COMSAE PHASE 1 FORM 116 | 200 PRACTICE QUESTIONS WITH
VERIFIED ANSWERS – NBOME SELF-ASSESSMENT FOR
COMLEX LEVEL 1 LATEST UPDATE THIS YEAR-JUST
RELEASED.PDF
Introduction
This comprehensive COMSAE Phase 1 Form 116 practice test bank contains 200 high-
yield questions covering all competency domains tested on the exam: Osteopathic
Principles & OMM, Human Anatomy, Pathology, Physiology, Pharmacology,
Microbiology/Immunology, Biochemistry/Genetics, and Neurology/Psychiatry . The
COMSAE Phase 1 examination contains 176 total items divided into four sections of 44
questions each, with all questions in single-best-answer multiple-choice format . Form 116
is available on a non-secure browser and includes answer keys with detailed rationales .
All answers are presented in bold italics with detailed rationales following each response.
Section 1: Osteopathic Principles & OMM (Questions 1-30)
Q1. 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
B) Pancreas
C) Stomach
D) Liver
Answer: B – Pancreas
Explanation: The clinical presentation is suggestive of acute pancreatitis. The
pancreas, stomach, liver, gallbladder, and duodenum are foregut structures receiving
sympathetic innervation from the greater splanchnic nerve originating from T5-T9 spinal
segments. Tissue texture changes in this region represent a viscerosomatic reflex
secondary to localized visceral inflammation .
,Q2. A patient with chronic low back pain has a seated flexion test positive on the left.
In the prone position, the left ILA is more posterior than the right. What is the most
likely diagnosis?
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral flexion
D) Bilateral sacral extension
Answer: A – Left on left sacral torsion
Explanation: The seated flexion test points to the side of dysfunction (left). A
posterior ILA indicates the axis. In a left on left torsion, the axis is on the left and the left ILA
is posterior. The side named first is the axis (side of deep sulcus and posterior ILA). The
equal spring test indicates torsion rather than unilateral flexion .
Q3. During a screening exam, you palpate a small, tender nodule in the second
intercostal space, right parasternal region. This Chapman's point is most likely
associated with which condition?
A) Mitral valve dysfunction
B) Gastric ulcer
C) Appendicitis
D) Pulmonary congestion
Answer: A – Mitral valve dysfunction
Explanation: Anterior Chapman's points for the heart are in the 2nd-5th intercostal
spaces parasternally. The mitral valve corresponds to the right 2nd intercostal space.
Gastric points are lower (6th-7th ribs) .
Q4. A patient has restriction of sidebending to the right and rotation to the left in the
thoracic spine with neutral mechanics. This is best described as:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Type IV dysfunction
Answer: A – Type I dysfunction
,Explanation: Type I dysfunctions in the thoracic spine involve a group of vertebrae
where sidebending and rotation occur to opposite sides. Type II involves sidebending and
rotation to the same side, typically isolated to one or two segments .
Q5. Use of which OMM technique has been shown to result in increased sIgA levels?
A) CV-4
B) HVLA
C) Muscle energy
D) Strain counterstrain
Answer: A – CV-4
Explanation: The CV-4 cranial technique has been shown to increase secretory IgA
levels, supporting immune function .
Q6. Which is an expected finding during the osteopathic exam of a 12-month-old
infant's head?
A) Asymmetry of facial features
B) Closed anterior fontanelle
C) Motion of individual cranial bones
D) Open posterior fontanelle
Answer: C – Motion of individual cranial bones
Explanation: At 12 months, cranial bone motion can still be palpated. The anterior
fontanelle typically closes by 12-18 months, but cranial bone motion persists .
Q7. At what age can segmental somatic dysfunction be diagnosed in a child?
A) 6 days old
B) 6 weeks old
C) 6 months old
D) 6 years old
Answer: B – 6 weeks old
Explanation: Segmental somatic dysfunction can be diagnosed as early as 6 weeks
of age .
, Q8. A patient presents with right-sided pelvic shear (superior innominate shear).
Which ligament would most likely be tense and tender upon palpation on the affected
side?
A) Sacrospinous ligament
B) Sacrotuberous ligament
C) Iliolumbar ligament
D) Anterior longitudinal ligament
Answer: C – Iliolumbar ligament
Explanation: An upslipped or superior pelvic shear shifts the innominate superiorly
relative to the sacrum. This stresses and stretches the iliolumbar ligament, which runs from
the transverse processes of L4-L5 to the iliac crest. It is typically very tender to palpation in
superior shears .
Q9. During osteopathic structural exam, a patient has a deep right sacral base and
the right ILA is posterior. The asymmetry improves in extension (Sphinx test). What
is the correct diagnosis?
A) Right-on-right backward torsion
B) Left-on-left backward torsion
C) Right-on-right forward torsion
D) Left-on-left forward torsion
Answer: C – Right-on-right forward torsion
Explanation: A deep right sacral base points to a left-rotated sacrum. The right ILA is
posterior/inferior, confirming rotation to the left. Since the asymmetry improves in extension
(Sphinx), it is a forward torsion. The axis is named opposite to the deep base in forward
torsions, meaning the axis is the right side. Thus, it is a Right-on-Right forward torsion .
Q10. A patient has a right anterior innominate rotation. Which finding is expected on
structural exam?
A) Right PSIS is superior
B) Right PSIS is inferior
C) Right ASIS is inferior
D) Compression test negative on right
Answer: A – Right PSIS is superior
VERIFIED ANSWERS – NBOME SELF-ASSESSMENT FOR
COMLEX LEVEL 1 LATEST UPDATE THIS YEAR-JUST
RELEASED.PDF
Introduction
This comprehensive COMSAE Phase 1 Form 116 practice test bank contains 200 high-
yield questions covering all competency domains tested on the exam: Osteopathic
Principles & OMM, Human Anatomy, Pathology, Physiology, Pharmacology,
Microbiology/Immunology, Biochemistry/Genetics, and Neurology/Psychiatry . The
COMSAE Phase 1 examination contains 176 total items divided into four sections of 44
questions each, with all questions in single-best-answer multiple-choice format . Form 116
is available on a non-secure browser and includes answer keys with detailed rationales .
All answers are presented in bold italics with detailed rationales following each response.
Section 1: Osteopathic Principles & OMM (Questions 1-30)
Q1. 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
B) Pancreas
C) Stomach
D) Liver
Answer: B – Pancreas
Explanation: The clinical presentation is suggestive of acute pancreatitis. The
pancreas, stomach, liver, gallbladder, and duodenum are foregut structures receiving
sympathetic innervation from the greater splanchnic nerve originating from T5-T9 spinal
segments. Tissue texture changes in this region represent a viscerosomatic reflex
secondary to localized visceral inflammation .
,Q2. A patient with chronic low back pain has a seated flexion test positive on the left.
In the prone position, the left ILA is more posterior than the right. What is the most
likely diagnosis?
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral flexion
D) Bilateral sacral extension
Answer: A – Left on left sacral torsion
Explanation: The seated flexion test points to the side of dysfunction (left). A
posterior ILA indicates the axis. In a left on left torsion, the axis is on the left and the left ILA
is posterior. The side named first is the axis (side of deep sulcus and posterior ILA). The
equal spring test indicates torsion rather than unilateral flexion .
Q3. During a screening exam, you palpate a small, tender nodule in the second
intercostal space, right parasternal region. This Chapman's point is most likely
associated with which condition?
A) Mitral valve dysfunction
B) Gastric ulcer
C) Appendicitis
D) Pulmonary congestion
Answer: A – Mitral valve dysfunction
Explanation: Anterior Chapman's points for the heart are in the 2nd-5th intercostal
spaces parasternally. The mitral valve corresponds to the right 2nd intercostal space.
Gastric points are lower (6th-7th ribs) .
Q4. A patient has restriction of sidebending to the right and rotation to the left in the
thoracic spine with neutral mechanics. This is best described as:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Type IV dysfunction
Answer: A – Type I dysfunction
,Explanation: Type I dysfunctions in the thoracic spine involve a group of vertebrae
where sidebending and rotation occur to opposite sides. Type II involves sidebending and
rotation to the same side, typically isolated to one or two segments .
Q5. Use of which OMM technique has been shown to result in increased sIgA levels?
A) CV-4
B) HVLA
C) Muscle energy
D) Strain counterstrain
Answer: A – CV-4
Explanation: The CV-4 cranial technique has been shown to increase secretory IgA
levels, supporting immune function .
Q6. Which is an expected finding during the osteopathic exam of a 12-month-old
infant's head?
A) Asymmetry of facial features
B) Closed anterior fontanelle
C) Motion of individual cranial bones
D) Open posterior fontanelle
Answer: C – Motion of individual cranial bones
Explanation: At 12 months, cranial bone motion can still be palpated. The anterior
fontanelle typically closes by 12-18 months, but cranial bone motion persists .
Q7. At what age can segmental somatic dysfunction be diagnosed in a child?
A) 6 days old
B) 6 weeks old
C) 6 months old
D) 6 years old
Answer: B – 6 weeks old
Explanation: Segmental somatic dysfunction can be diagnosed as early as 6 weeks
of age .
, Q8. A patient presents with right-sided pelvic shear (superior innominate shear).
Which ligament would most likely be tense and tender upon palpation on the affected
side?
A) Sacrospinous ligament
B) Sacrotuberous ligament
C) Iliolumbar ligament
D) Anterior longitudinal ligament
Answer: C – Iliolumbar ligament
Explanation: An upslipped or superior pelvic shear shifts the innominate superiorly
relative to the sacrum. This stresses and stretches the iliolumbar ligament, which runs from
the transverse processes of L4-L5 to the iliac crest. It is typically very tender to palpation in
superior shears .
Q9. During osteopathic structural exam, a patient has a deep right sacral base and
the right ILA is posterior. The asymmetry improves in extension (Sphinx test). What
is the correct diagnosis?
A) Right-on-right backward torsion
B) Left-on-left backward torsion
C) Right-on-right forward torsion
D) Left-on-left forward torsion
Answer: C – Right-on-right forward torsion
Explanation: A deep right sacral base points to a left-rotated sacrum. The right ILA is
posterior/inferior, confirming rotation to the left. Since the asymmetry improves in extension
(Sphinx), it is a forward torsion. The axis is named opposite to the deep base in forward
torsions, meaning the axis is the right side. Thus, it is a Right-on-Right forward torsion .
Q10. A patient has a right anterior innominate rotation. Which finding is expected on
structural exam?
A) Right PSIS is superior
B) Right PSIS is inferior
C) Right ASIS is inferior
D) Compression test negative on right
Answer: A – Right PSIS is superior
