COMLEX-USA Level 1 Prep | COMSAE Phase 1
Form 113 Practice Exam 2026 | 200+
Questions with Bold & Italic Answers,
Detailed Rationales & Explanations |
Osteopathic Medical Student Study Guide
PDF
• This practice exam mirrors the COMLEX-USA Level 1 / COMSAE Phase 1 format
with 200 high-yield questions spanning all core disciplines tested on the boards.
• Use this material by attempting each question independently before checking the
bolded correct answer and EXPERT RATIONALE beneath it — simulate real exam
conditions for best results.
COMLEX-USA Level 1 Prep | COMSAE Phase 1 Form 113 Practice Exam 2026 |
200 Questions
OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Question 1
A 35-year-old male presents with low back pain. On osteopathic structural
examination, the L3 vertebra is found to be rotated right and side-bent right,
and this position is more pronounced in flexion. How is this somatic
dysfunction classified?
A. L3 NRSL (Neutral, Rotated Left, Side-bent Left)
B. L3 FSRR (Flexed, Rotated Right, Side-bent Right)
C. L3 ERRL (Extended, Rotated Right, Side-bent Left)
D. L3 NSRR (Neutral, Side-bent Right, Rotated Right)
E. L3 ESRL (Extended, Side-bent Right, Rotated Left)
✔ Correct Answer: B. L3 FSRR (Flexed, Rotated Right, Side-bent Right)
,EXPERT RATIONALE: When a vertebral dysfunction is most pronounced in flexion,
it is classified as a Type II (non-neutral) dysfunction. In Type II mechanics, rotation
and side-bending occur to the same side. Since L3 is rotated right and side-bent
right, and worse in flexion, it is FSRR.
Question 2
A physician performs the seated flexion test on a patient and notes that the
right PSIS moves superiorly and anteriorly more than the left. What does this
finding indicate?
A. Left sacral dysfunction
B. Bilateral iliac dysfunction
C. Right innominate dysfunction
D. Left lumbar somatic dysfunction
E. Right pubic symphysis dysfunction
✔ Correct Answer: C. Right innominate dysfunction
EXPERT RATIONALE: The seated flexion test assesses sacroiliac joint motion. A
positive finding on the right (right PSIS moves more) indicates restricted motion on
the right side, pointing to a right innominate (iliac) dysfunction.
Question 3
A 45-year-old woman has cervical pain. Examination reveals C4 is extended,
rotated left, and side-bent left, and the position worsens in extension. What is
the correct diagnosis?
A. C4 NRLL (Neutral, Rotated Left, Side-bent Left)
B. C4 FSLL (Flexed, Side-bent Left, Rotated Left)
C. C4 ERLL (Extended, Rotated Left, Side-bent Left)
D. C4 ESLL (Extended, Side-bent Left, Rotated Left)
,E. C4 FRLL (Flexed, Rotated Left, Side-bent Left)
✔ Correct Answer: D. C4 ESLL (Extended, Side-bent Left, Rotated Left)
EXPERT RATIONALE: Type II (non-neutral) dysfunction occurs when rotation and
side-bending are coupled to the same side. Since this is worse in extension, the
classification is E (Extended), and since it is rotated left and side-bent left, it is ESLL.
Question 4
Which of the following best describes a Type I somatic dysfunction according
to Fryette's Laws?
A. Rotation and side-bending occur to the same side, restricted in flexion or
extension
B. Rotation and side-bending occur to opposite sides, involves a single vertebra
C. Rotation and side-bending occur to the same side, involves a single vertebra
D. Rotation and side-bending occur to opposite sides, involves multiple vertebrae in
neutral
E. Affects only the thoracic spine in all spinal positions
✔ Correct Answer: D. Rotation and side-bending occur to opposite sides,
involves multiple vertebrae in neutral
EXPERT RATIONALE: Fryette's Law I states that when the spine is in neutral (neither
fully flexed nor extended), side-bending in one direction is coupled with rotation to
the opposite side. This typically involves a group of vertebrae and is called a neutral
group dysfunction.
Question 5
A patient is found to have a sacral torsion where the axis of rotation is the
left oblique axis and the sacrum has rotated anteriorly to the right. What is
the correct name of this dysfunction?
, A. Right-on-right sacral torsion
B. Left-on-left sacral torsion
C. Right-on-left sacral torsion
D. Left-on-right sacral torsion
E. Bilateral sacral flexion
✔ Correct Answer: C. Right-on-left sacral torsion
EXPERT RATIONALE: Sacral torsions are named by the direction of rotation first,
then the axis. A sacrum rotating anteriorly to the right on the left oblique axis is
called a Right-on-Left sacral torsion.
Question 6
During a physical exam, a physician notices that when a patient bends
forward, the right iliac crest rises higher than the left. What structure is most
likely restricted?
A. Left hip joint
B. Right sacroiliac joint
C. Left sacroiliac joint
D. Right pubic ramus
E. Lumbar facet joints bilaterally
✔ Correct Answer: B. Right sacroiliac joint
EXPERT RATIONALE: The standing flexion test assesses sacroiliac joint mobility.
When the right PSIS/iliac crest rides higher during forward bending, it indicates
restricted motion at the right sacroiliac joint.
Question 7
Form 113 Practice Exam 2026 | 200+
Questions with Bold & Italic Answers,
Detailed Rationales & Explanations |
Osteopathic Medical Student Study Guide
• This practice exam mirrors the COMLEX-USA Level 1 / COMSAE Phase 1 format
with 200 high-yield questions spanning all core disciplines tested on the boards.
• Use this material by attempting each question independently before checking the
bolded correct answer and EXPERT RATIONALE beneath it — simulate real exam
conditions for best results.
COMLEX-USA Level 1 Prep | COMSAE Phase 1 Form 113 Practice Exam 2026 |
200 Questions
OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Question 1
A 35-year-old male presents with low back pain. On osteopathic structural
examination, the L3 vertebra is found to be rotated right and side-bent right,
and this position is more pronounced in flexion. How is this somatic
dysfunction classified?
A. L3 NRSL (Neutral, Rotated Left, Side-bent Left)
B. L3 FSRR (Flexed, Rotated Right, Side-bent Right)
C. L3 ERRL (Extended, Rotated Right, Side-bent Left)
D. L3 NSRR (Neutral, Side-bent Right, Rotated Right)
E. L3 ESRL (Extended, Side-bent Right, Rotated Left)
✔ Correct Answer: B. L3 FSRR (Flexed, Rotated Right, Side-bent Right)
,EXPERT RATIONALE: When a vertebral dysfunction is most pronounced in flexion,
it is classified as a Type II (non-neutral) dysfunction. In Type II mechanics, rotation
and side-bending occur to the same side. Since L3 is rotated right and side-bent
right, and worse in flexion, it is FSRR.
Question 2
A physician performs the seated flexion test on a patient and notes that the
right PSIS moves superiorly and anteriorly more than the left. What does this
finding indicate?
A. Left sacral dysfunction
B. Bilateral iliac dysfunction
C. Right innominate dysfunction
D. Left lumbar somatic dysfunction
E. Right pubic symphysis dysfunction
✔ Correct Answer: C. Right innominate dysfunction
EXPERT RATIONALE: The seated flexion test assesses sacroiliac joint motion. A
positive finding on the right (right PSIS moves more) indicates restricted motion on
the right side, pointing to a right innominate (iliac) dysfunction.
Question 3
A 45-year-old woman has cervical pain. Examination reveals C4 is extended,
rotated left, and side-bent left, and the position worsens in extension. What is
the correct diagnosis?
A. C4 NRLL (Neutral, Rotated Left, Side-bent Left)
B. C4 FSLL (Flexed, Side-bent Left, Rotated Left)
C. C4 ERLL (Extended, Rotated Left, Side-bent Left)
D. C4 ESLL (Extended, Side-bent Left, Rotated Left)
,E. C4 FRLL (Flexed, Rotated Left, Side-bent Left)
✔ Correct Answer: D. C4 ESLL (Extended, Side-bent Left, Rotated Left)
EXPERT RATIONALE: Type II (non-neutral) dysfunction occurs when rotation and
side-bending are coupled to the same side. Since this is worse in extension, the
classification is E (Extended), and since it is rotated left and side-bent left, it is ESLL.
Question 4
Which of the following best describes a Type I somatic dysfunction according
to Fryette's Laws?
A. Rotation and side-bending occur to the same side, restricted in flexion or
extension
B. Rotation and side-bending occur to opposite sides, involves a single vertebra
C. Rotation and side-bending occur to the same side, involves a single vertebra
D. Rotation and side-bending occur to opposite sides, involves multiple vertebrae in
neutral
E. Affects only the thoracic spine in all spinal positions
✔ Correct Answer: D. Rotation and side-bending occur to opposite sides,
involves multiple vertebrae in neutral
EXPERT RATIONALE: Fryette's Law I states that when the spine is in neutral (neither
fully flexed nor extended), side-bending in one direction is coupled with rotation to
the opposite side. This typically involves a group of vertebrae and is called a neutral
group dysfunction.
Question 5
A patient is found to have a sacral torsion where the axis of rotation is the
left oblique axis and the sacrum has rotated anteriorly to the right. What is
the correct name of this dysfunction?
, A. Right-on-right sacral torsion
B. Left-on-left sacral torsion
C. Right-on-left sacral torsion
D. Left-on-right sacral torsion
E. Bilateral sacral flexion
✔ Correct Answer: C. Right-on-left sacral torsion
EXPERT RATIONALE: Sacral torsions are named by the direction of rotation first,
then the axis. A sacrum rotating anteriorly to the right on the left oblique axis is
called a Right-on-Left sacral torsion.
Question 6
During a physical exam, a physician notices that when a patient bends
forward, the right iliac crest rises higher than the left. What structure is most
likely restricted?
A. Left hip joint
B. Right sacroiliac joint
C. Left sacroiliac joint
D. Right pubic ramus
E. Lumbar facet joints bilaterally
✔ Correct Answer: B. Right sacroiliac joint
EXPERT RATIONALE: The standing flexion test assesses sacroiliac joint mobility.
When the right PSIS/iliac crest rides higher during forward bending, it indicates
restricted motion at the right sacroiliac joint.
Question 7
