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COMSAE PHASE 1 – FORM 115 PRACTICE
EXAMINATION 2026 COMPLETE (125) CURRENT
TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
COMSAE
Prepare with confidence using this COMSAE 115 Exam practice exam
designed to reinforce essential clinical sciences, osteopathic principles,
patient assessment, and clinical reasoning skills. The exam-style
questions help strengthen your understanding, identify knowledge gaps,
and build confidence before the assessment. A valuable study resource
for focused review and effective exam preparation. Suitable for
osteopathic medical students preparing for the National Board of
Osteopathic Medical Examiners (NBOME) COMSAE examination.
MULTIPLE CHOICE.
Section 1: Osteopathic Principles & Practice (OPP/OMT)
Questions 1–15
1. A patient presents with a structural exam revealing a
restricted T5 segment. The segment prefers rotation to the right
and side-bending to the right. It improves when the patient
slumps forward into spinal flexion. What is the correct
diagnosis?
A. T5 Neutral SR RL
B. T5 Extended RR SR
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C. T5 Flexed RR SR
D. T5 Flexed RL SL
Correct answer: C. T5 Flexed RR SR
Rationale: Because the dysfunction improves in flexion, the
segment is diagnosed as Flexed. According to Fryette's Second Law
(Type II mechanics), when a single segment is in a non-neutral
position (flexion or extension), rotation and side-bending occur in
the same direction.
2. According to Fryette's first principle (Type I mechanics), when
the spine is in a neutral position (neither flexed nor extended),
which of the following occurs?
A. Side-bending and rotation occur to the same side
B. Side-bending occurs without rotation
C. Side-bending and rotation occur to opposite sides
D. Rotation occurs without side-bending
Correct answer: C. Side-bending and rotation occur to opposite
sides
Rationale: Fryette's first principle (Type I mechanics) describes that
when multiple vertebral segments are in neutral position, side-
bending and rotation occur in opposite directions.
3. In Muscle Energy Technique (MET), the patient's contraction
force should be:
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A. Maximal contraction against a fixed barrier
B. Submaximal (approximately 20% of maximal) isometric
contraction
C. Eccentric contraction only
D. Isotonic contraction through full range
Correct answer: B. Submaximal (approximately 20% of maximal)
isometric contraction
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric
contraction by the patient, followed by relaxation and repositioning
to the new barrier. This avoids muscle fatigue and injury.
4. A patient presents with chronic low back pain. During a
structural exam, you find that the left posterior superior iliac
spine (PSIS) is superior and posterior compared to the right, and
the patient reports pain with left hip extension. This finding
indicates which somatic dysfunction?
A. Right anterior innominate rotation
B. Left posterior innominate rotation
C. Left anterior innominate rotation
D. Right posterior innominate rotation
Correct answer: B. Left posterior innominate rotation
Rationale: A posterior innominate rotation occurs when the ilium
moves posteriorly on the sacrum. The PSIS is found to be more
superior and posterior on the affected side.
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5. Which muscle is most likely shortened in a patient with a right
posterior innominate rotation?
A. Right iliopsoas
B. Right hamstrings
C. Left quadratus lumborum
D. Left gluteus maximus
Correct answer: B. Right hamstrings
Rationale: In a posterior innominate rotation, the ipsilateral
hamstrings are shortened. The iliopsoas is typically shortened in an
anterior innominate rotation.
6. A patient presents with a right anterior innominate rotation.
Which of the following muscles is most likely shortened on the
affected side?
A. Right hamstrings
B. Right iliopsoas
C. Right gluteus maximus
D. Right quadratus lumborum
Correct answer: B. Right iliopsoas
Rationale: An anterior innominate rotation results in shortening of
the ipsilateral iliopsoas. The hamstrings are shortened in a posterior
innominate rotation.
COMSAE PHASE 1 – FORM 115 PRACTICE
EXAMINATION 2026 COMPLETE (125) CURRENT
TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
COMSAE
Prepare with confidence using this COMSAE 115 Exam practice exam
designed to reinforce essential clinical sciences, osteopathic principles,
patient assessment, and clinical reasoning skills. The exam-style
questions help strengthen your understanding, identify knowledge gaps,
and build confidence before the assessment. A valuable study resource
for focused review and effective exam preparation. Suitable for
osteopathic medical students preparing for the National Board of
Osteopathic Medical Examiners (NBOME) COMSAE examination.
MULTIPLE CHOICE.
Section 1: Osteopathic Principles & Practice (OPP/OMT)
Questions 1–15
1. A patient presents with a structural exam revealing a
restricted T5 segment. The segment prefers rotation to the right
and side-bending to the right. It improves when the patient
slumps forward into spinal flexion. What is the correct
diagnosis?
A. T5 Neutral SR RL
B. T5 Extended RR SR
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C. T5 Flexed RR SR
D. T5 Flexed RL SL
Correct answer: C. T5 Flexed RR SR
Rationale: Because the dysfunction improves in flexion, the
segment is diagnosed as Flexed. According to Fryette's Second Law
(Type II mechanics), when a single segment is in a non-neutral
position (flexion or extension), rotation and side-bending occur in
the same direction.
2. According to Fryette's first principle (Type I mechanics), when
the spine is in a neutral position (neither flexed nor extended),
which of the following occurs?
A. Side-bending and rotation occur to the same side
B. Side-bending occurs without rotation
C. Side-bending and rotation occur to opposite sides
D. Rotation occurs without side-bending
Correct answer: C. Side-bending and rotation occur to opposite
sides
Rationale: Fryette's first principle (Type I mechanics) describes that
when multiple vertebral segments are in neutral position, side-
bending and rotation occur in opposite directions.
3. In Muscle Energy Technique (MET), the patient's contraction
force should be:
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A. Maximal contraction against a fixed barrier
B. Submaximal (approximately 20% of maximal) isometric
contraction
C. Eccentric contraction only
D. Isotonic contraction through full range
Correct answer: B. Submaximal (approximately 20% of maximal)
isometric contraction
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric
contraction by the patient, followed by relaxation and repositioning
to the new barrier. This avoids muscle fatigue and injury.
4. A patient presents with chronic low back pain. During a
structural exam, you find that the left posterior superior iliac
spine (PSIS) is superior and posterior compared to the right, and
the patient reports pain with left hip extension. This finding
indicates which somatic dysfunction?
A. Right anterior innominate rotation
B. Left posterior innominate rotation
C. Left anterior innominate rotation
D. Right posterior innominate rotation
Correct answer: B. Left posterior innominate rotation
Rationale: A posterior innominate rotation occurs when the ilium
moves posteriorly on the sacrum. The PSIS is found to be more
superior and posterior on the affected side.
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5. Which muscle is most likely shortened in a patient with a right
posterior innominate rotation?
A. Right iliopsoas
B. Right hamstrings
C. Left quadratus lumborum
D. Left gluteus maximus
Correct answer: B. Right hamstrings
Rationale: In a posterior innominate rotation, the ipsilateral
hamstrings are shortened. The iliopsoas is typically shortened in an
anterior innominate rotation.
6. A patient presents with a right anterior innominate rotation.
Which of the following muscles is most likely shortened on the
affected side?
A. Right hamstrings
B. Right iliopsoas
C. Right gluteus maximus
D. Right quadratus lumborum
Correct answer: B. Right iliopsoas
Rationale: An anterior innominate rotation results in shortening of
the ipsilateral iliopsoas. The hamstrings are shortened in a posterior
innominate rotation.
