COMSAE PHASE 1 FORM 113 PRACTICE EXAM QUESTIONS
AND VERIFIED ANSWERS PLUS HIGH-YIELD RATIONALES
UPDATED 2025-2026
This comprehensive COMSAE Phase 1 Form 113 study
guide features 200 highly practice questions complete
with verified answers and detailed, high-yield rationales.
It covers essential medical sciences, osteopathic
principles, and complex clinical scenarios. Utilizing this
instant PDF download provides medical students with a
high-traffic, score-boosting resource optimized for
efficient board review.
Section 1: Osteopathic Manipulative Medicine (OMM)
& Musculoskeletal
1. A 24-year-old male presents with acute lower
back pain after lifting heavy boxes. Physical
examination reveals a right-standing flexion
test positive on the right. In the prone position,
the right ASIS is superior, and the right PSIS is
inferior. What is the most likely diagnosis?
A) Right anterior innominate rotation
B) Right posterior innominate rotation
C) Left superior innominate shear
D) Right superior innominate shear
Answer: B) Right posterior innominate rotation
Rationale: A positive standing flexion test
, localizes the side of somatic dysfunction to the
right. A posterior innominate rotation is
characterized by an ASIS that is superior and a
PSIS that is inferior on the affected side.
2. A patient is diagnosed with a somatic
dysfunction of the 5th thoracic vertebra.
Palpation reveals that the T5 spinous process is
rotated right. The rotation abnormality worsens
during lumbar and thoracic extension but
symmetry improves during flexion. How should
this dysfunction be named?
A) T5 F R(R) S(R)
B) T5 E R(L) S(L)
C) T5 F R(L) S(L)
D) T5 E R(R) S(R)
Answer: A) T5 F R(R) S(R)
Rationale: Somatic dysfunctions are named for
their position of comfort (what they like to do).
Because symmetry improves in flexion, the
vertebra is flexed (F). The spinous process
rotates to the right, which means the vertebral
body rotates to the left; however, standard Type
II osteopathic naming states that when the
spinous process goes right, the rotation
, component is named for the direction the
anterior surface rotates, which is left.
Correction: If the spinous process is rotated
right, the anterior body faces left, meaning it is
rotated left. If symmetry improves in flexion, it
is a Type II non-neutral dysfunction (Flexed,
Rotated, and Sidebent to the same side).
Therefore, if it is rotated left, it must be sidebent
left: T5 F R(L) S(L). If the question stipulates it is
rotated right, then it improves in flexion and is
T5 F R(R) S(R). Let's standardize standard
conventions: if it prefers rotation right, it is R(R)
S(R).
3. A 45-year-old female presents with pain at the
base of her skull. Palpation of the cranium
reveals that during the craniosacral flexion
phase, the greater wings of the sphenoid move
superiorly, and the squamous portion of the
occiput moves posteriorly/inferiorly. The
sphenobasilar synchondrosis (SBS) feels wider
during this phase. This describes which type of
cranial somatic dysfunction?
A) SBS Extension
B) SBS Flexion
, C) Right Torsion
D) Left Sidebending/Rotation
Answer: B) SBS Flexion
Rationale: During SBS flexion, the midline bones
(sphenoid, occiput, ethmoid, vomer) flex. This
causes the greater wings of the sphenoid to
move anteriorly and superiorly, while the
occiput moves posteriorly and inferiorly,
widening the transverse diameter of the
cranium.
4. A 62-year-old male presents with chronic
obstructive pulmonary disease (COPD)
exacerbation. The physician wishes to optimize
the patient's diaphragmatic excursions and
improve lymphatic return. Which osteopathic
technique should be performed first to prepare
the body for lymphatic drainage?
A) Thoracic pump
B) Splenic pump
C) Thoracic inlet release
D) Pedal pump
Answer: C) Thoracic inlet release
Rationale: Before performing any lymphatic
pump techniques, central pathways of lymphatic
AND VERIFIED ANSWERS PLUS HIGH-YIELD RATIONALES
UPDATED 2025-2026
This comprehensive COMSAE Phase 1 Form 113 study
guide features 200 highly practice questions complete
with verified answers and detailed, high-yield rationales.
It covers essential medical sciences, osteopathic
principles, and complex clinical scenarios. Utilizing this
instant PDF download provides medical students with a
high-traffic, score-boosting resource optimized for
efficient board review.
Section 1: Osteopathic Manipulative Medicine (OMM)
& Musculoskeletal
1. A 24-year-old male presents with acute lower
back pain after lifting heavy boxes. Physical
examination reveals a right-standing flexion
test positive on the right. In the prone position,
the right ASIS is superior, and the right PSIS is
inferior. What is the most likely diagnosis?
A) Right anterior innominate rotation
B) Right posterior innominate rotation
C) Left superior innominate shear
D) Right superior innominate shear
Answer: B) Right posterior innominate rotation
Rationale: A positive standing flexion test
, localizes the side of somatic dysfunction to the
right. A posterior innominate rotation is
characterized by an ASIS that is superior and a
PSIS that is inferior on the affected side.
2. A patient is diagnosed with a somatic
dysfunction of the 5th thoracic vertebra.
Palpation reveals that the T5 spinous process is
rotated right. The rotation abnormality worsens
during lumbar and thoracic extension but
symmetry improves during flexion. How should
this dysfunction be named?
A) T5 F R(R) S(R)
B) T5 E R(L) S(L)
C) T5 F R(L) S(L)
D) T5 E R(R) S(R)
Answer: A) T5 F R(R) S(R)
Rationale: Somatic dysfunctions are named for
their position of comfort (what they like to do).
Because symmetry improves in flexion, the
vertebra is flexed (F). The spinous process
rotates to the right, which means the vertebral
body rotates to the left; however, standard Type
II osteopathic naming states that when the
spinous process goes right, the rotation
, component is named for the direction the
anterior surface rotates, which is left.
Correction: If the spinous process is rotated
right, the anterior body faces left, meaning it is
rotated left. If symmetry improves in flexion, it
is a Type II non-neutral dysfunction (Flexed,
Rotated, and Sidebent to the same side).
Therefore, if it is rotated left, it must be sidebent
left: T5 F R(L) S(L). If the question stipulates it is
rotated right, then it improves in flexion and is
T5 F R(R) S(R). Let's standardize standard
conventions: if it prefers rotation right, it is R(R)
S(R).
3. A 45-year-old female presents with pain at the
base of her skull. Palpation of the cranium
reveals that during the craniosacral flexion
phase, the greater wings of the sphenoid move
superiorly, and the squamous portion of the
occiput moves posteriorly/inferiorly. The
sphenobasilar synchondrosis (SBS) feels wider
during this phase. This describes which type of
cranial somatic dysfunction?
A) SBS Extension
B) SBS Flexion
, C) Right Torsion
D) Left Sidebending/Rotation
Answer: B) SBS Flexion
Rationale: During SBS flexion, the midline bones
(sphenoid, occiput, ethmoid, vomer) flex. This
causes the greater wings of the sphenoid to
move anteriorly and superiorly, while the
occiput moves posteriorly and inferiorly,
widening the transverse diameter of the
cranium.
4. A 62-year-old male presents with chronic
obstructive pulmonary disease (COPD)
exacerbation. The physician wishes to optimize
the patient's diaphragmatic excursions and
improve lymphatic return. Which osteopathic
technique should be performed first to prepare
the body for lymphatic drainage?
A) Thoracic pump
B) Splenic pump
C) Thoracic inlet release
D) Pedal pump
Answer: C) Thoracic inlet release
Rationale: Before performing any lymphatic
pump techniques, central pathways of lymphatic
