Page 1 of 189
COMSAE Phase 1 Form 112 –EXAM ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
High-Yield OMM/OPP Topics
• TART (Tenderness, Asymmetry, Range of motion, Tissue texture changes)
• Viscerosomatic Reflexes – Organ-to-spine level mapping (e.g., stomach T6–T9, gallbladder T7–
T9)
• Chapman’s Reflexes (Points) – Anterior/posterior locations for organ dysfunction
• Fryette’s Laws – Type I (neutral, group, rotation opposite sidebending) vs. Type II (non-neutral,
single vertebra, rotation same side sidebending)
• Sacral Diagnoses – Seated flexion test, ILA position, spring test; torsions (L on L, R on R) vs.
unilateral flexion/extension
• Cranial Osteopathy – Sphenobasilar symphysis strains
• Lymphatics & Autonomics – Thoracic duct, cisterna chyli
• OMT Modalities – HVLA, muscle energy, counterstrain, Still technique, myofascial release
Biostatistics & Epidemiology
• Sensitivity, Specificity, PPV, NPV – Key formulas and clinical meaning
• Odds Ratio vs. Relative Risk – Case-control vs. cohort studies
• NNT (Number Needed to Treat) – NNT = 1 / Absolute Risk Reduction
• Confidence Intervals & P-values – Statistical significance (p < 0.05), CI interpretation
• Study Designs – RCT, cohort, case-control, cross-sectional, case series
• Bias & Confounding – Selection, recall, measurement bias
Ethics & Professionalism
• Informed Consent – Elements, exceptions
• Capacity vs. Competency – Clinical vs. legal determination
• Confidentiality – HIPAA, exceptions (reportable diseases, Tarasoff duty)
• Advance Directives – Living will, Durable Power of Attorney for Healthcare, DNR
• Error Disclosure – Full transparency to patient
• Physician Impairment – Duty to report
System-Specific Topics
Cardiovascular
• Valvular heart disease (murmurs), heart failure (HFrEF vs. HFpEF)
• Arrhythmias/AV blocks, ECG interpretation
• Shock types (distributive, cardiogenic, hypovolemic, obstructive)
• Atherosclerosis/MI pathogenesis and complication timeline
Pulmonary
• Obstructive vs. restrictive lung disease (FEV1/FVC ratio)
• V/Q mismatch (shunt vs. dead space), DLCO interpretation
• Pneumonia organisms by presentation, PE diagnosis (Wells, PERC, CTPA)
Renal/Acid-Base
• AKI (pre-renal, intrinsic, post-renal), GFR/RPF/clearance
• Nephritic vs. nephrotic syndromes
• Anion gap metabolic acidosis (MUDPILES) vs. non-gap (HARDUP)
• SIADH vs. Diabetes Insipidus
Endocrine
, Page 2 of 189
• Diabetes – DKA vs. HHS diagnosis/treatment
• Thyroid disorders – Hyperthyroidism (Graves) vs. Hypothyroidism (Hashimoto)
• Adrenal disorders – Cushing’s vs. Addison’s, Adrenal Insufficiency
• MEN syndromes
GI & Hepatobiliary
• Hepatitis serology (A, B, C)
• Liver enzyme patterns – hepatocellular vs. cholestatic
• PUD / H. pylori, IBD vs. IBS
• Gallstones/biliary disease
Hematology/Oncology
• Microcytic (IDA, thalassemia, ACD) vs. macrocytic (B12, folate) anemias
• Hemolysis labs (LDH, haptoglobin, indirect bilirubin)
• DIC vs. TTP vs. HUS
• Leukemias/lymphomas/myeloma
Neurology
• Stroke localization (ACA, MCA, PCA, PICA, basilar)
• Cranial nerve lesions
• Spinal cord syndromes (Brown-Séquard, anterior cord, central cord)
Musculoskeletal
• OA vs. RA, Gout vs. Pseudogout
• SLE antibodies (ANA, anti-dsDNA, anti-Smith, anti-Ro/La)
Microbiology
• Gram-positive (Staph vs. Strep ID)
• Respiratory pathogens, GI pathogens
• CNS infections by age (Neonate: GBS, E. coli; Adult: S. pneumoniae, N. meningitidis)
• Opportunistic infections (HIV-associated)
Pharmacology
• Autonomic drugs (cholinergic/adrenergic)
• Antibiotic mechanisms/resistance
• Antiviral/Antifungal, Chemotherapy toxicities
• CYP450 interactions
Section 1: Osteopathic Principles & OMM (Questions 1-75)
1. A 45-year-old woman presents with epigastric burning and bloating after meals for several months.
On osteopathic structural exam, you find tenderness and increased tissue texture at the right T6–T8
paraspinal region. Which viscerosomatic reflex best explains this finding?
A) Gallbladder
, Page 3 of 189
B) Pancreas
C) Liver
D) Stomach
Answer: D) Stomach
Rationale: Viscerosomatic reflexes map spinal cord levels to organs. The stomach corresponds to T6–T9,
with a predilection for the right side in many sources. The gallbladder (T7–T9) often presents on the
right, but epigastric symptoms and bilateral T6–T8 tenderness more specifically point to the stomach.
Pancreas (T6–T10) can be similar, but epigastric burning is classic for gastritis/PUD .
2. A 28-year-old runner presents with chronic low back pain. On seated flexion test, the right PSIS
moves superiorly earlier and more than the left. In the prone position, the right ILA is more posterior
than the left, and both ILAs move equally with spring test. What is the most likely sacral diagnosis?
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral flexion
D) Bilateral sacral extension
, Page 4 of 189
Answer: B) Right on right sacral torsion
Rationale: The seated flexion test indicates somatic dysfunction on the right (the side that moves
superiorly first). In a sacral torsion, the side named first is the axis (side of deep sulcus and posterior
ILA). Here, the right ILA is posterior, meaning the axis is on the right. The spring test is equal, indicating a
torsion rather than a unilateral flexion/extension. For a right on right torsion, the right ILA is posterior,
and the dysfunction is named for the axis (right) and the side of the posterior ILA (right) .
3. A 22-year-old college student develops sudden onset fever, chills, and productive cough with rust-
colored sputum. Chest x-ray shows right lower lobe consolidation. Gram stain reveals lancet-shaped
Gram-positive diplococci. Which virulence factor is most directly responsible for the organism’s ability
to avoid phagocytosis?
A) IgA protease
B) Protein M
C) Polysaccharide capsule
D) Exotoxin A
Answer: C) Polysaccharide capsule
COMSAE Phase 1 Form 112 –EXAM ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
High-Yield OMM/OPP Topics
• TART (Tenderness, Asymmetry, Range of motion, Tissue texture changes)
• Viscerosomatic Reflexes – Organ-to-spine level mapping (e.g., stomach T6–T9, gallbladder T7–
T9)
• Chapman’s Reflexes (Points) – Anterior/posterior locations for organ dysfunction
• Fryette’s Laws – Type I (neutral, group, rotation opposite sidebending) vs. Type II (non-neutral,
single vertebra, rotation same side sidebending)
• Sacral Diagnoses – Seated flexion test, ILA position, spring test; torsions (L on L, R on R) vs.
unilateral flexion/extension
• Cranial Osteopathy – Sphenobasilar symphysis strains
• Lymphatics & Autonomics – Thoracic duct, cisterna chyli
• OMT Modalities – HVLA, muscle energy, counterstrain, Still technique, myofascial release
Biostatistics & Epidemiology
• Sensitivity, Specificity, PPV, NPV – Key formulas and clinical meaning
• Odds Ratio vs. Relative Risk – Case-control vs. cohort studies
• NNT (Number Needed to Treat) – NNT = 1 / Absolute Risk Reduction
• Confidence Intervals & P-values – Statistical significance (p < 0.05), CI interpretation
• Study Designs – RCT, cohort, case-control, cross-sectional, case series
• Bias & Confounding – Selection, recall, measurement bias
Ethics & Professionalism
• Informed Consent – Elements, exceptions
• Capacity vs. Competency – Clinical vs. legal determination
• Confidentiality – HIPAA, exceptions (reportable diseases, Tarasoff duty)
• Advance Directives – Living will, Durable Power of Attorney for Healthcare, DNR
• Error Disclosure – Full transparency to patient
• Physician Impairment – Duty to report
System-Specific Topics
Cardiovascular
• Valvular heart disease (murmurs), heart failure (HFrEF vs. HFpEF)
• Arrhythmias/AV blocks, ECG interpretation
• Shock types (distributive, cardiogenic, hypovolemic, obstructive)
• Atherosclerosis/MI pathogenesis and complication timeline
Pulmonary
• Obstructive vs. restrictive lung disease (FEV1/FVC ratio)
• V/Q mismatch (shunt vs. dead space), DLCO interpretation
• Pneumonia organisms by presentation, PE diagnosis (Wells, PERC, CTPA)
Renal/Acid-Base
• AKI (pre-renal, intrinsic, post-renal), GFR/RPF/clearance
• Nephritic vs. nephrotic syndromes
• Anion gap metabolic acidosis (MUDPILES) vs. non-gap (HARDUP)
• SIADH vs. Diabetes Insipidus
Endocrine
, Page 2 of 189
• Diabetes – DKA vs. HHS diagnosis/treatment
• Thyroid disorders – Hyperthyroidism (Graves) vs. Hypothyroidism (Hashimoto)
• Adrenal disorders – Cushing’s vs. Addison’s, Adrenal Insufficiency
• MEN syndromes
GI & Hepatobiliary
• Hepatitis serology (A, B, C)
• Liver enzyme patterns – hepatocellular vs. cholestatic
• PUD / H. pylori, IBD vs. IBS
• Gallstones/biliary disease
Hematology/Oncology
• Microcytic (IDA, thalassemia, ACD) vs. macrocytic (B12, folate) anemias
• Hemolysis labs (LDH, haptoglobin, indirect bilirubin)
• DIC vs. TTP vs. HUS
• Leukemias/lymphomas/myeloma
Neurology
• Stroke localization (ACA, MCA, PCA, PICA, basilar)
• Cranial nerve lesions
• Spinal cord syndromes (Brown-Séquard, anterior cord, central cord)
Musculoskeletal
• OA vs. RA, Gout vs. Pseudogout
• SLE antibodies (ANA, anti-dsDNA, anti-Smith, anti-Ro/La)
Microbiology
• Gram-positive (Staph vs. Strep ID)
• Respiratory pathogens, GI pathogens
• CNS infections by age (Neonate: GBS, E. coli; Adult: S. pneumoniae, N. meningitidis)
• Opportunistic infections (HIV-associated)
Pharmacology
• Autonomic drugs (cholinergic/adrenergic)
• Antibiotic mechanisms/resistance
• Antiviral/Antifungal, Chemotherapy toxicities
• CYP450 interactions
Section 1: Osteopathic Principles & OMM (Questions 1-75)
1. A 45-year-old woman presents with epigastric burning and bloating after meals for several months.
On osteopathic structural exam, you find tenderness and increased tissue texture at the right T6–T8
paraspinal region. Which viscerosomatic reflex best explains this finding?
A) Gallbladder
, Page 3 of 189
B) Pancreas
C) Liver
D) Stomach
Answer: D) Stomach
Rationale: Viscerosomatic reflexes map spinal cord levels to organs. The stomach corresponds to T6–T9,
with a predilection for the right side in many sources. The gallbladder (T7–T9) often presents on the
right, but epigastric symptoms and bilateral T6–T8 tenderness more specifically point to the stomach.
Pancreas (T6–T10) can be similar, but epigastric burning is classic for gastritis/PUD .
2. A 28-year-old runner presents with chronic low back pain. On seated flexion test, the right PSIS
moves superiorly earlier and more than the left. In the prone position, the right ILA is more posterior
than the left, and both ILAs move equally with spring test. What is the most likely sacral diagnosis?
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral flexion
D) Bilateral sacral extension
, Page 4 of 189
Answer: B) Right on right sacral torsion
Rationale: The seated flexion test indicates somatic dysfunction on the right (the side that moves
superiorly first). In a sacral torsion, the side named first is the axis (side of deep sulcus and posterior
ILA). Here, the right ILA is posterior, meaning the axis is on the right. The spring test is equal, indicating a
torsion rather than a unilateral flexion/extension. For a right on right torsion, the right ILA is posterior,
and the dysfunction is named for the axis (right) and the side of the posterior ILA (right) .
3. A 22-year-old college student develops sudden onset fever, chills, and productive cough with rust-
colored sputum. Chest x-ray shows right lower lobe consolidation. Gram stain reveals lancet-shaped
Gram-positive diplococci. Which virulence factor is most directly responsible for the organism’s ability
to avoid phagocytosis?
A) IgA protease
B) Protein M
C) Polysaccharide capsule
D) Exotoxin A
Answer: C) Polysaccharide capsule
