Page 1 of 173
COMSAE Phase 1 Form 113 EXAM QUESTIONS AND CORRECT
VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR – JUST
RELEASED
COMSAE Phase 1 – Form 113: Comprehensive Practice Exam
Below is a complete exam coverage summary followed by 250 randomized, scenario-based
multiple-choice questions with answers and detailed rationales. Each question is exam-relevant
for COMSAE Phase 1 Form 113, which assesses readiness for COMLEX-USA Level 1, covering
foundational biomedical sciences, clinical medicine, and osteopathic principles .
Primary Exam Domains
Domain Key Topics
Somatic dysfunction, Chapman reflexes, HVLA, counterstrain, cranial
Osteopathic Principles &
manipulation (sphenobasilar symphysis), viscerosomatic reflexes, sympath
Practice
levels
General Principles &
Biochemistry, microbiology, immunology, pharmacology, pathology, geneti
Foundational Science
Ischemic heart disease, heart failure, arrhythmias, valvular disease,
Cardiovascular System
hypertension, aortic dissection
Asthma, COPD, pneumonia, pulmonary embolism, restrictive lung disease
Respiratory System
lung cancer
Pancreatitis, hepatitis, inflammatory bowel disease, peptic ulcer disease,
Gastrointestinal System
achalasia
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Domain Key Topics
Stroke, seizure disorders, Parkinson disease, multiple sclerosis, neuromusc
Neurology
disorders, meningitis
Acute kidney injury, chronic kidney disease, nephrotic syndrome,
Renal/Genitourinary
nephrolithiasis
Diabetes mellitus, thyroid disorders, adrenal disorders (pheochromocytom
Endocrine/Reproductive
Cushing, Addison), prolactinoma
Common pathogens, antibiotic therapy, prevention strategies, meningitis,
Infectious Disease
septic shock
Gout, pseudogout, septic arthritis, rheumatoid arthritis, osteoarthritis,
Musculoskeletal
fractures
250 Randomized, Scenario-Based Practice Questions
Questions 1-50
1. A 45-year-old male presents with chronic low back pain. Physical examination reveals an
apparent short left leg, a left posterior superior iliac spine (PSIS) that is superior compared to
the right, and a left anterior inferior iliac spine (AIIS) that is inferior. What is the most likely
sacral diagnosis?
A) Right-on-right torsion
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B) Left unilateral flexion
C) Left-on-left torsion
D) Right unilateral flexion
E) Left-on-right torsion
Answer: C – Left-on-left torsion – In sacral torsion, the side of the oblique axis is named first,
and the side of rotation is named second. The findings (deep sulcus on the right, shallow on the
left; ILA posterior on the left) indicate rotation around a left oblique axis. A "Left-on-left" torsion
means the axis is on the left and the base is rotating anteriorly on the left .
2. A patient with COPD is in respiratory distress. You note significant rib elevation and restricted
motion on the left side. Using a direct technique, you apply force to the superior aspect of the
left transverse process. Which rib dysfunction is being treated?
A) Pump handle
B) Bucket handle
C) Caliper
D) Posterior rib torsion
E) Anterior rib torsion
Answer: B – Bucket handle – Rib dysfunction is classified by the axis of motion. The "bucket
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handle" motion involves elevation and depression of the rib shaft. Applying force to the
superior aspect of the transverse process treats a rib that is restricted in its bucket handle
motion .
3. A 30-year-old woman presents with palpitations, weight loss, and heat intolerance. Labs show
low TSH and high free T4. What is the most likely diagnosis?
A) Hypothyroidism
B) Graves disease
C) Thyroiditis
D) Pituitary adenoma
E) Subacute thyroiditis
Answer: B – Graves disease – Hyperthyroidism with low TSH and high T4 suggests Graves
disease, an autoimmune stimulation of the thyroid by thyroid-stimulating immunoglobulins (TSI)
that activate TSH receptors .
4. A patient with chronic alcohol use presents with confusion, ataxia, and ophthalmoplegia.
What vitamin deficiency is most likely?
A) Vitamin B12 (cobalamin)
B) Thiamine (vitamin B1)
COMSAE Phase 1 Form 113 EXAM QUESTIONS AND CORRECT
VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR – JUST
RELEASED
COMSAE Phase 1 – Form 113: Comprehensive Practice Exam
Below is a complete exam coverage summary followed by 250 randomized, scenario-based
multiple-choice questions with answers and detailed rationales. Each question is exam-relevant
for COMSAE Phase 1 Form 113, which assesses readiness for COMLEX-USA Level 1, covering
foundational biomedical sciences, clinical medicine, and osteopathic principles .
Primary Exam Domains
Domain Key Topics
Somatic dysfunction, Chapman reflexes, HVLA, counterstrain, cranial
Osteopathic Principles &
manipulation (sphenobasilar symphysis), viscerosomatic reflexes, sympath
Practice
levels
General Principles &
Biochemistry, microbiology, immunology, pharmacology, pathology, geneti
Foundational Science
Ischemic heart disease, heart failure, arrhythmias, valvular disease,
Cardiovascular System
hypertension, aortic dissection
Asthma, COPD, pneumonia, pulmonary embolism, restrictive lung disease
Respiratory System
lung cancer
Pancreatitis, hepatitis, inflammatory bowel disease, peptic ulcer disease,
Gastrointestinal System
achalasia
, Page 2 of 173
Domain Key Topics
Stroke, seizure disorders, Parkinson disease, multiple sclerosis, neuromusc
Neurology
disorders, meningitis
Acute kidney injury, chronic kidney disease, nephrotic syndrome,
Renal/Genitourinary
nephrolithiasis
Diabetes mellitus, thyroid disorders, adrenal disorders (pheochromocytom
Endocrine/Reproductive
Cushing, Addison), prolactinoma
Common pathogens, antibiotic therapy, prevention strategies, meningitis,
Infectious Disease
septic shock
Gout, pseudogout, septic arthritis, rheumatoid arthritis, osteoarthritis,
Musculoskeletal
fractures
250 Randomized, Scenario-Based Practice Questions
Questions 1-50
1. A 45-year-old male presents with chronic low back pain. Physical examination reveals an
apparent short left leg, a left posterior superior iliac spine (PSIS) that is superior compared to
the right, and a left anterior inferior iliac spine (AIIS) that is inferior. What is the most likely
sacral diagnosis?
A) Right-on-right torsion
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B) Left unilateral flexion
C) Left-on-left torsion
D) Right unilateral flexion
E) Left-on-right torsion
Answer: C – Left-on-left torsion – In sacral torsion, the side of the oblique axis is named first,
and the side of rotation is named second. The findings (deep sulcus on the right, shallow on the
left; ILA posterior on the left) indicate rotation around a left oblique axis. A "Left-on-left" torsion
means the axis is on the left and the base is rotating anteriorly on the left .
2. A patient with COPD is in respiratory distress. You note significant rib elevation and restricted
motion on the left side. Using a direct technique, you apply force to the superior aspect of the
left transverse process. Which rib dysfunction is being treated?
A) Pump handle
B) Bucket handle
C) Caliper
D) Posterior rib torsion
E) Anterior rib torsion
Answer: B – Bucket handle – Rib dysfunction is classified by the axis of motion. The "bucket
, Page 4 of 173
handle" motion involves elevation and depression of the rib shaft. Applying force to the
superior aspect of the transverse process treats a rib that is restricted in its bucket handle
motion .
3. A 30-year-old woman presents with palpitations, weight loss, and heat intolerance. Labs show
low TSH and high free T4. What is the most likely diagnosis?
A) Hypothyroidism
B) Graves disease
C) Thyroiditis
D) Pituitary adenoma
E) Subacute thyroiditis
Answer: B – Graves disease – Hyperthyroidism with low TSH and high T4 suggests Graves
disease, an autoimmune stimulation of the thyroid by thyroid-stimulating immunoglobulins (TSI)
that activate TSH receptors .
4. A patient with chronic alcohol use presents with confusion, ataxia, and ophthalmoplegia.
What vitamin deficiency is most likely?
A) Vitamin B12 (cobalamin)
B) Thiamine (vitamin B1)
