COMSAE Phase 1 Level 1 ASA 111i NEWEST
UPDATED 2026–2027 ACTUAL FINAL EXAM
| Complete Exam Preparation Guide With
Well-Elaborated Questions, In-Depth
Rationales, High-Yield Review, and Board
Success Strategies
1. A 23-year-old man has severe pain in the right lower quadrant and rebound
tenderness. Which diagnosis is most likely?
A. Cholecystitis
B. Appendicitis
C. Pancreatitis
D. Gastroenteritis
Correct answer: B
Explanation: Right lower quadrant pain with rebound tenderness is classic
for appendicitis. This is a common surgical abdomen presentation and
requires prompt evaluation to prevent perforation.
2. A patient has a fasting blood glucose of 130 mg/dL on two separate
occasions. Which diagnosis is most likely?
A. Prediabetes
B. Type 1 diabetes mellitus
C. Diabetes mellitus
D. Hypoglycemia
Correct answer: C
Explanation: Fasting glucose of 126 mg/dL or higher on repeat testing
supports diabetes mellitus. Endocrine and metabolic disorders are
represented in COMLEX-style clinical presentations.
3. Which cranial nerve carries the sense of smell?
A. CN II
B. CN I
C. CN III
D. CN V
, Correct answer: B
Explanation: Cranial nerve I is the olfactory nerve and carries smell
sensation. Neuroanatomy is a core basic science domain for Level 1.
4. A patient with asthma has wheezing and prolonged expiration. Which drug
class is most useful for acute relief?
A. Inhaled corticosteroids
B. Short-acting beta-2 agonists
C. Leukotriene inhibitors only
D. Antihistamines
Correct answer: B
Explanation: Short-acting beta-2 agonists provide rapid bronchodilation for
acute asthma symptoms. Respiratory questions are common within the
COMLEX blueprint.
5. A child develops a generalized rash, cough, and Koplik spots. What is the
most likely diagnosis?
A. Rubella
B. Measles
C. Varicella
D. Scarlet fever
Correct answer: B
Explanation: Koplik spots are classic for measles. Microbiology and
infectious disease are key Level 1 topics.
6. A patient has macrocytic anemia and glossitis. Which vitamin deficiency is
most likely?
A. Iron
B. Vitamin B12
C. Vitamin C
D. Vitamin K
Correct answer: B
Explanation: Vitamin B12 deficiency causes macrocytic anemia and
neurologic findings, and may produce glossitis. Biochemistry and
hematology concepts are heavily tested.
7. Which artery is most commonly involved in a myocardial infarction causing
inferior wall changes?
A. Left anterior descending artery
, B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Correct answer: C
Explanation: The right coronary artery commonly supplies the inferior
wall, especially in right-dominant circulation. Circulatory system
presentations are emphasized in the blueprint.
8. A patient has fever, headache, neck stiffness, and photophobia. What is the
most likely diagnosis?
A. Migraine
B. Meningitis
C. Sinusitis
D. Encephalopathy
Correct answer: B
Explanation: This is the classic presentation of meningitis, an important
neurologic/infectious scenario. Neurologic and mental health presentations
are a major content area.
9. Which enzyme converts angiotensin I to angiotensin II?
A. Renin
B. ACE
C. Aldosterone
D. ACE2
Correct answer: B
Explanation: Angiotensin-converting enzyme converts angiotensin I into
angiotensin II. Physiology and pharmacology often intersect in COMLEX
questions.
10.A patient has painful urination and positive nitrites on urinalysis. Which
organism is the most likely cause?
A. Staphylococcus aureus
B. Escherichia coli
C. Candida albicans
D. Streptococcus pneumoniae
Correct answer: B
Explanation: E. coli is the most common cause of uncomplicated urinary
UPDATED 2026–2027 ACTUAL FINAL EXAM
| Complete Exam Preparation Guide With
Well-Elaborated Questions, In-Depth
Rationales, High-Yield Review, and Board
Success Strategies
1. A 23-year-old man has severe pain in the right lower quadrant and rebound
tenderness. Which diagnosis is most likely?
A. Cholecystitis
B. Appendicitis
C. Pancreatitis
D. Gastroenteritis
Correct answer: B
Explanation: Right lower quadrant pain with rebound tenderness is classic
for appendicitis. This is a common surgical abdomen presentation and
requires prompt evaluation to prevent perforation.
2. A patient has a fasting blood glucose of 130 mg/dL on two separate
occasions. Which diagnosis is most likely?
A. Prediabetes
B. Type 1 diabetes mellitus
C. Diabetes mellitus
D. Hypoglycemia
Correct answer: C
Explanation: Fasting glucose of 126 mg/dL or higher on repeat testing
supports diabetes mellitus. Endocrine and metabolic disorders are
represented in COMLEX-style clinical presentations.
3. Which cranial nerve carries the sense of smell?
A. CN II
B. CN I
C. CN III
D. CN V
, Correct answer: B
Explanation: Cranial nerve I is the olfactory nerve and carries smell
sensation. Neuroanatomy is a core basic science domain for Level 1.
4. A patient with asthma has wheezing and prolonged expiration. Which drug
class is most useful for acute relief?
A. Inhaled corticosteroids
B. Short-acting beta-2 agonists
C. Leukotriene inhibitors only
D. Antihistamines
Correct answer: B
Explanation: Short-acting beta-2 agonists provide rapid bronchodilation for
acute asthma symptoms. Respiratory questions are common within the
COMLEX blueprint.
5. A child develops a generalized rash, cough, and Koplik spots. What is the
most likely diagnosis?
A. Rubella
B. Measles
C. Varicella
D. Scarlet fever
Correct answer: B
Explanation: Koplik spots are classic for measles. Microbiology and
infectious disease are key Level 1 topics.
6. A patient has macrocytic anemia and glossitis. Which vitamin deficiency is
most likely?
A. Iron
B. Vitamin B12
C. Vitamin C
D. Vitamin K
Correct answer: B
Explanation: Vitamin B12 deficiency causes macrocytic anemia and
neurologic findings, and may produce glossitis. Biochemistry and
hematology concepts are heavily tested.
7. Which artery is most commonly involved in a myocardial infarction causing
inferior wall changes?
A. Left anterior descending artery
, B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Correct answer: C
Explanation: The right coronary artery commonly supplies the inferior
wall, especially in right-dominant circulation. Circulatory system
presentations are emphasized in the blueprint.
8. A patient has fever, headache, neck stiffness, and photophobia. What is the
most likely diagnosis?
A. Migraine
B. Meningitis
C. Sinusitis
D. Encephalopathy
Correct answer: B
Explanation: This is the classic presentation of meningitis, an important
neurologic/infectious scenario. Neurologic and mental health presentations
are a major content area.
9. Which enzyme converts angiotensin I to angiotensin II?
A. Renin
B. ACE
C. Aldosterone
D. ACE2
Correct answer: B
Explanation: Angiotensin-converting enzyme converts angiotensin I into
angiotensin II. Physiology and pharmacology often intersect in COMLEX
questions.
10.A patient has painful urination and positive nitrites on urinalysis. Which
organism is the most likely cause?
A. Staphylococcus aureus
B. Escherichia coli
C. Candida albicans
D. Streptococcus pneumoniae
Correct answer: B
Explanation: E. coli is the most common cause of uncomplicated urinary
