COMSAE 115 Exam – National Board of
Osteopathic Medical Examiners (NBOME)
COMSAE 2026/2027 Questions with Evidence-
Based Answers
Question
1: A patient has a T8 vertebral segment that rotates and side-bends to the left, and the
dysfunction worsens with flexion. How should this be diagnosed?
o A) T8 Neutral RL SL
o B) T8 Extended RR SR
o C) T8 Flexed RL SL
o D) T8 Flexed RR SR
Correct Answer: C) T8 Flexed RL SL
Rationale: Since the dysfunction worsens in flexion, it is a flexed dysfunction.
Fryette's Type II mechanics state rotation and side-bending occur to the same
side in non-neutral positions .
2. Question: According to Fryette's first principle (Type I mechanics), when the spine
is in a neutral position, which of the following occurs?
o A) Side-bending and rotation occur to the same side
o B) Side-bending occurs without rotation
o C) Side-bending and rotation occur to opposite sides
o D) Rotation occurs without side-bending
Correct Answer: C) Side-bending and rotation occur to opposite sides
Rationale: Fryette's First Law describes that in neutral mechanics, side-bending
and rotation occur in opposite directions .
, 3. Question: In muscle energy technique (MET), the patient's contraction force
should be:
o A) Maximal contraction against a fixed barrier
o B) Submaximal (approximately 20% of maximal) isometric contraction
o C) Eccentric contraction only
o D) Isotonic contraction through full range
Correct Answer: B) Submaximal (approximately 20% of maximal) isometric
contraction
Rationale: MET uses a gentle, submaximal isometric contraction by the patient,
followed by relaxation and repositioning to the new barrier .
4. Question: A patient has a cranial finding of sphenobasilar synchondrosis (SBS)
extension. Which of the following is correct?
o A) Occiput moves anteriorly and superiorly
o B) Occiput moves anteriorly and inferiorly
o C) Occiput moves posteriorly and superiorly
o D) Occiput moves posteriorly and inferiorly
Correct Answer: C) Occiput moves posteriorly and superiorly
Rationale: In SBS extension (often described as flexion of the cranium), the
sphenoid moves anteriorly and inferiorly, and the occiput moves posteriorly and
superiorly .
Section 2: Clinical Sciences (Cardiology, Pulmonology, ID, etc.)
5. Question: A 62-year-old with chest pain has ST elevation in V1-V4. Which vessel
is most likely occluded?
o A) Right Coronary Artery
o B) Left Circumflex
o C) Left Anterior Descending
o D) Posterior Descending
Correct Answer: C) Left Anterior Descending
, Rationale: Leads V1-V4 correspond to the anterior wall, which is supplied by the
LAD .
6. Question: A patient with a history of IV drug use presents with fever, back pain,
and a new heart murmur. Blood cultures grow Gram-positive cocci in clusters.
Which valvular lesion is most likely?
o A) Aortic regurgitation
o B) Mitral regurgitation
o C) Tricuspid regurgitation
o D) Pulmonic regurgitation
Correct Answer: C) Tricuspid regurgitation
Rationale: IV drug users often develop right-sided endocarditis, most commonly
of the tricuspid valve. Staphylococcus aureus is the typical pathogen .
7. Question: A patient presents with fever, cough, and rusty sputum. What is the
most likely organism?
o A) Mycoplasma pneumoniae
o B) Streptococcus pneumoniae
o C) Klebsiella pneumoniae
o D) Legionella pneumophila
Correct Answer: B) Streptococcus pneumoniae
Rationale: Rusty sputum is classic for pneumococcal pneumonia .
8. Question: A patient with sudden severe headache described as "worst of life"
likely has:
o A) Migraine
o B) Subarachnoid hemorrhage
o C) Tension headache
o D) Cluster headache
Correct Answer: B) Subarachnoid hemorrhage
Rationale: A thunderclap headache—sudden, severe, "worst of life"—strongly
suggests a subarachnoid hemorrhage .
Osteopathic Medical Examiners (NBOME)
COMSAE 2026/2027 Questions with Evidence-
Based Answers
Question
1: A patient has a T8 vertebral segment that rotates and side-bends to the left, and the
dysfunction worsens with flexion. How should this be diagnosed?
o A) T8 Neutral RL SL
o B) T8 Extended RR SR
o C) T8 Flexed RL SL
o D) T8 Flexed RR SR
Correct Answer: C) T8 Flexed RL SL
Rationale: Since the dysfunction worsens in flexion, it is a flexed dysfunction.
Fryette's Type II mechanics state rotation and side-bending occur to the same
side in non-neutral positions .
2. Question: According to Fryette's first principle (Type I mechanics), when the spine
is in a neutral position, which of the following occurs?
o A) Side-bending and rotation occur to the same side
o B) Side-bending occurs without rotation
o C) Side-bending and rotation occur to opposite sides
o D) Rotation occurs without side-bending
Correct Answer: C) Side-bending and rotation occur to opposite sides
Rationale: Fryette's First Law describes that in neutral mechanics, side-bending
and rotation occur in opposite directions .
, 3. Question: In muscle energy technique (MET), the patient's contraction force
should be:
o A) Maximal contraction against a fixed barrier
o B) Submaximal (approximately 20% of maximal) isometric contraction
o C) Eccentric contraction only
o D) Isotonic contraction through full range
Correct Answer: B) Submaximal (approximately 20% of maximal) isometric
contraction
Rationale: MET uses a gentle, submaximal isometric contraction by the patient,
followed by relaxation and repositioning to the new barrier .
4. Question: A patient has a cranial finding of sphenobasilar synchondrosis (SBS)
extension. Which of the following is correct?
o A) Occiput moves anteriorly and superiorly
o B) Occiput moves anteriorly and inferiorly
o C) Occiput moves posteriorly and superiorly
o D) Occiput moves posteriorly and inferiorly
Correct Answer: C) Occiput moves posteriorly and superiorly
Rationale: In SBS extension (often described as flexion of the cranium), the
sphenoid moves anteriorly and inferiorly, and the occiput moves posteriorly and
superiorly .
Section 2: Clinical Sciences (Cardiology, Pulmonology, ID, etc.)
5. Question: A 62-year-old with chest pain has ST elevation in V1-V4. Which vessel
is most likely occluded?
o A) Right Coronary Artery
o B) Left Circumflex
o C) Left Anterior Descending
o D) Posterior Descending
Correct Answer: C) Left Anterior Descending
, Rationale: Leads V1-V4 correspond to the anterior wall, which is supplied by the
LAD .
6. Question: A patient with a history of IV drug use presents with fever, back pain,
and a new heart murmur. Blood cultures grow Gram-positive cocci in clusters.
Which valvular lesion is most likely?
o A) Aortic regurgitation
o B) Mitral regurgitation
o C) Tricuspid regurgitation
o D) Pulmonic regurgitation
Correct Answer: C) Tricuspid regurgitation
Rationale: IV drug users often develop right-sided endocarditis, most commonly
of the tricuspid valve. Staphylococcus aureus is the typical pathogen .
7. Question: A patient presents with fever, cough, and rusty sputum. What is the
most likely organism?
o A) Mycoplasma pneumoniae
o B) Streptococcus pneumoniae
o C) Klebsiella pneumoniae
o D) Legionella pneumophila
Correct Answer: B) Streptococcus pneumoniae
Rationale: Rusty sputum is classic for pneumococcal pneumonia .
8. Question: A patient with sudden severe headache described as "worst of life"
likely has:
o A) Migraine
o B) Subarachnoid hemorrhage
o C) Tension headache
o D) Cluster headache
Correct Answer: B) Subarachnoid hemorrhage
Rationale: A thunderclap headache—sudden, severe, "worst of life"—strongly
suggests a subarachnoid hemorrhage .
