COMSAE PHASE 1 FORM 116 PRACTICE
EXAM WITH ACTUAL QUESTIONS & VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Core Domains:
• Osteopathic Principles and Manipulative Medicine (OMM)
• Cardiovascular Medicine
• Pulmonary Medicine
• Gastrointestinal Medicine
• Renal and Genitourinary Medicine
• Neurology and Psychiatry
• Infectious Disease and Immunology
• Endocrine and Reproductive Medicine
Introduction
The COMSAE Phase 1 Form 116 is a comprehensive self-assessment examination
designed to evaluate osteopathic medical students' readiness for the COMLEX-
USA Level 1 licensing exam. The examination contains 176 single-best-answer
multiple-choice questions organized by clinical competency domains. Form ASA
116 is available in a non-secure browser format for self-paced review, allowing
,students to identify areas requiring additional attention before their assessment.
This practice exam is structured to mirror the content blueprint of the actual
COMSAE Phase 1 Form 116, covering high-yield topics in osteopathic principles,
basic sciences integration, clinical vignette reasoning, and systems-based medical
knowledge.
SECTION ONE: OSTEOPATHIC PRINCIPLES AND OMM (QUESTIONS 1–15)
1. A 45-year-old female presents with chronic low back pain. On examination,
you find a right-on-right sacral torsion. Which of the following describes the
correct diagnosis and treatment?
• A. Right-on-right sacral torsion, treat with muscle energy to rotate the sacrum
to the right
• B. Right-on-right sacral torsion, treat with counterstrain of the sacroiliac joint
• C. Right-on-right sacral torsion, treat with high-velocity low-amplitude
(HVLA) thrust directed toward the left
• D. Right-on-right sacral torsion, treat with myofascial release of the lumbar
paraspinals
C. Right-on-right sacral torsion, treat with high-velocity low-amplitude (HVLA)
thrust directed toward the left
RATIONALE: In a right-on-right sacral torsion, the sacrum is rotated to the right
around a vertical axis, with the right side of the sacrum moving anteriorly. The
treatment involves a HVLA thrust directed toward the left (opposite the rotation) to
correct the somatic dysfunction. Muscle energy and counterstrain are alternative
approaches but are not specific for right-on-right torsion.
,2. A 55-year-old male with a history of COPD presents with low back pain. On
osteopathic examination, you note a lumbar spine somatic dysfunction with a
Type I (neutral) mechanics pattern. Which of the following best describes Type I
mechanics?
• A. The vertebral bodies rotate and sidebend in opposite directions
• B. The vertebral bodies rotate and sidebend in the same direction
• C. The vertebral bodies are fixed in extension
• D. The vertebral bodies are fixed in flexion
B. The vertebral bodies rotate and sidebend in the same direction
RATIONALE: Type I (neutral) mechanics occur when the vertebral bodies rotate
and sidebend in the same direction. This pattern is typically associated with groups
of vertebrae and is named by the direction of rotation (e.g., left rotation, left
sidebending). Type II (non-neutral) mechanics involve rotation and sidebending in
opposite directions.
3. A 30-year-old female presents with a chief complaint of headaches. On
osteopathic examination, you identify a restriction at the occipitoatlantal (C0-
C1) joint. Which of the following is the correct treatment for an occipitoatlantal
extension somatic dysfunction?
• A. Treat with a direct HVLA thrust into extension
• B. Treat with an indirect counterstrain technique into flexion
• C. Treat with muscle energy into flexion
• D. Treat with myofascial release into extension
B. Treat with an indirect counterstrain technique into flexion
RATIONALE: Occipitoatlantal extension somatic dysfunction is treated with an
indirect technique, such as counterstrain, into the direction of ease (flexion). In
, counterstrain, the dysfunctional position (extension) is treated by positioning the
joint into the opposite direction (flexion) to reduce the strain on the affected tissues.
4. A 25-year-old male presents with acute right-sided rib pain after a coughing
episode. On osteopathic examination, you find a right-sided inhalation rib
dysfunction involving ribs 3-5. Which of the following is the correct diagnosis
and treatment?
• A. Inhalation rib dysfunction, treat with an indirect technique into exhalation
• B. Inhalation rib dysfunction, treat with a direct technique into inhalation
• C. Exhalation rib dysfunction, treat with a direct technique into exhalation
• D. Exhalation rib dysfunction, treat with an indirect technique into inhalation
A. Inhalation rib dysfunction, treat with an indirect technique into exhalation
RATIONALE: In inhalation rib dysfunction, the ribs are "stuck" in the inhalation
(upward and outward) position. The treatment involves an indirect technique into
exhalation (downward and inward) to release the restriction. Direct techniques are
used for exhalation rib dysfunction.
5. A 40-year-old female with fibromyalgia presents with widespread
musculoskeletal pain. On osteopathic examination, you identify multiple
tender points. Which of the following statements best describes the difference
between a tender point and a trigger point?
• A. Tender points are associated with taut bands of muscle, while trigger
points are not
• B. Trigger points are associated with taut bands of muscle, while tender
points are not
• C. Both tender points and trigger points are associated with taut bands of
muscle
EXAM WITH ACTUAL QUESTIONS & VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Core Domains:
• Osteopathic Principles and Manipulative Medicine (OMM)
• Cardiovascular Medicine
• Pulmonary Medicine
• Gastrointestinal Medicine
• Renal and Genitourinary Medicine
• Neurology and Psychiatry
• Infectious Disease and Immunology
• Endocrine and Reproductive Medicine
Introduction
The COMSAE Phase 1 Form 116 is a comprehensive self-assessment examination
designed to evaluate osteopathic medical students' readiness for the COMLEX-
USA Level 1 licensing exam. The examination contains 176 single-best-answer
multiple-choice questions organized by clinical competency domains. Form ASA
116 is available in a non-secure browser format for self-paced review, allowing
,students to identify areas requiring additional attention before their assessment.
This practice exam is structured to mirror the content blueprint of the actual
COMSAE Phase 1 Form 116, covering high-yield topics in osteopathic principles,
basic sciences integration, clinical vignette reasoning, and systems-based medical
knowledge.
SECTION ONE: OSTEOPATHIC PRINCIPLES AND OMM (QUESTIONS 1–15)
1. A 45-year-old female presents with chronic low back pain. On examination,
you find a right-on-right sacral torsion. Which of the following describes the
correct diagnosis and treatment?
• A. Right-on-right sacral torsion, treat with muscle energy to rotate the sacrum
to the right
• B. Right-on-right sacral torsion, treat with counterstrain of the sacroiliac joint
• C. Right-on-right sacral torsion, treat with high-velocity low-amplitude
(HVLA) thrust directed toward the left
• D. Right-on-right sacral torsion, treat with myofascial release of the lumbar
paraspinals
C. Right-on-right sacral torsion, treat with high-velocity low-amplitude (HVLA)
thrust directed toward the left
RATIONALE: In a right-on-right sacral torsion, the sacrum is rotated to the right
around a vertical axis, with the right side of the sacrum moving anteriorly. The
treatment involves a HVLA thrust directed toward the left (opposite the rotation) to
correct the somatic dysfunction. Muscle energy and counterstrain are alternative
approaches but are not specific for right-on-right torsion.
,2. A 55-year-old male with a history of COPD presents with low back pain. On
osteopathic examination, you note a lumbar spine somatic dysfunction with a
Type I (neutral) mechanics pattern. Which of the following best describes Type I
mechanics?
• A. The vertebral bodies rotate and sidebend in opposite directions
• B. The vertebral bodies rotate and sidebend in the same direction
• C. The vertebral bodies are fixed in extension
• D. The vertebral bodies are fixed in flexion
B. The vertebral bodies rotate and sidebend in the same direction
RATIONALE: Type I (neutral) mechanics occur when the vertebral bodies rotate
and sidebend in the same direction. This pattern is typically associated with groups
of vertebrae and is named by the direction of rotation (e.g., left rotation, left
sidebending). Type II (non-neutral) mechanics involve rotation and sidebending in
opposite directions.
3. A 30-year-old female presents with a chief complaint of headaches. On
osteopathic examination, you identify a restriction at the occipitoatlantal (C0-
C1) joint. Which of the following is the correct treatment for an occipitoatlantal
extension somatic dysfunction?
• A. Treat with a direct HVLA thrust into extension
• B. Treat with an indirect counterstrain technique into flexion
• C. Treat with muscle energy into flexion
• D. Treat with myofascial release into extension
B. Treat with an indirect counterstrain technique into flexion
RATIONALE: Occipitoatlantal extension somatic dysfunction is treated with an
indirect technique, such as counterstrain, into the direction of ease (flexion). In
, counterstrain, the dysfunctional position (extension) is treated by positioning the
joint into the opposite direction (flexion) to reduce the strain on the affected tissues.
4. A 25-year-old male presents with acute right-sided rib pain after a coughing
episode. On osteopathic examination, you find a right-sided inhalation rib
dysfunction involving ribs 3-5. Which of the following is the correct diagnosis
and treatment?
• A. Inhalation rib dysfunction, treat with an indirect technique into exhalation
• B. Inhalation rib dysfunction, treat with a direct technique into inhalation
• C. Exhalation rib dysfunction, treat with a direct technique into exhalation
• D. Exhalation rib dysfunction, treat with an indirect technique into inhalation
A. Inhalation rib dysfunction, treat with an indirect technique into exhalation
RATIONALE: In inhalation rib dysfunction, the ribs are "stuck" in the inhalation
(upward and outward) position. The treatment involves an indirect technique into
exhalation (downward and inward) to release the restriction. Direct techniques are
used for exhalation rib dysfunction.
5. A 40-year-old female with fibromyalgia presents with widespread
musculoskeletal pain. On osteopathic examination, you identify multiple
tender points. Which of the following statements best describes the difference
between a tender point and a trigger point?
• A. Tender points are associated with taut bands of muscle, while trigger
points are not
• B. Trigger points are associated with taut bands of muscle, while tender
points are not
• C. Both tender points and trigger points are associated with taut bands of
muscle
