Page 1 of 153
COMSAE Phase 1 – Form 111 EXAM QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 1 Form 111 Exam study guide based on the official NBOME blueprint and aggregated
high-yield question patterns.
COMSAE Phase 1 – Form 111 (ASA 111i) Exam Preparation Guide
Exam Format & Logistics (Based on NBOME Blueprint)
• Total Questions: 176 multiple-choice questions divided into four sections of 44 questions each .
• Time Limit: Not publicly specified, but timed versions used by COMs typically allocate 4-5 hours
total.
• Format: Single-best-answer, vignette-based. Some forms contain videos or images.
• Official Forms Available: Student forms include ASA 107i, ASA 110i, ASA 111i (with answer key).
• Cost: $60 per form for individual student purchase.
• High-Yield Domains on Form 111
o Osteopathic Principles & Practice: Chapman reflexes (anterior/posterior points), sacral
diagnosis (torsions, dural tube tension), viscerosomatic reflexes, counterstrain tender
points, cranial motion, facilitated segmental examination.
o Cardiovascular System: Ischemic heart disease (STEMI/NSTEMI localization), heart
failure (HFrEF vs. HFpEF), arrhythmias (Long QT, WPW, atrial fibrillation), valvular
disorders, cardiac auscultation findings (S3, S4, murmurs).
o Neurology: Stroke localization (MCA, ACA, PCA, vertebrobasilar), seizure disorders,
meningitis, multiple sclerosis, Parkinson disease, brain tumors.
o Hematology & Oncology: Anemias (microcytic, macrocytic, hemolytic),
leukemias/lymphomas, coagulation disorders, transfusion medicine.
o Endocrinology: Thyroid disorders (hypo/hyper), adrenal disorders (Cushing's, Addison's),
diabetes mellitus (Type 1 vs. 2, complications), parathyroid disorders.
o Gastroenterology: Inflammatory bowel disease (Crohn's vs. UC), pancreatitis
(gallstones, alcohol), hepatitis (viral, autoimmune), cirrhosis, GI bleeding.
o Pulmonary System: COPD, asthma, restrictive lung disease, pneumonia, pulmonary
embolism, pneumothorax, lung cancer.
o Renal & Urinary System: Acute kidney injury (prerenal, intrarenal, postrenal), chronic
kidney disease, glomerulonephritis, nephrotic syndrome, acid-base disorders.
o Infectious Disease: Viral (EBV, CMV, HIV), bacterial (pneumonia, UTI, meningitis, STIs),
fungal (PJP, candida, histoplasmosis), parasitic (giardia, toxoplasma).
o General Principles & Foundational Science: Immunology, microbiology, biochemistry
(metabolic pathways, vitamin deficiencies), genetics, pharmacology (mechanisms,
adverse effects, drug interactions), pathology (neoplasia, inflammation, cell injury).
Osteopathic Principles & Practice (Questions 1–30)
1. A patient with chronic constipation has a tender anterior Chapman point at the tip of the left 12th
rib. Which part of the colon is affected?
, Page 2 of 153
A) Ascending colon
B) Transverse colon
C) Descending colon
D) Sigmoid colon
Answer: C
Rationale: The anterior Chapman reflex for the descending colon is located at the tip of the left 12th rib.
The ascending colon corresponds to the right 11th rib.
2. A patient with chronic GERD has a tender anterior Chapman point at the right 6th intercostal space
near the sternum. Which spinal level is most likely dyssynchronous?
A) T2–T4
B) T5–T7
C) T8–T10
D) T10–L1
Answer: B
Rationale: The stomach viscerosomatic reflex is associated with T5–T7 via parasympathetic vagus
innervation. Somatic dysfunction at these levels may accompany GERD.
, Page 3 of 153
3. A patient with asthma has a tender posterior Chapman point at the 3rd intercostal space, 2 cm from
the midline. Which structure does this correlate with?
A) Heart
B) Lung (bronchi)
C) Trachea
D) Esophagus
Answer: B
Rationale: The bronchus posterior Chapman reflex is located at T3, approximately 2 cm lateral to the
spinous process at the 3rd intercostal space.
4. A patient with chronic kidney stones has a tender posterior Chapman point at the tip of the right
12th rib. What is the most likely somatic component?
A) Referred pain from renal calculi
B) Local musculoskeletal strain
C) Viscerosomatic reflex from kidney dysfunction
D) Psoas spasm secondary to pain
Answer: C
, Page 4 of 153
Rationale: The kidney posterior reflex is located at the tip of the 12th rib. This viscerosomatic reflex may
accompany renal disease.
5. A patient with chronic dysmenorrhea has a tender anterior Chapman point just medial to the left
anterior superior iliac spine. Which organ does this correspond to?
A) Ovary
B) Bladder
C) Uterus
D) Kidney
Answer: C
Rationale: The anterior Chapman reflex for the uterus is located near the ASIS, approximately 1–2 cm
medial and superior. Ovarian points are slightly lower and medial.
6. A patient with chronic pancreatitis has a tender anterior Chapman point in the epigastrium, just to
the left of midline. Which spinal segments are likely dyssynchronous?
A) T2–T4
B) T4–T6
COMSAE Phase 1 – Form 111 EXAM QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
COMSAE Phase 1 Form 111 Exam study guide based on the official NBOME blueprint and aggregated
high-yield question patterns.
COMSAE Phase 1 – Form 111 (ASA 111i) Exam Preparation Guide
Exam Format & Logistics (Based on NBOME Blueprint)
• Total Questions: 176 multiple-choice questions divided into four sections of 44 questions each .
• Time Limit: Not publicly specified, but timed versions used by COMs typically allocate 4-5 hours
total.
• Format: Single-best-answer, vignette-based. Some forms contain videos or images.
• Official Forms Available: Student forms include ASA 107i, ASA 110i, ASA 111i (with answer key).
• Cost: $60 per form for individual student purchase.
• High-Yield Domains on Form 111
o Osteopathic Principles & Practice: Chapman reflexes (anterior/posterior points), sacral
diagnosis (torsions, dural tube tension), viscerosomatic reflexes, counterstrain tender
points, cranial motion, facilitated segmental examination.
o Cardiovascular System: Ischemic heart disease (STEMI/NSTEMI localization), heart
failure (HFrEF vs. HFpEF), arrhythmias (Long QT, WPW, atrial fibrillation), valvular
disorders, cardiac auscultation findings (S3, S4, murmurs).
o Neurology: Stroke localization (MCA, ACA, PCA, vertebrobasilar), seizure disorders,
meningitis, multiple sclerosis, Parkinson disease, brain tumors.
o Hematology & Oncology: Anemias (microcytic, macrocytic, hemolytic),
leukemias/lymphomas, coagulation disorders, transfusion medicine.
o Endocrinology: Thyroid disorders (hypo/hyper), adrenal disorders (Cushing's, Addison's),
diabetes mellitus (Type 1 vs. 2, complications), parathyroid disorders.
o Gastroenterology: Inflammatory bowel disease (Crohn's vs. UC), pancreatitis
(gallstones, alcohol), hepatitis (viral, autoimmune), cirrhosis, GI bleeding.
o Pulmonary System: COPD, asthma, restrictive lung disease, pneumonia, pulmonary
embolism, pneumothorax, lung cancer.
o Renal & Urinary System: Acute kidney injury (prerenal, intrarenal, postrenal), chronic
kidney disease, glomerulonephritis, nephrotic syndrome, acid-base disorders.
o Infectious Disease: Viral (EBV, CMV, HIV), bacterial (pneumonia, UTI, meningitis, STIs),
fungal (PJP, candida, histoplasmosis), parasitic (giardia, toxoplasma).
o General Principles & Foundational Science: Immunology, microbiology, biochemistry
(metabolic pathways, vitamin deficiencies), genetics, pharmacology (mechanisms,
adverse effects, drug interactions), pathology (neoplasia, inflammation, cell injury).
Osteopathic Principles & Practice (Questions 1–30)
1. A patient with chronic constipation has a tender anterior Chapman point at the tip of the left 12th
rib. Which part of the colon is affected?
, Page 2 of 153
A) Ascending colon
B) Transverse colon
C) Descending colon
D) Sigmoid colon
Answer: C
Rationale: The anterior Chapman reflex for the descending colon is located at the tip of the left 12th rib.
The ascending colon corresponds to the right 11th rib.
2. A patient with chronic GERD has a tender anterior Chapman point at the right 6th intercostal space
near the sternum. Which spinal level is most likely dyssynchronous?
A) T2–T4
B) T5–T7
C) T8–T10
D) T10–L1
Answer: B
Rationale: The stomach viscerosomatic reflex is associated with T5–T7 via parasympathetic vagus
innervation. Somatic dysfunction at these levels may accompany GERD.
, Page 3 of 153
3. A patient with asthma has a tender posterior Chapman point at the 3rd intercostal space, 2 cm from
the midline. Which structure does this correlate with?
A) Heart
B) Lung (bronchi)
C) Trachea
D) Esophagus
Answer: B
Rationale: The bronchus posterior Chapman reflex is located at T3, approximately 2 cm lateral to the
spinous process at the 3rd intercostal space.
4. A patient with chronic kidney stones has a tender posterior Chapman point at the tip of the right
12th rib. What is the most likely somatic component?
A) Referred pain from renal calculi
B) Local musculoskeletal strain
C) Viscerosomatic reflex from kidney dysfunction
D) Psoas spasm secondary to pain
Answer: C
, Page 4 of 153
Rationale: The kidney posterior reflex is located at the tip of the 12th rib. This viscerosomatic reflex may
accompany renal disease.
5. A patient with chronic dysmenorrhea has a tender anterior Chapman point just medial to the left
anterior superior iliac spine. Which organ does this correspond to?
A) Ovary
B) Bladder
C) Uterus
D) Kidney
Answer: C
Rationale: The anterior Chapman reflex for the uterus is located near the ASIS, approximately 1–2 cm
medial and superior. Ovarian points are slightly lower and medial.
6. A patient with chronic pancreatitis has a tender anterior Chapman point in the epigastrium, just to
the left of midline. Which spinal segments are likely dyssynchronous?
A) T2–T4
B) T4–T6
