COMSAE Phase 1 Form 116 — Actual Exam COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST UPDATE
THIS YEAR-JUST RELEASED.pdf
Exam Overview:
The COMSAE Phase 1 examination contains 176 single-best-answer multiple-choice
questions . This question bank follows the COMLEX-USA Level 1 blueprint and covers
osteopathic principles, human anatomy, pathology, physiology, pharmacology,
microbiology/immunology, biochemistry/genetics, and neurology/psychiatry . Answer keys
and rationales are provided with student-purchased forms to help identify knowledge gaps .
Please respond with the single best answer for each question, per COMSAE format.
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1-35)
Q1. A 45-year-old woman presents with epigastric burning and bloating after meals for
several months. On osteopathic structural exam, you find tenderness and increased tissue
texture at the right T6-T8 paraspinal region. Which viscerosomatic reflex best explains this
finding?
Answer: Stomach
Rationale: The stomach corresponds to T6-T9 on the right. Viscerosomatic reflexes map
spinal levels to organs; the stomach's spinal level is T5-T9 with a right-sided presentation .
Q2. A patient has a positive seated flexion test on the right. In the prone position, the right
ILA is posterior and inferior. What is the most likely diagnosis?
Answer: Right on right sacral torsion
Rationale: The seated flexion test indicates somatic dysfunction on the right. In a sacral
torsion, the side named first is the axis (side of deep sulcus and posterior ILA). Here, the
right ILA is posterior, meaning the axis is on the right. The equal spring test helps
differentiate torsion from unilateral flexion .
,Q3. A patient with chronic low back pain has a seated flexion test positive on the left. In the
prone position, the left ILA is more posterior than the right. What is the most likely
diagnosis?
Answer: Left on left sacral torsion
Rationale: The seated flexion test points to the side of dysfunction (left). A posterior ILA
indicates the axis. In a left on left torsion, the axis is on the left and the left ILA is posterior .
Q4. During a screening exam, you palpate a small, tender nodule in the second intercostal
space, right parasternal region. This Chapman's point is most likely associated with which
condition?
Answer: Mitral valve dysfunction
Rationale: Anterior Chapman's points for the heart are in the 2nd-5th intercostal spaces
parasternally. The mitral valve corresponds to the right 2nd intercostal space. Gastric points
are lower (6th-7th ribs) .
Q5. A patient has restriction of sidebending to the right and rotation to the left in the thoracic
spine with neutral mechanics. This is best described as:
Answer: Type I dysfunction
Rationale: Type I (neutral) dysfunction follows Fryette's First Law: sidebending and rotation
occur in opposite directions. Type II (non-neutral) dysfunction involves sidebending and
rotation in the same direction .
Q6. Which OMM technique has been shown to result in increased sIgA levels?
Answer: CV-4
Rationale: The CV-4 cranial technique has been shown to increase secretory IgA levels .
Q7. Which is an expected finding during the osteopathic exam of a 12-month-old infant's
head?
Answer: Motion of individual cranial bones
,Rationale: At 12 months, cranial bone motion can be palpated .
Q8. At what age can segmental somatic dysfunction be diagnosed in a child?
Answer: 6 weeks old
Rationale: Segmental somatic dysfunction can be diagnosed as early as 6 weeks of age .
Q9. A 45-year-old male presents with acute, severe epigastric pain radiating to his back.
Physical examination reveals marked tenderness in the epigastrium. Tissue texture
changes are noted in the paraspinal muscles. Which spinal level represents the primary
viscerosomatic reflex point for this patient's acute condition?
Answer: T5–T9
Rationale: The clinical presentation is highly suggestive of acute pancreatitis. The
pancreas, stomach, liver, gallbladder, and duodenum are foregut structures. They receive
sympathetic innervation from the greater splanchnic nerve, which originates from the T5–T9
spinal segments .
Q10. A patient presents with acute onset of severe, tearing chest pain radiating to the back.
On exam, blood pressure is 160/90 mmHg in the right arm and 110/70 mmHg in the left
arm. What is the most likely diagnosis?
Answer: Aortic dissection
Rationale: Aortic dissection classically presents with sudden onset of severe, tearing chest
pain that radiates to the back. Differential blood pressures between arms is a hallmark
finding due to involvement of the subclavian arteries .
Q11. A patient has a positive seated flexion test on the left. This test indicates:
Answer: Left iliosacral restriction (pelvic dysfunction)
Rationale: The seated flexion test removes the influence of the sacrum on pelvic motion. A
positive test (earlier/more motion on one side) indicates iliosacral restriction on that side.
The standing flexion test indicates sacral dysfunction .
, Q12. A patient has a restriction of the right sacroiliac joint in a posterior innominate
dysfunction. Which muscle energy technique is appropriate?
Answer: Patient supine, right leg over table edge, patient extends the hip against
resistance (agonist contraction)
Rationale: For a posterior innominate (ischium rotated posterosuperior, relative to sacrum),
the hip is extended. Muscle energy: patient actively extends the hip against resistance
(agonist contraction of gluteals). Position: leg over table edge allows hip extension .
Q13. The "lymphatic pump" technique is used to:
Answer: Enhance lymphatic circulation and immune function
Rationale: The lymphatic pump (thoracic pump, pedal pump) increases lymphatic flow,
which can enhance immune function and reduce edema. It is used in patients with
respiratory infections, lymphedema, and post-surgical swelling .
Q14. Which of the following is a contraindication to high-velocity low-amplitude (HVLA)
thrust?
Answer: Rheumatoid arthritis with cervical instability
Rationale: Absolute contraindications to HVLA include: fracture, dislocation, tumor,
infection, instability (e.g., RA with atlantoaxial subluxation), ligamentous rupture, and acute
myelopathy .
Q15. The Still technique involves:
Answer: Exaggeration of the dysfunction into a position of ease, then rapid return through
the barrier
Rationale: Still technique (named after A.T. Still) exaggerates the somatic dysfunction into
the direction of ease, holds it, then the physician gives a rapid "bounce" or thrust through
the restrictive barrier, returning toward neutral .
QUESTIONS AND DETAILED SOLUTIONS LATEST UPDATE
THIS YEAR-JUST RELEASED.pdf
Exam Overview:
The COMSAE Phase 1 examination contains 176 single-best-answer multiple-choice
questions . This question bank follows the COMLEX-USA Level 1 blueprint and covers
osteopathic principles, human anatomy, pathology, physiology, pharmacology,
microbiology/immunology, biochemistry/genetics, and neurology/psychiatry . Answer keys
and rationales are provided with student-purchased forms to help identify knowledge gaps .
Please respond with the single best answer for each question, per COMSAE format.
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1-35)
Q1. A 45-year-old woman presents with epigastric burning and bloating after meals for
several months. On osteopathic structural exam, you find tenderness and increased tissue
texture at the right T6-T8 paraspinal region. Which viscerosomatic reflex best explains this
finding?
Answer: Stomach
Rationale: The stomach corresponds to T6-T9 on the right. Viscerosomatic reflexes map
spinal levels to organs; the stomach's spinal level is T5-T9 with a right-sided presentation .
Q2. A patient has a positive seated flexion test on the right. In the prone position, the right
ILA is posterior and inferior. What is the most likely diagnosis?
Answer: Right on right sacral torsion
Rationale: The seated flexion test indicates somatic dysfunction on the right. In a sacral
torsion, the side named first is the axis (side of deep sulcus and posterior ILA). Here, the
right ILA is posterior, meaning the axis is on the right. The equal spring test helps
differentiate torsion from unilateral flexion .
,Q3. A patient with chronic low back pain has a seated flexion test positive on the left. In the
prone position, the left ILA is more posterior than the right. What is the most likely
diagnosis?
Answer: Left on left sacral torsion
Rationale: The seated flexion test points to the side of dysfunction (left). A posterior ILA
indicates the axis. In a left on left torsion, the axis is on the left and the left ILA is posterior .
Q4. During a screening exam, you palpate a small, tender nodule in the second intercostal
space, right parasternal region. This Chapman's point is most likely associated with which
condition?
Answer: Mitral valve dysfunction
Rationale: Anterior Chapman's points for the heart are in the 2nd-5th intercostal spaces
parasternally. The mitral valve corresponds to the right 2nd intercostal space. Gastric points
are lower (6th-7th ribs) .
Q5. A patient has restriction of sidebending to the right and rotation to the left in the thoracic
spine with neutral mechanics. This is best described as:
Answer: Type I dysfunction
Rationale: Type I (neutral) dysfunction follows Fryette's First Law: sidebending and rotation
occur in opposite directions. Type II (non-neutral) dysfunction involves sidebending and
rotation in the same direction .
Q6. Which OMM technique has been shown to result in increased sIgA levels?
Answer: CV-4
Rationale: The CV-4 cranial technique has been shown to increase secretory IgA levels .
Q7. Which is an expected finding during the osteopathic exam of a 12-month-old infant's
head?
Answer: Motion of individual cranial bones
,Rationale: At 12 months, cranial bone motion can be palpated .
Q8. At what age can segmental somatic dysfunction be diagnosed in a child?
Answer: 6 weeks old
Rationale: Segmental somatic dysfunction can be diagnosed as early as 6 weeks of age .
Q9. A 45-year-old male presents with acute, severe epigastric pain radiating to his back.
Physical examination reveals marked tenderness in the epigastrium. Tissue texture
changes are noted in the paraspinal muscles. Which spinal level represents the primary
viscerosomatic reflex point for this patient's acute condition?
Answer: T5–T9
Rationale: The clinical presentation is highly suggestive of acute pancreatitis. The
pancreas, stomach, liver, gallbladder, and duodenum are foregut structures. They receive
sympathetic innervation from the greater splanchnic nerve, which originates from the T5–T9
spinal segments .
Q10. A patient presents with acute onset of severe, tearing chest pain radiating to the back.
On exam, blood pressure is 160/90 mmHg in the right arm and 110/70 mmHg in the left
arm. What is the most likely diagnosis?
Answer: Aortic dissection
Rationale: Aortic dissection classically presents with sudden onset of severe, tearing chest
pain that radiates to the back. Differential blood pressures between arms is a hallmark
finding due to involvement of the subclavian arteries .
Q11. A patient has a positive seated flexion test on the left. This test indicates:
Answer: Left iliosacral restriction (pelvic dysfunction)
Rationale: The seated flexion test removes the influence of the sacrum on pelvic motion. A
positive test (earlier/more motion on one side) indicates iliosacral restriction on that side.
The standing flexion test indicates sacral dysfunction .
, Q12. A patient has a restriction of the right sacroiliac joint in a posterior innominate
dysfunction. Which muscle energy technique is appropriate?
Answer: Patient supine, right leg over table edge, patient extends the hip against
resistance (agonist contraction)
Rationale: For a posterior innominate (ischium rotated posterosuperior, relative to sacrum),
the hip is extended. Muscle energy: patient actively extends the hip against resistance
(agonist contraction of gluteals). Position: leg over table edge allows hip extension .
Q13. The "lymphatic pump" technique is used to:
Answer: Enhance lymphatic circulation and immune function
Rationale: The lymphatic pump (thoracic pump, pedal pump) increases lymphatic flow,
which can enhance immune function and reduce edema. It is used in patients with
respiratory infections, lymphedema, and post-surgical swelling .
Q14. Which of the following is a contraindication to high-velocity low-amplitude (HVLA)
thrust?
Answer: Rheumatoid arthritis with cervical instability
Rationale: Absolute contraindications to HVLA include: fracture, dislocation, tumor,
infection, instability (e.g., RA with atlantoaxial subluxation), ligamentous rupture, and acute
myelopathy .
Q15. The Still technique involves:
Answer: Exaggeration of the dysfunction into a position of ease, then rapid return through
the barrier
Rationale: Still technique (named after A.T. Still) exaggerates the somatic dysfunction into
the direction of ease, holds it, then the physician gives a rapid "bounce" or thrust through
the restrictive barrier, returning toward neutral .
