COMSAE Phase 1 Form 110 Practice Exam | 250 High-Yield
Q&A Bank
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 47-year-old male with a history of alcohol use disorder presents to the clinic with
chronic, boring epigastric pain that radiates straight through to his back. Physical
examination reveals an anterior Chapman reflex point at the right 7th intercostal space
near the costochondral junction. Which of the following organs is most likely associated
with this finding?
A) Gallbladder
B) Pancreas
C) Spleen
D) Duodenum
Answer:
B) Pancreas
Rationale:
The anterior Chapman reflex point for the pancreas is located at the right 7th intercostal
space near the costochondral junction. The corresponding posterior point is located
between the spinous and transverse processes of T7 and T8 on the right side. The
gallbladder maps to the right 5th intercostal space, and the duodenum maps to the right
8th intercostal space.
Question 2:
An osteopathic physician performs a cranial evaluation on a 25-year-old female
complaining of a dull, diffuse headache. The physician notes that during the inhalation
phase of the primary respiratory mechanism, the sphenobasilar synchondrosis (SBS)
moves superiorly, narrowing the transverse diameter of the cranium and lengthening the
head anteroposteriorly. Which of the following describes this cranial somatic
dysfunction?
A) Flexion strain
B) Extension strain
C) Torsion
D) Vertical shear
,Answer:
B) Extension strain
Rationale:
In a cranial extension strain, the SBS moves superiorly during the primary respiratory
mechanism (failing to go into normal flexion), which narrows the transverse diameter of
the head and increases the anteroposterior diameter. Conversely, during a flexion
strain, the SBS moves inferiorly, creating a short and wide head configuration.
Question 3:
A 31-year-old female presents with severe fatigue, weight gain, and generalized muscle
aches. Lab results reveal a normocytic anemia, elevated thyroid-stimulating hormone
(TSH), and low free T4. Antithyroid peroxidase (anti-TPO) antibodies are strongly
positive. Which of the following histological features is classic for this patient's
underlying condition?
A) Intracellular amyloid stroma with psammoma bodies
B) Germinal centers with intense lymphocytic infiltration and Hurthle cells
C) Fibrous tissue invading past the thyroid capsule into adjacent neck structures
D) Papillary projections with optically clear nuclei
Answer:
B) Germinal centers with intense lymphocytic infiltration and Hurthle cells
Rationale:
The clinical picture represents Hashimoto thyroiditis, the most common cause of
primary hypothyroidism in the United States. Histology characteristically shows a diffuse
lymphocytic infiltrate with germinal centers and Hurthle cells (follicular cells altered by
chronic inflammation). Optically clear nuclei signify papillary thyroid cancer.
Question 4:
A 19-year-old male athlete presents with sharp right lower quadrant abdominal pain,
nausea, and a low-grade fever. The physician suspects acute appendicitis. To confirm a
viscerosomatic reflex pattern, the physician checks for a Chapman reflex point. Where
is the classic posterior Chapman point for the appendix located?
A) Tip of the right 12th rib
B) Transverse process of T11 on the right
C) Transverse process of T12 on the right
D) Periumbilical region
Answer:
B) Transverse process of T11 on the right
Rationale:
The posterior Chapman reflex point for the appendix is located at the tip of the right T11
transverse process. Its anterior counterpart is located at the tip of the right 12th rib. The
right T12 transverse space corresponds to kidney reflex structures.
Question 5:
A 63-year-old female with chronic hypertension presents for an osteopathic structural
examination. The physician diagnoses a Type I neutral somatic dysfunction involving
,the thoracic spine from T5 to T8. Which of the following structural relationships is
expected regarding the positional mechanics of this dysfunction?
A) Sidebending and rotation occur in the same direction
B) Sidebending and rotation occur in opposite directions
C) It involves a single vertebral segment that is highly restricted in flexion
D) It is an isolated non-neutral dysfunction that corrects with extension
Answer:
B) Sidebending and rotation occur in opposite directions
Rationale:
According to Fryette’s Principles, Type I somatic dysfunctions occur in a neutral spinal
state, involve a group of three or more vertebrae, and feature sidebending and rotation
to opposite sides (e.g., T5–T8 N SxRx). Type II dysfunctions occur in a non-neutral
state (flexed or extended), involve a single segment, and sidebend and rotate to the
same side.
Question 6:
A 22-year-old female presents with persistent, foul-smelling vaginal discharge. A wet
mount preparation of the discharge reveals motile, pear-shaped protozoa with flagella.
Which of the following is the most appropriate first-line pharmacotherapeutic agent?
A) Fluconazole
B) Metronidazole
C) Azithromycin
D) Doxycycline
Answer:
B) Metronidazole
Rationale:
The description points to Trichomonas vaginalis infection. Metronidazole is the drug of
choice for trichomoniasis and treats both the patient and their sexual partners.
Fluconazole is an antifungal used for Candida, while azithromycin and doxycycline
target bacterial pathogens like Chlamydia.
Question 7:
During an osteopathic evaluation of a 40-year-old male with acute lower back pain, a
positive standing flexion test is noted on the right side. Palpation reveals a deep right
sacral sulcus and a posterior, inferior right inferior lateral angle (ILA). What is the most
likely sacral somatic dysfunction?
A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Right unilateral sacral flexion
D) Right unilateral sacral extension
Answer:
C) Right unilateral sacral flexion
Rationale:
In a unilateral sacral flexion (sacral shear), the positive seated/standing flexion test is on
, the same side as the deep sacral sulcus and the posterior/inferior ILA. If the deep
sulcus and posterior/inferior ILA were on opposite sides, it would instead indicate a
sacral torsion pattern.
Question 8:
A 53-year-old male with chronic kidney disease presents for an evaluation. On structural
exam, an anterior Chapman reflex point is identified 1 inch superior and 1 inch lateral to
the umbilicus. Which of the following structures matches this reflex location?
A) Adrenal gland
B) Kidney
C) Urinary bladder
D) Gonads
Answer:
B) Kidney
Rationale:
The anterior Chapman point for the kidney is situated 1 inch superior and 1 inch lateral
to the umbilicus. The adrenal glands are located slightly higher, 2 inches superior and 1
inch lateral to the umbilicus. Bladder points are periumbilical or pubic.
Question 9:
A 34-year-old construction worker presents with sharp pain in his mid-back. Structural
assessment reveals that T6 is rotated right and sidebent right in the flexed position.
What is the most appropriate initial setup position if treating this dysfunction with Muscle
Energy Technique?
A) Extended, sidebent left, rotated left
B) Flexed, sidebent left, rotated left
C) Extended, sidebent right, rotated right
D) Flexed, sidebent right, rotated left
Answer:
A) Extended, sidebent left, rotated left
Rationale:
This is a Type II non-neutral somatic dysfunction (T6 F SxRx). Muscle energy is a direct
technique, meaning the patient must be placed into their restrictive barrier. To treat a
flexed, right-sidebent, right-rotated segment, the physician moves it into extension, left
sidebending, and left rotation.
Question 10:
A 28-year-old female presents with severe, unilateral throbbing headaches
accompanied by photophobia. She has been diagnosed with migraines and is
prescribed sumatriptan. What is the primary mechanism of action of this abortive
medication?
A) 5-HT1B/1D receptor agonist
B) 5-HT3 receptor antagonist
C) Dopamine D2 receptor agonist
D) Alpha-1 adrenergic antagonist
Q&A Bank
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 47-year-old male with a history of alcohol use disorder presents to the clinic with
chronic, boring epigastric pain that radiates straight through to his back. Physical
examination reveals an anterior Chapman reflex point at the right 7th intercostal space
near the costochondral junction. Which of the following organs is most likely associated
with this finding?
A) Gallbladder
B) Pancreas
C) Spleen
D) Duodenum
Answer:
B) Pancreas
Rationale:
The anterior Chapman reflex point for the pancreas is located at the right 7th intercostal
space near the costochondral junction. The corresponding posterior point is located
between the spinous and transverse processes of T7 and T8 on the right side. The
gallbladder maps to the right 5th intercostal space, and the duodenum maps to the right
8th intercostal space.
Question 2:
An osteopathic physician performs a cranial evaluation on a 25-year-old female
complaining of a dull, diffuse headache. The physician notes that during the inhalation
phase of the primary respiratory mechanism, the sphenobasilar synchondrosis (SBS)
moves superiorly, narrowing the transverse diameter of the cranium and lengthening the
head anteroposteriorly. Which of the following describes this cranial somatic
dysfunction?
A) Flexion strain
B) Extension strain
C) Torsion
D) Vertical shear
,Answer:
B) Extension strain
Rationale:
In a cranial extension strain, the SBS moves superiorly during the primary respiratory
mechanism (failing to go into normal flexion), which narrows the transverse diameter of
the head and increases the anteroposterior diameter. Conversely, during a flexion
strain, the SBS moves inferiorly, creating a short and wide head configuration.
Question 3:
A 31-year-old female presents with severe fatigue, weight gain, and generalized muscle
aches. Lab results reveal a normocytic anemia, elevated thyroid-stimulating hormone
(TSH), and low free T4. Antithyroid peroxidase (anti-TPO) antibodies are strongly
positive. Which of the following histological features is classic for this patient's
underlying condition?
A) Intracellular amyloid stroma with psammoma bodies
B) Germinal centers with intense lymphocytic infiltration and Hurthle cells
C) Fibrous tissue invading past the thyroid capsule into adjacent neck structures
D) Papillary projections with optically clear nuclei
Answer:
B) Germinal centers with intense lymphocytic infiltration and Hurthle cells
Rationale:
The clinical picture represents Hashimoto thyroiditis, the most common cause of
primary hypothyroidism in the United States. Histology characteristically shows a diffuse
lymphocytic infiltrate with germinal centers and Hurthle cells (follicular cells altered by
chronic inflammation). Optically clear nuclei signify papillary thyroid cancer.
Question 4:
A 19-year-old male athlete presents with sharp right lower quadrant abdominal pain,
nausea, and a low-grade fever. The physician suspects acute appendicitis. To confirm a
viscerosomatic reflex pattern, the physician checks for a Chapman reflex point. Where
is the classic posterior Chapman point for the appendix located?
A) Tip of the right 12th rib
B) Transverse process of T11 on the right
C) Transverse process of T12 on the right
D) Periumbilical region
Answer:
B) Transverse process of T11 on the right
Rationale:
The posterior Chapman reflex point for the appendix is located at the tip of the right T11
transverse process. Its anterior counterpart is located at the tip of the right 12th rib. The
right T12 transverse space corresponds to kidney reflex structures.
Question 5:
A 63-year-old female with chronic hypertension presents for an osteopathic structural
examination. The physician diagnoses a Type I neutral somatic dysfunction involving
,the thoracic spine from T5 to T8. Which of the following structural relationships is
expected regarding the positional mechanics of this dysfunction?
A) Sidebending and rotation occur in the same direction
B) Sidebending and rotation occur in opposite directions
C) It involves a single vertebral segment that is highly restricted in flexion
D) It is an isolated non-neutral dysfunction that corrects with extension
Answer:
B) Sidebending and rotation occur in opposite directions
Rationale:
According to Fryette’s Principles, Type I somatic dysfunctions occur in a neutral spinal
state, involve a group of three or more vertebrae, and feature sidebending and rotation
to opposite sides (e.g., T5–T8 N SxRx). Type II dysfunctions occur in a non-neutral
state (flexed or extended), involve a single segment, and sidebend and rotate to the
same side.
Question 6:
A 22-year-old female presents with persistent, foul-smelling vaginal discharge. A wet
mount preparation of the discharge reveals motile, pear-shaped protozoa with flagella.
Which of the following is the most appropriate first-line pharmacotherapeutic agent?
A) Fluconazole
B) Metronidazole
C) Azithromycin
D) Doxycycline
Answer:
B) Metronidazole
Rationale:
The description points to Trichomonas vaginalis infection. Metronidazole is the drug of
choice for trichomoniasis and treats both the patient and their sexual partners.
Fluconazole is an antifungal used for Candida, while azithromycin and doxycycline
target bacterial pathogens like Chlamydia.
Question 7:
During an osteopathic evaluation of a 40-year-old male with acute lower back pain, a
positive standing flexion test is noted on the right side. Palpation reveals a deep right
sacral sulcus and a posterior, inferior right inferior lateral angle (ILA). What is the most
likely sacral somatic dysfunction?
A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Right unilateral sacral flexion
D) Right unilateral sacral extension
Answer:
C) Right unilateral sacral flexion
Rationale:
In a unilateral sacral flexion (sacral shear), the positive seated/standing flexion test is on
, the same side as the deep sacral sulcus and the posterior/inferior ILA. If the deep
sulcus and posterior/inferior ILA were on opposite sides, it would instead indicate a
sacral torsion pattern.
Question 8:
A 53-year-old male with chronic kidney disease presents for an evaluation. On structural
exam, an anterior Chapman reflex point is identified 1 inch superior and 1 inch lateral to
the umbilicus. Which of the following structures matches this reflex location?
A) Adrenal gland
B) Kidney
C) Urinary bladder
D) Gonads
Answer:
B) Kidney
Rationale:
The anterior Chapman point for the kidney is situated 1 inch superior and 1 inch lateral
to the umbilicus. The adrenal glands are located slightly higher, 2 inches superior and 1
inch lateral to the umbilicus. Bladder points are periumbilical or pubic.
Question 9:
A 34-year-old construction worker presents with sharp pain in his mid-back. Structural
assessment reveals that T6 is rotated right and sidebent right in the flexed position.
What is the most appropriate initial setup position if treating this dysfunction with Muscle
Energy Technique?
A) Extended, sidebent left, rotated left
B) Flexed, sidebent left, rotated left
C) Extended, sidebent right, rotated right
D) Flexed, sidebent right, rotated left
Answer:
A) Extended, sidebent left, rotated left
Rationale:
This is a Type II non-neutral somatic dysfunction (T6 F SxRx). Muscle energy is a direct
technique, meaning the patient must be placed into their restrictive barrier. To treat a
flexed, right-sidebent, right-rotated segment, the physician moves it into extension, left
sidebending, and left rotation.
Question 10:
A 28-year-old female presents with severe, unilateral throbbing headaches
accompanied by photophobia. She has been diagnosed with migraines and is
prescribed sumatriptan. What is the primary mechanism of action of this abortive
medication?
A) 5-HT1B/1D receptor agonist
B) 5-HT3 receptor antagonist
C) Dopamine D2 receptor agonist
D) Alpha-1 adrenergic antagonist
