COMSAE Phase 1 Form 117 – Complete Test Bank Questions with Correct Verified Answers & Detailed Rationales Based on Current NBOME Standards and COMLEX-USA Level 1 Blueprint for the 2026 Examination Cycle

COMSAE Phase 1 Form 117 – Complete Test Bank
Questions with Correct Verified Answers &
Detailed Rationales Based on Current NBOME
Standards and COMLEX-USA Level 1 Blueprint for
the 2026 Examination Cycle

Instructions
This comprehensive examination consists of multiple-choice
questions covering all major topics for COMLEX-USA Level 1 preparation,
including osteopathic principles and practice (OMM), viscerosomatic reflexes,
Chapman's reflexes, cranial osteopathy, sacral and pelvic mechanics, and
musculoskeletal diagnosis. Questions are designed to match the style and
difficulty of the actual COMSAE Phase 1 exam. Select the single best
answer for each question.


Question 1
A patient presents with a right posterior innominate rotation. Which muscle
group is most appropriate to treat using muscle energy technique?
• A) Treat the right hip flexors
• B) Treat the right hamstrings
• C) Treat the left hip flexors
• D) Treat the left hamstrings
• E) Treat the right adductors
Answer: B) Treat the right hamstrings
Rationale: In a posterior innominate rotation, the ilium rotates posteriorly
relative to the sacrum. The hamstrings on the affected side are shortened and
should be treated with muscle energy. The hip flexors (iliopsoas) would be
lengthened in a posterior rotation. The contralateral side would not be the
primary focus.

,Question 2
A patient presents with a left anterior innominate rotation. Which muscle is
most likely shortened and should be targeted for treatment?
• A) Left hamstrings
• B) Left hip flexors (iliopsoas)
• C) Right hamstrings
• D) Right hip flexors
• E) Left gluteus maximus
Answer: B) Left hip flexors (iliopsoas)
Rationale: In an anterior innominate rotation, the ilium rotates anteriorly on
the sacrum. The hip flexors (iliopsoas) on the affected side are shortened and
should be treated. The hamstrings would be lengthened on the anteriorly
rotated side. The contralateral side would not be the primary focus.


Question 3
When documenting a lumbar dysfunction as "L5 Flexed LR SL," what type of
mechanics does this represent?
• A) Type I mechanics
• B) Type II mechanics
• C) Type III mechanics
• D) Neutral mechanics
• E) Non-neutral mechanics
Answer: B) Type II mechanics
Rationale: The documentation "L5 Flexed LR SL" represents Type II
mechanics. Type II mechanics involve rotation and sidebending in
the same direction and occur in the non-neutral (flexed or extended) position.

,Type I mechanics (neutral) involve rotation and sidebending in opposite
directions.


Question 4
A patient presents with a right posterior innominate rotation. On standing
flexion test, you would expect:
• A) Right PSIS moves superiorly
• B) Right PSIS moves inferiorly
• C) Left PSIS moves inferiorly
• D) No movement of either PSIS
• E) Bilateral PSIS movement
Answer: B) Right PSIS moves inferiorly
Rationale: In a posterior innominate rotation, the ilium rotates posteriorly,
causing the PSIS on the affected side to move inferiorly and laterally. This is
assessed with the standing flexion test. The contralateral side would appear to
move superiorly relative to the affected side.


Question 5
The diagnosis of a sacral torsion is documented as "L on L." This indicates:
• A) Left axis rotation on left oblique axis
• B) Left axis rotation on left oblique axis
• C) Right axis rotation on right oblique axis
• D) Left axis rotation on right oblique axis
• E) Right axis rotation on left oblique axis
Answer: B) Left axis rotation on left oblique axis
Rationale: Sacral torsion is documented with the axis first, then the side of
rotation. "L on L" means the sacrum rotates on a left oblique axis toward the
left. "R on R" means rotation on a right oblique axis toward the right.

, Question 6
A patient has a right unilateral sacral flexion (right on right). The standing
flexion test would show:
• A) Left PSIS moves inferiorly
• B) Right PSIS moves inferiorly
• C) Both PSIS move inferiorly
• D) No movement of either PSIS
• E) Left PSIS moves superiorly
Answer: B) Right PSIS moves inferiorly
Rationale: In right unilateral sacral flexion, the right side of the sacrum is
flexed (shortened) and the right PSIS moves inferiorly. The standing flexion
test is positive on the side of the dysfunction (right side).


Question 7
In a left unilateral sacral extension (left on left), the seated flexion test would
show:
• A) Left PSIS moves superiorly
• B) Right PSIS moves inferiorly
• C) Right PSIS moves superiorly
• D) Left PSIS moves inferiorly
• E) No movement of either PSIS
Answer: B) Right PSIS moves inferiorly
Rationale: In left unilateral sacral extension, the left side of the sacrum is
extended (lengthened). The seated flexion test is positive on the side opposite
to the dysfunction, meaning the right PSIS moves inferiorly and laterally.