COMSAE Phase 1 Form 115 Practice Exam Questions And
Correct Answers (Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Master your exam with 250 highly realistic practice questions meticulously mapped to the NBOME
COMLEX-USA Blueprint for Form 115. 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 with recurrent, severe right-sided headaches, nausea,
and visual changes. Physical examination reveals an anterior Chapman reflex point at
the 2nd intercostal space near the sternum. Which of the following organs is most likely
associated with this finding?
A) Thyroid
B) Heart
C) Esophagus
D) Retina/Eye
Answer:
B) Heart
Rationale:
The anterior Chapman reflex point for the heart is located at the 2nd intercostal space
near the sternum. The myocardium shares autonomic pathways that manifest at this
specific somatic location. The thyroid point is at the 2nd rib near the costochondral
junction, and the eyes map to the surgical neck of the humerus.
Question 2:
A 19-year-old male presents to the emergency department after a football injury.
Structural evaluation reveals that during craniosacral extension, the paired bones of his
cranium internally rotate, and the base of the sphenoid moves superiorly. Which of the
following describes the physiological motion of the sacrum during this phase?
A) Sacral nutation
B) Sacral counternutation
C) Right unilateral flexion
D) Left-on-left sacral torsion
Answer:
A) Sacral nutation
Rationale:
During craniosacral extension, the sphenobasilar synchondrosis (SBS) moves
,superiorly, the paired bones internally rotate, and the sacral base moves anteriorly and
inferiorly (sacral nutation). Conversely, during craniosacral flexion, the SBS moves
inferiorly, paired bones externally rotate, and the sacral base moves posteriorly
(counternutation).
Question 3:
A 29-year-old G1P0 female at 39 weeks gestation presents in active labor. The
physician wants to apply inhibitory pressure to the sacrum to alleviate severe low back
pain caused by hyperparasympathetic activity. Which spinal levels provide the primary
parasympathetic innervation to the uterus and cervix?
A) T10–T11
B) T12–L2
C) S2–S4
D) L3–L5
Answer:
C) S2–S4
Rationale:
The pelvic splanchnic nerves derived from the S2 to S4 nerve roots supply
parasympathetic innervation to the pelvic organs, including the uterus, cervix, and distal
colon. Sympathetic innervation to the uterus arises from the T10 to L2 segments.
Targeting S2 to S4 with structural techniques modulates parasympathetic tone.
Question 4:
A 62-year-old male with a history of chronic smoking presents with a productive cough
and shortness of breath. Structural examination reveals a right-sided thoracic somatic
dysfunction where ribs 3 through 5 lag behind during exhalation. Which muscle should
be targeted to correct this inhalation somatic dysfunction using muscle energy
technique?
A) Pectoralis minor
B) Anterior scalene
C) Serratus anterior
D) Latissimus dorsi
Answer:
A) Pectoralis minor
Rationale:
Ribs 3 through 5 lag during exhalation, indicating they are held in inhalation (an
inhalation somatic dysfunction). For an inhalation rib dysfunction, the key rib is the
bottom rib of the group (Rib 5). The pectoralis minor muscle originates or inserts in a
way that allows it to be used during muscle energy to help treat dysfunction involving
ribs 3–5.
Question 5:
A 55-year-old male presents with severe pain in his right great toe. Lab results reveal
hyperuricemia, and a joint aspirate shows negatively birefringent, needle-shaped
crystals under polarized light. Which of the following mechanisms of action describes
,the first-line acute pharmaceutical management that directly inhibits microtubule
polymerization?
A) Reversible inhibition of cyclooxygenase-1 and 2
B) Inhibition of xanthine oxidase
C) Binding to tubulin to prevent leukocyte migration
D) Competitive inhibition of organic anion transporters
Answer:
C) Binding to tubulin to prevent leukocyte migration
Rationale:
The clinical picture describes acute gouty arthritis. Colchicine is an acute treatment
choice that works by binding to intracellular tubulin, preventing microtubule
polymerization, which directly inhibits leukocyte migration and degranulation. Allopurinol
inhibits xanthine oxidase but is used for chronic prophylaxis, not acute flare-ups.
Question 6:
A 24-year-old female medical student presents with severe, throbbing right-sided
headaches. Structural examination reveals that the sphenoid base and occipital base
both rotate superiorly to the right around a vertical axis, and both deviate to the right
around a longitudinal axis. What is this cranial strain pattern?
A) Right torsion
B) Right sidebending/rotation
C) Left lateral strain
D) Vertical strain
Answer:
B) Right sidebending/rotation
Rationale:
A sidebending/rotation cranial strain pattern occurs around one longitudinal axis and
two vertical axes. The sphenoid and occiput rotate in opposite directions around the
vertical axes, but both deviate toward the same side (the side of naming) around the
longitudinal axis. In a right sidebending/rotation strain, the SBS widens on the right side.
Question 7:
A 38-year-old male presents with burning retrosternal chest pain that worsens when
lying flat after meals. Structural evaluation demonstrates an anterior Chapman reflex
point at the left 5th intercostal space near the sternum. What is the sympathetic spinal
level origin for this patient's underlying condition?
A) T1–T4
B) T5–T9
C) T10–T11
D) T12–L2
Answer:
B) T5–T9
Rationale:
The patient presents with symptoms of gastroesophageal reflux disease (GERD) or
, gastritis. The upper gastrointestinal tract (stomach, duodenum, liver, gallbladder,
spleen) receives sympathetic innervation from the T5–T9 spinal levels via the greater
splanchnic nerve and celiac ganglion. The anterior Chapman point for the stomach/acid
production is found at the left 5th intercostal space.
Question 8:
A 65-year-old female with a history of osteoporosis presents with sudden-onset mid-
back pain after lifting a grocery bag. Evaluation confirms a compression fracture at the
T8 vertebral level. Which of the following osteopathic treatments is strictly
contraindicated at this segment?
A) High-velocity, low-amplitude (HVLA)
B) Myofascial release (MFR)
C) Counterstrain
D) Balanced ligamentous tension (BLT)
Answer:
A) High-velocity, low-amplitude (HVLA)
Rationale:
HVLA is an absolute contraindication in areas of acute vertebral fractures, severe
osteoporosis, bone metastasis, osteomyelitis, or severe joint instability. Passive, gentle
modalities like counterstrain, myofascial release, and indirect techniques are safe
alternative approaches to manage paraspinal muscle spasms.
Question 9:
A 50-year-old male with a history of alcohol use disorder presents to the emergency
department with severe, stabbing epigastric pain that radiates to his back. Labs show
elevated serum lipase. A Chapman reflex point is identified at the right 7th intercostal
space near the costochondral junction. Which ganglion is associated with the
sympathetic pathway of this organ?
A) Celiac ganglion
B) Superior mesenteric ganglion
C) Inferior mesenteric ganglion
D) Pterygopalatine ganglion
Answer:
***A) Celiac ganglion ***
Rationale:
Acute pancreatitis presents with epigastric pain radiating to the back and elevated
lipase. The pancreas is an upper abdominal organ derived from the foregut, meaning its
sympathetic innervation arises from T5–T9 and synapses in the celiac ganglion. The
anterior Chapman point for the pancreas is at the right 7th intercostal space.
Question 10:
An osteopathic physician assesses a patient and notes a positive standing flexion test
on the right side. During the gait assessment, the patient demonstrates an asymmetric
stride length. What does a positive standing flexion test primarily indicate?
A) Sacrosanct sacroiliac joint restriction
Correct Answers (Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Master your exam with 250 highly realistic practice questions meticulously mapped to the NBOME
COMLEX-USA Blueprint for Form 115. 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 with recurrent, severe right-sided headaches, nausea,
and visual changes. Physical examination reveals an anterior Chapman reflex point at
the 2nd intercostal space near the sternum. Which of the following organs is most likely
associated with this finding?
A) Thyroid
B) Heart
C) Esophagus
D) Retina/Eye
Answer:
B) Heart
Rationale:
The anterior Chapman reflex point for the heart is located at the 2nd intercostal space
near the sternum. The myocardium shares autonomic pathways that manifest at this
specific somatic location. The thyroid point is at the 2nd rib near the costochondral
junction, and the eyes map to the surgical neck of the humerus.
Question 2:
A 19-year-old male presents to the emergency department after a football injury.
Structural evaluation reveals that during craniosacral extension, the paired bones of his
cranium internally rotate, and the base of the sphenoid moves superiorly. Which of the
following describes the physiological motion of the sacrum during this phase?
A) Sacral nutation
B) Sacral counternutation
C) Right unilateral flexion
D) Left-on-left sacral torsion
Answer:
A) Sacral nutation
Rationale:
During craniosacral extension, the sphenobasilar synchondrosis (SBS) moves
,superiorly, the paired bones internally rotate, and the sacral base moves anteriorly and
inferiorly (sacral nutation). Conversely, during craniosacral flexion, the SBS moves
inferiorly, paired bones externally rotate, and the sacral base moves posteriorly
(counternutation).
Question 3:
A 29-year-old G1P0 female at 39 weeks gestation presents in active labor. The
physician wants to apply inhibitory pressure to the sacrum to alleviate severe low back
pain caused by hyperparasympathetic activity. Which spinal levels provide the primary
parasympathetic innervation to the uterus and cervix?
A) T10–T11
B) T12–L2
C) S2–S4
D) L3–L5
Answer:
C) S2–S4
Rationale:
The pelvic splanchnic nerves derived from the S2 to S4 nerve roots supply
parasympathetic innervation to the pelvic organs, including the uterus, cervix, and distal
colon. Sympathetic innervation to the uterus arises from the T10 to L2 segments.
Targeting S2 to S4 with structural techniques modulates parasympathetic tone.
Question 4:
A 62-year-old male with a history of chronic smoking presents with a productive cough
and shortness of breath. Structural examination reveals a right-sided thoracic somatic
dysfunction where ribs 3 through 5 lag behind during exhalation. Which muscle should
be targeted to correct this inhalation somatic dysfunction using muscle energy
technique?
A) Pectoralis minor
B) Anterior scalene
C) Serratus anterior
D) Latissimus dorsi
Answer:
A) Pectoralis minor
Rationale:
Ribs 3 through 5 lag during exhalation, indicating they are held in inhalation (an
inhalation somatic dysfunction). For an inhalation rib dysfunction, the key rib is the
bottom rib of the group (Rib 5). The pectoralis minor muscle originates or inserts in a
way that allows it to be used during muscle energy to help treat dysfunction involving
ribs 3–5.
Question 5:
A 55-year-old male presents with severe pain in his right great toe. Lab results reveal
hyperuricemia, and a joint aspirate shows negatively birefringent, needle-shaped
crystals under polarized light. Which of the following mechanisms of action describes
,the first-line acute pharmaceutical management that directly inhibits microtubule
polymerization?
A) Reversible inhibition of cyclooxygenase-1 and 2
B) Inhibition of xanthine oxidase
C) Binding to tubulin to prevent leukocyte migration
D) Competitive inhibition of organic anion transporters
Answer:
C) Binding to tubulin to prevent leukocyte migration
Rationale:
The clinical picture describes acute gouty arthritis. Colchicine is an acute treatment
choice that works by binding to intracellular tubulin, preventing microtubule
polymerization, which directly inhibits leukocyte migration and degranulation. Allopurinol
inhibits xanthine oxidase but is used for chronic prophylaxis, not acute flare-ups.
Question 6:
A 24-year-old female medical student presents with severe, throbbing right-sided
headaches. Structural examination reveals that the sphenoid base and occipital base
both rotate superiorly to the right around a vertical axis, and both deviate to the right
around a longitudinal axis. What is this cranial strain pattern?
A) Right torsion
B) Right sidebending/rotation
C) Left lateral strain
D) Vertical strain
Answer:
B) Right sidebending/rotation
Rationale:
A sidebending/rotation cranial strain pattern occurs around one longitudinal axis and
two vertical axes. The sphenoid and occiput rotate in opposite directions around the
vertical axes, but both deviate toward the same side (the side of naming) around the
longitudinal axis. In a right sidebending/rotation strain, the SBS widens on the right side.
Question 7:
A 38-year-old male presents with burning retrosternal chest pain that worsens when
lying flat after meals. Structural evaluation demonstrates an anterior Chapman reflex
point at the left 5th intercostal space near the sternum. What is the sympathetic spinal
level origin for this patient's underlying condition?
A) T1–T4
B) T5–T9
C) T10–T11
D) T12–L2
Answer:
B) T5–T9
Rationale:
The patient presents with symptoms of gastroesophageal reflux disease (GERD) or
, gastritis. The upper gastrointestinal tract (stomach, duodenum, liver, gallbladder,
spleen) receives sympathetic innervation from the T5–T9 spinal levels via the greater
splanchnic nerve and celiac ganglion. The anterior Chapman point for the stomach/acid
production is found at the left 5th intercostal space.
Question 8:
A 65-year-old female with a history of osteoporosis presents with sudden-onset mid-
back pain after lifting a grocery bag. Evaluation confirms a compression fracture at the
T8 vertebral level. Which of the following osteopathic treatments is strictly
contraindicated at this segment?
A) High-velocity, low-amplitude (HVLA)
B) Myofascial release (MFR)
C) Counterstrain
D) Balanced ligamentous tension (BLT)
Answer:
A) High-velocity, low-amplitude (HVLA)
Rationale:
HVLA is an absolute contraindication in areas of acute vertebral fractures, severe
osteoporosis, bone metastasis, osteomyelitis, or severe joint instability. Passive, gentle
modalities like counterstrain, myofascial release, and indirect techniques are safe
alternative approaches to manage paraspinal muscle spasms.
Question 9:
A 50-year-old male with a history of alcohol use disorder presents to the emergency
department with severe, stabbing epigastric pain that radiates to his back. Labs show
elevated serum lipase. A Chapman reflex point is identified at the right 7th intercostal
space near the costochondral junction. Which ganglion is associated with the
sympathetic pathway of this organ?
A) Celiac ganglion
B) Superior mesenteric ganglion
C) Inferior mesenteric ganglion
D) Pterygopalatine ganglion
Answer:
***A) Celiac ganglion ***
Rationale:
Acute pancreatitis presents with epigastric pain radiating to the back and elevated
lipase. The pancreas is an upper abdominal organ derived from the foregut, meaning its
sympathetic innervation arises from T5–T9 and synapses in the celiac ganglion. The
anterior Chapman point for the pancreas is at the right 7th intercostal space.
Question 10:
An osteopathic physician assesses a patient and notes a positive standing flexion test
on the right side. During the gait assessment, the patient demonstrates an asymmetric
stride length. What does a positive standing flexion test primarily indicate?
A) Sacrosanct sacroiliac joint restriction
