1
COMSAE Phase 1 Form 116 Exam Test Bank – Newest
2026 Edition | Comprehensive 176-Question Set with
Verified Answers & Detailed Rationales
Exam Blueprint at a Glance
The COMSAE Phase 1 exam contains 176 single-best-answer multiple-choice questions divided into four sections of 44
questions each. The content distribution follows the COMLEX-USA Level 1 blueprint, with approximately:
Approximate
Category Topics Included
%
Osteopathic Principles & Viscerosomatic reflexes, Chapman points, Fryette’s laws, sacral/innominate diagnostics, HVLA,
15%
OMM muscle energy, counterstrain, cranial, lymphatic
Brachial plexus, cranial nerves, spinal cord syndromes, vascular supply, pelvic anatomy, hernia
Human Anatomy 15%
nerve injuries
Cell injury, inflammation, neoplasia, autoimmune diseases, organ-specific pathology, shock,
Pathology 18%
hemostasis
Cardiac cycle, renal function, acid-base, pulmonary mechanics, endocrine axes, GI physiology,
Physiology 15%
neurophysiology
Autonomic drugs, antibiotics, cardiovascular agents, CNS drugs, chemotherapy, endocrine agen
Pharmacology 12%
adverse effects
Microbiology / Bacterial/viral/fungal identification, toxins, STIs, CNS infections, HIV, hypersensitivity,
10%
Immunology immunodeficiencies
Metabolic pathways, vitamin deficiencies, lysosomal storage diseases, inheritance patterns, inb
Biochemistry / Genetics 8%
errors
Stroke localization, spinal cord syndromes, neurodegenerative diseases, aphasias, psychiatric
Neurology / Psychiatry 7%
disorders
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1–30)
pg. 1
,2
Question 1.
A 24-year-old man presents with fever, headache, and neck stiffness. Lumbar
puncture shows elevated opening pressure, low glucose, and high protein. Which
organism is most likely responsible?
A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Listeria monocytogenes
D) Escherichia coli
: Correct Answer : B) Streptococcus pneumoniae
Rationale: Bacterial meningitis in adults is most commonly caused
by Streptococcus pneumoniae. The CSF findings (elevated opening pressure, low
glucose, high protein) are classic for bacterial meningitis. While N. meningitidis (A)
is also a common cause, S. pneumoniae is the most frequent pathogen overall in
adults.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 2.
A 65-year-old smoker presents with hematuria and flank pain. CT reveals a renal
mass. Which is the most likely diagnosis?
A) Wilms tumor
B) Renal cell carcinoma
C) Transitional cell carcinoma
D) Angiomyolipoma
: Correct Answer : B) Renal cell carcinoma
Rationale: Renal cell carcinoma is the most common malignant renal tumor in
adults, strongly associated with smoking and typically presenting with hematuria,
flank pain, and a palpable mass. Wilms tumor (A) occurs in children. Transitional
cell carcinoma (C) arises from the urothelium of the renal pelvis/ureter.
Angiomyolipoma (D) is benign and often contains fat on imaging.
pg. 2
,3
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 3.
Which electrolyte abnormality is most associated with ECG showing peaked T
waves?
A) Hypokalemia
B) Hyperkalemia
C) Hypercalcemia
D) Hyponatremia
: Correct Answer : B) Hyperkalemia
Rationale: Hyperkalemia causes peaked (“tented”) T waves due to altered cardiac
repolarization. Other ECG changes include widened QRS, prolonged PR interval,
and eventually sine wave pattern and asystole. Hypokalemia (A) causes flat T
waves and prominent U waves. Hypercalcemia (C) shortens the QT interval.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 4.
A child presents with barking cough and inspiratory stridor. What is the most
likely diagnosis?
A) Epiglottitis
B) Croup
C) Bronchiolitis
D) Asthma
: Correct Answer : B) Croup
Rationale: Croup (laryngotracheobronchitis) classically presents with a barking
cough, inspiratory stridor, and respiratory distress in young children. Epiglottitis
(A) presents with high fever, drooling, and tripod positioning, often without
barking cough. Bronchiolitis (C) presents with wheezing and respiratory distress in
infants; asthma (D) presents with wheezing.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
pg. 3
, 4
Question 5.
Which hormone is produced by the posterior pituitary?
A) ACTH
B) TSH
C) Oxytocin
D) GH
: Correct Answer : C) Oxytocin
Rationale: The posterior pituitary stores and releases oxytocin and antidiuretic
hormone (ADH, vasopressin), which are synthesized in the hypothalamus. ACTH
(A), TSH (B), and GH (D) are produced by the anterior pituitary.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 6.
A patient has a right hemispheric stroke. Which finding would you expect?
A) Expressive aphasia
B) Left-sided neglect
C) Right homonymous hemianopia
D) Apraxia of speech
: Correct Answer : B) Left-sided neglect
Rationale: Right hemisphere lesions commonly cause left-sided neglect
(inattention to the contralateral side), as well as anosognosia and constructional
apraxia. Expressive aphasia (A) is associated with left frontal lesions (Broca’s
area). Right homonymous hemianopia (C) occurs with lesions of the left optic
radiations but can occur from either side. Apraxia of speech (D) is typically seen
with left frontal lesions.
Question 7.
A 45-year-old woman has epigastric burning and bloating after meals. OMT
pg. 4
COMSAE Phase 1 Form 116 Exam Test Bank – Newest
2026 Edition | Comprehensive 176-Question Set with
Verified Answers & Detailed Rationales
Exam Blueprint at a Glance
The COMSAE Phase 1 exam contains 176 single-best-answer multiple-choice questions divided into four sections of 44
questions each. The content distribution follows the COMLEX-USA Level 1 blueprint, with approximately:
Approximate
Category Topics Included
%
Osteopathic Principles & Viscerosomatic reflexes, Chapman points, Fryette’s laws, sacral/innominate diagnostics, HVLA,
15%
OMM muscle energy, counterstrain, cranial, lymphatic
Brachial plexus, cranial nerves, spinal cord syndromes, vascular supply, pelvic anatomy, hernia
Human Anatomy 15%
nerve injuries
Cell injury, inflammation, neoplasia, autoimmune diseases, organ-specific pathology, shock,
Pathology 18%
hemostasis
Cardiac cycle, renal function, acid-base, pulmonary mechanics, endocrine axes, GI physiology,
Physiology 15%
neurophysiology
Autonomic drugs, antibiotics, cardiovascular agents, CNS drugs, chemotherapy, endocrine agen
Pharmacology 12%
adverse effects
Microbiology / Bacterial/viral/fungal identification, toxins, STIs, CNS infections, HIV, hypersensitivity,
10%
Immunology immunodeficiencies
Metabolic pathways, vitamin deficiencies, lysosomal storage diseases, inheritance patterns, inb
Biochemistry / Genetics 8%
errors
Stroke localization, spinal cord syndromes, neurodegenerative diseases, aphasias, psychiatric
Neurology / Psychiatry 7%
disorders
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1–30)
pg. 1
,2
Question 1.
A 24-year-old man presents with fever, headache, and neck stiffness. Lumbar
puncture shows elevated opening pressure, low glucose, and high protein. Which
organism is most likely responsible?
A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Listeria monocytogenes
D) Escherichia coli
: Correct Answer : B) Streptococcus pneumoniae
Rationale: Bacterial meningitis in adults is most commonly caused
by Streptococcus pneumoniae. The CSF findings (elevated opening pressure, low
glucose, high protein) are classic for bacterial meningitis. While N. meningitidis (A)
is also a common cause, S. pneumoniae is the most frequent pathogen overall in
adults.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 2.
A 65-year-old smoker presents with hematuria and flank pain. CT reveals a renal
mass. Which is the most likely diagnosis?
A) Wilms tumor
B) Renal cell carcinoma
C) Transitional cell carcinoma
D) Angiomyolipoma
: Correct Answer : B) Renal cell carcinoma
Rationale: Renal cell carcinoma is the most common malignant renal tumor in
adults, strongly associated with smoking and typically presenting with hematuria,
flank pain, and a palpable mass. Wilms tumor (A) occurs in children. Transitional
cell carcinoma (C) arises from the urothelium of the renal pelvis/ureter.
Angiomyolipoma (D) is benign and often contains fat on imaging.
pg. 2
,3
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 3.
Which electrolyte abnormality is most associated with ECG showing peaked T
waves?
A) Hypokalemia
B) Hyperkalemia
C) Hypercalcemia
D) Hyponatremia
: Correct Answer : B) Hyperkalemia
Rationale: Hyperkalemia causes peaked (“tented”) T waves due to altered cardiac
repolarization. Other ECG changes include widened QRS, prolonged PR interval,
and eventually sine wave pattern and asystole. Hypokalemia (A) causes flat T
waves and prominent U waves. Hypercalcemia (C) shortens the QT interval.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 4.
A child presents with barking cough and inspiratory stridor. What is the most
likely diagnosis?
A) Epiglottitis
B) Croup
C) Bronchiolitis
D) Asthma
: Correct Answer : B) Croup
Rationale: Croup (laryngotracheobronchitis) classically presents with a barking
cough, inspiratory stridor, and respiratory distress in young children. Epiglottitis
(A) presents with high fever, drooling, and tripod positioning, often without
barking cough. Bronchiolitis (C) presents with wheezing and respiratory distress in
infants; asthma (D) presents with wheezing.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
pg. 3
, 4
Question 5.
Which hormone is produced by the posterior pituitary?
A) ACTH
B) TSH
C) Oxytocin
D) GH
: Correct Answer : C) Oxytocin
Rationale: The posterior pituitary stores and releases oxytocin and antidiuretic
hormone (ADH, vasopressin), which are synthesized in the hypothalamus. ACTH
(A), TSH (B), and GH (D) are produced by the anterior pituitary.
Source: Docsity COMSAE Phase 1 Form 116 Practice Exam
Question 6.
A patient has a right hemispheric stroke. Which finding would you expect?
A) Expressive aphasia
B) Left-sided neglect
C) Right homonymous hemianopia
D) Apraxia of speech
: Correct Answer : B) Left-sided neglect
Rationale: Right hemisphere lesions commonly cause left-sided neglect
(inattention to the contralateral side), as well as anosognosia and constructional
apraxia. Expressive aphasia (A) is associated with left frontal lesions (Broca’s
area). Right homonymous hemianopia (C) occurs with lesions of the left optic
radiations but can occur from either side. Apraxia of speech (D) is typically seen
with left frontal lesions.
Question 7.
A 45-year-old woman has epigastric burning and bloating after meals. OMT
pg. 4
