COMSAE 114 EXAM
2026–2027
(200 QUESTIONS AND CORRECT ANSWERS)
ALREADY GRADED A+ | 100% VERIFIED
Osteopathic Medical Self-Assessment
Key Domains:
Foundational Biomedical Science • Osteopathic Principles and Practice (OPP)
Clinical Diagnosis • Patient Safety • Pharmacology
Pathophysiology • Evidence-Based Medicine
Expert-Aligned Structure | Exam-Ready Format | COMLEX Level 1 / Level 2 CE
,Introduction
This structured COMSAE 114 Exam format for 2026–2027 provides a complete 200-
question, high-yield osteopathic self-assessment modeled precisely after the NBOME
COMLEX-USA / COMSAE Phase 1 blueprint. It emphasizes clinical reasoning, osteopathic
principles, patient safety, and evidence-based medical knowledge critical to professional
osteopathic practice and successful COMLEX preparation.
Answer Format: All correct answers appear in bold and cyan, accompanied by concise
rationales explaining safety/clinical reasoning, NBOME code adherence, and why
alternative options are less appropriate.
COMLEX Dimension 2 Distribution (COMSAE 114):
Clinical Presentation % Questions Q# Range
Domain
Musculoskeletal System 13% 1–26
Community Health / 12% 27–50
Patient Safety / EBM /
Ethics
Nervous System & Mental 10% 51–70
Health
Gastrointestinal System & 10% 71–90
Nutrition
Circulatory & 10% 91–110
Hematologic Systems
Respiratory System 10% 111–130
Human Development / 8% 131–146
Reproduction / Sexuality
Endocrine System & 8% 147–162
Metabolism
Genitourinary / Renal 8% 163–178
System
Integumentary System 6% 179–190
OPP / OMM Integrated 12% competency 191–200 + integrated
throughout
,1. A 24-year-old basketball player lands awkwardly and hears a pop in his right knee,
with immediate effusion. Anterior drawer test is positive. Which ligament is most
likely injured?
A. Posterior cruciate ligament
B. Medial collateral ligament
C. Anterior cruciate ligament
D. Lateral collateral ligament
E. Patellar tendon
Correct Answer: C. Anterior cruciate ligament
Rationale: ACL tear: non-contact pivot, audible pop, immediate hemarthrosis,
positive anterior drawer/Lachman. PCL is posterior drawer. MCL is valgus stress.
Domain: MSK | COMSAE 114 | NBOME-aligned
2. A 68-year-old woman trips and falls on an outstretched hand. She has dorsal wrist
swelling, dinner-fork deformity. Which nerve is at greatest risk?
A. Ulnar nerve
B. Radial nerve
C. Median nerve
D. Anterior interosseous nerve
E. Axillary nerve
Correct Answer: C. Median nerve
Rationale: Colles fracture – distal radius with dorsal displacement. Acute median
nerve compression / carpal tunnel is classic complication. Correct answer: Median
nerve.
Domain: MSK | COMSAE 114 | NBOME-aligned
3. A 45-year-old carpenter has lateral elbow pain worsened by wrist extension
against resistance. Point tenderness 1 cm distal to lateral epicondyle. Diagnosis?
A. Medial epicondylitis
B. Lateral epicondylitis
C. Olecranon bursitis
D. Radial tunnel syndrome
E. Ulnar neuropathy
Correct Answer: B. Lateral epicondylitis
Rationale: Lateral epicondylitis – ECRB tendinopathy. Pain with resisted wrist
extension. Medial is golfer’s elbow with wrist flexion.
Domain: MSK | COMSAE 114 | NBOME-aligned
, 4. A 32-year-old female with 3 months morning stiffness >1 hour, MCP and PIP
symmetric swelling, ulnar deviation. RF and anti-CCP positive. First-line DMARD?
A. Hydroxychloroquine monotherapy
B. Methotrexate
C. Prednisone long-term
D. Etanercept alone
E. Naproxen alone
Correct Answer: B. Methotrexate
Rationale: Rheumatoid arthritis. Methotrexate is first-line DMARD, reduces
progression. NSAIDs/steroids are symptomatic only. Correct: Methotrexate.
Domain: MSK | COMSAE 114 | NBOME-aligned
5. A 16-year-old boy with sudden severe left hip pain after sprinting, leg externally
rotated, shortened. SCFE vs slipped capital femoral epiphysis is suspected. Most
common age/gender?
A. 8-year-old girls
B. Obese adolescent males 12–16
C. 25-year-old athletes
D. 65-year-old women
E. Newborn males
Correct Answer: B. Obese adolescent males 12–16
Rationale: SCFE: obese adolescent males 12–16, limp, external rotation, Klein line.
Urgent orthopedic pinning.
Domain: MSK | COMSAE 114 | NBOME-aligned
6. L5 radiculopathy is most likely to cause which deficit?
A. Loss of ankle jerk
B. Weakness of great toe dorsiflexion
C. Loss of patellar reflex
D. Foot eversion weakness only
E. Perianal numbness
Correct Answer: B. Weakness of great toe dorsiflexion
Rationale: L5: dorsiflexion of great toe / foot – extensor hallucis longus, tibialis
anterior. S1 = ankle jerk / plantarflexion. L4 = patellar reflex / quadriceps.
Domain: MSK / Neuro | COMSAE 114 | NBOME-aligned
7. A 22-year-old has shoulder dislocation anteriorly after fall. Which finding is most
expected?
A. Loss of deltoid sensation – axillary nerve
2026–2027
(200 QUESTIONS AND CORRECT ANSWERS)
ALREADY GRADED A+ | 100% VERIFIED
Osteopathic Medical Self-Assessment
Key Domains:
Foundational Biomedical Science • Osteopathic Principles and Practice (OPP)
Clinical Diagnosis • Patient Safety • Pharmacology
Pathophysiology • Evidence-Based Medicine
Expert-Aligned Structure | Exam-Ready Format | COMLEX Level 1 / Level 2 CE
,Introduction
This structured COMSAE 114 Exam format for 2026–2027 provides a complete 200-
question, high-yield osteopathic self-assessment modeled precisely after the NBOME
COMLEX-USA / COMSAE Phase 1 blueprint. It emphasizes clinical reasoning, osteopathic
principles, patient safety, and evidence-based medical knowledge critical to professional
osteopathic practice and successful COMLEX preparation.
Answer Format: All correct answers appear in bold and cyan, accompanied by concise
rationales explaining safety/clinical reasoning, NBOME code adherence, and why
alternative options are less appropriate.
COMLEX Dimension 2 Distribution (COMSAE 114):
Clinical Presentation % Questions Q# Range
Domain
Musculoskeletal System 13% 1–26
Community Health / 12% 27–50
Patient Safety / EBM /
Ethics
Nervous System & Mental 10% 51–70
Health
Gastrointestinal System & 10% 71–90
Nutrition
Circulatory & 10% 91–110
Hematologic Systems
Respiratory System 10% 111–130
Human Development / 8% 131–146
Reproduction / Sexuality
Endocrine System & 8% 147–162
Metabolism
Genitourinary / Renal 8% 163–178
System
Integumentary System 6% 179–190
OPP / OMM Integrated 12% competency 191–200 + integrated
throughout
,1. A 24-year-old basketball player lands awkwardly and hears a pop in his right knee,
with immediate effusion. Anterior drawer test is positive. Which ligament is most
likely injured?
A. Posterior cruciate ligament
B. Medial collateral ligament
C. Anterior cruciate ligament
D. Lateral collateral ligament
E. Patellar tendon
Correct Answer: C. Anterior cruciate ligament
Rationale: ACL tear: non-contact pivot, audible pop, immediate hemarthrosis,
positive anterior drawer/Lachman. PCL is posterior drawer. MCL is valgus stress.
Domain: MSK | COMSAE 114 | NBOME-aligned
2. A 68-year-old woman trips and falls on an outstretched hand. She has dorsal wrist
swelling, dinner-fork deformity. Which nerve is at greatest risk?
A. Ulnar nerve
B. Radial nerve
C. Median nerve
D. Anterior interosseous nerve
E. Axillary nerve
Correct Answer: C. Median nerve
Rationale: Colles fracture – distal radius with dorsal displacement. Acute median
nerve compression / carpal tunnel is classic complication. Correct answer: Median
nerve.
Domain: MSK | COMSAE 114 | NBOME-aligned
3. A 45-year-old carpenter has lateral elbow pain worsened by wrist extension
against resistance. Point tenderness 1 cm distal to lateral epicondyle. Diagnosis?
A. Medial epicondylitis
B. Lateral epicondylitis
C. Olecranon bursitis
D. Radial tunnel syndrome
E. Ulnar neuropathy
Correct Answer: B. Lateral epicondylitis
Rationale: Lateral epicondylitis – ECRB tendinopathy. Pain with resisted wrist
extension. Medial is golfer’s elbow with wrist flexion.
Domain: MSK | COMSAE 114 | NBOME-aligned
, 4. A 32-year-old female with 3 months morning stiffness >1 hour, MCP and PIP
symmetric swelling, ulnar deviation. RF and anti-CCP positive. First-line DMARD?
A. Hydroxychloroquine monotherapy
B. Methotrexate
C. Prednisone long-term
D. Etanercept alone
E. Naproxen alone
Correct Answer: B. Methotrexate
Rationale: Rheumatoid arthritis. Methotrexate is first-line DMARD, reduces
progression. NSAIDs/steroids are symptomatic only. Correct: Methotrexate.
Domain: MSK | COMSAE 114 | NBOME-aligned
5. A 16-year-old boy with sudden severe left hip pain after sprinting, leg externally
rotated, shortened. SCFE vs slipped capital femoral epiphysis is suspected. Most
common age/gender?
A. 8-year-old girls
B. Obese adolescent males 12–16
C. 25-year-old athletes
D. 65-year-old women
E. Newborn males
Correct Answer: B. Obese adolescent males 12–16
Rationale: SCFE: obese adolescent males 12–16, limp, external rotation, Klein line.
Urgent orthopedic pinning.
Domain: MSK | COMSAE 114 | NBOME-aligned
6. L5 radiculopathy is most likely to cause which deficit?
A. Loss of ankle jerk
B. Weakness of great toe dorsiflexion
C. Loss of patellar reflex
D. Foot eversion weakness only
E. Perianal numbness
Correct Answer: B. Weakness of great toe dorsiflexion
Rationale: L5: dorsiflexion of great toe / foot – extensor hallucis longus, tibialis
anterior. S1 = ankle jerk / plantarflexion. L4 = patellar reflex / quadriceps.
Domain: MSK / Neuro | COMSAE 114 | NBOME-aligned
7. A 22-year-old has shoulder dislocation anteriorly after fall. Which finding is most
expected?
A. Loss of deltoid sensation – axillary nerve
