Page 1 of 106
COMSAE Phase 1 Form 114 — exam COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR-JUST RELEASED
1. Osteopathic Principles/OPP/OMM (TART, autonomics, Chapman points, counterstrain, muscle
energy, HVLA, MFR, ribs, Fryette mechanics, sacral/innominate dysfunctions, lymphatics, cranial
SBS patterns, clinical OMM applications).
2. Biostatistics & Epidemiology (sensitivity/specificity, PPV/NPV, RR vs OR, ARR/NNT, likelihood
ratios, CI/p-values, Type I/II errors, study designs, bias/confounding, screening concepts).
3. Ethics/Professionalism/Health Policy (informed consent, capacity vs competency,
confidentiality/reporting, surrogate decisions, end-of-life, error disclosure, impairment, conflicts
of interest).
4. Cardiovascular System (cardiac cycle/hemodynamics, HF, murmurs, arrhythmias, shock, HTN
drugs, MI pathogenesis/complications, endocarditis/rheumatic/pericarditis).
5. Pulmonary & Critical Care (obstructive vs restrictive, V/Q mismatch/shunt/dead space,
asthma/COPD, ARDS, pneumonia, PE, pleural effusions, respiratory acid-base).
6. Renal/Electrolytes/Acid-Base (GFR/RPF/clearance, AKI types, nephritic vs nephrotic, diuretics,
anion gap logic, Winter’s formula, K+ disorders/ECG, SIADH vs DI).
7. Endocrine System (diabetes/DKA/HHS, thyroid emergencies, adrenal disorders,
hyperaldosteronism, pituitary axes, MEN syndromes, calcium/PTH disorders).
8. GI & Hepatobiliary (hepatitis serology, cirrhosis complications, portal HTN/shunts, pancreatitis,
PUD/H. pylori, malabsorption/IBD, gallbladder/biliary disease).
9. Hematology & Oncology (anemias, hemolysis labs, coagulation/anticoagulants, DIC vs TTP vs
HUS, leukemias/lymphomas, myeloma, paraneoplastic syndromes).
10. Neurology & Psychiatry (stroke territories, brainstem lesions, spinal cord syndromes,
seizures/drugs, MS/GBS, neurodegeneration, neurotransmitters, psych disorders,
intoxication/withdrawal).
11. MSK/Derm/Rheumatology (OA vs RA, gout/pseudogout, SLE antibodies, Sjogren, vasculitis
patterns, bone tumors, osteomyelitis, skin cancers, psoriasis).
12. Reproductive/Embryology/Genetics (embryologic derivatives, pregnancy hormones, menstrual
cycle, STIs, gynecologic cancers, testicular tumors, inheritance, chromosomal disorders).
13. Microbiology (gram ID, catalase/coagulase/hemolysis, respiratory/GI/CNS organisms, STIs,
opportunistic infections, fungi, parasites, DNA vs RNA viruses).
14. Immunology (innate/adaptive, antibody classes, T/B cell markers, complement deficiencies,
hypersensitivity I–IV, immunodeficiencies, autoimmune mechanisms, vaccines).
15. Pharmacology (autonomics, antimicrobials, CV drugs, CNS drugs, endocrine drugs, chemo,
CYP450 interactions, teratogens).
16. Biochemistry & Metabolism (enzyme kinetics, glycolysis/gluconeogenesis/glycogen,
TCA/OXPHOS, fatty acids/ketones, amino acid disorders, urea cycle, heme synthesis, vitamin
deficiencies).
17. General Pathology & Cell Biology (cell injury/adaptation, free radicals, inflammation, wound
healing, granulomas, carcinogenesis, thrombosis/embolism/infarction, amyloidosis).
18. Systems Integration/Clinical Reasoning (multi-step mixed questions, labs/imaging interpretation,
mechanism-based therapy, next-best-step decisions, classic board patterns, emergency ABC
priorities).
, Page 2 of 106
COMSAE Phase 1 Form 114 —
1.
A patient with pneumonia has increased sympathetic activity affecting the lungs. Which spinal cord
levels are most associated with sympathetic innervation to the lungs?
A. C1–C4
B. T1–T6
C. T7–T12
D. L1–L4
Answer: B. T1–T6
Rationale: Pulmonary sympathetic innervation originates from upper thoracic spinal segments,
commonly T1–T6.
2.
, Page 3 of 106
A patient develops acute pulmonary edema due to left-sided heart failure. Which hemodynamic change
most directly contributes to fluid accumulation in alveoli?
A. Decreased oncotic pressure
B. Increased capillary hydrostatic pressure
C. Reduced interstitial osmotic pressure
D. Increased lymphatic drainage
Answer: B. Increased capillary hydrostatic pressure
Rationale: Elevated pulmonary venous pressure increases hydrostatic pressure, forcing fluid into alveoli.
3.
A patient with fever, productive cough, and lobar consolidation most likely has infection caused by
which organism?
A. Mycoplasma pneumoniae
B. Legionella pneumophila
, Page 4 of 106
C. Streptococcus pneumoniae
D. Chlamydia pneumoniae
Answer: C. Streptococcus pneumoniae
Rationale: S. pneumoniae is the most common cause of typical community-acquired lobar pneumonia.
4.
A patient with severe osteoporosis should avoid which osteopathic treatment modality because of
fracture risk?
A. Counterstrain
B. Myofascial release
C. HVLA
D. Lymphatic pump
Answer: C. HVLA
Rationale: High-velocity low-amplitude treatment is contraindicated in severe osteoporosis.
COMSAE Phase 1 Form 114 — exam COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR-JUST RELEASED
1. Osteopathic Principles/OPP/OMM (TART, autonomics, Chapman points, counterstrain, muscle
energy, HVLA, MFR, ribs, Fryette mechanics, sacral/innominate dysfunctions, lymphatics, cranial
SBS patterns, clinical OMM applications).
2. Biostatistics & Epidemiology (sensitivity/specificity, PPV/NPV, RR vs OR, ARR/NNT, likelihood
ratios, CI/p-values, Type I/II errors, study designs, bias/confounding, screening concepts).
3. Ethics/Professionalism/Health Policy (informed consent, capacity vs competency,
confidentiality/reporting, surrogate decisions, end-of-life, error disclosure, impairment, conflicts
of interest).
4. Cardiovascular System (cardiac cycle/hemodynamics, HF, murmurs, arrhythmias, shock, HTN
drugs, MI pathogenesis/complications, endocarditis/rheumatic/pericarditis).
5. Pulmonary & Critical Care (obstructive vs restrictive, V/Q mismatch/shunt/dead space,
asthma/COPD, ARDS, pneumonia, PE, pleural effusions, respiratory acid-base).
6. Renal/Electrolytes/Acid-Base (GFR/RPF/clearance, AKI types, nephritic vs nephrotic, diuretics,
anion gap logic, Winter’s formula, K+ disorders/ECG, SIADH vs DI).
7. Endocrine System (diabetes/DKA/HHS, thyroid emergencies, adrenal disorders,
hyperaldosteronism, pituitary axes, MEN syndromes, calcium/PTH disorders).
8. GI & Hepatobiliary (hepatitis serology, cirrhosis complications, portal HTN/shunts, pancreatitis,
PUD/H. pylori, malabsorption/IBD, gallbladder/biliary disease).
9. Hematology & Oncology (anemias, hemolysis labs, coagulation/anticoagulants, DIC vs TTP vs
HUS, leukemias/lymphomas, myeloma, paraneoplastic syndromes).
10. Neurology & Psychiatry (stroke territories, brainstem lesions, spinal cord syndromes,
seizures/drugs, MS/GBS, neurodegeneration, neurotransmitters, psych disorders,
intoxication/withdrawal).
11. MSK/Derm/Rheumatology (OA vs RA, gout/pseudogout, SLE antibodies, Sjogren, vasculitis
patterns, bone tumors, osteomyelitis, skin cancers, psoriasis).
12. Reproductive/Embryology/Genetics (embryologic derivatives, pregnancy hormones, menstrual
cycle, STIs, gynecologic cancers, testicular tumors, inheritance, chromosomal disorders).
13. Microbiology (gram ID, catalase/coagulase/hemolysis, respiratory/GI/CNS organisms, STIs,
opportunistic infections, fungi, parasites, DNA vs RNA viruses).
14. Immunology (innate/adaptive, antibody classes, T/B cell markers, complement deficiencies,
hypersensitivity I–IV, immunodeficiencies, autoimmune mechanisms, vaccines).
15. Pharmacology (autonomics, antimicrobials, CV drugs, CNS drugs, endocrine drugs, chemo,
CYP450 interactions, teratogens).
16. Biochemistry & Metabolism (enzyme kinetics, glycolysis/gluconeogenesis/glycogen,
TCA/OXPHOS, fatty acids/ketones, amino acid disorders, urea cycle, heme synthesis, vitamin
deficiencies).
17. General Pathology & Cell Biology (cell injury/adaptation, free radicals, inflammation, wound
healing, granulomas, carcinogenesis, thrombosis/embolism/infarction, amyloidosis).
18. Systems Integration/Clinical Reasoning (multi-step mixed questions, labs/imaging interpretation,
mechanism-based therapy, next-best-step decisions, classic board patterns, emergency ABC
priorities).
, Page 2 of 106
COMSAE Phase 1 Form 114 —
1.
A patient with pneumonia has increased sympathetic activity affecting the lungs. Which spinal cord
levels are most associated with sympathetic innervation to the lungs?
A. C1–C4
B. T1–T6
C. T7–T12
D. L1–L4
Answer: B. T1–T6
Rationale: Pulmonary sympathetic innervation originates from upper thoracic spinal segments,
commonly T1–T6.
2.
, Page 3 of 106
A patient develops acute pulmonary edema due to left-sided heart failure. Which hemodynamic change
most directly contributes to fluid accumulation in alveoli?
A. Decreased oncotic pressure
B. Increased capillary hydrostatic pressure
C. Reduced interstitial osmotic pressure
D. Increased lymphatic drainage
Answer: B. Increased capillary hydrostatic pressure
Rationale: Elevated pulmonary venous pressure increases hydrostatic pressure, forcing fluid into alveoli.
3.
A patient with fever, productive cough, and lobar consolidation most likely has infection caused by
which organism?
A. Mycoplasma pneumoniae
B. Legionella pneumophila
, Page 4 of 106
C. Streptococcus pneumoniae
D. Chlamydia pneumoniae
Answer: C. Streptococcus pneumoniae
Rationale: S. pneumoniae is the most common cause of typical community-acquired lobar pneumonia.
4.
A patient with severe osteoporosis should avoid which osteopathic treatment modality because of
fracture risk?
A. Counterstrain
B. Myofascial release
C. HVLA
D. Lymphatic pump
Answer: C. HVLA
Rationale: High-velocity low-amplitude treatment is contraindicated in severe osteoporosis.
