COMSAE Phase 1 Form 114 Test Bank |
200+ Practice Questions with Bold Italic
Answers & Rationales – NBOME
Osteopathic Medical Knowledge Self
Assessment Prep
The COMSAE Phase 1 Form 114 is a comprehensive self-assessment examination
designed by the NBOME (National Board of Osteopathic Medical Examiners) to help
osteopathic medical students prepare for COMLEX-USA Level 1. This test bank mirrors
the content, format, and difficulty of the actual examination.
Exam Structure:
• Total Questions: 200
• Format: Multiple-choice, single-best-answer
• Domains: Osteopathic Principles & Practice, Basic Sciences, Clinical Presentation
& Diagnosis
• Time Allotment: Simulates the actual 4-hour testing experience
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1–40)
,Question 1
A 45-year-old male presents with low back pain after lifting. 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.
The superior movement of the PSIS often correlates with a right anterior innominate,
where the ASIS is positioned anteriorly and inferiorly, creating a functional short leg.
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. This is a common
somatic dysfunction encountered in OPP.
Question 4
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. Knowing these points is essential for OPP and COMLEX preparation.
, Question 5
A patient presents with a sacral torsion on a left oblique axis. What is the most likely
position of the sacrum?
• A) Right rotation, left sidebending
• B) Left rotation, right sidebending
• C) Left rotation, left sidebending
• D) Right rotation, right sidebending
Correct Answer: A) Right rotation, left sidebending
Rationale: In a left oblique axis sacral torsion, the sacrum rotates to the right and
sidebends to the left. This is a classic OPP question frequently tested on COMSAE and
COMLEX.
Question 6
During an osteopathic structural examination, the physician notes that the patient's iliac
crests are at different heights. The right iliac crest is higher than the left. What is the
most likely diagnosis?
• A) Right short leg
• B) Left short leg
• C) Right pelvic torsion
• D) Left pelvic torsion
Correct Answer: A) Right short leg
Rationale: A higher iliac crest on the right indicates a relative short leg on the right. This
is because the pelvis tilts down on the side of the short leg, causing the opposite iliac
crest to elevate.
200+ Practice Questions with Bold Italic
Answers & Rationales – NBOME
Osteopathic Medical Knowledge Self
Assessment Prep
The COMSAE Phase 1 Form 114 is a comprehensive self-assessment examination
designed by the NBOME (National Board of Osteopathic Medical Examiners) to help
osteopathic medical students prepare for COMLEX-USA Level 1. This test bank mirrors
the content, format, and difficulty of the actual examination.
Exam Structure:
• Total Questions: 200
• Format: Multiple-choice, single-best-answer
• Domains: Osteopathic Principles & Practice, Basic Sciences, Clinical Presentation
& Diagnosis
• Time Allotment: Simulates the actual 4-hour testing experience
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1–40)
,Question 1
A 45-year-old male presents with low back pain after lifting. 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.
The superior movement of the PSIS often correlates with a right anterior innominate,
where the ASIS is positioned anteriorly and inferiorly, creating a functional short leg.
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. This is a common
somatic dysfunction encountered in OPP.
Question 4
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. Knowing these points is essential for OPP and COMLEX preparation.
, Question 5
A patient presents with a sacral torsion on a left oblique axis. What is the most likely
position of the sacrum?
• A) Right rotation, left sidebending
• B) Left rotation, right sidebending
• C) Left rotation, left sidebending
• D) Right rotation, right sidebending
Correct Answer: A) Right rotation, left sidebending
Rationale: In a left oblique axis sacral torsion, the sacrum rotates to the right and
sidebends to the left. This is a classic OPP question frequently tested on COMSAE and
COMLEX.
Question 6
During an osteopathic structural examination, the physician notes that the patient's iliac
crests are at different heights. The right iliac crest is higher than the left. What is the
most likely diagnosis?
• A) Right short leg
• B) Left short leg
• C) Right pelvic torsion
• D) Left pelvic torsion
Correct Answer: A) Right short leg
Rationale: A higher iliac crest on the right indicates a relative short leg on the right. This
is because the pelvis tilts down on the side of the short leg, causing the opposite iliac
crest to elevate.
