COMSAE PHASE 1 FORM 114 Actual
EXAM – 176 QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM
UPDATE | STUVIA VERIFIED | EXAM PREP
| STUDY GUIDE | PRACTICE TEST
The COMSAE Phase 1 Form 114 is a comprehensive self-assessment examination
developed by the NBOME (National Board of Osteopathic Medical Examiners) to help
osteopathic medical students prepare for COMLEX-USA Level 1. The actual exam
contains 176 items divided into four sections of 44 questions each in single-best-
answer format.
Content Areas Covered:
• Osteopathic Principles & Practice (OPP) — Fryette's laws, sacral torsions,
cranial strain patterns, Chapman reflexes, counterstrain
• Foundational Biomedical Sciences — Anatomy, Biochemistry, Microbiology,
Pathology, Pharmacology, Physiology
• Clinical Presentation Integration — Diagnosis, patient management, and
clinical reasoning
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
— Questions 1–44
,Question 1
A 45-year-old male presents with low back pain after lifting a box. On examination, the
standing flexion test shows superior movement of the right PSIS. Which somatic
dysfunction is most likely?
• A) Right anterior innominate
• B) Left posterior innominate
• C) Right sacral torsion on a left oblique axis
• D) Bilateral innominate rotation
Correct Answer: A) Right anterior innominate
Rationale: A positive standing flexion test on the right suggests iliosacral dysfunction on
that side. For a right anterior innominate, the right ASIS is positioned more inferiorly,
creating a functional short right leg and a positive standing flexion test on the right.
Question 2
According to Fryette's first principle (Type I mechanics), when the spine is in a neutral
position, sidebending and rotation occur:
• A) To the same side
• B) To opposite sides
• C) Without rotation
• D) Only in the lumbar spine
Correct Answer: B) To opposite sides
,Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. For example, sidebending
right is accompanied by rotation left.
Question 3
A patient has a somatic dysfunction described as "left fibular head, posterior." What
motion is restricted?
• A) Anterior glide
• B) Posterior glide
• C) Lateral glide
• D) Medial glide
Correct Answer: A) Anterior glide
Rationale: A posterior fibular head restricts anterior glide. Treatment involves applying
an anterior force to the fibular head to restore normal motion.
Question 4
According to Fryette's third principle, when the spine is in a non-neutral position (flexion
or extension), sidebending and rotation occur:
• A) To the same side
• B) To opposite sides
• C) Without any pattern
• D) Only in the thoracic spine
Correct Answer: A) To the same side
, Rationale: Fryette's third principle states that when the spine is in a non-neutral position,
sidebending and rotation occur to the same side. Type II mechanics involve single
vertebral segments where rotation and sidebending occur in opposite directions.
Question 5
Which of the following is a Chapman reflex point for the heart?
• A) 2nd intercostal space, midclavicular line
• B) 4th intercostal space, sternal border
• C) 3rd intercostal space, midclavicular line
• D) 5th intercostal space, anterior axillary line
Correct Answer: B) 4th intercostal space, sternal border
Rationale: Chapman reflexes are viscerosomatic reflexes that present as small, tender
nodules. The heart's Chapman reflex is located in the 4th intercostal space near the
sternal border.
Question 6
A patient presents with a somatic dysfunction of the sacrum. You note that the left
sulcus is deeper than the right, and the left ILA is more posterior than the right. What is
the diagnosis?
• A) Left-on-Left L5 dysfunction
• B) Right On Left Torsion
• C) Left On Right Torsion
• D) Bilateral Sacral Flexion
EXAM – 176 QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM
UPDATE | STUVIA VERIFIED | EXAM PREP
| STUDY GUIDE | PRACTICE TEST
The COMSAE Phase 1 Form 114 is a comprehensive self-assessment examination
developed by the NBOME (National Board of Osteopathic Medical Examiners) to help
osteopathic medical students prepare for COMLEX-USA Level 1. The actual exam
contains 176 items divided into four sections of 44 questions each in single-best-
answer format.
Content Areas Covered:
• Osteopathic Principles & Practice (OPP) — Fryette's laws, sacral torsions,
cranial strain patterns, Chapman reflexes, counterstrain
• Foundational Biomedical Sciences — Anatomy, Biochemistry, Microbiology,
Pathology, Pharmacology, Physiology
• Clinical Presentation Integration — Diagnosis, patient management, and
clinical reasoning
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
— Questions 1–44
,Question 1
A 45-year-old male presents with low back pain after lifting a box. On examination, the
standing flexion test shows superior movement of the right PSIS. Which somatic
dysfunction is most likely?
• A) Right anterior innominate
• B) Left posterior innominate
• C) Right sacral torsion on a left oblique axis
• D) Bilateral innominate rotation
Correct Answer: A) Right anterior innominate
Rationale: A positive standing flexion test on the right suggests iliosacral dysfunction on
that side. For a right anterior innominate, the right ASIS is positioned more inferiorly,
creating a functional short right leg and a positive standing flexion test on the right.
Question 2
According to Fryette's first principle (Type I mechanics), when the spine is in a neutral
position, sidebending and rotation occur:
• A) To the same side
• B) To opposite sides
• C) Without rotation
• D) Only in the lumbar spine
Correct Answer: B) To opposite sides
,Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. For example, sidebending
right is accompanied by rotation left.
Question 3
A patient has a somatic dysfunction described as "left fibular head, posterior." What
motion is restricted?
• A) Anterior glide
• B) Posterior glide
• C) Lateral glide
• D) Medial glide
Correct Answer: A) Anterior glide
Rationale: A posterior fibular head restricts anterior glide. Treatment involves applying
an anterior force to the fibular head to restore normal motion.
Question 4
According to Fryette's third principle, when the spine is in a non-neutral position (flexion
or extension), sidebending and rotation occur:
• A) To the same side
• B) To opposite sides
• C) Without any pattern
• D) Only in the thoracic spine
Correct Answer: A) To the same side
, Rationale: Fryette's third principle states that when the spine is in a non-neutral position,
sidebending and rotation occur to the same side. Type II mechanics involve single
vertebral segments where rotation and sidebending occur in opposite directions.
Question 5
Which of the following is a Chapman reflex point for the heart?
• A) 2nd intercostal space, midclavicular line
• B) 4th intercostal space, sternal border
• C) 3rd intercostal space, midclavicular line
• D) 5th intercostal space, anterior axillary line
Correct Answer: B) 4th intercostal space, sternal border
Rationale: Chapman reflexes are viscerosomatic reflexes that present as small, tender
nodules. The heart's Chapman reflex is located in the 4th intercostal space near the
sternal border.
Question 6
A patient presents with a somatic dysfunction of the sacrum. You note that the left
sulcus is deeper than the right, and the left ILA is more posterior than the right. What is
the diagnosis?
• A) Left-on-Left L5 dysfunction
• B) Right On Left Torsion
• C) Left On Right Torsion
• D) Bilateral Sacral Flexion
