COMSAE Phase 1 Form 110 Practice Exam | 250 High-Yield
Q&A Bank 2026
Ace your upcoming exam with 250 highly realistic questions meticulously mapped to the
NBOME COMLEX-USA Blueprint for Form 110. Each question features a bolded
answer key and a high-yield italicized rationale crafted for quick scanning and rapid
active recall during dedicated study. This comprehensive bank delivers the exact
practice you need across complex OMM, pathology, and pharmacology concepts to
confidently secure your pass
Question 1
A 43-year-old female presents to the clinic complaining of intermittent right upper
quadrant abdominal pain that radiates to her right scapula, particularly after eating fatty
meals. Physical examination reveals an exquisitely tender, pea-sized nodule located in
the right 6th intercostal space along the midclavicular line. This palpatory finding
represents a viscerosomatic reflex originating from which of the following structures?
A. Stomach
B. Liver
C. Gallbladder
D. Pancreas
E. Duodenum
Answer: C
Rationale: The patient's clinical presentation is highly suggestive of biliary colic or
cholecystitis. The palpable, tender nodule described in the right 6th intercostal space
along the midclavicular line represents the anterior Chapman reflex point for the
gallbladder. Chapman points are ganglioform contractions in the deep fascia that
manifest as a somatic reflection of visceral pathology. Option A is incorrect because the
anterior Chapman point for the stomach (peristalsis) is located in the left 6th intercostal
space. Option B is incorrect because the liver point is located in the right 5th intercostal
space. Option D is incorrect because the pancreas point is located in the right 7th
intercostal space. Option E is incorrect because the duodenum point is found in the right
8th intercostal space.
Question 2
A 26-year-old pregnant female at 34 weeks gestation presents with severe lower back
pain and bilateral lower extremity edema. Structural examination reveals a positive
seated flexion test on the right. In the prone position, the right sacral base is deep, the
,left ILA is posterior and inferior, and there is a restriction when pressing anteriorly on the
right sacral base (positive spring test). What is the most likely sacral somatic
dysfunction?
A. Left-on-left sacral torsion
B. Right-on-right sacral torsion
C. Left-on-right sacral torsion
D. Right-on-left sacral torsion
E. Bilateral sacral flexion
Answer: D
Rationale: To diagnose a sacral torsion, we first look at the spring test. A positive spring
test indicates a backward sacral torsion or a non-physiologic extension pattern,
meaning the sacral base resists anterior springing because it is already rotated
backward. This narrows our options to backward torsions (Left-on-Right or Right-on-
Left). In backward torsions, the side of the positive flexion test matches the side of the
engaged oblique axis. Since the seated flexion test is positive on the right, the axis is a
left oblique axis. A right-rotated sacrum on a left oblique axis is named a Right-on-Left
(R on L) sacral torsion. In an R on L torsion, the right sacral base rotates posteriorly
(appearing shallow, though dynamically restricted, leading to a deep opposite side or a
distorted presentation depending on compensatory mechanics; specifically, the right
side resists springing because it is stuck posterior). Option A and B are incorrect
because forward torsions yield a negative spring test. Option C is incorrect because a
left-on-right torsion occurs on a right oblique axis, which would yield a positive seated
flexion test on the left.
Question 3
A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents with an acute exacerbation characterized by increased wheezing and
productive cough. An osteopathic physician decides to utilize the rib raising technique to
optimize respiratory mechanics and modulate autonomic tone. Which of the following
best describes the primary neurophysiological mechanism achieved by this specific
treatment?
A. Stimulation of the vagus nerve to decrease mucus production
B. Inhibition of the hypersympathetic thoracolumbar paraspinal ganglia
C. Activation of the pelvic splanchnic nerves to improve lymphatic drainage
D. Stimulation of the phrenic nerve to increase diaphragmatic excursion
E. Inhibition of the cervical chain ganglia to decrease bronchoconstriction
Answer: B
Rationale: Rib raising is a well-established osteopathic manipulative technique used to
decrease hypersympathetic tone. The sympathetic chain ganglia lie directly anterior to
the heads of the ribs. By gently articulating the ribs, the physician applies a mechanical
stretch to these paraspinal ganglia, which initially stimulates but ultimately inhibits
,overactive sympathetic activity (paraspinal inhibition). This is highly beneficial in COPD
patients because hypersympathetic tone leads to bronchodilation but also increases
thick, tenacious secretions and impairs ciliary clearance. Option A is incorrect because
rib raising targets the sympathetic chain, not the parasympathetic vagus nerve. Option
C is incorrect because pelvic splanchnic nerves arise from S2–S4 and do not supply the
pulmonary system. Option D and E are incorrect because this technique does not
directly target the phrenic nerve or cervical chain ganglia.
Question 4
A 19-year-old cross-country runner presents with acute-on-chronic right groin pain.
Structural examination demonstrates a positive standing flexion test on the right. Bony
landmark assessment reveals that the right anterior superior iliac spine (ASIS) is inferior
and the right posterior superior iliac spine (PSIS) is superior compared to the left side.
What is the most appropriate initial setup position if the physician chooses to treat this
patient using Muscle Energy Technique (MET)?
A. Right hip flexed, patient resists extension
B. Right hip extended, patient resists flexion
C. Right hip abducted, patient resists adduction
D. Left hip flexed, patient resists extension
E. Right hip flexed and adducted, patient resists abduction
Answer: A
Rationale: The patient exhibits a right anterior innominate rotation, diagnosed by the
positive standing flexion test on the right, an inferior ASIS, and a superior PSIS. Muscle
Energy Technique is a direct, active treatment modality, meaning the patient is placed
into the restrictive barrier (the direction they do not want to go). Because the right
innominate bone is rotated anteriorly, its restrictive barrier is posterior rotation (flexion of
the hip). To treat this, the physician must flex the patient's right hip until the restrictive
barrier is engaged, and the patient is then instructed to gently push their leg back into
extension against the physician's isometric resistance. Option B describes the setup for
a posterior innominate rotation. Options C, D, and E do not align with the structural
mechanics of an anterior innominate dysfunction.
Question 5
An osteopathic physician performs a cranial structural examination on a 32-year-old
female who complains of chronic tension headaches. The physician notes that during
the expansive phase of the primary respiratory mechanism (PRM), the sphenobasilar
synchondrosis (SBS) moves superiorly, the paired bones externally rotate, the
anteroposterior diameter of the cranium decreases, and the transverse diameter
increases. Which midline bone movement matches this physiological phase?
, A. Extension of the occiput
B. Flexion of the sphenoid
C. Internal rotation of the temporal bones
D. Superior movement of the vomer
E. Posterior rotation of the ethmoid
Answer: B
Rationale: The physical findings described—widening of the transverse diameter,
narrowing of the anteroposterior diameter, superior movement of the SBS, and external
rotation of the paired bones—define the flexion phase of the primary respiratory
mechanism (PRM). During this phase, all midline bones (sphenoid, occiput, ethmoid,
vomer) undergo flexion. Option A is incorrect because the occiput flexes during this
phase, not extends. Option C is incorrect because the temporal bones are paired bones
and undergo external rotation during cranial flexion. Option D is incorrect because the
vomer moves inferiorly during cranial flexion. Option E is incorrect because the ethmoid
rotates anteriorly/inferiorly along its axis during flexion.
Question 6
A 62-year-old male presents to the emergency department with severe, crushing
substernal chest pain radiating to his left arm, accompanied by diaphoresis and nausea.
An electrocardiogram confirms an acute ST-elevation myocardial infarction (STEMI) of
the anterior wall. Palpation of his spine is most likely to reveal somatosomatic or
viscerosomatic tissue changes, such as hypertonicity and overlying warmth, at which of
the following spinal segments?
A. C3 to C5
B. T1 to T4
C. T5 to T9
D. T10 to T11
E. T12 to L2
Answer: B
Rationale: The heart receives its sympathetic innervation from the T1 to T5 spinal cord
segments (primarily T1–T4). Visceral pathology of the myocardium, such as an acute
myocardial infarction, sends retrogrades visceral afferent signals back to these exact
spinal levels, resulting in localized viscerosomatic tissue changes (bogginess,
hypertonicity, asymmetry) in the upper thoracic paraspinal region. Option A is incorrect
because C3–C5 corresponds to the phrenic nerve, which can mediate referred pain to
the shoulder via diaphragmatic irritation, but not primary viscerosomatic paraspinal
changes. Options C, D, and E correspond to abdominal and pelvic viscera (e.g., T5–T9
for upper GI, T10–T11 for kidneys/gonads, T12–L2 for lower colon/pelvic organs).
Q&A Bank 2026
Ace your upcoming exam with 250 highly realistic questions meticulously mapped to the
NBOME COMLEX-USA Blueprint for Form 110. Each question features a bolded
answer key and a high-yield italicized rationale crafted for quick scanning and rapid
active recall during dedicated study. This comprehensive bank delivers the exact
practice you need across complex OMM, pathology, and pharmacology concepts to
confidently secure your pass
Question 1
A 43-year-old female presents to the clinic complaining of intermittent right upper
quadrant abdominal pain that radiates to her right scapula, particularly after eating fatty
meals. Physical examination reveals an exquisitely tender, pea-sized nodule located in
the right 6th intercostal space along the midclavicular line. This palpatory finding
represents a viscerosomatic reflex originating from which of the following structures?
A. Stomach
B. Liver
C. Gallbladder
D. Pancreas
E. Duodenum
Answer: C
Rationale: The patient's clinical presentation is highly suggestive of biliary colic or
cholecystitis. The palpable, tender nodule described in the right 6th intercostal space
along the midclavicular line represents the anterior Chapman reflex point for the
gallbladder. Chapman points are ganglioform contractions in the deep fascia that
manifest as a somatic reflection of visceral pathology. Option A is incorrect because the
anterior Chapman point for the stomach (peristalsis) is located in the left 6th intercostal
space. Option B is incorrect because the liver point is located in the right 5th intercostal
space. Option D is incorrect because the pancreas point is located in the right 7th
intercostal space. Option E is incorrect because the duodenum point is found in the right
8th intercostal space.
Question 2
A 26-year-old pregnant female at 34 weeks gestation presents with severe lower back
pain and bilateral lower extremity edema. Structural examination reveals a positive
seated flexion test on the right. In the prone position, the right sacral base is deep, the
,left ILA is posterior and inferior, and there is a restriction when pressing anteriorly on the
right sacral base (positive spring test). What is the most likely sacral somatic
dysfunction?
A. Left-on-left sacral torsion
B. Right-on-right sacral torsion
C. Left-on-right sacral torsion
D. Right-on-left sacral torsion
E. Bilateral sacral flexion
Answer: D
Rationale: To diagnose a sacral torsion, we first look at the spring test. A positive spring
test indicates a backward sacral torsion or a non-physiologic extension pattern,
meaning the sacral base resists anterior springing because it is already rotated
backward. This narrows our options to backward torsions (Left-on-Right or Right-on-
Left). In backward torsions, the side of the positive flexion test matches the side of the
engaged oblique axis. Since the seated flexion test is positive on the right, the axis is a
left oblique axis. A right-rotated sacrum on a left oblique axis is named a Right-on-Left
(R on L) sacral torsion. In an R on L torsion, the right sacral base rotates posteriorly
(appearing shallow, though dynamically restricted, leading to a deep opposite side or a
distorted presentation depending on compensatory mechanics; specifically, the right
side resists springing because it is stuck posterior). Option A and B are incorrect
because forward torsions yield a negative spring test. Option C is incorrect because a
left-on-right torsion occurs on a right oblique axis, which would yield a positive seated
flexion test on the left.
Question 3
A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents with an acute exacerbation characterized by increased wheezing and
productive cough. An osteopathic physician decides to utilize the rib raising technique to
optimize respiratory mechanics and modulate autonomic tone. Which of the following
best describes the primary neurophysiological mechanism achieved by this specific
treatment?
A. Stimulation of the vagus nerve to decrease mucus production
B. Inhibition of the hypersympathetic thoracolumbar paraspinal ganglia
C. Activation of the pelvic splanchnic nerves to improve lymphatic drainage
D. Stimulation of the phrenic nerve to increase diaphragmatic excursion
E. Inhibition of the cervical chain ganglia to decrease bronchoconstriction
Answer: B
Rationale: Rib raising is a well-established osteopathic manipulative technique used to
decrease hypersympathetic tone. The sympathetic chain ganglia lie directly anterior to
the heads of the ribs. By gently articulating the ribs, the physician applies a mechanical
stretch to these paraspinal ganglia, which initially stimulates but ultimately inhibits
,overactive sympathetic activity (paraspinal inhibition). This is highly beneficial in COPD
patients because hypersympathetic tone leads to bronchodilation but also increases
thick, tenacious secretions and impairs ciliary clearance. Option A is incorrect because
rib raising targets the sympathetic chain, not the parasympathetic vagus nerve. Option
C is incorrect because pelvic splanchnic nerves arise from S2–S4 and do not supply the
pulmonary system. Option D and E are incorrect because this technique does not
directly target the phrenic nerve or cervical chain ganglia.
Question 4
A 19-year-old cross-country runner presents with acute-on-chronic right groin pain.
Structural examination demonstrates a positive standing flexion test on the right. Bony
landmark assessment reveals that the right anterior superior iliac spine (ASIS) is inferior
and the right posterior superior iliac spine (PSIS) is superior compared to the left side.
What is the most appropriate initial setup position if the physician chooses to treat this
patient using Muscle Energy Technique (MET)?
A. Right hip flexed, patient resists extension
B. Right hip extended, patient resists flexion
C. Right hip abducted, patient resists adduction
D. Left hip flexed, patient resists extension
E. Right hip flexed and adducted, patient resists abduction
Answer: A
Rationale: The patient exhibits a right anterior innominate rotation, diagnosed by the
positive standing flexion test on the right, an inferior ASIS, and a superior PSIS. Muscle
Energy Technique is a direct, active treatment modality, meaning the patient is placed
into the restrictive barrier (the direction they do not want to go). Because the right
innominate bone is rotated anteriorly, its restrictive barrier is posterior rotation (flexion of
the hip). To treat this, the physician must flex the patient's right hip until the restrictive
barrier is engaged, and the patient is then instructed to gently push their leg back into
extension against the physician's isometric resistance. Option B describes the setup for
a posterior innominate rotation. Options C, D, and E do not align with the structural
mechanics of an anterior innominate dysfunction.
Question 5
An osteopathic physician performs a cranial structural examination on a 32-year-old
female who complains of chronic tension headaches. The physician notes that during
the expansive phase of the primary respiratory mechanism (PRM), the sphenobasilar
synchondrosis (SBS) moves superiorly, the paired bones externally rotate, the
anteroposterior diameter of the cranium decreases, and the transverse diameter
increases. Which midline bone movement matches this physiological phase?
, A. Extension of the occiput
B. Flexion of the sphenoid
C. Internal rotation of the temporal bones
D. Superior movement of the vomer
E. Posterior rotation of the ethmoid
Answer: B
Rationale: The physical findings described—widening of the transverse diameter,
narrowing of the anteroposterior diameter, superior movement of the SBS, and external
rotation of the paired bones—define the flexion phase of the primary respiratory
mechanism (PRM). During this phase, all midline bones (sphenoid, occiput, ethmoid,
vomer) undergo flexion. Option A is incorrect because the occiput flexes during this
phase, not extends. Option C is incorrect because the temporal bones are paired bones
and undergo external rotation during cranial flexion. Option D is incorrect because the
vomer moves inferiorly during cranial flexion. Option E is incorrect because the ethmoid
rotates anteriorly/inferiorly along its axis during flexion.
Question 6
A 62-year-old male presents to the emergency department with severe, crushing
substernal chest pain radiating to his left arm, accompanied by diaphoresis and nausea.
An electrocardiogram confirms an acute ST-elevation myocardial infarction (STEMI) of
the anterior wall. Palpation of his spine is most likely to reveal somatosomatic or
viscerosomatic tissue changes, such as hypertonicity and overlying warmth, at which of
the following spinal segments?
A. C3 to C5
B. T1 to T4
C. T5 to T9
D. T10 to T11
E. T12 to L2
Answer: B
Rationale: The heart receives its sympathetic innervation from the T1 to T5 spinal cord
segments (primarily T1–T4). Visceral pathology of the myocardium, such as an acute
myocardial infarction, sends retrogrades visceral afferent signals back to these exact
spinal levels, resulting in localized viscerosomatic tissue changes (bogginess,
hypertonicity, asymmetry) in the upper thoracic paraspinal region. Option A is incorrect
because C3–C5 corresponds to the phrenic nerve, which can mediate referred pain to
the shoulder via diaphragmatic irritation, but not primary viscerosomatic paraspinal
changes. Options C, D, and E correspond to abdominal and pelvic viscera (e.g., T5–T9
for upper GI, T10–T11 for kidneys/gonads, T12–L2 for lower colon/pelvic organs).
