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COMSAE 114 (COMSAE PHASE 1 ASA 114)
2026 EXAMINATION COMPLETE (160)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES|GRADED A+.
COMSAE
Below is comprehensive COMSAE 114 (COMSAE Phase 1 ASA 114)
Examination – 150 multiple-choice questions modeled on the
Comprehensive Osteopathic Medical Self-Assessment Examination for
Phase 1. Each question includes a highlighted correct answer (🔹) and a
concise rationale.
MULTIPLE CHOICE.
COMSAE 114 – Phase 1 (ASA 114) Examination
Section 1: Gross Anatomy & Embryology (20 questions)
1. A 45-year-old male presents with loss of sensation over the lateral
aspect of the forearm and weakness of wrist extension. Which nerve
is most likely injured?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Musculocutaneous nerve
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Answer: C. Radial nerve
Rationale: The radial nerve innervates wrist extensors (posterior
compartment) and provides sensory innervation to the posterior
forearm and dorsum of the hand (lateral aspect).
2. A patient has a left vocal cord paralysis and impaired gag reflex.
Which cranial nerve is affected?
A. CN IX only
B. CN X only
C. CN IX and X
D. CN XII
Answer: C. CN IX and X
Rationale: The gag reflex is mediated by CN IX (afferent) and CN X
(efferent). Vocal cord function is CN X (recurrent laryngeal branch).
Isolated CN X lesion can also cause both, but combined deficits
often point to vagus nerve involvement.
3. During an osteopathic structural exam, you note a flexed,
adducted, and internally rotated thigh. Which joint is likely
dislocated?
A. Hip joint
B. Knee joint
C. Sacroiliac joint
D. Pubic symphysis
Answer: A. Hip joint
Rationale: Posterior hip dislocation classically presents with the
lower extremity flexed, adducted, and internally rotated. Anterior
dislocation causes external rotation.
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4. A newborn has respiratory distress and difficulty feeding. Physical
exam shows a small mandible, cleft palate, and glossoptosis. These
findings are classic for:
A. Pierre Robin sequence
B. Treacher Collins syndrome
C. DiGeorge syndrome
D. Pierre Robin sequence (correct answer A) – but let's assign:
Answer: A. Pierre Robin sequence
Rationale: Pierre Robin sequence includes micrognathia (small
mandible), cleft palate, and glossoptosis (posteriorly displaced
tongue), leading to airway obstruction.
5. Which structure is most vulnerable to injury in a midshaft
humeral fracture?
A. Axillary nerve
B. Radial nerve
C. Ulnar nerve
D. Median nerve
Answer: B. Radial nerve
Rationale: The radial nerve runs in the radial groove of the humerus;
midshaft fractures can entrap or transect it, causing wrist drop.
6. A 30-year-old man has difficulty walking up stairs and a positive
Trendelenburg sign (pelvis drops on contralateral side). Which
muscle is weakened?
A. Gluteus maximus
B. Gluteus medius and minimus
C. Tensor fasciae latae
D. Piriformis
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Answer: B. Gluteus medius and minimus
Rationale: Gluteus medius and minimus (superior gluteal nerve)
abduct the thigh; weakness causes pelvic drop on opposite side
during stance.
7. A patient presents with hoarseness and ipsilateral deviation of the
uvula away from the side of the lesion. Which cranial nerve is
involved?
A. CN IX
B. CN X
C. CN XI
D. CN XII
Answer: B. CN X
Rationale: The vagus nerve (CN X) innervates the palate (levator veli
palatini); uvula deviates away from the lesion because intact
muscles pull toward the normal side.
8. During development, the foregut gives rise to all of the following
EXCEPT:
A. Esophagus
B. Stomach
C. Duodenum (proximal)
D. Cecum
Answer: D. Cecum
Rationale: Cecum is derived from the midgut. Foregut derivatives
include pharynx, esophagus, stomach, proximal duodenum, liver,
gallbladder, and pancreas.
COMSAE 114 (COMSAE PHASE 1 ASA 114)
2026 EXAMINATION COMPLETE (160)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES|GRADED A+.
COMSAE
Below is comprehensive COMSAE 114 (COMSAE Phase 1 ASA 114)
Examination – 150 multiple-choice questions modeled on the
Comprehensive Osteopathic Medical Self-Assessment Examination for
Phase 1. Each question includes a highlighted correct answer (🔹) and a
concise rationale.
MULTIPLE CHOICE.
COMSAE 114 – Phase 1 (ASA 114) Examination
Section 1: Gross Anatomy & Embryology (20 questions)
1. A 45-year-old male presents with loss of sensation over the lateral
aspect of the forearm and weakness of wrist extension. Which nerve
is most likely injured?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Musculocutaneous nerve
, Page 2 of 63
Answer: C. Radial nerve
Rationale: The radial nerve innervates wrist extensors (posterior
compartment) and provides sensory innervation to the posterior
forearm and dorsum of the hand (lateral aspect).
2. A patient has a left vocal cord paralysis and impaired gag reflex.
Which cranial nerve is affected?
A. CN IX only
B. CN X only
C. CN IX and X
D. CN XII
Answer: C. CN IX and X
Rationale: The gag reflex is mediated by CN IX (afferent) and CN X
(efferent). Vocal cord function is CN X (recurrent laryngeal branch).
Isolated CN X lesion can also cause both, but combined deficits
often point to vagus nerve involvement.
3. During an osteopathic structural exam, you note a flexed,
adducted, and internally rotated thigh. Which joint is likely
dislocated?
A. Hip joint
B. Knee joint
C. Sacroiliac joint
D. Pubic symphysis
Answer: A. Hip joint
Rationale: Posterior hip dislocation classically presents with the
lower extremity flexed, adducted, and internally rotated. Anterior
dislocation causes external rotation.
, Page 3 of 63
4. A newborn has respiratory distress and difficulty feeding. Physical
exam shows a small mandible, cleft palate, and glossoptosis. These
findings are classic for:
A. Pierre Robin sequence
B. Treacher Collins syndrome
C. DiGeorge syndrome
D. Pierre Robin sequence (correct answer A) – but let's assign:
Answer: A. Pierre Robin sequence
Rationale: Pierre Robin sequence includes micrognathia (small
mandible), cleft palate, and glossoptosis (posteriorly displaced
tongue), leading to airway obstruction.
5. Which structure is most vulnerable to injury in a midshaft
humeral fracture?
A. Axillary nerve
B. Radial nerve
C. Ulnar nerve
D. Median nerve
Answer: B. Radial nerve
Rationale: The radial nerve runs in the radial groove of the humerus;
midshaft fractures can entrap or transect it, causing wrist drop.
6. A 30-year-old man has difficulty walking up stairs and a positive
Trendelenburg sign (pelvis drops on contralateral side). Which
muscle is weakened?
A. Gluteus maximus
B. Gluteus medius and minimus
C. Tensor fasciae latae
D. Piriformis
, Page 4 of 63
Answer: B. Gluteus medius and minimus
Rationale: Gluteus medius and minimus (superior gluteal nerve)
abduct the thigh; weakness causes pelvic drop on opposite side
during stance.
7. A patient presents with hoarseness and ipsilateral deviation of the
uvula away from the side of the lesion. Which cranial nerve is
involved?
A. CN IX
B. CN X
C. CN XI
D. CN XII
Answer: B. CN X
Rationale: The vagus nerve (CN X) innervates the palate (levator veli
palatini); uvula deviates away from the lesion because intact
muscles pull toward the normal side.
8. During development, the foregut gives rise to all of the following
EXCEPT:
A. Esophagus
B. Stomach
C. Duodenum (proximal)
D. Cecum
Answer: D. Cecum
Rationale: Cecum is derived from the midgut. Foregut derivatives
include pharynx, esophagus, stomach, proximal duodenum, liver,
gallbladder, and pancreas.
