COMSAE Phase 1 Form 114 | Mastery Study Guide & Question Bank | Complete Practice MCQs with Correct Answers & Detailed Rationales | Latest Update 2026/2027

COMSAE Phase 1 Form 114 | Mastery Study
Guide & Question Bank | Complete Practice
MCQs with Correct Answers & Detailed
Rationales | Latest Update 2026/2027

PART 1: EXAM OVERVIEW & STRUCTURE
What is COMSAE Phase 1 Form 114?
The Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE)
Phase 1 Form 114 is a practice exam administered by the National Board of Osteopathic
Medical Examiners (NBOME) to help osteopathic medical students assess their
readiness for COMLEX-USA Level 1. Form ASA 114 is available on a secure browser.
NBOME Content Blueprint

Domain Percentage

Osteopathic Principles & Practice (OPP) 20-25%

General Medicine 25-30%

Pathology 15-20%

Pharmacology 10-15%

Microbiology/Immunology 10-15%

Core Disciplines Tested
• Anatomy & Embryology
• Physiology & Pathophysiology
• Biochemistry & Molecular Biology
• Microbiology & Immunology
• Pharmacology
• Pathology
• Behavioral Science & Ethics
• Osteopathic Principles and Practice (OPP)

pg. 1

,PART 2: COMPLETE PRACTICE EXAM (MCQs)

SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP/OMM)
Topics: Fryette's principles, Chapman reflexes, viscerosomatic reflexes,
cranial OMM, sacral diagnosis


Question 1
A 24-year-old male presents with acute lower back pain after lifting heavy boxes.
Physical examination reveals a positive standing flexion test on the right. In the prone
position, the right ASIS is superior, and the right PSIS is inferior. What is the most likely
diagnosis?
A. Right anterior innominate rotation
B. Right posterior innominate rotation
C. Left superior innominate shear
D. Right superior innominate shear
Answer: B
Rationale: A positive standing flexion test localizes the side of somatic dysfunction to
the right. A posterior innominate rotation is characterized by an ASIS that is superior
and a PSIS that is inferior on the affected side.


Question 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
Answer: C
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.




pg. 2

,Question 3
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
C. T5 Flexed RR SR
D. T5 Flexed RL SL
Answer: C
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.


Question 4
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
Answer: A
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 5
A 45-year-old male presents with chronic low back pain. Physical examination reveals
an apparent short left leg, a left posterior superior iliac spine (PSIS) that is superior
compared to the right, and a left anterior inferior iliac spine (AIIS) that is inferior. What
is the most likely sacral diagnosis?
A. Right-on-right torsion
B. Left unilateral flexion
C. Left-on-left torsion
D. Right unilateral flexion
E. Left-on-right torsion


pg. 3

, Answer: C
Rationale: In a sacral torsion, the side of the oblique axis is named first, and the side of
the rotation is named second. The findings (deep sulcus on the right, shallow on the left;
ILA posterior on the left) indicate rotation around a left oblique axis.


Question 6
In Muscle Energy Technique (MET), the patient's contraction force should be:
A. Maximum effort for 10 seconds
B. Submaximal (about 20% of maximum) for 3-5 seconds
C. Isometric contraction held for 30 seconds
D. Rhythmic contraction and relaxation
Answer: B
Rationale: In MET, the patient uses a submaximal contraction (approximately 20% of
available strength) held for 3-5 seconds against a counterforce provided by the
physician.


Question 7
A patient presents with a right unilateral sacral flexion. Which of the following findings
would you expect on examination?
A. Deep right sulcus, prominent right ILA
B. Shallow right sulcus, prominent right ILA
C. Deep right sulcus, posterior right ILA
D. Shallow right sulcus, posterior left ILA
Answer: B
Rationale: In unilateral sacral flexion, the sulcus on the affected side is shallow, and
the ILA on the affected side is prominent (more posterior). The base of the sacrum is
flexed anteriorly on the affected side.


Question 8
What is the most appropriate treatment for a patient with an acute torticollis (wry neck)
with the head rotated to the right and side-bent to the left?
A. HVLA thrust to the left
B. Muscle energy to the right
C. Counterstrain for the right sternocleidomastoid
D. Myofascial release of the left trapezius

pg. 4