COMSAE PHASE 1 (FORM 105) LEVEL 1 ACTUAL
EXAM 2026-2027 COMPLETE EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS A NEW
UPDATED VERSION LATEST 2026-2027 (VERIFIED
ANSWERS) ALREADY GRADED A+
1. A 45-year-old female presents with right upper quadrant pain that is
exacerbated by deep palpation. On examination, you find tenderness at the
right T5-T9 paraspinal region. This viscerosomatic reflex is most consistent with
dysfunction of which organ?
A. Stomach
B. Liver/Gallbladder
C. Appendix
D. Kidney
Correct Answer: B. Liver/Gallbladder
Rationale: Viscerosomatic reflexes follow predictable spinal levels. The gallbladder
and liver are innervated by spinal segments T5-T9. Somatic dysfunction at these
levels on the right side is a classic finding in biliary pathology.
,2. A patient presents with low back pain and a history of a recent fall.
Osteopathic evaluation reveals a sacral base that is deep on the left and
superficial on the right. This is consistent with which diagnosis?
A. Left-on-left sacral torsion
B. Right-on-right sacral torsion
C. Left unilateral extension
D. Right unilateral flexion
Correct Answer: A. Left-on-left sacral torsion
Rationale: In a left-on-left sacral torsion, the left sacral base is more posterior
(deep), and the right base is more anterior (superficial). This is commonly
associated with a left axis rotation and often occurs as a compensatory pattern
after lumbar dysfunction.
3. During an OMM session, you are performing a technique to treat cervical
somatic dysfunction. You position the patient's head in flexion, sidebending left,
and rotation right. This position engages which type of Fryette mechanics?
A. Type I mechanics
B. Type II mechanics
C. Neutral mechanics
D. Non-neutral mechanics
Correct Answer: B. Type II mechanics
Rationale: Fryette Type II mechanics describe a group of vertebrae that are
sidebent and rotated in opposite directions in a non-neutral (flexion or extension)
position. The positioning described (flexion, sidebent left, rotated right) is
characteristic of a Type II dysfunction.
4. A 60-year-old female with a history of chronic obstructive pulmonary disease
(COPD) presents with shortness of breath. Rib evaluation reveals a restrictive
,pattern in the upper ribs. The optimal position to treat an inhalation rib
dysfunction of ribs 1-5 is:
A. During exhalation with the patient supine
B. During inhalation with the patient prone
C. During exhalation with the patient prone
D. During inhalation with the patient supine
Correct Answer: A. During exhalation with the patient supine
Rationale: Inhalation rib dysfunction occurs when ribs are stuck in the up
(inhalation) position. Treatment involves applying a force during exhalation to
move the ribs into the exhalation position. For upper ribs 1-5, the patient is
typically supine, and the physician applies pressure inferiorly during exhalation.
5. A patient with a history of chronic constipation presents with a tender nodule
in the right lower quadrant at the level of the umbilicus. This Chapman's point is
associated with which viscus?
A. Appendix
B. Cecum
C. Descending colon
D. Small intestine
Correct Answer: B. Cecum
Rationale: Chapman's points are reflex points representing viscerosomatic
dysfunction. The Chapman's point for the cecum is located in the right lower
quadrant, near McBurney's point. The appendix point is also in the right lower
quadrant but typically slightly more medial and inferior.
6. A 28-year-old male experiences a fall onto an outstretched hand. You
diagnose a wrist drop and an inability to extend the thumb. This presentation
indicates injury to which nerve?
, A. Ulnar nerve
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve
Correct Answer: C. Radial nerve
Rationale: Wrist drop (inability to extend the wrist and fingers) is the classic
presentation of radial nerve injury. The radial nerve runs in the spiral groove of the
humerus and is most commonly injured in mid-shaft humeral fractures.
7. A 32-year-old female presents with a chief complaint of chronic headaches
that feel like a band around her head. On examination, you find suboccipital
muscle tension and restriction at the occipitoatlantal joint. Which diagnosis is
most consistent with this presentation?
A. Tension headache
B. Migraine headache
C. Cluster headache
D. Sinus headache
Correct Answer: A. Tension headache
Rationale: Tension headaches are often associated with suboccipital and cervical
muscle tension. The band-like quality of the headache is characteristic.
Osteopathic treatment often targets the occipitoatlantal and cervical regions to
relieve muscle tension and improve joint mobility.
8. A 72-year-old male with a history of atrial fibrillation presents with acute
onset of right-sided weakness and aphasia. Which artery is most likely
occluded?
EXAM 2026-2027 COMPLETE EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS A NEW
UPDATED VERSION LATEST 2026-2027 (VERIFIED
ANSWERS) ALREADY GRADED A+
1. A 45-year-old female presents with right upper quadrant pain that is
exacerbated by deep palpation. On examination, you find tenderness at the
right T5-T9 paraspinal region. This viscerosomatic reflex is most consistent with
dysfunction of which organ?
A. Stomach
B. Liver/Gallbladder
C. Appendix
D. Kidney
Correct Answer: B. Liver/Gallbladder
Rationale: Viscerosomatic reflexes follow predictable spinal levels. The gallbladder
and liver are innervated by spinal segments T5-T9. Somatic dysfunction at these
levels on the right side is a classic finding in biliary pathology.
,2. A patient presents with low back pain and a history of a recent fall.
Osteopathic evaluation reveals a sacral base that is deep on the left and
superficial on the right. This is consistent with which diagnosis?
A. Left-on-left sacral torsion
B. Right-on-right sacral torsion
C. Left unilateral extension
D. Right unilateral flexion
Correct Answer: A. Left-on-left sacral torsion
Rationale: In a left-on-left sacral torsion, the left sacral base is more posterior
(deep), and the right base is more anterior (superficial). This is commonly
associated with a left axis rotation and often occurs as a compensatory pattern
after lumbar dysfunction.
3. During an OMM session, you are performing a technique to treat cervical
somatic dysfunction. You position the patient's head in flexion, sidebending left,
and rotation right. This position engages which type of Fryette mechanics?
A. Type I mechanics
B. Type II mechanics
C. Neutral mechanics
D. Non-neutral mechanics
Correct Answer: B. Type II mechanics
Rationale: Fryette Type II mechanics describe a group of vertebrae that are
sidebent and rotated in opposite directions in a non-neutral (flexion or extension)
position. The positioning described (flexion, sidebent left, rotated right) is
characteristic of a Type II dysfunction.
4. A 60-year-old female with a history of chronic obstructive pulmonary disease
(COPD) presents with shortness of breath. Rib evaluation reveals a restrictive
,pattern in the upper ribs. The optimal position to treat an inhalation rib
dysfunction of ribs 1-5 is:
A. During exhalation with the patient supine
B. During inhalation with the patient prone
C. During exhalation with the patient prone
D. During inhalation with the patient supine
Correct Answer: A. During exhalation with the patient supine
Rationale: Inhalation rib dysfunction occurs when ribs are stuck in the up
(inhalation) position. Treatment involves applying a force during exhalation to
move the ribs into the exhalation position. For upper ribs 1-5, the patient is
typically supine, and the physician applies pressure inferiorly during exhalation.
5. A patient with a history of chronic constipation presents with a tender nodule
in the right lower quadrant at the level of the umbilicus. This Chapman's point is
associated with which viscus?
A. Appendix
B. Cecum
C. Descending colon
D. Small intestine
Correct Answer: B. Cecum
Rationale: Chapman's points are reflex points representing viscerosomatic
dysfunction. The Chapman's point for the cecum is located in the right lower
quadrant, near McBurney's point. The appendix point is also in the right lower
quadrant but typically slightly more medial and inferior.
6. A 28-year-old male experiences a fall onto an outstretched hand. You
diagnose a wrist drop and an inability to extend the thumb. This presentation
indicates injury to which nerve?
, A. Ulnar nerve
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve
Correct Answer: C. Radial nerve
Rationale: Wrist drop (inability to extend the wrist and fingers) is the classic
presentation of radial nerve injury. The radial nerve runs in the spiral groove of the
humerus and is most commonly injured in mid-shaft humeral fractures.
7. A 32-year-old female presents with a chief complaint of chronic headaches
that feel like a band around her head. On examination, you find suboccipital
muscle tension and restriction at the occipitoatlantal joint. Which diagnosis is
most consistent with this presentation?
A. Tension headache
B. Migraine headache
C. Cluster headache
D. Sinus headache
Correct Answer: A. Tension headache
Rationale: Tension headaches are often associated with suboccipital and cervical
muscle tension. The band-like quality of the headache is characteristic.
Osteopathic treatment often targets the occipitoatlantal and cervical regions to
relieve muscle tension and improve joint mobility.
8. A 72-year-old male with a history of atrial fibrillation presents with acute
onset of right-sided weakness and aphasia. Which artery is most likely
occluded?
