COMSAE Cheat Sheet 2026

The 30 highest-yield COMSAE facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. What type of immune cell is primarily involved in antibody production? → Macrophages
2. A 38-year-old man with hypertension has hypokalemia and elevated aldosterone with suppressed renin. Which is the most likely diagnosis? → Primary hyperaldosteronism (Conn's syndrome)
3. Which hormone is primarily responsible for the maintenance of pregnancy? → Progesterone
4. Which hormone is primarily responsible for stimulating milk ejection (let-down reflex) during breastfeeding? → Oxytocin
5. Which finding on renal biopsy is most consistent with IgA nephropathy (Berger disease)? → Mesangial IgA deposits on immunofluorescence
6. A patient with a kidney stone passes it spontaneously and analysis shows calcium oxalate composition. Which dietary modification is most evidence-based? → Increased fluid intake to >2.5 L/day
7. On COMSAE, which medication should be held 24-48 hours before administration of iodinated contrast in a patient with chronic kidney disease? → Metformin
8. Which maneuver is used to assess the anterior cruciate ligament (ACL) integrity in the knee? → Lachman test
9. Which of the following techniques is a direct osteopathic manipulative treatment? → High-velocity, low-amplitude (HVLA) thrust
10. What does the TART acronym in osteopathic practice stand for? → Tenderness, Asymmetry, Range of motion, Tissue texture changes
11. What is a core tenet of osteopathic medicine? → The body is a unit; the person is a unity of body, mind, and spirit.
12. A diabetic patient is found unconscious with a blood glucose of 32 mg/dL. Which is the immediate treatment if IV access cannot be established? → Glucagon IM injection
13. Which feature best distinguishes prerenal AKI from intrinsic renal AKI? → BUN:creatinine ratio >20:1 and FeNa <1%
14. A 55-year-old man with CKD Stage 3 has serum phosphate of 5.8 mg/dL. Which treatment best addresses hyperphosphatemia in this patient? → Dietary phosphate restriction and phosphate binders with meals
15. In a patient with chronic kidney disease, which dietary modification helps prevent secondary hyperparathyroidism? → Phosphate restriction and phosphate binders
16. Which of the following ABCDE features of a pigmented skin lesion is MOST associated with early melanoma detection? → Asymmetry — one half does not match the other
17. Which enzyme deficiency in congenital adrenal hyperplasia (CAH) causes hypertension, hypokalemia, and ambiguous genitalia in females? → 11-beta hydroxylase deficiency
18. In a patient with multiple endocrine neoplasia type 1 (MEN1), which triad of tumors is classically expected? → Parathyroid, pituitary, and pancreatic tumors
19. On COMSAE, which finding differentiates primary adrenal insufficiency (Addison's disease) from secondary adrenal insufficiency? → Hyperpigmentation
20. What is the most common initial treatment for acute bacterial sinusitis? → Amoxicillin-clavulanate
21. What is the preferred treatment for an acute gout flare? → Colchicine
22. In a patient with ESRD, which chronic complication results from impaired renal conversion of 25-OH vitamin D to its active form? → Renal osteodystrophy
23. Which osteopathic technique is indicated to address lymphatic drainage of the renal and pelvic region? → Pelvic diaphragm release
24. Which medication is first-line to slow progression of diabetic nephropathy in a patient with type 2 diabetes and proteinuria? → ACE inhibitors or ARBs
25. Which neurological condition is associated with "butterfly" lesions in the white matter of the brain? → Glioblastoma multiforme
26. A 16-year-old girl presents with primary amenorrhea, short stature, webbed neck, and shield chest. Karyotype is 45,X. Which is the most likely diagnosis? → Turner syndrome
27. In a pregnant woman at 10 weeks gestation, which hormone produced by the corpus luteum maintains the endometrium until placental function is established? → Progesterone
28. Which urinalysis finding is most characteristic of nephrotic syndrome? → Massive proteinuria (>3.5 g/day)
29. Which of the following coagulation factors are dependent on Vitamin K for their synthesis and function? → Factors II, VII, IX, and X
30. In glycolysis, what is the end product that enters the citric acid cycle under aerobic conditions? → Acetyl-CoA