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COMSAE Phase 1 ASA 116 – The Complete 176 Question Test
Bank All questions with correct verified answers & detailed
rationales – graded A+ for the newest 2026 actual exam
1. OMM – Fryette’s Mechanics
A patient with chronic neck pain has a restricted C5 segment that rotates more
easily to the right and sidebends more easily to the right. The restriction improves
when the patient extends the cervical spine. According to Fryette’s principles,
what is the correct diagnosis?
A) C5 Extended RR SR
B) C5 Extended RR SL
C) C5 Flexed RR SR
D) C5 Neutral RR SR
: Correct Answer : A
Rationale: The segment improves in extension, so it is an Extended dysfunction.
In Type II (non-neutral) mechanics, rotation and sidebending occur in the same
direction. Thus, rotation right (RR) and sidebending right (SR) yields “Extended RR
SR.”
2. Anatomy – Chapman’s Reflex
A patient with a history of recurrent urinary tract infections has tenderness in the
right lower quadrant at the tip of the 12th rib. This Chapman reflex is associated
with which organ?
A) Appendix
B) Right kidney
C) Right ureter
D) Right ovary
: Correct Answer : B
Rationale: The kidney Chapman reflex is located at the tip of the 12th rib. The
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appendix reflex is also at the tip of the 12th rib (right), but kidney is more
appropriate for a history of recurrent UTIs.
3. Physiology – Cardiovascular
A 55-year-old man presents with acute onset of severe substernal chest pain
radiating to his left arm. ECG shows ST-segment elevation in leads V1-V4. Which
coronary artery is most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery
D) Posterior descending artery
: Correct Answer : C
Rationale: ST elevation in V1-V4 indicates an anterior wall MI, which is caused by
occlusion of the left anterior descending artery (LAD). The LAD supplies the
anterior septum and anterior wall.
4. Microbiology – Osteopathic Education
A 22-year-old college student presents with fever, headache, and stiff neck. CSF
analysis shows elevated WBC (lymphocytic predominance), normal glucose, and
elevated protein. What is the most likely diagnosis?
A) Viral meningitis
B) Bacterial meningitis
C) Fungal meningitis
D) Tuberculous meningitis
: Correct Answer : A
Rationale: Viral meningitis (aseptic) typically shows lymphocytic pleocytosis,
normal or mildly low glucose, and elevated protein. CSF culture is negative.
5. Pathology – Shock
A 68-year-old man presents with acute onset of severe, tearing chest pain
radiating to his back. His blood pressure is 180/100 mm Hg in the right arm and
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110/70 mm Hg in the left arm. Which imaging study is most appropriate?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography of the chest
D) Ventilation-perfusion scan
: Correct Answer : C
Rationale: The presentation is classic for aortic dissection. CT angiography is the
preferred initial imaging modality because it is rapid and can visualize the entire
aorta.
6. Pharmacology – Antiarrhythmics
A 35-year-old woman with no cardiac history presents with episodic palpitations
triggered by exercise. ECG shows a short PR interval and a delta wave. What is the
most definitive treatment for her condition?
A) Chronic oral verapamil
B) Radiofrequency catheter ablation
C) Implantable cardioverter-defibrillator (ICD)
D) Propranolol
: Correct Answer : B
Explanation: WPW syndrome with symptomatic reentrant tachycardia is
definitively treated with catheter ablation of the accessory pathway.
7. Biochemistry – Vitamins
A 40-year-old man with a history of alcoholism presents with acute onset of
confusion, ataxia, and ophthalmoplegia. Which vitamin deficiency is most likely?
A) Vitamin B1 (Thiamine)
B) Vitamin B3 (Niacin)
C) Vitamin B12
D) Vitamin K
: Correct Answer : A
Rationale: Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia) is
caused by thiamine deficiency, commonly seen in alcoholics.
pg. 3
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8. Behavioral Science – Psychopathology
A 50-year-old woman presents with a 6-month history of excessive worry about
her health, finances, and family. She feels restless, fatigued, and has difficulty
sleeping. What is the most likely diagnosis?
A) Generalized anxiety disorder (GAD)
B) Panic disorder
C) Social anxiety disorder
D) Adjustment disorder
: Correct Answer : A
Rationale: GAD is characterized by excessive, uncontrollable worry occurring
more days than not for at least 6 months, with at least three associated
symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle
tension, sleep disturbance).
9. Microbiology – Immunology
A 35-year-old woman presents with photosensitive malar rash, oral ulcers, and
arthritis. ANA is positive at 1:640. What is the most likely diagnosis?
A) Systemic lupus erythematosus (SLE)
B) Rheumatoid arthritis
C) Sjögren’s syndrome
D) Mixed connective tissue disease
: Correct Answer : A
Rationale: Malar rash, photosensitivity, oral ulcers, arthritis, and positive ANA are
highly suggestive of SLE.
10. OMM – Viscerosomatic Reflex
A patient with a history of asthma and frequent upper respiratory infections
presents with a tender point at the tip of the spinous process of T3. This is most
likely a viscerosomatic reflex from which organ?
A) Heart
B) Lung
pg. 4
COMSAE Phase 1 ASA 116 – The Complete 176 Question Test
Bank All questions with correct verified answers & detailed
rationales – graded A+ for the newest 2026 actual exam
1. OMM – Fryette’s Mechanics
A patient with chronic neck pain has a restricted C5 segment that rotates more
easily to the right and sidebends more easily to the right. The restriction improves
when the patient extends the cervical spine. According to Fryette’s principles,
what is the correct diagnosis?
A) C5 Extended RR SR
B) C5 Extended RR SL
C) C5 Flexed RR SR
D) C5 Neutral RR SR
: Correct Answer : A
Rationale: The segment improves in extension, so it is an Extended dysfunction.
In Type II (non-neutral) mechanics, rotation and sidebending occur in the same
direction. Thus, rotation right (RR) and sidebending right (SR) yields “Extended RR
SR.”
2. Anatomy – Chapman’s Reflex
A patient with a history of recurrent urinary tract infections has tenderness in the
right lower quadrant at the tip of the 12th rib. This Chapman reflex is associated
with which organ?
A) Appendix
B) Right kidney
C) Right ureter
D) Right ovary
: Correct Answer : B
Rationale: The kidney Chapman reflex is located at the tip of the 12th rib. The
pg. 1
,2
appendix reflex is also at the tip of the 12th rib (right), but kidney is more
appropriate for a history of recurrent UTIs.
3. Physiology – Cardiovascular
A 55-year-old man presents with acute onset of severe substernal chest pain
radiating to his left arm. ECG shows ST-segment elevation in leads V1-V4. Which
coronary artery is most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery
D) Posterior descending artery
: Correct Answer : C
Rationale: ST elevation in V1-V4 indicates an anterior wall MI, which is caused by
occlusion of the left anterior descending artery (LAD). The LAD supplies the
anterior septum and anterior wall.
4. Microbiology – Osteopathic Education
A 22-year-old college student presents with fever, headache, and stiff neck. CSF
analysis shows elevated WBC (lymphocytic predominance), normal glucose, and
elevated protein. What is the most likely diagnosis?
A) Viral meningitis
B) Bacterial meningitis
C) Fungal meningitis
D) Tuberculous meningitis
: Correct Answer : A
Rationale: Viral meningitis (aseptic) typically shows lymphocytic pleocytosis,
normal or mildly low glucose, and elevated protein. CSF culture is negative.
5. Pathology – Shock
A 68-year-old man presents with acute onset of severe, tearing chest pain
radiating to his back. His blood pressure is 180/100 mm Hg in the right arm and
pg. 2
,3
110/70 mm Hg in the left arm. Which imaging study is most appropriate?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography of the chest
D) Ventilation-perfusion scan
: Correct Answer : C
Rationale: The presentation is classic for aortic dissection. CT angiography is the
preferred initial imaging modality because it is rapid and can visualize the entire
aorta.
6. Pharmacology – Antiarrhythmics
A 35-year-old woman with no cardiac history presents with episodic palpitations
triggered by exercise. ECG shows a short PR interval and a delta wave. What is the
most definitive treatment for her condition?
A) Chronic oral verapamil
B) Radiofrequency catheter ablation
C) Implantable cardioverter-defibrillator (ICD)
D) Propranolol
: Correct Answer : B
Explanation: WPW syndrome with symptomatic reentrant tachycardia is
definitively treated with catheter ablation of the accessory pathway.
7. Biochemistry – Vitamins
A 40-year-old man with a history of alcoholism presents with acute onset of
confusion, ataxia, and ophthalmoplegia. Which vitamin deficiency is most likely?
A) Vitamin B1 (Thiamine)
B) Vitamin B3 (Niacin)
C) Vitamin B12
D) Vitamin K
: Correct Answer : A
Rationale: Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia) is
caused by thiamine deficiency, commonly seen in alcoholics.
pg. 3
, 4
8. Behavioral Science – Psychopathology
A 50-year-old woman presents with a 6-month history of excessive worry about
her health, finances, and family. She feels restless, fatigued, and has difficulty
sleeping. What is the most likely diagnosis?
A) Generalized anxiety disorder (GAD)
B) Panic disorder
C) Social anxiety disorder
D) Adjustment disorder
: Correct Answer : A
Rationale: GAD is characterized by excessive, uncontrollable worry occurring
more days than not for at least 6 months, with at least three associated
symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle
tension, sleep disturbance).
9. Microbiology – Immunology
A 35-year-old woman presents with photosensitive malar rash, oral ulcers, and
arthritis. ANA is positive at 1:640. What is the most likely diagnosis?
A) Systemic lupus erythematosus (SLE)
B) Rheumatoid arthritis
C) Sjögren’s syndrome
D) Mixed connective tissue disease
: Correct Answer : A
Rationale: Malar rash, photosensitivity, oral ulcers, arthritis, and positive ANA are
highly suggestive of SLE.
10. OMM – Viscerosomatic Reflex
A patient with a history of asthma and frequent upper respiratory infections
presents with a tender point at the tip of the spinous process of T3. This is most
likely a viscerosomatic reflex from which organ?
A) Heart
B) Lung
pg. 4
