COMSAE EXAM REVIEW COMPLETE PRACTICE
QUESTIONS WITH CORRECT 100% VERIFIED ANSWERS WITH CLEASR
EXPLANATIONS FOR LEVEL 1, 2, AND 3 COVERING THE RECENT
TESTED QUESTIONS
This document features a comprehensive review of the 2024/2025 COMSAE
exams (Comprehensive Osteopathic Medical Self-Assessment Examination),
including accurate practice questions and verified answers for COMLEX-USA
Levels 1, 2-CE, and 3. It covers high-yield topics such as osteopathic principles,
clinical decision-making, pharmacology, physiology, and system-based
pathology. Designed to reflect NBOME standards, this resource is ideal for
osteopathic medical students preparing to assess readiness and strengthen
performance on official COMLEX exams.
A 42-year-old woman is brought to the emergency department by EMS in an unresponsive state. The
paramedics report a tonic-clonic seizure in the field, which resolved before treatment could be
instituted. The patient's family reports that she said she had a headache prior to becoming
unconscious. Vital signs reveal a temperature of 36.8°C (98.2°F) and a blood pressure of 155/92
mmHg. On examination, the patient has a stiff neck and is responsive only to deep, painful stimuli.
Cerebrospinal fluid has a yellow discoloration, and analysis reveals:
Protein = 1,500 mg/dL15-45 mg/dL
Erythrocyte count = 950 cells/mcL0 cells/mcL
Leukocyte count = 22 cells/mcL< 5 cells/mcL
A CT scan of the head shows no evidence of hemorrhage. The most likely diagnosis is A.
encephalitis
B. idiopathic epilepsy
C. meningitis
D. stroke
E. subarachnoid hemorrhage
,E. subarachnoid haemorrhage
- The patient presents with a sudden onset headache followed by a tonic-clonic seizure and
loss of consciousness. This sequence of events is highly suggestive of a subarachnoid hemorrhage.
- The cerebrospinal fluid analysis shows xanthochromia (yellow discoloration), which is classic
for SAH. The presence of a high erythrocyte count in the CSF further supports the diagnosis of SAH.
- Even though the CT scan does not show evidence of hemorrhage, this can happen if the scan
is performed after a delay or if the bleed is small. In such cases, lumbar puncture (which was done
here) is the definitive test, and the findings (xanthochromia and high red cell count) confirm SAH.
Given these findings, subarachnoid hemorrhage is indeed the most likely diagnosis
A 37-year-old man presents to the emergency department with the sudden onset of hematemesis.
He also reports that he has a 3-day history of nausea, but he did not begin vomiting until 1 day ago.
Past medical history reveals a herniated lumbar disk 2 months ago, for which he has been taking 3
over-the-counter naproxen tablets twice daily for the past 3 weeks. Physical examination reveals
mild epigastric tenderness but findings are otherwise unremarkable. In addition to medical
management, the most appropriate osteopathic manipulative treatment to help normalize this
patient's sympathetic tone is
A. counterstrain to the pelvic region
B. high velocity, low amplitude to the lumbar region
C. mesenteric release of the sigmoid region
D. muscle energy to the OA region
E. myofascial release of the midthoracic spine
E. myofascial release of the midthoracic spine
A 4-year-old boy is brought to the office with a 3-week history of a worsening cough, which has
made it difficult for him to sleep at night. His mother reports that this cough tends to occur every
year in the fall. She denies any fever and says that over-the-counter cough medications have
provided minimal symptomatic improvement. Past medical history is significant for viral bronchiolitis
at 12 months of age. The patient is not currently taking any medications but has used albuterol in
the past for his cough. Auscultation of the lungs reveals end-expiratory wheezes near the bases.
,Physical examination findings are otherwise normal. The patient's condition could most likely have
been prevented by using
A. inhaled budesonide daily
B. nebulized albuterol every morning and night
C. oral albuterol syrup daily
D. oral prednisone daily
E. oral theophylline every night
A. inhaled budesonide daily
Asthma-like Symptoms: The recurrent nature of the cough, especially its seasonal pattern, and the
presence of wheezing suggest that the child might have underlying asthma or reactive airway
disease, which often follows a history of bronchiolitis in infancy.
Prevention Strategy:
Inhaled Corticosteroids (e.g., Budesonide): These are the cornerstone of asthma management and
are used to prevent inflammation and control chronic symptoms. Daily use of an inhaled
corticosteroid like budesonide would help prevent the chronic and recurrent cough by reducing
airway inflammation.
Albuterol: This is a short-acting beta-agonist (SABA) that provides quick relief of bronchospasm but
does not address the underlying inflammation that leads to the symptoms. Thus, while it may relieve
symptoms temporarily, it does not prevent the recurrence of symptoms as effectively as inhaled
corticosteroids.
Conclusion:
Inhaled budesonide daily would have been the most effective in preventing the recurrent symptoms
by controlling the underlying inflammation, whereas nebulized albuterol is used for symptomatic
relief during an acute episode but does not prevent the condition.
, ✅ A 65-year-old man presents to the office with the sudden onset of painless, right-sided vision loss.
Past medical history reveals hypertension, diabetes, and a myocardial infarction. Surgical history is
remarkable for an appendectomy as a child and a carotid endarterectomy 8 years ago. Visual
examination of the right eye reveals markedly reduced visual acuity with a prominent afferent
pupillary defect. Funduscopic examination reveals the findings shown in the exhibit. The most likely
diagnosis is
A. angle-closure glaucoma
B. central retinal artery occlusion
C. exudative macular degeneration
D. retinal detachment
E. vitreous hemorrhage
B. central retinal artery occlusion
Sudden Painless Vision Loss: CRAO typically presents with sudden, painless monocular vision loss,
often described as a curtain falling over the visual field.
Prominent Afferent Pupillary Defect: This defect (also known as a Marcus Gunn pupil) is often
present in CRAO due to significant retinal damage.
Funduscopic Findings: The image shows a pale retina with a cherry-red spot, which is a classic finding
in CRAO. The pale retina occurs due to ischemia, while the cherry-red spot is visible because the
macula receives its blood supply from the choroid, which is not affected by the occlusion.
Risk Factors: The patient's history of hypertension, diabetes, and carotid artery disease increases the
risk of embolic events, which are the most common cause of CRAO.
Given the acute presentation and the combination of clinical and funduscopic findings, CRAO is the
most likely diagnosis.
A 22-year-old woman presents to the office for evaluation of abdominal pain and bloating relieved
by defecation. She reports that her symptoms began during her freshman year of college but have
gotten worse the past month when she began graduate school. Which of the following physical
examination findings would most likely support the diagnosis?
a. hypertonicity of the upper thoracic paraspinal musculature
QUESTIONS WITH CORRECT 100% VERIFIED ANSWERS WITH CLEASR
EXPLANATIONS FOR LEVEL 1, 2, AND 3 COVERING THE RECENT
TESTED QUESTIONS
This document features a comprehensive review of the 2024/2025 COMSAE
exams (Comprehensive Osteopathic Medical Self-Assessment Examination),
including accurate practice questions and verified answers for COMLEX-USA
Levels 1, 2-CE, and 3. It covers high-yield topics such as osteopathic principles,
clinical decision-making, pharmacology, physiology, and system-based
pathology. Designed to reflect NBOME standards, this resource is ideal for
osteopathic medical students preparing to assess readiness and strengthen
performance on official COMLEX exams.
A 42-year-old woman is brought to the emergency department by EMS in an unresponsive state. The
paramedics report a tonic-clonic seizure in the field, which resolved before treatment could be
instituted. The patient's family reports that she said she had a headache prior to becoming
unconscious. Vital signs reveal a temperature of 36.8°C (98.2°F) and a blood pressure of 155/92
mmHg. On examination, the patient has a stiff neck and is responsive only to deep, painful stimuli.
Cerebrospinal fluid has a yellow discoloration, and analysis reveals:
Protein = 1,500 mg/dL15-45 mg/dL
Erythrocyte count = 950 cells/mcL0 cells/mcL
Leukocyte count = 22 cells/mcL< 5 cells/mcL
A CT scan of the head shows no evidence of hemorrhage. The most likely diagnosis is A.
encephalitis
B. idiopathic epilepsy
C. meningitis
D. stroke
E. subarachnoid hemorrhage
,E. subarachnoid haemorrhage
- The patient presents with a sudden onset headache followed by a tonic-clonic seizure and
loss of consciousness. This sequence of events is highly suggestive of a subarachnoid hemorrhage.
- The cerebrospinal fluid analysis shows xanthochromia (yellow discoloration), which is classic
for SAH. The presence of a high erythrocyte count in the CSF further supports the diagnosis of SAH.
- Even though the CT scan does not show evidence of hemorrhage, this can happen if the scan
is performed after a delay or if the bleed is small. In such cases, lumbar puncture (which was done
here) is the definitive test, and the findings (xanthochromia and high red cell count) confirm SAH.
Given these findings, subarachnoid hemorrhage is indeed the most likely diagnosis
A 37-year-old man presents to the emergency department with the sudden onset of hematemesis.
He also reports that he has a 3-day history of nausea, but he did not begin vomiting until 1 day ago.
Past medical history reveals a herniated lumbar disk 2 months ago, for which he has been taking 3
over-the-counter naproxen tablets twice daily for the past 3 weeks. Physical examination reveals
mild epigastric tenderness but findings are otherwise unremarkable. In addition to medical
management, the most appropriate osteopathic manipulative treatment to help normalize this
patient's sympathetic tone is
A. counterstrain to the pelvic region
B. high velocity, low amplitude to the lumbar region
C. mesenteric release of the sigmoid region
D. muscle energy to the OA region
E. myofascial release of the midthoracic spine
E. myofascial release of the midthoracic spine
A 4-year-old boy is brought to the office with a 3-week history of a worsening cough, which has
made it difficult for him to sleep at night. His mother reports that this cough tends to occur every
year in the fall. She denies any fever and says that over-the-counter cough medications have
provided minimal symptomatic improvement. Past medical history is significant for viral bronchiolitis
at 12 months of age. The patient is not currently taking any medications but has used albuterol in
the past for his cough. Auscultation of the lungs reveals end-expiratory wheezes near the bases.
,Physical examination findings are otherwise normal. The patient's condition could most likely have
been prevented by using
A. inhaled budesonide daily
B. nebulized albuterol every morning and night
C. oral albuterol syrup daily
D. oral prednisone daily
E. oral theophylline every night
A. inhaled budesonide daily
Asthma-like Symptoms: The recurrent nature of the cough, especially its seasonal pattern, and the
presence of wheezing suggest that the child might have underlying asthma or reactive airway
disease, which often follows a history of bronchiolitis in infancy.
Prevention Strategy:
Inhaled Corticosteroids (e.g., Budesonide): These are the cornerstone of asthma management and
are used to prevent inflammation and control chronic symptoms. Daily use of an inhaled
corticosteroid like budesonide would help prevent the chronic and recurrent cough by reducing
airway inflammation.
Albuterol: This is a short-acting beta-agonist (SABA) that provides quick relief of bronchospasm but
does not address the underlying inflammation that leads to the symptoms. Thus, while it may relieve
symptoms temporarily, it does not prevent the recurrence of symptoms as effectively as inhaled
corticosteroids.
Conclusion:
Inhaled budesonide daily would have been the most effective in preventing the recurrent symptoms
by controlling the underlying inflammation, whereas nebulized albuterol is used for symptomatic
relief during an acute episode but does not prevent the condition.
, ✅ A 65-year-old man presents to the office with the sudden onset of painless, right-sided vision loss.
Past medical history reveals hypertension, diabetes, and a myocardial infarction. Surgical history is
remarkable for an appendectomy as a child and a carotid endarterectomy 8 years ago. Visual
examination of the right eye reveals markedly reduced visual acuity with a prominent afferent
pupillary defect. Funduscopic examination reveals the findings shown in the exhibit. The most likely
diagnosis is
A. angle-closure glaucoma
B. central retinal artery occlusion
C. exudative macular degeneration
D. retinal detachment
E. vitreous hemorrhage
B. central retinal artery occlusion
Sudden Painless Vision Loss: CRAO typically presents with sudden, painless monocular vision loss,
often described as a curtain falling over the visual field.
Prominent Afferent Pupillary Defect: This defect (also known as a Marcus Gunn pupil) is often
present in CRAO due to significant retinal damage.
Funduscopic Findings: The image shows a pale retina with a cherry-red spot, which is a classic finding
in CRAO. The pale retina occurs due to ischemia, while the cherry-red spot is visible because the
macula receives its blood supply from the choroid, which is not affected by the occlusion.
Risk Factors: The patient's history of hypertension, diabetes, and carotid artery disease increases the
risk of embolic events, which are the most common cause of CRAO.
Given the acute presentation and the combination of clinical and funduscopic findings, CRAO is the
most likely diagnosis.
A 22-year-old woman presents to the office for evaluation of abdominal pain and bloating relieved
by defecation. She reports that her symptoms began during her freshman year of college but have
gotten worse the past month when she began graduate school. Which of the following physical
examination findings would most likely support the diagnosis?
a. hypertonicity of the upper thoracic paraspinal musculature
