COMSAE Phase 1 Form 113 Study
Guide: High-Yield Board Review
Questions And Well Graded Solutions
With Rationales Updated 2026-2027
Master your COMLEX Level 1 prep with this comprehensive study guide for the
COMSAE Phase 1 Form 113. Features highly detailed multiple-choice questions,
accurate answers, and thorough clinical rationales. Covers high-yield board concepts
including OMM autonomic levels, viscerosomatic reflexes, cranial strain motions,
pathology, and high-yield pharmacology. Perfect baseline resource to clear your
school's score threshold and build testing confidence. Boost your score today!
Osteopathic Manipulative Medicine (OMM) & Anatomy
Question 1
A 42-year-old female presents with chronic epigastric pain that worsens after eating
fatty meals. On osteopathic structural examination, a tissue texture abnormality is
noted at the T5–T9 paraspinal levels on the right. Which of the following organs is
most likely associated with this finding?
A. Duodenum
B. Gallbladder
C. Spleen
D. Kidneys
B. Gallbladder
Rationale: The gallbladder and liver receive sympathetic innervation from the T5–T9
spinal segments via the greater splanchnic nerve. Viscerosomatic reflexes for these
upper gastrointestinal tract structures manifest as right-sided paraspinal tissue
texture changes. The duodenum is primarily T6–T8. The spleen is a left-sided T5–T9
structure. The kidneys are T10–T11.
Question 2
A patient presents with a somatic dysfunction of the sacrum. Structural exam reveals
that the right sacral base is anterior, and the left ILA is posterior and inferior. The
spring test is negative. Which of the following is the correct diagnosis?
A. Right-on-right forward sacral torsion
B. Left-on-left forward sacral torsion
C. Right-on-left backward sacral torsion
D. Left-on-right backward sacral torsion
A. Right-on-right forward sacral torsion
Rationale: A negative spring test indicates a forward (physiologic) sacral torsion. In a
right-on-right torsion, the sacrum rotates right on a right oblique axis. This causes the
,left sacral base to move anteriorly relative to the right, or the right sacral base to
appear relatively anterior if the axis itself is shifted, resulting in a prominent left ILA
that is posterior and inferior.
Question 3
During a cranial examination, the physician notes that the sphenobasilar
synchondrosis (SBS) moves superiorly during the inhalation phase of primary
respiration. The paired bones of the cranium are noted to externally rotate. Which of
the following is the correct term for this cranial motion phase?
A. Extension
B. Flexion
C. Torsion
D. Sidebending/Rotation
B. Flexion
Rationale: During the inhalation phase of the primary respiratory mechanism, the
SBS moves superiorly (rises), and the midline bones flex. This movement causes the
paired bones of the cranium to externally rotate. Extension is the opposite motion,
occurring during exhalation, where the SBS moves inferiorly.
Question 4
A 24-year-old male athlete sustains an eversion ankle sprain. Structural examination
reveals a posterior fibular head on the affected side. Which of the following
peripheral nerve findings is most consistent with this somatic dysfunction?
A. Foot drop due to deep peroneal nerve compression
B. Paresthesia along the medial malleolus due to tibial nerve compression
C. Foot drop or paresthesia due to common peroneal nerve compression
D. Weakness in plantarflexion due to superficial peroneal nerve compression
C. Foot drop or paresthesia due to common peroneal nerve compression
Rationale: The common peroneal (fibular) nerve winds closely around the neck of
the fibula. A posterior fibular head can entrap or compress this nerve, leading to
symptoms of common peroneal nerve injury, including foot drop (loss of dorsiflexion)
and sensory loss on the dorsum of the foot.
,Question 5
An osteopathic physician utilizes muscle energy technique to treat a type II somatic
dysfunction at L4. The diagnosis is L4 flexed, rotated right, sidebent right
(\(L_{4}FR_{R}S_{R}\)). In which direction should the patient be instructed to push
against the physician’s resistance to engage the post-isometric relaxation
mechanism?
A. Into extension, rotation left, and sidebending left
B. Into flexion, rotation right, and sidebending right
C. Into extension, rotation right, and sidebending right
D. Into flexion, rotation left, and sidebending left
B. Into flexion, rotation right, and sidebending right
Rationale: To treat using post-isometric relaxation muscle energy, the patient is
placed into their restrictive barrier (extension, rotation left, sidebending left). The
patient is then instructed to gently push back toward their position of comfort (the
diagnosis: flexion, rotation right, sidebending right) against equal and opposite
physician resistance.
Question 6
A 35-year-old male presents with acute lower back pain after lifting heavy boxes.
Examination reveals a tender point located on the lateral aspect of the ascending
ramus of the pubis, just inferior to the anterior superior iliac spine (ASIS). This
corresponds to which counterstrain tender point?
A. Iliacus
B. Psoas major
C. Piriformis
D. Gluteus medius
A. Iliacus
Rationale: The iliacus counterstrain tender point is located deep within the iliac fossa
or on the lateral aspect of the pubic ramus/medial to the ASIS. Treatment requires
the patient to be supine with bilateral hip flexion and external rotation (the "frog-leg"
position).
Question 7
A patient presents with a tissue texture abnormality at the left paraspinal region from
T10 to T11. An osteopathic physician suspects a viscerosomatic reflex from a
visceral organ. Which of the following pathologies is most consistent with this
finding?
A. Acute appendicitis
, B. Left-sided nephrolithiasis
C. Acute prostatitis
D. Gastric ulceritis
B. Left-sided nephrolithiasis
Rationale: The kidneys and upper ureters receive sympathetic innervation from the
T10–T11 spinal cord segments. A kidney stone on the left will yield a left-sided
viscerosomatic reflex at T10–T11. Appendicitis yields a right-sided reflex at T10–
T11. Prostatitis corresponds to T12–L2.
Question 8
A 19-year-old college baseball pitcher presents with shoulder pain. Structural exam
reveals an anterior exhalation somatic dysfunction of rib 2 on the right side. Which of
the following muscles is the primary key muscle used to treat an exhalation
dysfunction of rib 2?
A. Anterior scalene
B. Posterior scalene
C. Pectoralis minor
D. Serratus anterior
B. Posterior scalene
Rationale: In muscle energy for exhalation rib dysfunctions, specific muscles are
used to pull the rib back into place. Rib 1 utilizes the anterior and middle scalenes;
rib 2 utilizes the posterior scalene; ribs 3–5 use the pectoralis minor; ribs 6–9 use the
serratus anterior.
Question 9
A physician evaluates a patient's thoracic spine and finds that T6 is rotated left in
both flexion and extension. When the patient sidebends to the left, the rotation
worsens. What is the correct somatic dysfunction diagnosis for T6?
A. T6 neutral, rotated left, sidebent right
B. T6 flexed, rotated left, sidebent left
C. T6 extended, rotated left, sidebent right
D. T6 neutral, rotated right, sidebent left
A. T6 neutral, rotated left, sidebent right
Rationale: Type I somatic dysfunctions (neutral) involve a group of vertebrae where
rotation and sidebending occur in opposite directions. Because the rotation is
present in both flexion and extension, it is a neutral (Type I) dysfunction.
Guide: High-Yield Board Review
Questions And Well Graded Solutions
With Rationales Updated 2026-2027
Master your COMLEX Level 1 prep with this comprehensive study guide for the
COMSAE Phase 1 Form 113. Features highly detailed multiple-choice questions,
accurate answers, and thorough clinical rationales. Covers high-yield board concepts
including OMM autonomic levels, viscerosomatic reflexes, cranial strain motions,
pathology, and high-yield pharmacology. Perfect baseline resource to clear your
school's score threshold and build testing confidence. Boost your score today!
Osteopathic Manipulative Medicine (OMM) & Anatomy
Question 1
A 42-year-old female presents with chronic epigastric pain that worsens after eating
fatty meals. On osteopathic structural examination, a tissue texture abnormality is
noted at the T5–T9 paraspinal levels on the right. Which of the following organs is
most likely associated with this finding?
A. Duodenum
B. Gallbladder
C. Spleen
D. Kidneys
B. Gallbladder
Rationale: The gallbladder and liver receive sympathetic innervation from the T5–T9
spinal segments via the greater splanchnic nerve. Viscerosomatic reflexes for these
upper gastrointestinal tract structures manifest as right-sided paraspinal tissue
texture changes. The duodenum is primarily T6–T8. The spleen is a left-sided T5–T9
structure. The kidneys are T10–T11.
Question 2
A patient presents with a somatic dysfunction of the sacrum. Structural exam reveals
that the right sacral base is anterior, and the left ILA is posterior and inferior. The
spring test is negative. Which of the following is the correct diagnosis?
A. Right-on-right forward sacral torsion
B. Left-on-left forward sacral torsion
C. Right-on-left backward sacral torsion
D. Left-on-right backward sacral torsion
A. Right-on-right forward sacral torsion
Rationale: A negative spring test indicates a forward (physiologic) sacral torsion. In a
right-on-right torsion, the sacrum rotates right on a right oblique axis. This causes the
,left sacral base to move anteriorly relative to the right, or the right sacral base to
appear relatively anterior if the axis itself is shifted, resulting in a prominent left ILA
that is posterior and inferior.
Question 3
During a cranial examination, the physician notes that the sphenobasilar
synchondrosis (SBS) moves superiorly during the inhalation phase of primary
respiration. The paired bones of the cranium are noted to externally rotate. Which of
the following is the correct term for this cranial motion phase?
A. Extension
B. Flexion
C. Torsion
D. Sidebending/Rotation
B. Flexion
Rationale: During the inhalation phase of the primary respiratory mechanism, the
SBS moves superiorly (rises), and the midline bones flex. This movement causes the
paired bones of the cranium to externally rotate. Extension is the opposite motion,
occurring during exhalation, where the SBS moves inferiorly.
Question 4
A 24-year-old male athlete sustains an eversion ankle sprain. Structural examination
reveals a posterior fibular head on the affected side. Which of the following
peripheral nerve findings is most consistent with this somatic dysfunction?
A. Foot drop due to deep peroneal nerve compression
B. Paresthesia along the medial malleolus due to tibial nerve compression
C. Foot drop or paresthesia due to common peroneal nerve compression
D. Weakness in plantarflexion due to superficial peroneal nerve compression
C. Foot drop or paresthesia due to common peroneal nerve compression
Rationale: The common peroneal (fibular) nerve winds closely around the neck of
the fibula. A posterior fibular head can entrap or compress this nerve, leading to
symptoms of common peroneal nerve injury, including foot drop (loss of dorsiflexion)
and sensory loss on the dorsum of the foot.
,Question 5
An osteopathic physician utilizes muscle energy technique to treat a type II somatic
dysfunction at L4. The diagnosis is L4 flexed, rotated right, sidebent right
(\(L_{4}FR_{R}S_{R}\)). In which direction should the patient be instructed to push
against the physician’s resistance to engage the post-isometric relaxation
mechanism?
A. Into extension, rotation left, and sidebending left
B. Into flexion, rotation right, and sidebending right
C. Into extension, rotation right, and sidebending right
D. Into flexion, rotation left, and sidebending left
B. Into flexion, rotation right, and sidebending right
Rationale: To treat using post-isometric relaxation muscle energy, the patient is
placed into their restrictive barrier (extension, rotation left, sidebending left). The
patient is then instructed to gently push back toward their position of comfort (the
diagnosis: flexion, rotation right, sidebending right) against equal and opposite
physician resistance.
Question 6
A 35-year-old male presents with acute lower back pain after lifting heavy boxes.
Examination reveals a tender point located on the lateral aspect of the ascending
ramus of the pubis, just inferior to the anterior superior iliac spine (ASIS). This
corresponds to which counterstrain tender point?
A. Iliacus
B. Psoas major
C. Piriformis
D. Gluteus medius
A. Iliacus
Rationale: The iliacus counterstrain tender point is located deep within the iliac fossa
or on the lateral aspect of the pubic ramus/medial to the ASIS. Treatment requires
the patient to be supine with bilateral hip flexion and external rotation (the "frog-leg"
position).
Question 7
A patient presents with a tissue texture abnormality at the left paraspinal region from
T10 to T11. An osteopathic physician suspects a viscerosomatic reflex from a
visceral organ. Which of the following pathologies is most consistent with this
finding?
A. Acute appendicitis
, B. Left-sided nephrolithiasis
C. Acute prostatitis
D. Gastric ulceritis
B. Left-sided nephrolithiasis
Rationale: The kidneys and upper ureters receive sympathetic innervation from the
T10–T11 spinal cord segments. A kidney stone on the left will yield a left-sided
viscerosomatic reflex at T10–T11. Appendicitis yields a right-sided reflex at T10–
T11. Prostatitis corresponds to T12–L2.
Question 8
A 19-year-old college baseball pitcher presents with shoulder pain. Structural exam
reveals an anterior exhalation somatic dysfunction of rib 2 on the right side. Which of
the following muscles is the primary key muscle used to treat an exhalation
dysfunction of rib 2?
A. Anterior scalene
B. Posterior scalene
C. Pectoralis minor
D. Serratus anterior
B. Posterior scalene
Rationale: In muscle energy for exhalation rib dysfunctions, specific muscles are
used to pull the rib back into place. Rib 1 utilizes the anterior and middle scalenes;
rib 2 utilizes the posterior scalene; ribs 3–5 use the pectoralis minor; ribs 6–9 use the
serratus anterior.
Question 9
A physician evaluates a patient's thoracic spine and finds that T6 is rotated left in
both flexion and extension. When the patient sidebends to the left, the rotation
worsens. What is the correct somatic dysfunction diagnosis for T6?
A. T6 neutral, rotated left, sidebent right
B. T6 flexed, rotated left, sidebent left
C. T6 extended, rotated left, sidebent right
D. T6 neutral, rotated right, sidebent left
A. T6 neutral, rotated left, sidebent right
Rationale: Type I somatic dysfunctions (neutral) involve a group of vertebrae where
rotation and sidebending occur in opposite directions. Because the rotation is
present in both flexion and extension, it is a neutral (Type I) dysfunction.
