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COMSAE Phase 1 ASA 115 – The Complete 176 Question Test
Bank All questions with correct verified answers & detailed
rationales – graded A+ for the newest 2026 actual exam
Section 1: Anatomy & Neuroanatomy (Questions 1–25)
1. A 55-year-old man presents with difficulty chewing and deviation of the jaw
to the left upon opening the mouth. Which nerve is most likely affected?
A. Left trigeminal nerve (V3)
B. Right trigeminal nerve (V3)
C. Left facial nerve
D. Right facial nerve
: Correct Answer : A. Left trigeminal nerve (V3)
Rationale: The motor fibers of V3 innervate the muscles of mastication, including
the lateral pterygoid. Unilateral damage causes the jaw to deviate toward the
weak side (ipsilateral) upon opening due to unopposed action of the intact lateral
pterygoid. Deviation to the left indicates left V3 involvement.
2. A 62-year-old woman with a history of hypertension suddenly develops a
severe headache and neck stiffness. CT shows blood in the subarachnoid space.
What is the most common cause?
A. Arteriovenous malformation
B. Ruptured saccular aneurysm
C. Intracerebral hemorrhage
D. Cavernous angioma
: Correct Answer : B. Ruptured saccular aneurysm
Rationale: Most nontraumatic subarachnoid hemorrhage results from rupture of a
saccular (berry) aneurysm, usually at the circle of Willis. Hypertension is a risk
factor.
pg. 1
,2
3. A 3-year-old child has a palpable abdominal mass, hypertension, and elevated
urine catecholamines. Where does this tumor most likely arise?
A. Renal cortex
B. Adrenal medulla or sympathetic chain
C. Liver
D. Cerebellum
: Correct Answer : B. Adrenal medulla or sympathetic chain
Rationale: Neuroblastoma arises from neural crest cells in the adrenal medulla or
sympathetic chain. It secretes catecholamines, causing hypertension and elevated
urine VMA/HVA. Wilms tumor is renal but does not elevate catecholamines.
4. A 45-year-old woman has a meningioma compressing the right optic nerve
near the optic canal. Which visual field defect would be expected?
A. Bitemporal hemianopia
B. Right monocular blindness
C. Left homonymous hemianopia
D. Right nasal hemianopia
: Correct Answer : B. Right monocular blindness
Rationale: A lesion anterior to the optic chiasm (e.g., optic nerve) causes complete
visual loss in the ipsilateral eye. Bitemporal hemianopia occurs with chiasmal
lesions. Homonymous hemianopia with lesions posterior to the chiasm.
5. A 28-year-old man sustains a knife wound to the upper medial arm. He has
sensory loss on the medial forearm and weakness of finger
abduction/adduction. Which nerve is injured?
A. Ulnar nerve
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve
: Correct Answer : A. Ulnar nerve
*Rationale: The ulnar nerve innervates intrinsic hand muscles responsible for
pg. 2
,3
finger abduction/adduction (interossei) and provides sensation to the medial 1½
fingers. Median nerve injury would affect thumb opposition.*
6. A 70-year-old man falls and lands on his right hip. The right leg is shortened
and externally rotated. Which type of fracture is most likely?
A. Intertrochanteric fracture
B. Femoral neck fracture
C. Subtrochanteric fracture
D. Pubic ramus fracture
: Correct Answer : B. Femoral neck fracture
Rationale: Femoral neck fractures (intracapsular) classically present with a
shortened, externally rotated leg. They are common in elderly osteoporotic
women and risk avascular necrosis of the femoral head.
7. A patient has a “claw hand” deformity with hyperextension at the MCP joints
and flexion at the IP joints of the ring and little fingers. Sensation is lost over the
medial hand. Which nerve is injured?
A. Median nerve
B. Radial nerve
C. Ulnar nerve
D. Axillary nerve
: Correct Answer : C. Ulnar nerve
*Rationale: Ulnar nerve injury causes paralysis of intrinsic hand muscles
(interossei, lumbricals 3/4), resulting in clawing of ring and little fingers, and
sensory loss over the ulnar 1½ fingers.*
8. A 34-year-old woman has a fracture of the surgical neck of the humerus after
a fall. She cannot abduct her arm beyond 15 degrees. Which nerve is damaged?
A. Axillary nerve
B. Radial nerve
pg. 3
, 4
C. Musculocutaneous nerve
D. Suprascapular nerve
: Correct Answer : A. Axillary nerve
Rationale: The axillary nerve wraps around the surgical neck of the humerus and
innervates the deltoid. Injury causes deltoid paralysis, limiting shoulder abduction
beyond the initial 15 degrees (supraspinatus). Sensory loss occurs over the lateral
shoulder.
9. A 50-year-old man with hoarseness has a left vocal cord paralysis. Imaging
reveals a mass in the aortopulmonary window. Which nerve is compressed?
A. Left recurrent laryngeal nerve
B. Right recurrent laryngeal nerve
C. Left phrenic nerve
D. Left vagus nerve (high)
: Correct Answer : A. Left recurrent laryngeal nerve
Rationale: The left recurrent laryngeal nerve hooks around the aortic arch and
passes through the aortopulmonary window. A mass here can compress it,
causing hoarseness. The right recurrent loops around the right subclavian artery.
10. A 12-year-old boy has pain and swelling over the tibial tubercle. Radiographs
show fragmentation. What is the most likely diagnosis?
A. Osgood-Schlatter disease
B. Legg-Calvé-Perthes disease
C. Slipped capital femoral epiphysis
D. Osteosarcoma
: Correct Answer : A. Osgood-Schlatter disease
Rationale: Osgood-Schlatter is a traction apophysitis of the tibial tubercle from
repetitive stress via the patellar tendon, common in adolescent boys. Radiographs
show fragmentation.
pg. 4
COMSAE Phase 1 ASA 115 – The Complete 176 Question Test
Bank All questions with correct verified answers & detailed
rationales – graded A+ for the newest 2026 actual exam
Section 1: Anatomy & Neuroanatomy (Questions 1–25)
1. A 55-year-old man presents with difficulty chewing and deviation of the jaw
to the left upon opening the mouth. Which nerve is most likely affected?
A. Left trigeminal nerve (V3)
B. Right trigeminal nerve (V3)
C. Left facial nerve
D. Right facial nerve
: Correct Answer : A. Left trigeminal nerve (V3)
Rationale: The motor fibers of V3 innervate the muscles of mastication, including
the lateral pterygoid. Unilateral damage causes the jaw to deviate toward the
weak side (ipsilateral) upon opening due to unopposed action of the intact lateral
pterygoid. Deviation to the left indicates left V3 involvement.
2. A 62-year-old woman with a history of hypertension suddenly develops a
severe headache and neck stiffness. CT shows blood in the subarachnoid space.
What is the most common cause?
A. Arteriovenous malformation
B. Ruptured saccular aneurysm
C. Intracerebral hemorrhage
D. Cavernous angioma
: Correct Answer : B. Ruptured saccular aneurysm
Rationale: Most nontraumatic subarachnoid hemorrhage results from rupture of a
saccular (berry) aneurysm, usually at the circle of Willis. Hypertension is a risk
factor.
pg. 1
,2
3. A 3-year-old child has a palpable abdominal mass, hypertension, and elevated
urine catecholamines. Where does this tumor most likely arise?
A. Renal cortex
B. Adrenal medulla or sympathetic chain
C. Liver
D. Cerebellum
: Correct Answer : B. Adrenal medulla or sympathetic chain
Rationale: Neuroblastoma arises from neural crest cells in the adrenal medulla or
sympathetic chain. It secretes catecholamines, causing hypertension and elevated
urine VMA/HVA. Wilms tumor is renal but does not elevate catecholamines.
4. A 45-year-old woman has a meningioma compressing the right optic nerve
near the optic canal. Which visual field defect would be expected?
A. Bitemporal hemianopia
B. Right monocular blindness
C. Left homonymous hemianopia
D. Right nasal hemianopia
: Correct Answer : B. Right monocular blindness
Rationale: A lesion anterior to the optic chiasm (e.g., optic nerve) causes complete
visual loss in the ipsilateral eye. Bitemporal hemianopia occurs with chiasmal
lesions. Homonymous hemianopia with lesions posterior to the chiasm.
5. A 28-year-old man sustains a knife wound to the upper medial arm. He has
sensory loss on the medial forearm and weakness of finger
abduction/adduction. Which nerve is injured?
A. Ulnar nerve
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve
: Correct Answer : A. Ulnar nerve
*Rationale: The ulnar nerve innervates intrinsic hand muscles responsible for
pg. 2
,3
finger abduction/adduction (interossei) and provides sensation to the medial 1½
fingers. Median nerve injury would affect thumb opposition.*
6. A 70-year-old man falls and lands on his right hip. The right leg is shortened
and externally rotated. Which type of fracture is most likely?
A. Intertrochanteric fracture
B. Femoral neck fracture
C. Subtrochanteric fracture
D. Pubic ramus fracture
: Correct Answer : B. Femoral neck fracture
Rationale: Femoral neck fractures (intracapsular) classically present with a
shortened, externally rotated leg. They are common in elderly osteoporotic
women and risk avascular necrosis of the femoral head.
7. A patient has a “claw hand” deformity with hyperextension at the MCP joints
and flexion at the IP joints of the ring and little fingers. Sensation is lost over the
medial hand. Which nerve is injured?
A. Median nerve
B. Radial nerve
C. Ulnar nerve
D. Axillary nerve
: Correct Answer : C. Ulnar nerve
*Rationale: Ulnar nerve injury causes paralysis of intrinsic hand muscles
(interossei, lumbricals 3/4), resulting in clawing of ring and little fingers, and
sensory loss over the ulnar 1½ fingers.*
8. A 34-year-old woman has a fracture of the surgical neck of the humerus after
a fall. She cannot abduct her arm beyond 15 degrees. Which nerve is damaged?
A. Axillary nerve
B. Radial nerve
pg. 3
, 4
C. Musculocutaneous nerve
D. Suprascapular nerve
: Correct Answer : A. Axillary nerve
Rationale: The axillary nerve wraps around the surgical neck of the humerus and
innervates the deltoid. Injury causes deltoid paralysis, limiting shoulder abduction
beyond the initial 15 degrees (supraspinatus). Sensory loss occurs over the lateral
shoulder.
9. A 50-year-old man with hoarseness has a left vocal cord paralysis. Imaging
reveals a mass in the aortopulmonary window. Which nerve is compressed?
A. Left recurrent laryngeal nerve
B. Right recurrent laryngeal nerve
C. Left phrenic nerve
D. Left vagus nerve (high)
: Correct Answer : A. Left recurrent laryngeal nerve
Rationale: The left recurrent laryngeal nerve hooks around the aortic arch and
passes through the aortopulmonary window. A mass here can compress it,
causing hoarseness. The right recurrent loops around the right subclavian artery.
10. A 12-year-old boy has pain and swelling over the tibial tubercle. Radiographs
show fragmentation. What is the most likely diagnosis?
A. Osgood-Schlatter disease
B. Legg-Calvé-Perthes disease
C. Slipped capital femoral epiphysis
D. Osteosarcoma
: Correct Answer : A. Osgood-Schlatter disease
Rationale: Osgood-Schlatter is a traction apophysitis of the tibial tubercle from
repetitive stress via the patellar tendon, common in adolescent boys. Radiographs
show fragmentation.
pg. 4
