COMSAE Phase 1, 2 & 3 – Osteopathic Principles &
Practice (OMM/OMT) High-Yield Review | 90 Exam-
Style Questions with Verified Answers & Rationales |
2025–2026 PDF Download
Content coverage includes: Cardiology, Pulmonology,
Neurology, OMM/OPP, Microbiology, Endocrinology,
Gastroenterology, Biochemistry, Physiology,
Pharmacology, and Osteopathic Principles
1. A 23-year-old man has severe right lower quadrant pain with rebound
tenderness and fever. Which diagnosis is most likely?
A. Cholecystitis
B. Appendicitis
C. Pancreatitis
D. Gastroenteritis
Correct answer: B
Rationale: Right lower quadrant pain with rebound tenderness is classic for
appendicitis, a common surgical abdomen requiring prompt evaluation to prevent
perforation.
2. A patient has a fasting blood glucose of 130 mg/dL on two separate
occasions. What is the most appropriate diagnosis?
A. Normal glucose
B. Impaired fasting glucose
C. Diabetes mellitus
D. Hypoglycemia
Correct answer: C
Rationale: Fasting glucose ≥126 mg/dL on two occasions meets diagnostic criteria
for diabetes mellitus per ADA guidelines.
,3. [Image: Normal sagittal MRI of the lumbar spine showing vertebral bodies,
intervertebral discs, and spinal canal.] Which structure is most commonly
herniated in lumbar disc disease?
A. Vertebral body
B. Intervertebral disc
C. Spinal cord
D. Posterior longitudinal ligament
Correct answer: B
Rationale: Lumbar disc herniation involves the intervertebral disc protruding into
the spinal canal, commonly compressing nerve roots.
4. A patient presents with tremor, weight loss, heat intolerance, and low TSH.
What is the most likely diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Pituitary failure
D. Addison disease
,Correct answer: B
Rationale: Low TSH with symptoms of increased adrenergic activity (tremor,
weight loss, heat intolerance) indicates primary hyperthyroidism.
5. Which organism is most associated with peptic ulcers and urease
production?
A. Helicobacter pylori
B. Salmonella typhi
C. Escherichia coli
D. Staphylococcus aureus
Correct answer: A
Rationale: H. pylori produces urease, survives in acidic gastric environment, and
is the primary cause of chronic peptic ulcers.
6. A 65-year-old man has progressive dyspnea, wheezing, and a long smoking
history. Which diagnosis is most likely?
A. Asthma
B. COPD
C. Pneumothorax
D. Pulmonary embolism
Correct answer: B
Rationale: COPD is strongly associated with smoking and presents with chronic
progressive airflow limitation and dyspnea.
7. Which osteopathic finding is used to diagnose somatic dysfunction?
A. Severe leukocytosis
B. TART findings
C. Positive blood cultures
D. Elevated troponin
, Correct answer: B
Rationale: TART stands for tenderness, asymmetry, restriction, and tissue texture
change—key findings for osteopathic somatic dysfunction.
8. A patient has severe hypocalcemia. Which clinical sign is most likely?
A. Bradycardia
B. Tetany
C. Hypertension
D. Hyperreflexia
Correct answer: B
Rationale: Hypocalcemia increases neuromuscular excitability, leading to tetany
(muscle spasms, Chvostek's and Trousseau's signs).
9. Which osteopathic technique uses a rapid, low-amplitude thrust through
the restrictive barrier?
A. Counterstrain
B. Muscle energy
C. HVLA
D. Myofascial release
Correct answer: C
Rationale: HVLA (high-velocity, low-amplitude) is a direct technique using a
quick thrust to move past the restrictive barrier.
10. A patient has severe low back pain and is placed in a position of maximal
comfort to reduce a tender point. Which technique is being used?
A. Muscle energy
B. HVLA
C. Counterstrain
D. Myofascial release
Practice (OMM/OMT) High-Yield Review | 90 Exam-
Style Questions with Verified Answers & Rationales |
2025–2026 PDF Download
Content coverage includes: Cardiology, Pulmonology,
Neurology, OMM/OPP, Microbiology, Endocrinology,
Gastroenterology, Biochemistry, Physiology,
Pharmacology, and Osteopathic Principles
1. A 23-year-old man has severe right lower quadrant pain with rebound
tenderness and fever. Which diagnosis is most likely?
A. Cholecystitis
B. Appendicitis
C. Pancreatitis
D. Gastroenteritis
Correct answer: B
Rationale: Right lower quadrant pain with rebound tenderness is classic for
appendicitis, a common surgical abdomen requiring prompt evaluation to prevent
perforation.
2. A patient has a fasting blood glucose of 130 mg/dL on two separate
occasions. What is the most appropriate diagnosis?
A. Normal glucose
B. Impaired fasting glucose
C. Diabetes mellitus
D. Hypoglycemia
Correct answer: C
Rationale: Fasting glucose ≥126 mg/dL on two occasions meets diagnostic criteria
for diabetes mellitus per ADA guidelines.
,3. [Image: Normal sagittal MRI of the lumbar spine showing vertebral bodies,
intervertebral discs, and spinal canal.] Which structure is most commonly
herniated in lumbar disc disease?
A. Vertebral body
B. Intervertebral disc
C. Spinal cord
D. Posterior longitudinal ligament
Correct answer: B
Rationale: Lumbar disc herniation involves the intervertebral disc protruding into
the spinal canal, commonly compressing nerve roots.
4. A patient presents with tremor, weight loss, heat intolerance, and low TSH.
What is the most likely diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Pituitary failure
D. Addison disease
,Correct answer: B
Rationale: Low TSH with symptoms of increased adrenergic activity (tremor,
weight loss, heat intolerance) indicates primary hyperthyroidism.
5. Which organism is most associated with peptic ulcers and urease
production?
A. Helicobacter pylori
B. Salmonella typhi
C. Escherichia coli
D. Staphylococcus aureus
Correct answer: A
Rationale: H. pylori produces urease, survives in acidic gastric environment, and
is the primary cause of chronic peptic ulcers.
6. A 65-year-old man has progressive dyspnea, wheezing, and a long smoking
history. Which diagnosis is most likely?
A. Asthma
B. COPD
C. Pneumothorax
D. Pulmonary embolism
Correct answer: B
Rationale: COPD is strongly associated with smoking and presents with chronic
progressive airflow limitation and dyspnea.
7. Which osteopathic finding is used to diagnose somatic dysfunction?
A. Severe leukocytosis
B. TART findings
C. Positive blood cultures
D. Elevated troponin
, Correct answer: B
Rationale: TART stands for tenderness, asymmetry, restriction, and tissue texture
change—key findings for osteopathic somatic dysfunction.
8. A patient has severe hypocalcemia. Which clinical sign is most likely?
A. Bradycardia
B. Tetany
C. Hypertension
D. Hyperreflexia
Correct answer: B
Rationale: Hypocalcemia increases neuromuscular excitability, leading to tetany
(muscle spasms, Chvostek's and Trousseau's signs).
9. Which osteopathic technique uses a rapid, low-amplitude thrust through
the restrictive barrier?
A. Counterstrain
B. Muscle energy
C. HVLA
D. Myofascial release
Correct answer: C
Rationale: HVLA (high-velocity, low-amplitude) is a direct technique using a
quick thrust to move past the restrictive barrier.
10. A patient has severe low back pain and is placed in a position of maximal
comfort to reduce a tender point. Which technique is being used?
A. Muscle energy
B. HVLA
C. Counterstrain
D. Myofascial release
