COMSAE Phase 1 Form 115 Style UP-TO-
DATE 2026 Practice Questions with 100%
Accurate Solutions & Detailed Rationales
Core Domains Covered
• Osteopathic Principles & Practice (OPP/OMT) – Fryette's mechanics,
Chapman's reflexes, counterstrain, muscle energy, HVLA, myofascial
release, viscerosomatic reflexes, somatic dysfunction, treatment
positions
• Anatomy – Gross anatomy, neuroanatomy, embryology,
musculoskeletal system, visceral anatomy
• Biochemistry & Nutrition – Metabolism, vitamins, enzyme kinetics,
molecular biology, genetics
• Microbiology & Immunology – Bacteriology, virology, mycology,
parasitology, immunology, infectious disease
• Pathology – General pathology, systemic pathology, neoplasia,
inflammation, immune-mediated diseases
• Pharmacology – Mechanisms of action, adverse effects, drug
interactions, autonomic pharmacology, antimicrobials
• Physiology – Cardiovascular, respiratory, renal, gastrointestinal,
endocrine, neurology, reproductive
• Behavioral Sciences – Doctor-patient relationship, ethics, biostatistics,
epidemiology, mental health
• Clinical Presentation & Diagnosis – History taking, physical
examination, diagnostic reasoning
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (Questions 1–30)
,1. A 35-year-old with chronic low back pain has a right posterior
innominate rotation. Which muscle is likely shortened?
A. Left quadratus lumborum
B. Right hamstrings
C. Right iliopsoas
D. Left gluteus maximus
Rationale: A posterior innominate rotation is a shear of the ilium in which the
ilium moves posteriorly on the sacrum. In this dysfunction, the ipsilateral
hamstrings are shortened, whereas the iliopsoas is typically shortened in an
anterior innominate.
2. During an osteopathic structural exam, you find a T4 spinous process
deviated left, with right rotation restriction. Fryette's Type II mechanics
apply. Which of the following is true?
A. Sidebending and rotation occur to opposite sides
B. Neutral mechanics apply
C. Rotation and sidebending occur to same side
D. Only rotation is restricted
Rationale: Fryette's Type II (nonneutral) mechanics dictate that rotation and
sidebending occur to the same side when a single segment is in a non-neutral
position (flexion or extension). Type I (neutral) mechanics involve rotation
and sidebending to opposite sides.
3. A patient with asthma has tenderness at the 2nd intercostal space,
right parasternal region. This is a Chapman's reflex for which organ?
A. Kidney
B. Lung
C. Liver
D. Spleen
Rationale: Chapman's reflexes are viscerosomatic reflex points. The lung
reflex points are located in the 2nd and 3rd intercostal spaces, right and left
parasternal regions.
,4. A patient with right lateral bending of the lumbar spine with rotation
to the left. According to Fryette, this is a:
A. Type I dysfunction
B. Type II dysfunction
C. Type III dysfunction
D. Neutral dysfunction
Rationale: In Fryette's Type I (neutral) mechanics, sidebending and rotation
occur to opposite sides. Right lateral bending with left rotation is the classic
Type I pattern, typically occurring in group curves involving multiple
vertebral segments.
5. A 50-year-old with chronic constipation has a tender point at the tip of
the 12th rib on the right. Which viscerosomatic reflex is most likely?
A. Colon
B. Stomach
C. Gallbladder
D. Appendix
Rationale: Viscerosomatic reflexes for the colon are located at T10–L1, often
presenting as tenderness at the 11th or 12th ribs. Chronic constipation
suggests colonic dysfunction.
6. In counterstrain, you find a tender point at the anterior medial knee.
Which muscle is likely the primary dysfunction?
A. Vastus lateralis
B. Sartorius
C. Rectus femoris
D. Gracilis
Rationale: The sartorius muscle has a tender point located at the anterior
medial knee. The treatment position for the sartorius using counterstrain
involves flexion, abduction, and external rotation of the hip.
, 7. A patient presents with a chronic headache. You find restriction of
cervical spine motion, particularly in rotation. Which of the following is
the most appropriate osteopathic treatment?
A. High-velocity low-amplitude (HVLA) to C2
B. Muscle energy technique (MET) to the cervical region
C. Counterstrain only
D. Myofascial release to the thoracic spine
Rationale: MET is appropriate for treating cervical spine restrictions,
particularly when there is a muscular component to the dysfunction. HVLA
may be used but requires specific diagnosis and screening.
8. Which of the following is a hallmark of Fryette's Type I mechanics?
A. Rotation and sidebending to the same side
B. Only one segment is involved
C. Rotation and sidebending to opposite sides
D. Occurs in non-neutral positions
Rationale: Fryette's Type I mechanics occur in neutral positions and involve
rotation and sidebending to opposite sides. Type II mechanics involve rotation
and sidebending to the same side in non-neutral positions.
9. The primary function of the lymphatic system in osteopathic medicine
is:
A. To produce red blood cells
B. To remove waste products and support immune function
C. To regulate body temperature
D. To store calcium
Rationale: The lymphatic system removes waste products, supports immune
function, and helps maintain fluid balance. Osteopathic manipulative
treatment can enhance lymphatic drainage.
DATE 2026 Practice Questions with 100%
Accurate Solutions & Detailed Rationales
Core Domains Covered
• Osteopathic Principles & Practice (OPP/OMT) – Fryette's mechanics,
Chapman's reflexes, counterstrain, muscle energy, HVLA, myofascial
release, viscerosomatic reflexes, somatic dysfunction, treatment
positions
• Anatomy – Gross anatomy, neuroanatomy, embryology,
musculoskeletal system, visceral anatomy
• Biochemistry & Nutrition – Metabolism, vitamins, enzyme kinetics,
molecular biology, genetics
• Microbiology & Immunology – Bacteriology, virology, mycology,
parasitology, immunology, infectious disease
• Pathology – General pathology, systemic pathology, neoplasia,
inflammation, immune-mediated diseases
• Pharmacology – Mechanisms of action, adverse effects, drug
interactions, autonomic pharmacology, antimicrobials
• Physiology – Cardiovascular, respiratory, renal, gastrointestinal,
endocrine, neurology, reproductive
• Behavioral Sciences – Doctor-patient relationship, ethics, biostatistics,
epidemiology, mental health
• Clinical Presentation & Diagnosis – History taking, physical
examination, diagnostic reasoning
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (Questions 1–30)
,1. A 35-year-old with chronic low back pain has a right posterior
innominate rotation. Which muscle is likely shortened?
A. Left quadratus lumborum
B. Right hamstrings
C. Right iliopsoas
D. Left gluteus maximus
Rationale: A posterior innominate rotation is a shear of the ilium in which the
ilium moves posteriorly on the sacrum. In this dysfunction, the ipsilateral
hamstrings are shortened, whereas the iliopsoas is typically shortened in an
anterior innominate.
2. During an osteopathic structural exam, you find a T4 spinous process
deviated left, with right rotation restriction. Fryette's Type II mechanics
apply. Which of the following is true?
A. Sidebending and rotation occur to opposite sides
B. Neutral mechanics apply
C. Rotation and sidebending occur to same side
D. Only rotation is restricted
Rationale: Fryette's Type II (nonneutral) mechanics dictate that rotation and
sidebending occur to the same side when a single segment is in a non-neutral
position (flexion or extension). Type I (neutral) mechanics involve rotation
and sidebending to opposite sides.
3. A patient with asthma has tenderness at the 2nd intercostal space,
right parasternal region. This is a Chapman's reflex for which organ?
A. Kidney
B. Lung
C. Liver
D. Spleen
Rationale: Chapman's reflexes are viscerosomatic reflex points. The lung
reflex points are located in the 2nd and 3rd intercostal spaces, right and left
parasternal regions.
,4. A patient with right lateral bending of the lumbar spine with rotation
to the left. According to Fryette, this is a:
A. Type I dysfunction
B. Type II dysfunction
C. Type III dysfunction
D. Neutral dysfunction
Rationale: In Fryette's Type I (neutral) mechanics, sidebending and rotation
occur to opposite sides. Right lateral bending with left rotation is the classic
Type I pattern, typically occurring in group curves involving multiple
vertebral segments.
5. A 50-year-old with chronic constipation has a tender point at the tip of
the 12th rib on the right. Which viscerosomatic reflex is most likely?
A. Colon
B. Stomach
C. Gallbladder
D. Appendix
Rationale: Viscerosomatic reflexes for the colon are located at T10–L1, often
presenting as tenderness at the 11th or 12th ribs. Chronic constipation
suggests colonic dysfunction.
6. In counterstrain, you find a tender point at the anterior medial knee.
Which muscle is likely the primary dysfunction?
A. Vastus lateralis
B. Sartorius
C. Rectus femoris
D. Gracilis
Rationale: The sartorius muscle has a tender point located at the anterior
medial knee. The treatment position for the sartorius using counterstrain
involves flexion, abduction, and external rotation of the hip.
, 7. A patient presents with a chronic headache. You find restriction of
cervical spine motion, particularly in rotation. Which of the following is
the most appropriate osteopathic treatment?
A. High-velocity low-amplitude (HVLA) to C2
B. Muscle energy technique (MET) to the cervical region
C. Counterstrain only
D. Myofascial release to the thoracic spine
Rationale: MET is appropriate for treating cervical spine restrictions,
particularly when there is a muscular component to the dysfunction. HVLA
may be used but requires specific diagnosis and screening.
8. Which of the following is a hallmark of Fryette's Type I mechanics?
A. Rotation and sidebending to the same side
B. Only one segment is involved
C. Rotation and sidebending to opposite sides
D. Occurs in non-neutral positions
Rationale: Fryette's Type I mechanics occur in neutral positions and involve
rotation and sidebending to opposite sides. Type II mechanics involve rotation
and sidebending to the same side in non-neutral positions.
9. The primary function of the lymphatic system in osteopathic medicine
is:
A. To produce red blood cells
B. To remove waste products and support immune function
C. To regulate body temperature
D. To store calcium
Rationale: The lymphatic system removes waste products, supports immune
function, and helps maintain fluid balance. Osteopathic manipulative
treatment can enhance lymphatic drainage.
