1
COMSAE Phase 1 Form 114 Practice Exam
176 Questions And Correct Answers
(Verified Answers) Plus Rationales 2025|2026
Q&A | Instant Download Pdf
Original exam
1. A 55-year-old man presents with acute onset of severe, tearing chest pain
radiating to his back. His blood pressure is 180/100 mm Hg in the right arm
and 140/80 mm Hg in the left arm. Which of the following is the most
appropriate immediate imaging study?
• A) Chest X-ray
• B) Transesophageal echocardiography
• C) CT angiography of the chest
• D) MRI of the chest
Correct ,,,answer,,,: C
Rationale: The presentation is classic for acute aortic dissection. CT angiography
(CTA) is rapid, widely available, and highly sensitive for identifying dissection.
Transesophageal echocardiography is an alternative but more operator-dependent.
,2
2. A 28-year-old woman with systemic lupus erythematosus (SLE) presents
with acute flank pain, hematuria, and hypertension. Urinalysis shows red
blood cell casts. What is the most likely renal pathology?
• A) Focal segmental glomerulosclerosis
• B) Membranous nephropathy
• C) Diffuse proliferative glomerulonephritis
• D) Minimal change disease
Correct ,,,answer,,,: C
Rationale: Active SLE nephritis (class III or IV) often presents with hematuria,
RBC casts, hypertension, and proteinuria. Diffuse proliferative glomerulonephritis
(class IV) is the most common and severe form, often requiring
immunosuppression.
3. A 35-year-old man has a 2-week history of low-grade fever, night sweats,
and a non-productive cough. Chest X-ray shows bilateral hilar
lymphadenopathy. An elevated serum angiotensin-converting enzyme (ACE)
level is noted. What is the most likely diagnosis?
• A) Tuberculosis
• B) Sarcoidosis
• C) Hodgkin lymphoma
• D) Coccidioidomycosis
Correct ,,,answer,,,: B
Rationale: Bilateral hilar lymphadenopathy with an elevated ACE level is classic
for sarcoidosis. TB often has unilateral hilar or cavitary lesions; lymphoma may
have mediastinal nodes but not typically an elevated ACE.
,3
4. A 68-year-old man with chronic kidney disease (stage 4) is on hemodialysis.
He complains of severe bone pain and has a serum calcium of 8.0 mg/dL,
phosphorus of 6.5 mg/dL, and PTH of 800 pg/mL. Which of the following is
the most appropriate treatment for his bone disease?
• A) Calcium carbonate with meals
• B) Oral calcitriol
• C) Aluminum hydroxide
• D) Sevelamer carbonate
Correct ,,,answer,,,: B
Rationale: This patient has renal osteodystrophy with secondary
hyperparathyroidism. Calcitriol (active vitamin D) suppresses PTH secretion and
improves bone mineralization. Sevelamer reduces phosphorus but does not directly
lower PTH.
5. During a comprehensive osteopathic structural exam, you find that a
patient’s right anterior superior iliac spine (ASIS) is inferior to the left ASIS.
The patient is supine. What is the most likely somatic dysfunction?
• A) Right anterior innominate
• B) Right posterior innominate
• C) Left anterior innominate
• D) Left posterior innominate
Correct ,,,answer,,,: B
Rationale: In supine, an inferior ASIS indicates that the ilium has rotated
, 4
posteriorly on that side. Thus, right ASIS inferior = right posterior innominate.
Anterior innominate would make the ASIS superior.
6. A 45-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. Her TSH is 25 µIU/mL and free T4 is 0.4 ng/dL. Which
antibody is most likely positive?
• A) Thyroid peroxidase (TPO) antibody
• B) Thyroid-stimulating immunoglobulin (TSI)
• C) Anti-thyroglobulin antibody
• D) TSH receptor blocking antibody
Correct ,,,answer,,,: A
Rationale: Hashimoto thyroiditis is the most common cause of hypothyroidism.
TPO antibodies are present in >90% of cases. TSI is seen in Graves disease
(hyperthyroidism).
7. A 55-year-old man with type 2 diabetes is started on a medication that
causes weight loss and a modest reduction in HbA1c. It works by increasing
glucagon-like peptide-1 (GLP-1) activity. Which medication is most likely
prescribed?
• A) Metformin
• B) Sitagliptin
• C) Liraglutide
• D) Empagliflozin
COMSAE Phase 1 Form 114 Practice Exam
176 Questions And Correct Answers
(Verified Answers) Plus Rationales 2025|2026
Q&A | Instant Download Pdf
Original exam
1. A 55-year-old man presents with acute onset of severe, tearing chest pain
radiating to his back. His blood pressure is 180/100 mm Hg in the right arm
and 140/80 mm Hg in the left arm. Which of the following is the most
appropriate immediate imaging study?
• A) Chest X-ray
• B) Transesophageal echocardiography
• C) CT angiography of the chest
• D) MRI of the chest
Correct ,,,answer,,,: C
Rationale: The presentation is classic for acute aortic dissection. CT angiography
(CTA) is rapid, widely available, and highly sensitive for identifying dissection.
Transesophageal echocardiography is an alternative but more operator-dependent.
,2
2. A 28-year-old woman with systemic lupus erythematosus (SLE) presents
with acute flank pain, hematuria, and hypertension. Urinalysis shows red
blood cell casts. What is the most likely renal pathology?
• A) Focal segmental glomerulosclerosis
• B) Membranous nephropathy
• C) Diffuse proliferative glomerulonephritis
• D) Minimal change disease
Correct ,,,answer,,,: C
Rationale: Active SLE nephritis (class III or IV) often presents with hematuria,
RBC casts, hypertension, and proteinuria. Diffuse proliferative glomerulonephritis
(class IV) is the most common and severe form, often requiring
immunosuppression.
3. A 35-year-old man has a 2-week history of low-grade fever, night sweats,
and a non-productive cough. Chest X-ray shows bilateral hilar
lymphadenopathy. An elevated serum angiotensin-converting enzyme (ACE)
level is noted. What is the most likely diagnosis?
• A) Tuberculosis
• B) Sarcoidosis
• C) Hodgkin lymphoma
• D) Coccidioidomycosis
Correct ,,,answer,,,: B
Rationale: Bilateral hilar lymphadenopathy with an elevated ACE level is classic
for sarcoidosis. TB often has unilateral hilar or cavitary lesions; lymphoma may
have mediastinal nodes but not typically an elevated ACE.
,3
4. A 68-year-old man with chronic kidney disease (stage 4) is on hemodialysis.
He complains of severe bone pain and has a serum calcium of 8.0 mg/dL,
phosphorus of 6.5 mg/dL, and PTH of 800 pg/mL. Which of the following is
the most appropriate treatment for his bone disease?
• A) Calcium carbonate with meals
• B) Oral calcitriol
• C) Aluminum hydroxide
• D) Sevelamer carbonate
Correct ,,,answer,,,: B
Rationale: This patient has renal osteodystrophy with secondary
hyperparathyroidism. Calcitriol (active vitamin D) suppresses PTH secretion and
improves bone mineralization. Sevelamer reduces phosphorus but does not directly
lower PTH.
5. During a comprehensive osteopathic structural exam, you find that a
patient’s right anterior superior iliac spine (ASIS) is inferior to the left ASIS.
The patient is supine. What is the most likely somatic dysfunction?
• A) Right anterior innominate
• B) Right posterior innominate
• C) Left anterior innominate
• D) Left posterior innominate
Correct ,,,answer,,,: B
Rationale: In supine, an inferior ASIS indicates that the ilium has rotated
, 4
posteriorly on that side. Thus, right ASIS inferior = right posterior innominate.
Anterior innominate would make the ASIS superior.
6. A 45-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. Her TSH is 25 µIU/mL and free T4 is 0.4 ng/dL. Which
antibody is most likely positive?
• A) Thyroid peroxidase (TPO) antibody
• B) Thyroid-stimulating immunoglobulin (TSI)
• C) Anti-thyroglobulin antibody
• D) TSH receptor blocking antibody
Correct ,,,answer,,,: A
Rationale: Hashimoto thyroiditis is the most common cause of hypothyroidism.
TPO antibodies are present in >90% of cases. TSI is seen in Graves disease
(hyperthyroidism).
7. A 55-year-old man with type 2 diabetes is started on a medication that
causes weight loss and a modest reduction in HbA1c. It works by increasing
glucagon-like peptide-1 (GLP-1) activity. Which medication is most likely
prescribed?
• A) Metformin
• B) Sitagliptin
• C) Liraglutide
• D) Empagliflozin
