COMSAE Phase 1,2,3 Form 115 – The Complete Question Test
Bank All questions with correct verified answers & detailed
rationales verified based on current NBOME standards and
COMLEX-USA Level 1 blueprint for the 2026 examination
cycle
,Content Area Distribution
Content Area Approximate Percentage
Osteopathic Principles & Practice (OPP/OMT) ~12%
Foundational Biomedical Sciences ~25%
Clinical Systems ~45%
Behavioral Science/Biostatistics/Ethics ~10%
Multisystem/Interdisciplinary Topics ~8%
High-Yield Focus Areas: OMM (Sacral Torsions, Cranial Strains,
Chapman Points), Neuro (stroke/cranial nerves), Cardio
(murmurs/ECG), Ethics (autonomy, informed consent).
COMSAE Phase 2 & 3 Additions
For Phase 2 and 3, clinical reasoning and patient management
scenarios are emphasized, including Internal Medicine, Surgery,
Pediatrics, Obstetrics & Gynecology, Psychiatry, Family Medicine,
Emergency Medicine, Preventive Medicine, and patient
management.
,SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(OPP/OMT)
Questions 1-60
Q1. A 54-year-old man presents with crushing substernal
chest pain radiating to his left arm. ECG shows ST-segment
elevations in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A) Left anterior descending artery
B) Circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct ,,,,,,answer,,,,,,: C) Right coronary artery
Rationale: Inferior wall myocardial infarctions involving leads II,
III, and aVF are most commonly associated with occlusion of the
right coronary artery (RCA). The RCA supplies the inferior wall of
the heart in most individuals. LAD occlusion usually causes
anterior wall MI, while circumflex artery occlusion commonly
causes lateral wall infarction.
Q2. A patient presents with a structural exam revealing a
restricted T5 segment. The segment prefers rotation to the
right and sidebending 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
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 sidebending
occur in the same direction. Hence, rotation right and
sidebending right yields a diagnosis of "Flexed RR SR".
Q3. A 35-year-old male presents with low back pain. On
examination, the right iliac crest is inferior and the right PSIS
is more prominent posteriorly. What is the diagnosis?
A) Right anterior innominate
B) Right posterior innominate
C) Left anterior innominate
D) Bilateral innominate dysfunction
Correct ,,,,,,answer,,,,,,: B) Right posterior innominate
Rationale: A posterior innominate rotation is a shear of the ilium
where the ilium moves posteriorly on the sacrum. Key findings
Bank All questions with correct verified answers & detailed
rationales verified based on current NBOME standards and
COMLEX-USA Level 1 blueprint for the 2026 examination
cycle
,Content Area Distribution
Content Area Approximate Percentage
Osteopathic Principles & Practice (OPP/OMT) ~12%
Foundational Biomedical Sciences ~25%
Clinical Systems ~45%
Behavioral Science/Biostatistics/Ethics ~10%
Multisystem/Interdisciplinary Topics ~8%
High-Yield Focus Areas: OMM (Sacral Torsions, Cranial Strains,
Chapman Points), Neuro (stroke/cranial nerves), Cardio
(murmurs/ECG), Ethics (autonomy, informed consent).
COMSAE Phase 2 & 3 Additions
For Phase 2 and 3, clinical reasoning and patient management
scenarios are emphasized, including Internal Medicine, Surgery,
Pediatrics, Obstetrics & Gynecology, Psychiatry, Family Medicine,
Emergency Medicine, Preventive Medicine, and patient
management.
,SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(OPP/OMT)
Questions 1-60
Q1. A 54-year-old man presents with crushing substernal
chest pain radiating to his left arm. ECG shows ST-segment
elevations in leads II, III, and aVF. Which coronary artery is
most likely occluded?
A) Left anterior descending artery
B) Circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct ,,,,,,answer,,,,,,: C) Right coronary artery
Rationale: Inferior wall myocardial infarctions involving leads II,
III, and aVF are most commonly associated with occlusion of the
right coronary artery (RCA). The RCA supplies the inferior wall of
the heart in most individuals. LAD occlusion usually causes
anterior wall MI, while circumflex artery occlusion commonly
causes lateral wall infarction.
Q2. A patient presents with a structural exam revealing a
restricted T5 segment. The segment prefers rotation to the
right and sidebending 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
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 sidebending
occur in the same direction. Hence, rotation right and
sidebending right yields a diagnosis of "Flexed RR SR".
Q3. A 35-year-old male presents with low back pain. On
examination, the right iliac crest is inferior and the right PSIS
is more prominent posteriorly. What is the diagnosis?
A) Right anterior innominate
B) Right posterior innominate
C) Left anterior innominate
D) Bilateral innominate dysfunction
Correct ,,,,,,answer,,,,,,: B) Right posterior innominate
Rationale: A posterior innominate rotation is a shear of the ilium
where the ilium moves posteriorly on the sacrum. Key findings
