Page 1 of 138
COMSAE Phase 2 Form 115 –EXAM ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
COMSAE Phase 2 Form 115 – Complete Study Guide & Practice Exam
Based on the official NBOME COMSAE Phase 2 specifications and expert-curated question banks aligned
with COMLEX-USA Level 2-CE, this guide includes a comprehensive point-form summary of exam
coverage and over 200 practice questions with detailed rationales .
Core Competencies (COMLEX-USA Level 2-CE Blueprint)
Domain Approx. Weight
Osteopathic Principles & OMM 15-20%
Internal Medicine 20-25%
Surgery 10-15%
Pediatrics 8-12%
Obstetrics & Gynecology 8-12%
Psychiatry 8-12%
Emergency Medicine 8-12%
Preventive Medicine & Public Health 5-10%
Osteopathic Principles & OMM (High Yield)
• Innominate Rotations – Anterior (ASIS inferior/anterior, ischial tuberosity superior) vs. Posterior
(ASIS superior/posterior)
• Fryette’s Laws – Type I (neutral, group, rotation opposite sidebending) vs. Type II (non-neutral,
single vertebra, rotation same sidebending)
• Sacral Diagnoses – Seated flexion test, ILA position, spring test; torsions vs. unilateral
flexion/extension
• Chapman’s Reflexes (Points) – Anterior/posterior locations for organ dysfunction
• Rib Dysfunction – Inhalation vs. exhalation restrictions; sympathetic chain ganglia
correspondence
• Cranial Osteopathy – CV4 technique (compression of the fourth ventricle)
• Viscerosomatic Reflexes – Organ-to-spine level mapping (e.g., heart T2–T6, colon T10–L1)
• Muscle Energy Technique (MET) – Post-isometric relaxation for specific dysfunctions
High-Yield Clinical Topics by System
Cardiovascular
• Aortic stenosis – age-related calcific degeneration, crescendo-decrescendo murmur at RUSB
radiating to carotids
, Page 2 of 138
• Inferior MI – RCA occlusion, ST elevation leads II, III, aVF
• Aortic dissection – tearing chest pain radiating to back
• Cardiac tamponade – Beck triad (hypotension, JVD, muffled heart sounds)
Pulmonary
• COPD exacerbation – hypercapnic respiratory failure, BiPAP first-line
• Croup – parainfluenza virus, barking cough, inspiratory stridor
• Tuberculosis – cavitary lesions, night sweats, upper lobe involvement
Gastroenterology
• Acute pancreatitis – epigastric pain radiating to back, elevated lipase
• Esophageal cancer – progressive dysphagia (solids first then liquids)
• Cirrhosis/varices – massive upper GI bleeding, portal hypertension
• Celiac disease – steatorrhea, weight loss, malabsorption
Endocrine
• Graves disease – hyperthyroidism, low TSH, elevated T4, TRAb (TSH receptor antibody)
• Hashimoto thyroiditis – primary hypothyroidism, high TSH, low T4
• Pheochromocytoma – episodic headache, sweating, palpitations
• Type 2 diabetes – fasting glucose >126 mg/dL
Infectious Disease
• Bacterial vaginosis – fishy odor, clue cells
• Cystitis – nitrofurantoin for uncomplicated UTI
• Scarlet fever – group A strep, strawberry tongue
• Parvovirus B19 – erythema infectiosum, slapped cheek rash
• Pelvic inflammatory disease – cervical motion tenderness
Neurology
• Parkinson disease – resting tremor, bradykinesia, rigidity, dopamine deficiency
• Bell palsy – LMN facial palsy (forehead involved)
• Wernicke encephalopathy – thiamine deficiency (alcoholics), confusion, ophthalmoplegia,
ataxia
Hematology/Oncology
• Iron deficiency anemia – koilonychia, microcytic anemia
• Bladder cancer – painless hematuria in older smoker
OB/GYN
• Ovarian torsion – sudden pelvic pain, reduced blood flow on Doppler
• Uterine fibroids – menorrhagia, enlarged uterus
• Preeclampsia – hypertension after 20 weeks + proteinuria
Ophthalmology
• Acute angle-closure glaucoma – sudden painful vision loss, fixed mid-dilated pupil, halos
• Retinal detachment – painless vision loss, "curtain falling"
Pediatrics
• Hirschsprung disease – failure to pass meconium within 48 hours
• Hemolytic disease of newborn – jaundice within 24 hours (ABO/Rh incompatibility)
• Croup – barking cough, stridor
Pharmacology
• Nitrofurantoin – first-line for uncomplicated cystitis in young women
• BiPAP – first-line for hypercapnic respiratory failure in COPD exacerbation
• Anticoagulation for PE – heparin/warfarin
, Page 3 of 138
Section 1: Osteopathic Principles & OMM (Questions 1-40)
1. A 45-year-old male presents with chronic low back pain. During osteopathic evaluation, you note a
right anterior innominate rotation. Which of the following findings is consistent with this diagnosis?
A) Right ASIS superior and posterior, right ischial tuberosity inferior
B) Right ASIS inferior and anterior, right ischial tuberosity superior
C) Left ASIS inferior and posterior, left ischial tuberosity inferior
D) Symmetric PSIS levels with the patient in a seated position
Answer: B
Rationale: In a right anterior innominate rotation, the ilium rotates anteriorly relative to the sacrum.
The ASIS moves inferior and anterior, while the ischial tuberosity moves superior. This dysfunction is
often associated with a shortened ipsilateral hip flexor (iliopsoas). High-yield concept: Anterior
innominate → shortened iliopsoas; Posterior innominate → shortened hamstrings .
2. A patient presents with acute onset shortness of breath and decreased breath sounds on the right.
You suspect a rib dysfunction. Which rib group is most likely associated with sympathetic innervation
affecting bronchial smooth muscle?
, Page 4 of 138
A) Ribs 1–2
B) Ribs 3–5
C) Ribs 6–10
D) Ribs 11–12
Answer: B
Rationale: Ribs 3–5 correspond to the sympathetics from T2–T6, which innervate the lungs and bronchi.
Rib raising in this area is used to treat increased sympathetic tone in conditions such as asthma or
bronchitis. High-yield concept: Viscerosomatic reflexes: Lung pathology → T2–T6 somatic dysfunction .
3. A 30-year-old female with a history of migraines undergoes OMM. You perform a CV4 (compression
of the fourth ventricle) technique. What is the intended physiologic effect?
A) Increase parasympathetic tone
B) Decrease cerebrospinal fluid pressure
C) Increase sympathetic outflow
D) Enhance lymphatic drainage of the brain
Answer: B
COMSAE Phase 2 Form 115 –EXAM ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
COMSAE Phase 2 Form 115 – Complete Study Guide & Practice Exam
Based on the official NBOME COMSAE Phase 2 specifications and expert-curated question banks aligned
with COMLEX-USA Level 2-CE, this guide includes a comprehensive point-form summary of exam
coverage and over 200 practice questions with detailed rationales .
Core Competencies (COMLEX-USA Level 2-CE Blueprint)
Domain Approx. Weight
Osteopathic Principles & OMM 15-20%
Internal Medicine 20-25%
Surgery 10-15%
Pediatrics 8-12%
Obstetrics & Gynecology 8-12%
Psychiatry 8-12%
Emergency Medicine 8-12%
Preventive Medicine & Public Health 5-10%
Osteopathic Principles & OMM (High Yield)
• Innominate Rotations – Anterior (ASIS inferior/anterior, ischial tuberosity superior) vs. Posterior
(ASIS superior/posterior)
• Fryette’s Laws – Type I (neutral, group, rotation opposite sidebending) vs. Type II (non-neutral,
single vertebra, rotation same sidebending)
• Sacral Diagnoses – Seated flexion test, ILA position, spring test; torsions vs. unilateral
flexion/extension
• Chapman’s Reflexes (Points) – Anterior/posterior locations for organ dysfunction
• Rib Dysfunction – Inhalation vs. exhalation restrictions; sympathetic chain ganglia
correspondence
• Cranial Osteopathy – CV4 technique (compression of the fourth ventricle)
• Viscerosomatic Reflexes – Organ-to-spine level mapping (e.g., heart T2–T6, colon T10–L1)
• Muscle Energy Technique (MET) – Post-isometric relaxation for specific dysfunctions
High-Yield Clinical Topics by System
Cardiovascular
• Aortic stenosis – age-related calcific degeneration, crescendo-decrescendo murmur at RUSB
radiating to carotids
, Page 2 of 138
• Inferior MI – RCA occlusion, ST elevation leads II, III, aVF
• Aortic dissection – tearing chest pain radiating to back
• Cardiac tamponade – Beck triad (hypotension, JVD, muffled heart sounds)
Pulmonary
• COPD exacerbation – hypercapnic respiratory failure, BiPAP first-line
• Croup – parainfluenza virus, barking cough, inspiratory stridor
• Tuberculosis – cavitary lesions, night sweats, upper lobe involvement
Gastroenterology
• Acute pancreatitis – epigastric pain radiating to back, elevated lipase
• Esophageal cancer – progressive dysphagia (solids first then liquids)
• Cirrhosis/varices – massive upper GI bleeding, portal hypertension
• Celiac disease – steatorrhea, weight loss, malabsorption
Endocrine
• Graves disease – hyperthyroidism, low TSH, elevated T4, TRAb (TSH receptor antibody)
• Hashimoto thyroiditis – primary hypothyroidism, high TSH, low T4
• Pheochromocytoma – episodic headache, sweating, palpitations
• Type 2 diabetes – fasting glucose >126 mg/dL
Infectious Disease
• Bacterial vaginosis – fishy odor, clue cells
• Cystitis – nitrofurantoin for uncomplicated UTI
• Scarlet fever – group A strep, strawberry tongue
• Parvovirus B19 – erythema infectiosum, slapped cheek rash
• Pelvic inflammatory disease – cervical motion tenderness
Neurology
• Parkinson disease – resting tremor, bradykinesia, rigidity, dopamine deficiency
• Bell palsy – LMN facial palsy (forehead involved)
• Wernicke encephalopathy – thiamine deficiency (alcoholics), confusion, ophthalmoplegia,
ataxia
Hematology/Oncology
• Iron deficiency anemia – koilonychia, microcytic anemia
• Bladder cancer – painless hematuria in older smoker
OB/GYN
• Ovarian torsion – sudden pelvic pain, reduced blood flow on Doppler
• Uterine fibroids – menorrhagia, enlarged uterus
• Preeclampsia – hypertension after 20 weeks + proteinuria
Ophthalmology
• Acute angle-closure glaucoma – sudden painful vision loss, fixed mid-dilated pupil, halos
• Retinal detachment – painless vision loss, "curtain falling"
Pediatrics
• Hirschsprung disease – failure to pass meconium within 48 hours
• Hemolytic disease of newborn – jaundice within 24 hours (ABO/Rh incompatibility)
• Croup – barking cough, stridor
Pharmacology
• Nitrofurantoin – first-line for uncomplicated cystitis in young women
• BiPAP – first-line for hypercapnic respiratory failure in COPD exacerbation
• Anticoagulation for PE – heparin/warfarin
, Page 3 of 138
Section 1: Osteopathic Principles & OMM (Questions 1-40)
1. A 45-year-old male presents with chronic low back pain. During osteopathic evaluation, you note a
right anterior innominate rotation. Which of the following findings is consistent with this diagnosis?
A) Right ASIS superior and posterior, right ischial tuberosity inferior
B) Right ASIS inferior and anterior, right ischial tuberosity superior
C) Left ASIS inferior and posterior, left ischial tuberosity inferior
D) Symmetric PSIS levels with the patient in a seated position
Answer: B
Rationale: In a right anterior innominate rotation, the ilium rotates anteriorly relative to the sacrum.
The ASIS moves inferior and anterior, while the ischial tuberosity moves superior. This dysfunction is
often associated with a shortened ipsilateral hip flexor (iliopsoas). High-yield concept: Anterior
innominate → shortened iliopsoas; Posterior innominate → shortened hamstrings .
2. A patient presents with acute onset shortness of breath and decreased breath sounds on the right.
You suspect a rib dysfunction. Which rib group is most likely associated with sympathetic innervation
affecting bronchial smooth muscle?
, Page 4 of 138
A) Ribs 1–2
B) Ribs 3–5
C) Ribs 6–10
D) Ribs 11–12
Answer: B
Rationale: Ribs 3–5 correspond to the sympathetics from T2–T6, which innervate the lungs and bronchi.
Rib raising in this area is used to treat increased sympathetic tone in conditions such as asthma or
bronchitis. High-yield concept: Viscerosomatic reflexes: Lung pathology → T2–T6 somatic dysfunction .
3. A 30-year-old female with a history of migraines undergoes OMM. You perform a CV4 (compression
of the fourth ventricle) technique. What is the intended physiologic effect?
A) Increase parasympathetic tone
B) Decrease cerebrospinal fluid pressure
C) Increase sympathetic outflow
D) Enhance lymphatic drainage of the brain
Answer: B
