Comsae Phase 1 Form 114 Actual Exam 2026: 176 High-
Yield Content Questions With Verified Answers &
Rationales – Comlex-Usa Level 1 Prep |Latest Update This
Year.Pdf Instant Download Pdf
Exam Overview:
The COMSAE Phase 1 examination contains 176 items, divided into four sections of 44
questions each. All questions are single-best-answer, multiple-choice format. This
document is compiled from verified sources to help you prepare for the COMSAE Phase 1
Form 114 assessment .
EXAM FORMAT
Feature Detail
Total Questions 176 items
Sections 4 sections of 44 questions each
Format Single-best-answer, multiple-choice
Content Basic and clinical sciences, OMM, biostatistics, pharmacology
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP) (Questions 1-44)
Q1. A 45-year-old male presents with low back pain after lifting a box. Standing
flexion test shows superior movement of the right PSIS. Which somatic dysfunction
is most likely?
Answer: Right anterior innominate
Rationale: The standing flexion test is positive on the side of iliosacral dysfunction. In a
right anterior innominate, the right ASIS is more inferior, causing a functional short right leg
and positive standing flexion test on the right .
,Q2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur:
Answer: To opposite sides
Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides .
Q3. A patient has a somatic dysfunction described as "left fibular head, posterior."
What motion is restricted?
Answer: Anterior glide
Rationale: A posterior fibular head is fixed posteriorly, so anterior glide is restricted.
Treatment restores anterior motion .
Q4. Which condition is an absolute contraindication to cervical HVLA thrust?
Answer: Rheumatoid arthritis with atlantoaxial instability
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial instability) is
an absolute contraindication to HVLA due to risk of spinal cord injury .
Q5. A 28-year-old female presents with chronic headaches and cervical spine
tenderness. The OA joint is restricted in flexion and sidebending to the right. What is
the most appropriate OMT for this dysfunction?
Answer: Direct HVLA with patient supine, OA joint flexed, rotated left, sidebent right
Rationale: The OA joint is a modified synovial joint. If restricted in flexion and sidebending
to the right, the restrictive barrier is in flexion and right sidebending. HVLA positioning: flex,
rotate left (away), sidebent right (toward barrier) .
Q6. A patient has a somatic dysfunction of the sacrum. The left sulcus is deeper than
the right, and the left ILA is more posterior than the right. What is the diagnosis?
Answer: Left on Right torsion
,Rationale: A deep sulcus and posterior ILA on the same side indicate a forward sacral
torsion about an oblique axis. The naming convention is "side of the deep sulcus" on "side
of the posterior ILA" .
Q7. Which of the following cranial techniques is specifically designed to enhance the
amplitude of the cranial rhythmic impulse (CRI)?
Answer: Bulb compression (CV-4)
Rationale: Compression of the fourth ventricle (CV-4) is explicitly utilized to encourage fluid
movement, enhance CRI amplitude, and assist with autonomic nervous system balancing .
Q8. A 24-year-old male presents with acute lower back pain. The right L4 transverse
process is more posterior than the left. The asymmetry normalizes in extension. What
is the correct somatic dysfunction?
Answer: L4 Extended, Rotated Right, Sidebent Right
Rationale: Asymmetry normalizes in extension, indicating an extension (E) somatic
dysfunction (Type II mechanics). Type II mechanics dictate rotation and sidebending to the
same side. Since the right transverse process is posterior, the vertebra is rotated right and
sidebent right .
Q9. A 40-year-old female with asthma complains of right upper back pain. On
inhalation, the right 3rd rib is elevated and moves poorly. Which somatic dysfunction
is most likely?
Answer: Pump handle rib dysfunction
Rationale: Pump handle motion (vertical axis) is dominant in ribs 1-5. If a rib is stuck in
inhalation (elevated), it is a pump handle dysfunction. Bucket handle (ribs 6-10) is more
lateral .
Q10. Which Chapman point is associated with the gallbladder?
Answer: Right anterior 6th intercostal space
, Rationale: Chapman points are viscerosomatic reflexes. The gallbladder point is located in
the right anterior 6th intercostal space .
Q11. Sympathetic innervation to the lungs arises from which spinal levels?
Answer: T1-T5
Rationale: Sympathetic innervation to the lungs arises from the T1 to T5 spinal levels, with
postganglionic fibers traveling via the cardiopulmonary splanchnic nerves to the pulmonary
plexus .
Q12. Chronic, burning epigastric pain that worsens 2 to 3 hours after eating
corresponds to which viscerosomatic reflex levels?
Answer: T5-T9
Rationale: The stomach and proximal duodenum receive their sympathetic innervation from
spinal levels T5-T9. Irritation from a duodenal ulcer can cause a viscerosomatic reflex at
these spinal levels .
Q13. A patient presents with low back pain that worsens with lumbar extension and
improves with flexion. On examination, there is a prominent right PSIS and a short
right leg in the supine position, with the leg length equalizing when seated. This is
most consistent with:
Answer: Unilateral anterior innominate
Rationale: An anterior innominate (ASIS moves anterior/inferior) produces a functional
short leg on the same side in supine, which corrects when sitting (pelvis fixed). Extension
worsens pain (anterior rotation increases lumbar lordosis), flexion improves it .
Q14. In muscle energy technique (MET), the patient's contraction force should be:
Answer: Mild to moderate effort (approximately 20-25% of maximal force)
Rationale: MET uses a mild to moderate isometric contraction (approximately 20-25% of
maximal force) from the patient against a counterforce applied by the physician .
Yield Content Questions With Verified Answers &
Rationales – Comlex-Usa Level 1 Prep |Latest Update This
Year.Pdf Instant Download Pdf
Exam Overview:
The COMSAE Phase 1 examination contains 176 items, divided into four sections of 44
questions each. All questions are single-best-answer, multiple-choice format. This
document is compiled from verified sources to help you prepare for the COMSAE Phase 1
Form 114 assessment .
EXAM FORMAT
Feature Detail
Total Questions 176 items
Sections 4 sections of 44 questions each
Format Single-best-answer, multiple-choice
Content Basic and clinical sciences, OMM, biostatistics, pharmacology
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP) (Questions 1-44)
Q1. A 45-year-old male presents with low back pain after lifting a box. Standing
flexion test shows superior movement of the right PSIS. Which somatic dysfunction
is most likely?
Answer: Right anterior innominate
Rationale: The standing flexion test is positive on the side of iliosacral dysfunction. In a
right anterior innominate, the right ASIS is more inferior, causing a functional short right leg
and positive standing flexion test on the right .
,Q2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur:
Answer: To opposite sides
Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides .
Q3. A patient has a somatic dysfunction described as "left fibular head, posterior."
What motion is restricted?
Answer: Anterior glide
Rationale: A posterior fibular head is fixed posteriorly, so anterior glide is restricted.
Treatment restores anterior motion .
Q4. Which condition is an absolute contraindication to cervical HVLA thrust?
Answer: Rheumatoid arthritis with atlantoaxial instability
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial instability) is
an absolute contraindication to HVLA due to risk of spinal cord injury .
Q5. A 28-year-old female presents with chronic headaches and cervical spine
tenderness. The OA joint is restricted in flexion and sidebending to the right. What is
the most appropriate OMT for this dysfunction?
Answer: Direct HVLA with patient supine, OA joint flexed, rotated left, sidebent right
Rationale: The OA joint is a modified synovial joint. If restricted in flexion and sidebending
to the right, the restrictive barrier is in flexion and right sidebending. HVLA positioning: flex,
rotate left (away), sidebent right (toward barrier) .
Q6. A patient has a somatic dysfunction of the sacrum. The left sulcus is deeper than
the right, and the left ILA is more posterior than the right. What is the diagnosis?
Answer: Left on Right torsion
,Rationale: A deep sulcus and posterior ILA on the same side indicate a forward sacral
torsion about an oblique axis. The naming convention is "side of the deep sulcus" on "side
of the posterior ILA" .
Q7. Which of the following cranial techniques is specifically designed to enhance the
amplitude of the cranial rhythmic impulse (CRI)?
Answer: Bulb compression (CV-4)
Rationale: Compression of the fourth ventricle (CV-4) is explicitly utilized to encourage fluid
movement, enhance CRI amplitude, and assist with autonomic nervous system balancing .
Q8. A 24-year-old male presents with acute lower back pain. The right L4 transverse
process is more posterior than the left. The asymmetry normalizes in extension. What
is the correct somatic dysfunction?
Answer: L4 Extended, Rotated Right, Sidebent Right
Rationale: Asymmetry normalizes in extension, indicating an extension (E) somatic
dysfunction (Type II mechanics). Type II mechanics dictate rotation and sidebending to the
same side. Since the right transverse process is posterior, the vertebra is rotated right and
sidebent right .
Q9. A 40-year-old female with asthma complains of right upper back pain. On
inhalation, the right 3rd rib is elevated and moves poorly. Which somatic dysfunction
is most likely?
Answer: Pump handle rib dysfunction
Rationale: Pump handle motion (vertical axis) is dominant in ribs 1-5. If a rib is stuck in
inhalation (elevated), it is a pump handle dysfunction. Bucket handle (ribs 6-10) is more
lateral .
Q10. Which Chapman point is associated with the gallbladder?
Answer: Right anterior 6th intercostal space
, Rationale: Chapman points are viscerosomatic reflexes. The gallbladder point is located in
the right anterior 6th intercostal space .
Q11. Sympathetic innervation to the lungs arises from which spinal levels?
Answer: T1-T5
Rationale: Sympathetic innervation to the lungs arises from the T1 to T5 spinal levels, with
postganglionic fibers traveling via the cardiopulmonary splanchnic nerves to the pulmonary
plexus .
Q12. Chronic, burning epigastric pain that worsens 2 to 3 hours after eating
corresponds to which viscerosomatic reflex levels?
Answer: T5-T9
Rationale: The stomach and proximal duodenum receive their sympathetic innervation from
spinal levels T5-T9. Irritation from a duodenal ulcer can cause a viscerosomatic reflex at
these spinal levels .
Q13. A patient presents with low back pain that worsens with lumbar extension and
improves with flexion. On examination, there is a prominent right PSIS and a short
right leg in the supine position, with the leg length equalizing when seated. This is
most consistent with:
Answer: Unilateral anterior innominate
Rationale: An anterior innominate (ASIS moves anterior/inferior) produces a functional
short leg on the same side in supine, which corrects when sitting (pelvis fixed). Extension
worsens pain (anterior rotation increases lumbar lordosis), flexion improves it .
Q14. In muscle energy technique (MET), the patient's contraction force should be:
Answer: Mild to moderate effort (approximately 20-25% of maximal force)
Rationale: MET uses a mild to moderate isometric contraction (approximately 20-25% of
maximal force) from the patient against a counterforce applied by the physician .
