COMSAE Phase 1 Form 112 Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales 2025/2026
Q&A | Instant Download Pdf
1. A 45-year-old woman presents with epigastric burning and bloating after
meals. On osteopathic structural exam, you find tenderness and increased
tissue texture at the right T6–T8 paraspinal region. Which viscerosomatic
reflex best explains this finding?
A) Gallbladder
B) Pancreas
C) Liver
D) Stomach
✅ Correct Answer: D) Stomach
📝 Rationale: Viscerosomatic reflexes map spinal cord levels to organs. The
stomach corresponds to T6–T9, with a predilection for the right side in many
sources. The gallbladder (T7–T9) often presents on the right, but the epigastric
symptoms and bilateral T6–T8 tenderness more specifically point to the stomach.
Recognizing spinal levels for common organs is essential for COMSAE .
2. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. Chest CT shows a 4 cm right
,hilar mass with mediastinal lymphadenopathy. Biopsy reveals small round
blue cells. Which immunohistochemical stain is most likely positive in this
tumor?
A) Cytokeratin 7
B) Thyroid transcription factor-1 (TTF-1)
C) Chromogranin
D) p63
✅ Correct Answer: C) Chromogranin
📝 Rationale: Small cell lung cancer (small round blue cells) is a neuroendocrine
tumor. Chromogranin, synaptophysin, and CD56 are positive markers of
neuroendocrine differentiation. TTF-1 is also often positive but less specific for
neuroendocrine differentiation; chromogranin is the classic neuroendocrine
marker .
3. A 22-year-old college student develops sudden onset of fever, chills, and a
productive cough with rust-colored sputum. A chest X-ray shows right lower
lobe consolidation. Gram stain of sputum reveals numerous neutrophils and
lancet-shaped Gram-positive diplococci. Which virulence factor is most
directly responsible for the organism's ability to avoid phagocytosis?
A) IgA protease
B) Protein M
C) Polysaccharide capsule
D) Exotoxin A
✅ Correct Answer: C) Polysaccharide capsule
📝 Rationale: The presentation is classic for Streptococcus pneumoniae
(pneumococcus). Its primary virulence factor is the polysaccharide capsule, which
,prevents phagocytosis by inhibiting complement deposition and opsonization. IgA
protease is associated with Haemophilus influenzae and Neisseria. Protein M is a
virulence factor of Streptococcus pyogenes .
4. A 72-year-old man with chronic kidney disease stage 4 (eGFR 25 mL/min)
presents with fatigue, bone pain, serum calcium 8.0 mg/dL, phosphorus 6.0
mg/dL, and PTH 450 pg/mL. Which medication reduces PTH in this setting?
A) Calcium acetate
B) Sevelamer
C) Calcitriol
D) Aluminum hydroxide
✅ Correct Answer: C) Calcitriol
📝 Rationale: Secondary hyperparathyroidism of CKD is treated with active
vitamin D (calcitriol) to suppress PTH, along with phosphate binders. Calcium
acetate and sevelamer are phosphate binders that address hyperphosphatemia but
do not directly suppress PTH. Calcitriol acts to increase calcium absorption and
directly suppress parathyroid gland activity .
5. A 68-year-old man with a history of hypertension reports progressive
dyspnea on exertion. On cardiac auscultation, you hear a harsh, crescendo-
decrescendo murmur at the right upper sternal border that radiates to the
carotids. The murmur increases in intensity with squatting. What is the most
likely diagnosis?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
, C) Mitral regurgitation
D) Pulmonic stenosis
✅ Correct Answer: A) Aortic stenosis
📝 Rationale: Aortic stenosis presents with a harsh, crescendo-decrescendo
systolic murmur best heard at the right upper sternal border (aortic area) with
radiation to the carotids. The murmur increases with squatting (increased preload)
and decreases with Valsalva. Hypertrophic cardiomyopathy also has a systolic
murmur but typically decreases with squatting and increases with Valsalva .
6. A 56-year-old man with hypertension and type 2 diabetes presents with a
non-healing ulcer on his right great toe. Ankle-brachial index is 0.45. Which
finding on physical examination is most consistent with this condition?
A) Bounding dorsalis pedis pulses
B) Hair loss on the lower leg and shiny skin
C) Warm, erythematous toes with edema
D) Pigmentation around the ankles
✅ Correct Answer: B) Hair loss on the lower leg and shiny skin
📝 Rationale: Chronic arterial insufficiency (ABI < 0.90 indicates peripheral
artery disease) leads to loss of hair, shiny atrophic skin, thickened nails, and cool
extremities. Bounding pulses suggest hyperdynamic circulation, not ischemia.
Warm, erythematous toes with edema suggest cellulitis or inflammatory
conditions .
Questions And Correct Answers (Verified
Answers) Plus Rationales 2025/2026
Q&A | Instant Download Pdf
1. A 45-year-old woman presents with epigastric burning and bloating after
meals. On osteopathic structural exam, you find tenderness and increased
tissue texture at the right T6–T8 paraspinal region. Which viscerosomatic
reflex best explains this finding?
A) Gallbladder
B) Pancreas
C) Liver
D) Stomach
✅ Correct Answer: D) Stomach
📝 Rationale: Viscerosomatic reflexes map spinal cord levels to organs. The
stomach corresponds to T6–T9, with a predilection for the right side in many
sources. The gallbladder (T7–T9) often presents on the right, but the epigastric
symptoms and bilateral T6–T8 tenderness more specifically point to the stomach.
Recognizing spinal levels for common organs is essential for COMSAE .
2. A 45-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a persistent cough. Chest CT shows a 4 cm right
,hilar mass with mediastinal lymphadenopathy. Biopsy reveals small round
blue cells. Which immunohistochemical stain is most likely positive in this
tumor?
A) Cytokeratin 7
B) Thyroid transcription factor-1 (TTF-1)
C) Chromogranin
D) p63
✅ Correct Answer: C) Chromogranin
📝 Rationale: Small cell lung cancer (small round blue cells) is a neuroendocrine
tumor. Chromogranin, synaptophysin, and CD56 are positive markers of
neuroendocrine differentiation. TTF-1 is also often positive but less specific for
neuroendocrine differentiation; chromogranin is the classic neuroendocrine
marker .
3. A 22-year-old college student develops sudden onset of fever, chills, and a
productive cough with rust-colored sputum. A chest X-ray shows right lower
lobe consolidation. Gram stain of sputum reveals numerous neutrophils and
lancet-shaped Gram-positive diplococci. Which virulence factor is most
directly responsible for the organism's ability to avoid phagocytosis?
A) IgA protease
B) Protein M
C) Polysaccharide capsule
D) Exotoxin A
✅ Correct Answer: C) Polysaccharide capsule
📝 Rationale: The presentation is classic for Streptococcus pneumoniae
(pneumococcus). Its primary virulence factor is the polysaccharide capsule, which
,prevents phagocytosis by inhibiting complement deposition and opsonization. IgA
protease is associated with Haemophilus influenzae and Neisseria. Protein M is a
virulence factor of Streptococcus pyogenes .
4. A 72-year-old man with chronic kidney disease stage 4 (eGFR 25 mL/min)
presents with fatigue, bone pain, serum calcium 8.0 mg/dL, phosphorus 6.0
mg/dL, and PTH 450 pg/mL. Which medication reduces PTH in this setting?
A) Calcium acetate
B) Sevelamer
C) Calcitriol
D) Aluminum hydroxide
✅ Correct Answer: C) Calcitriol
📝 Rationale: Secondary hyperparathyroidism of CKD is treated with active
vitamin D (calcitriol) to suppress PTH, along with phosphate binders. Calcium
acetate and sevelamer are phosphate binders that address hyperphosphatemia but
do not directly suppress PTH. Calcitriol acts to increase calcium absorption and
directly suppress parathyroid gland activity .
5. A 68-year-old man with a history of hypertension reports progressive
dyspnea on exertion. On cardiac auscultation, you hear a harsh, crescendo-
decrescendo murmur at the right upper sternal border that radiates to the
carotids. The murmur increases in intensity with squatting. What is the most
likely diagnosis?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
, C) Mitral regurgitation
D) Pulmonic stenosis
✅ Correct Answer: A) Aortic stenosis
📝 Rationale: Aortic stenosis presents with a harsh, crescendo-decrescendo
systolic murmur best heard at the right upper sternal border (aortic area) with
radiation to the carotids. The murmur increases with squatting (increased preload)
and decreases with Valsalva. Hypertrophic cardiomyopathy also has a systolic
murmur but typically decreases with squatting and increases with Valsalva .
6. A 56-year-old man with hypertension and type 2 diabetes presents with a
non-healing ulcer on his right great toe. Ankle-brachial index is 0.45. Which
finding on physical examination is most consistent with this condition?
A) Bounding dorsalis pedis pulses
B) Hair loss on the lower leg and shiny skin
C) Warm, erythematous toes with edema
D) Pigmentation around the ankles
✅ Correct Answer: B) Hair loss on the lower leg and shiny skin
📝 Rationale: Chronic arterial insufficiency (ABI < 0.90 indicates peripheral
artery disease) leads to loss of hair, shiny atrophic skin, thickened nails, and cool
extremities. Bounding pulses suggest hyperdynamic circulation, not ischemia.
Warm, erythematous toes with edema suggest cellulitis or inflammatory
conditions .
