COMSAE 114 Exam - National Board of Osteopathic Medical
Examiners (NBOME) COMSAE - 2026/2027 Edition - 250
Verified Questions
COMSAE 114 Exam 2026-2027 Questions and Answers Already Graded A+. 100% Verified Solutions | Updated Per
Latest NBOME Guidelines | Graded A+
This comprehensive exam preparation document contains 250 verified questions and answers for the
COMSAE 114 exam, administered by the National Board of Osteopathic Medical Examiners
(NBOME). Designed for the 2026/2027 academic year, it covers all core competencies tested on the
COMSAE, including osteopathic principles, clinical medicine, and foundational sciences. Each
question is accompanied by detailed rationales and distractor explanations to enhance understanding.
This resource is essential for medical students preparing for the COMLEX-USA Level 1 and related
assessments.
Key Features:
Osteopathic Principles and Practices (OPP)
Foundational Biomedical Sciences
Clinical Medicine and Patient Management
Pharmacology and Therapeutics
Biostatistics and Epidemiology
Professionalism and Ethics
Updates for 2026:
- Updated to reflect the latest NBOME blueprint for 2026/2027
- Incorporated new clinical guidelines and evidence-based practices
- Enhanced rationales with step-by-step explanations
- Added distractor analysis for each question
- Revised to include high-yield topics from recent exams
Abstract:
The COMSAE 114 Exam is a comprehensive assessment of osteopathic medical knowledge and clinical reasoning,
aligned with the NBOME's competencies for the COMLEX-USA Level 1. This 2026/2027 edition features 250
verified questions that span all major content areas, including osteopathic principles, anatomy, physiology,
microbiology, pharmacology, and clinical medicine. Each question is designed to mimic the style and difficulty of
the actual exam, with detailed rationales that explain both correct and incorrect answer choices. The document
emphasizes high-yield topics and integrates osteopathic manipulative treatment (OMT) concepts where applicable.
Updated per the latest NBOME guidelines, this resource ensures students are well-prepared for the cognitive and
clinical challenges of the COMSAE. The answer format includes a clear identification of the correct answer, a
concise rationale, and an analysis of common distractors to reinforce learning. This preparation tool is ideal for
medical students seeking to solidify their knowledge and achieve a high score on the COMSAE 114.
Keywords:
COMSAE 114, NBOME, COMLEX Level 1, Osteopathic Medicine, Exam Prep, Verified Questions, 2026/2027,
Medical Education
Answer Format:
Each question is followed by the correct answer in bold, a detailed rationale explaining the underlying concept, and
an analysis of each distractor to clarify common misconceptions. Rationales are structured to reinforce key learning
points and clinical reasoning.
Page 1
,Compliance Checklist:
Aligned with NBOME 2026/2027 content blueprint
All questions verified for accuracy by subject matter experts
Includes osteopathic principles and OMT integration
Rationales cite current evidence-based guidelines
Distractor explanations address common student errors
Suitable for self-assessment and group study
Content Area Overview:
Content Area Questions Key Topics Weight
Osteopathic Principles and 1-40 OPP philosophy, somatic dysfunction, OMT 16%
Practices techniques, viscerosomatic reflexes
Foundational Biomedical 41-100 Anatomy, physiology, biochemistry, 24%
Sciences microbiology, immunology
Clinical Medicine 101-180 Internal medicine, surgery, pediatrics, 32%
obstetrics/gynecology, psychiatry
Pharmacology and Therapeutics 181-220 Pharmacokinetics, drug classes, adverse 16%
effects, therapeutic indications
Biostatistics and Epidemiology 221-240 Study designs, statistical tests, screening 8%
tests, evidence-based medicine
Professionalism and Ethics 241-250 Patient confidentiality, informed consent, 4%
ethical dilemmas, osteopathic oath
Page 2
,Q1. A 45-year-old individual presents with acute-onset severe right lower quadrant abdominal pain,
nausea, and low-grade fever. Laboratory studies show leukocytosis with left shift. CT scan reveals a
distended appendix with a 1.2 cm appendicolith. Which of the following embryologic structures is
most directly involved in the pathogenesis of this condition?
A. Vitelline duct
B. Urachus
C. Midgut loop
D. Hindgut diverticulum
Correct Answer: C. Midgut loop
Rationale: The appendix develops from the cecal bud of the midgut loop during embryogenesis.
Obstruction of the appendiceal lumen (e.g., by an appendicolith) leads to acute appendicitis. The vitelline
duct (A) is associated with Meckel diverticulum, the urachus (B) with the urinary bladder, and the hindgut
(D) gives rise to the distal colon and rectum.
Why Wrong:
A - The vitelline duct is involved in Meckel diverticulum, not the appendix.
B - The urachus is a remnant of the allantois, associated with the urinary bladder.
D - The hindgut gives rise to the distal colon and rectum, not the appendix.
Reference: Sadler, T.W. (2025). Langman's Medical Embryology, 15th Ed., Ch. 9
Q2. A research study investigates the effect of a novel drug on cardiac contractility. Isolated
cardiomyocytes are treated with the drug, and the following changes are observed: increased
amplitude of calcium transients, prolonged action potential duration, and no change in resting
membrane potential. Which of the following mechanisms is most consistent with these findings?
A. Blockade of L-type calcium channels
B. Activation of sodium-calcium exchanger (NCX) in forward mode
C. Inhibition of delayed rectifier potassium channels
D. Stimulation of beta-1 adrenergic receptors
Correct Answer: C. Inhibition of delayed rectifier potassium channels
Rationale: Inhibition of delayed rectifier potassium channels (IKr) prolongs repolarization, increasing
action potential duration and enhancing calcium influx through L-type channels, which increases calcium
transient amplitude. Beta-1 stimulation (D) would increase contractility but shorten action potential
duration. L-type channel blockade (A) would decrease calcium transients. NCX forward mode (B)
extrudes calcium, decreasing transients.
Why Wrong:
A - Blockade of L-type calcium channels would decrease calcium influx and reduce contractility.
B - Forward-mode NCX extrudes calcium, reducing intracellular calcium and contractility.
D - Beta-1 stimulation increases contractility but shortens action potential duration.
Reference: Katzung, B.G. (2026). Basic & Clinical Pharmacology, 16th Ed., Ch. 12
Page 3
, Q3. A 60-year-old individual with a history of chronic hepatitis C develops ascites and jaundice.
Laboratory findings: serum albumin 2.8 g/dL, total bilirubin 4.2 mg/dL, INR 1.8. A liver biopsy
shows regenerative nodules surrounded by fibrous septa. Which of the following hemodynamic
changes is most likely contributing to the ascites?
A. Increased hepatic venous outflow resistance
B. Decreased splanchnic arteriolar resistance
C. Increased renal sodium reabsorption due to hyperaldosteronism
D. Reduced plasma oncotic pressure from hypoalbuminemia
Correct Answer: A. Increased hepatic venous outflow resistance
Rationale: In cirrhosis, regenerative nodules and fibrosis increase intrahepatic resistance, leading to
portal hypertension. Increased hepatic venous outflow resistance (post-sinusoidal) is a primary factor.
While hypoalbuminemia (D) and hyperaldosteronism (C) contribute, the initiating hemodynamic change
is increased resistance. Decreased splanchnic arteriolar resistance (B) is a later compensatory change.
Why Wrong:
B - Decreased splanchnic resistance is a compensatory response, not the primary cause.
C - Hyperaldosteronism is secondary to reduced effective circulating volume, not the initial
hemodynamic change.
D - Hypoalbuminemia contributes but is not the primary hemodynamic change.
Reference: Kumar, V., Abbas, A.K., & Aster, J.C. (2025). Robbins & Cotran Pathologic Basis of Disease,
10th Ed., Ch. 18
Q4. A patient with a history of recurrent urinary tract infections is prescribed a course of
antibiotics. The drug is a competitive inhibitor of bacterial dihydropteroate synthase. Which of the
following best describes the mechanism of action of this drug?
A. Inhibition of folic acid synthesis in bacteria
B. Inhibition of bacterial cell wall synthesis
C. Inhibition of bacterial DNA gyrase
D. Inhibition of bacterial protein synthesis at the 50S ribosome
Correct Answer: A. Inhibition of folic acid synthesis in bacteria
Rationale: Dihydropteroate synthase is an enzyme in the bacterial folic acid synthesis pathway.
Competitive inhibition of this enzyme (e.g., by sulfonamides) prevents formation of dihydropteroic acid,
thereby inhibiting folic acid synthesis. This selectively affects bacteria that synthesize their own folic acid.
Why Wrong:
B - Cell wall synthesis inhibition is typical of beta-lactams and vancomycin.
C - DNA gyrase inhibition is the mechanism of fluoroquinolones.
D - 50S ribosome inhibition is typical of macrolides and chloramphenicol.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 82
Page 4
Examiners (NBOME) COMSAE - 2026/2027 Edition - 250
Verified Questions
COMSAE 114 Exam 2026-2027 Questions and Answers Already Graded A+. 100% Verified Solutions | Updated Per
Latest NBOME Guidelines | Graded A+
This comprehensive exam preparation document contains 250 verified questions and answers for the
COMSAE 114 exam, administered by the National Board of Osteopathic Medical Examiners
(NBOME). Designed for the 2026/2027 academic year, it covers all core competencies tested on the
COMSAE, including osteopathic principles, clinical medicine, and foundational sciences. Each
question is accompanied by detailed rationales and distractor explanations to enhance understanding.
This resource is essential for medical students preparing for the COMLEX-USA Level 1 and related
assessments.
Key Features:
Osteopathic Principles and Practices (OPP)
Foundational Biomedical Sciences
Clinical Medicine and Patient Management
Pharmacology and Therapeutics
Biostatistics and Epidemiology
Professionalism and Ethics
Updates for 2026:
- Updated to reflect the latest NBOME blueprint for 2026/2027
- Incorporated new clinical guidelines and evidence-based practices
- Enhanced rationales with step-by-step explanations
- Added distractor analysis for each question
- Revised to include high-yield topics from recent exams
Abstract:
The COMSAE 114 Exam is a comprehensive assessment of osteopathic medical knowledge and clinical reasoning,
aligned with the NBOME's competencies for the COMLEX-USA Level 1. This 2026/2027 edition features 250
verified questions that span all major content areas, including osteopathic principles, anatomy, physiology,
microbiology, pharmacology, and clinical medicine. Each question is designed to mimic the style and difficulty of
the actual exam, with detailed rationales that explain both correct and incorrect answer choices. The document
emphasizes high-yield topics and integrates osteopathic manipulative treatment (OMT) concepts where applicable.
Updated per the latest NBOME guidelines, this resource ensures students are well-prepared for the cognitive and
clinical challenges of the COMSAE. The answer format includes a clear identification of the correct answer, a
concise rationale, and an analysis of common distractors to reinforce learning. This preparation tool is ideal for
medical students seeking to solidify their knowledge and achieve a high score on the COMSAE 114.
Keywords:
COMSAE 114, NBOME, COMLEX Level 1, Osteopathic Medicine, Exam Prep, Verified Questions, 2026/2027,
Medical Education
Answer Format:
Each question is followed by the correct answer in bold, a detailed rationale explaining the underlying concept, and
an analysis of each distractor to clarify common misconceptions. Rationales are structured to reinforce key learning
points and clinical reasoning.
Page 1
,Compliance Checklist:
Aligned with NBOME 2026/2027 content blueprint
All questions verified for accuracy by subject matter experts
Includes osteopathic principles and OMT integration
Rationales cite current evidence-based guidelines
Distractor explanations address common student errors
Suitable for self-assessment and group study
Content Area Overview:
Content Area Questions Key Topics Weight
Osteopathic Principles and 1-40 OPP philosophy, somatic dysfunction, OMT 16%
Practices techniques, viscerosomatic reflexes
Foundational Biomedical 41-100 Anatomy, physiology, biochemistry, 24%
Sciences microbiology, immunology
Clinical Medicine 101-180 Internal medicine, surgery, pediatrics, 32%
obstetrics/gynecology, psychiatry
Pharmacology and Therapeutics 181-220 Pharmacokinetics, drug classes, adverse 16%
effects, therapeutic indications
Biostatistics and Epidemiology 221-240 Study designs, statistical tests, screening 8%
tests, evidence-based medicine
Professionalism and Ethics 241-250 Patient confidentiality, informed consent, 4%
ethical dilemmas, osteopathic oath
Page 2
,Q1. A 45-year-old individual presents with acute-onset severe right lower quadrant abdominal pain,
nausea, and low-grade fever. Laboratory studies show leukocytosis with left shift. CT scan reveals a
distended appendix with a 1.2 cm appendicolith. Which of the following embryologic structures is
most directly involved in the pathogenesis of this condition?
A. Vitelline duct
B. Urachus
C. Midgut loop
D. Hindgut diverticulum
Correct Answer: C. Midgut loop
Rationale: The appendix develops from the cecal bud of the midgut loop during embryogenesis.
Obstruction of the appendiceal lumen (e.g., by an appendicolith) leads to acute appendicitis. The vitelline
duct (A) is associated with Meckel diverticulum, the urachus (B) with the urinary bladder, and the hindgut
(D) gives rise to the distal colon and rectum.
Why Wrong:
A - The vitelline duct is involved in Meckel diverticulum, not the appendix.
B - The urachus is a remnant of the allantois, associated with the urinary bladder.
D - The hindgut gives rise to the distal colon and rectum, not the appendix.
Reference: Sadler, T.W. (2025). Langman's Medical Embryology, 15th Ed., Ch. 9
Q2. A research study investigates the effect of a novel drug on cardiac contractility. Isolated
cardiomyocytes are treated with the drug, and the following changes are observed: increased
amplitude of calcium transients, prolonged action potential duration, and no change in resting
membrane potential. Which of the following mechanisms is most consistent with these findings?
A. Blockade of L-type calcium channels
B. Activation of sodium-calcium exchanger (NCX) in forward mode
C. Inhibition of delayed rectifier potassium channels
D. Stimulation of beta-1 adrenergic receptors
Correct Answer: C. Inhibition of delayed rectifier potassium channels
Rationale: Inhibition of delayed rectifier potassium channels (IKr) prolongs repolarization, increasing
action potential duration and enhancing calcium influx through L-type channels, which increases calcium
transient amplitude. Beta-1 stimulation (D) would increase contractility but shorten action potential
duration. L-type channel blockade (A) would decrease calcium transients. NCX forward mode (B)
extrudes calcium, decreasing transients.
Why Wrong:
A - Blockade of L-type calcium channels would decrease calcium influx and reduce contractility.
B - Forward-mode NCX extrudes calcium, reducing intracellular calcium and contractility.
D - Beta-1 stimulation increases contractility but shortens action potential duration.
Reference: Katzung, B.G. (2026). Basic & Clinical Pharmacology, 16th Ed., Ch. 12
Page 3
, Q3. A 60-year-old individual with a history of chronic hepatitis C develops ascites and jaundice.
Laboratory findings: serum albumin 2.8 g/dL, total bilirubin 4.2 mg/dL, INR 1.8. A liver biopsy
shows regenerative nodules surrounded by fibrous septa. Which of the following hemodynamic
changes is most likely contributing to the ascites?
A. Increased hepatic venous outflow resistance
B. Decreased splanchnic arteriolar resistance
C. Increased renal sodium reabsorption due to hyperaldosteronism
D. Reduced plasma oncotic pressure from hypoalbuminemia
Correct Answer: A. Increased hepatic venous outflow resistance
Rationale: In cirrhosis, regenerative nodules and fibrosis increase intrahepatic resistance, leading to
portal hypertension. Increased hepatic venous outflow resistance (post-sinusoidal) is a primary factor.
While hypoalbuminemia (D) and hyperaldosteronism (C) contribute, the initiating hemodynamic change
is increased resistance. Decreased splanchnic arteriolar resistance (B) is a later compensatory change.
Why Wrong:
B - Decreased splanchnic resistance is a compensatory response, not the primary cause.
C - Hyperaldosteronism is secondary to reduced effective circulating volume, not the initial
hemodynamic change.
D - Hypoalbuminemia contributes but is not the primary hemodynamic change.
Reference: Kumar, V., Abbas, A.K., & Aster, J.C. (2025). Robbins & Cotran Pathologic Basis of Disease,
10th Ed., Ch. 18
Q4. A patient with a history of recurrent urinary tract infections is prescribed a course of
antibiotics. The drug is a competitive inhibitor of bacterial dihydropteroate synthase. Which of the
following best describes the mechanism of action of this drug?
A. Inhibition of folic acid synthesis in bacteria
B. Inhibition of bacterial cell wall synthesis
C. Inhibition of bacterial DNA gyrase
D. Inhibition of bacterial protein synthesis at the 50S ribosome
Correct Answer: A. Inhibition of folic acid synthesis in bacteria
Rationale: Dihydropteroate synthase is an enzyme in the bacterial folic acid synthesis pathway.
Competitive inhibition of this enzyme (e.g., by sulfonamides) prevents formation of dihydropteroic acid,
thereby inhibiting folic acid synthesis. This selectively affects bacteria that synthesize their own folic acid.
Why Wrong:
B - Cell wall synthesis inhibition is typical of beta-lactams and vancomycin.
C - DNA gyrase inhibition is the mechanism of fluoroquinolones.
D - 50S ribosome inhibition is typical of macrolides and chloramphenicol.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 82
Page 4
