
C. Start empiric antibiotics
D. Obtain abdominal ultrasound and observe
Answer: B. Start IV fluids and schedule surgical pyloromyotomy
Rationale: Classic hypertrophic pyloric stenosis. Initial step is IV
fluids/electrolyte correction, followed by pyloromyotomy.
3. A 45-year-old woman with long-standing GERD has new
dysphagia to solids. Upper endoscopy shows an irregular mass at
the gastroesophageal junction. Which of the following is the most
likely histologic finding?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Barrett’s esophagus with metaplasia
D. Peptic ulcer disease
Answer: B. Adenocarcinoma
Rationale: Chronic GERD predisposes to Barrett’s esophagus, which
increases risk for adenocarcinoma of the distal esophagus.
4. A 30-year-old woman presents with progressive weakness,
diplopia, and difficulty chewing at night. Symptoms improve with
rest. Which of the following is most likely?
A. Lambert-Eaton syndrome
B. Myasthenia gravis
C. Botulism
D. Multiple sclerosis
,Answer: B. Myasthenia gravis
Rationale: MG presents with fluctuating, fatigable muscle weakness
(ocular and bulbar involvement). Lambert-Eaton improves with
activity; botulism causes flaccid paralysis; MS has demyelination
signs.
5. A 35-year-old construction worker presents with lower back pain
after lifting heavy objects. Exam shows paraspinal muscle
tenderness without neurologic deficits. Which OMT technique is
most appropriate initially?
A. HVLA of the lumbar spine
B. Counterstrain for lumbar paraspinal muscles
C. Craniosacral therapy
D. Direct myofascial release of the thoracic inlet
Answer: B. Counterstrain for lumbar paraspinal muscles
Rationale: Acute somatic dysfunction with muscle spasm is best
managed initially with indirect techniques like counterstrain, not
HVLA.
Perfect! Let’s continue with Questions 6–50 in the same
COMSAE/COMLEX-style format, each with a correct answer and
rationale.
COMSAE-Style Questions 6–50
6. A 67-year-old woman presents with sudden-onset severe
headache, nausea, and vomiting. She has hypertension and
, hyperlipidemia. CT scan without contrast shows hyperdensity in the
subarachnoid space. What is the next best diagnostic test?
A. MRI of the brain
B. Lumbar puncture
C. CT angiography of the head
D. Carotid Doppler ultrasound
Answer: C. CT angiography of the head
Rationale: Subarachnoid hemorrhage (likely ruptured aneurysm)
requires vascular imaging (CTA or MRA) to locate the aneurysm. LP
is contraindicated with visible blood on CT.
7. A 25-year-old man presents with cough, hemoptysis, and night
sweats. He recently emigrated from India. Chest X-ray shows upper
lobe cavitary lesions. What is the most likely diagnosis?
A. Histoplasmosis
B. Tuberculosis
C. Lung abscess
D. Sarcoidosis
Answer: B. Tuberculosis
Rationale: Cavitary lesions in upper lobes with hemoptysis and night
sweats in a patient from an endemic region is classic TB.
8. A 50-year-old woman presents with fatigue, cold intolerance, and
weight gain. Exam shows dry skin, bradycardia, and delayed
reflexes. TSH is elevated, T4 is low. Which autoimmune disease is
most likely?
A. Graves disease
B. Hashimoto thyroiditis
C. Addison disease
D. Type 1 diabetes mellitus
Detailed Answers and Rationales for
Comprehensive Osteopathic Board Review”
•
• 200 original COMLEX-style MCQs (mirroring COMSAE Form
110 difficulty & blueprint).
• Include correct answer & detailed rationale for each question.
• Cover all systems (cardio, resp, GI, MSK, neuro, etc.) and OPP
content.
Sample COMSAE/COMLEX-Style Questions
1. A 23-year-old man presents with severe right lower quadrant
abdominal pain, nausea, and fever. His pain started near the
umbilicus and migrated. On exam, he has rebound tenderness at
McBurney’s point. What is the most likely diagnosis?
A. Crohn’s disease
B. Appendicitis
C. Diverticulitis
D. Gastroenteritis
Answer: B. Appendicitis
Rationale: Migratory pain from periumbilical to RLQ with rebound
tenderness is classic for acute appendicitis. Crohn’s is chronic,
diverticulitis is LLQ, gastroenteritis has diffuse pain.
2. A 2-week-old infant has persistent vomiting and fails to gain
weight. Exam shows dehydration and a palpable olive-shaped mass
,in the RUQ. Labs reveal metabolic alkalosis. What is the next step in
management?
A. Begin oral feeding
B. Start IV fluids and schedule surgical pyloromyotomy
C. Start empiric antibiotics
D. Obtain abdominal ultrasound and observe
Answer: B. Start IV fluids and schedule surgical pyloromyotomy
Rationale: Classic hypertrophic pyloric stenosis. Initial step is IV
fluids/electrolyte correction, followed by pyloromyotomy.
3. A 45-year-old woman with long-standing GERD has new
dysphagia to solids. Upper endoscopy shows an irregular mass at
the gastroesophageal junction. Which of the following is the most
likely histologic finding?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Barrett’s esophagus with metaplasia
D. Peptic ulcer disease
Answer: B. Adenocarcinoma
Rationale: Chronic GERD predisposes to Barrett’s esophagus, which
increases risk for adenocarcinoma of the distal esophagus.
4. A 30-year-old woman presents with progressive weakness,
diplopia, and difficulty chewing at night. Symptoms improve with
rest. Which of the following is most likely?
A. Lambert-Eaton syndrome
B. Myasthenia gravis
C. Botulism
D. Multiple sclerosis
,Answer: B. Myasthenia gravis
Rationale: MG presents with fluctuating, fatigable muscle weakness
(ocular and bulbar involvement). Lambert-Eaton improves with
activity; botulism causes flaccid paralysis; MS has demyelination
signs.
5. A 35-year-old construction worker presents with lower back pain
after lifting heavy objects. Exam shows paraspinal muscle
tenderness without neurologic deficits. Which OMT technique is
most appropriate initially?
A. HVLA of the lumbar spine
B. Counterstrain for lumbar paraspinal muscles
C. Craniosacral therapy
D. Direct myofascial release of the thoracic inlet
Answer: B. Counterstrain for lumbar paraspinal muscles
Rationale: Acute somatic dysfunction with muscle spasm is best
managed initially with indirect techniques like counterstrain, not
HVLA.
Perfect! Let’s continue with Questions 6–50 in the same
COMSAE/COMLEX-style format, each with a correct answer and
rationale.
COMSAE-Style Questions 6–50
6. A 67-year-old woman presents with sudden-onset severe
headache, nausea, and vomiting. She has hypertension and
, hyperlipidemia. CT scan without contrast shows hyperdensity in the
subarachnoid space. What is the next best diagnostic test?
A. MRI of the brain
B. Lumbar puncture
C. CT angiography of the head
D. Carotid Doppler ultrasound
Answer: C. CT angiography of the head
Rationale: Subarachnoid hemorrhage (likely ruptured aneurysm)
requires vascular imaging (CTA or MRA) to locate the aneurysm. LP
is contraindicated with visible blood on CT.
7. A 25-year-old man presents with cough, hemoptysis, and night
sweats. He recently emigrated from India. Chest X-ray shows upper
lobe cavitary lesions. What is the most likely diagnosis?
A. Histoplasmosis
B. Tuberculosis
C. Lung abscess
D. Sarcoidosis
Answer: B. Tuberculosis
Rationale: Cavitary lesions in upper lobes with hemoptysis and night
sweats in a patient from an endemic region is classic TB.
8. A 50-year-old woman presents with fatigue, cold intolerance, and
weight gain. Exam shows dry skin, bradycardia, and delayed
reflexes. TSH is elevated, T4 is low. Which autoimmune disease is
most likely?
A. Graves disease
B. Hashimoto thyroiditis
C. Addison disease
D. Type 1 diabetes mellitus
