COMSAE 110 EXAM 2026–2027 | (176 QUESTIONS AND CORRECT
ANSWERS) | ALREADY GRADED A+ | 100% VERIFIED
Osteopathic Medicine & Clinical Sciences | National Board of Osteopathic Medical Examiners (NBOME) | Key
Domains: Foundational Biomedical Sciences, Osteopathic Principles and Practice (OPP), Clinical Medicine,
Pharmacology, Pathology, and Patient-Centered Care | Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured practice examination for 2026-2027 provides the complete layout for generating
high-quality exam-style questions with correct answers and rationales. It emphasizes foundational
osteopathic medical principles, evidence-based clinical reasoning, patient safety protocols, and
NBOME guideline adherence critical to professional medical practice and successful COMLEX-USA
Level 1 preparation. DISCLAIMER: This document contains ORIGINAL practice questions developed
for study purposes aligned to NBOME COMSAE/COMLEX blueprint. It does NOT contain actual
confidential NBOME COMSAE Form 110 items and is not affiliated with NBOME. Use for educational
review only. Form 110 comprises 176 questions divided into 4 sections of 44.
Answer Format & STRICT RANDOMIZATION PROTOCOL
All correct answers appear in bold and cyan, accompanied by concise rationales explaining clinical
reasoning, OPP principles, and why alternative options are less appropriate. Placement of correct
choice (A, B, C, or D) is strictly and unpredictably randomized with even distribution (44 each) and
no 3 consecutive identical letters to guarantee authentic simulation.
--- SECTION 1 - Questions 1 to 44 ---
Question 1: Which nerve provides parasympathetic innervation to the parotid gland via otic
ganglion?
A. Facial nerve CN VII via chorda tympani
B. Trigeminal nerve V3 only
C. Hypoglossal nerve CN XII
D. Glossopharyngeal nerve (CN IX) via tympanic nerve and lesser petrosal nerve
Correct Answer: D – Glossopharyngeal nerve (CN IX) via tympanic nerve and lesser petrosal
nerve
Rationale: CN IX carries parasympathetic from inferior salivatory nucleus -> tympanic nerve -> lesser petrosal -
> otic ganglion -> auriculotemporal nerve to parotid. CN VII to submandibular/sublingual/lacrimal. CN III to
ciliary. Trigeminal sensory not parasympathetic.
Question 2: Somatic dysfunction with vertebra rotated right and sidebent right is described
as:
, A. Physiologic normal motion
B. Only muscle spasm without joint component
C. Neutral with rotation and sidebending opposite - type I
D. Non-neutral with rotation and sidebending to same side - typical for lumbar/thoracic type II
Correct Answer: D – Non-neutral with rotation and sidebending to same side - typical for
lumbar/thoracic type II
Rationale: Fryette: Type II single segment dysfunction - non-neutral mechanics, RS and SB same side,
restriction opposite. Type I group curve neutral, R and SB opposite.
Question 3: Chapman's point for appendix is located:
A. Clavicle bilateral
B. Left anterior thigh only
C. Right anterior - tip of 12th rib extending toward umbilicus, and posterior near right T11-T12
transverse process region
D. Posterior sacrum only
Correct Answer: C – Right anterior - tip of 12th rib extending toward umbilicus, and posterior
near right T11-T12 transverse process region
Rationale: Chapman's reflex anterior appendix at right 12th rib tip near lateral abdominal, posterior at T11-T12
intertransverse. Indicates visceral dysfunction via lymphatic/neuro.
Question 4: Counterstrain tender point for anterior Knee: quadriceps?
A. Treat with extension only
B. Posterior point only never anterior
C. Anterior tender point inferior pole patella region, treat with knee flexion, tender point position
of comfort ~90 sec
D. No tender point exists for knee
Correct Answer: C – Anterior tender point inferior pole patella region, treat with knee flexion,
tender point position of comfort ~90 sec
Rationale: Anterior knee counterstrain often inferior patella region treat with knee flexion (shortening
quadriceps). Posterior knee with extension.
,Question 5: Muscle energy technique for forward sacral torsion left-on-left (L on L) includes:
A. Cranial technique only
B. No patient effort, passive only
C. High velocity thrust only at L5
D. Patient in supine, practitioner resists isometric contraction of deep sacral muscles using lower
extremity as lever
Correct Answer: D – Patient in supine, practitioner resists isometric contraction of deep sacral
muscles using lower extremity as lever
Rationale: Muscle energy uses patient voluntary isometric contraction against practitioner resistance to
reposition sacrum, correct sacral torsion. HVLA contraindicated in osteoporosis, RA, Down syndrome
atlantoaxial etc.
Question 6: High velocity low amplitude (HVLA) contraindication includes:
A. Somatic dysfunction in healthy adult
B. Down syndrome with atlantoaxial instability, severe osteoporosis, fracture, tumor, infection,
vertebrobasilar insufficiency for cervical
C. Acute low back pain without red flags
D. Mild muscle spasm without neurologic deficit
Correct Answer: B – Down syndrome with atlantoaxial instability, severe osteoporosis,
fracture, tumor, infection, vertebrobasilar insufficiency for cervical
Rationale: HVLA absolute/relative contraindications: unstable atlantoaxial, severe osteoporosis, fracture,
infection, tumor, hematoma, anticoagulation severe, vertebrobasilar signs for cervical.
Question 7: Sacrum: Right unilateral sacral flexion (anterior sacrum) is:
A. Not a real sacral diagnosis
B. Bilateral flexion from respiratory motion only
C. Right sacral base moves anterior and inferior relative to ilium, deep sulcus on right, restriction
extension
D. Right base posterior
Correct Answer: C – Right sacral base moves anterior and inferior relative to ilium, deep
sulcus on right, restriction extension
, Rationale: Anterior sacrum base anterior deeper sulcus, ILA posterior inferior. Restriction posterior extension.
Treat muscle energy.
Question 8: Cranial strain pattern with sphenoid and occiput rotating opposite directions
around parallel axes is:
A. Extension pattern
B. Torsion - twist around AP axis, named for sphenoid side high
C. Compression pattern
D. Flexion pattern
Correct Answer: B – Torsion - twist around AP axis, named for sphenoid side high
Rationale: Cranial: flexion sphenoid and occiput flex together, extension extend together, torsion opposite
rotation around AP axis, sidebending/rotation around vertical/AP. Torsion named for high side of sphenoid.
Question 9: Anatomy: thoracic duct drains into venous system at:
A. Junction of right subclavian and right jugular
B. Inferior vena cava
C. Right atrium directly
D. Junction of left subclavian and left internal jugular veins (left venous angle)
Correct Answer: D – Junction of left subclavian and left internal jugular veins (left venous
angle)
Rationale: Thoracic duct left lymphatic drains left side body and both legs, enters left venous angle. Right
lymphatic duct drains right upper quadrant into right venous angle.
Question 10: Brachial plexus injury of C5-C6 (Erb palsy) presents as:
A. Winged scapula only
B. Foot drop
C. Waiter's tip: arm adducted internally rotated, extended elbow, pronated forearm due to loss of
deltoid, biceps, brachialis, supinator
D. Claw hand C8-T1
Correct Answer: C – Waiter's tip: arm adducted internally rotated, extended elbow, pronated
forearm due to loss of deltoid, biceps, brachialis, supinator
ANSWERS) | ALREADY GRADED A+ | 100% VERIFIED
Osteopathic Medicine & Clinical Sciences | National Board of Osteopathic Medical Examiners (NBOME) | Key
Domains: Foundational Biomedical Sciences, Osteopathic Principles and Practice (OPP), Clinical Medicine,
Pharmacology, Pathology, and Patient-Centered Care | Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured practice examination for 2026-2027 provides the complete layout for generating
high-quality exam-style questions with correct answers and rationales. It emphasizes foundational
osteopathic medical principles, evidence-based clinical reasoning, patient safety protocols, and
NBOME guideline adherence critical to professional medical practice and successful COMLEX-USA
Level 1 preparation. DISCLAIMER: This document contains ORIGINAL practice questions developed
for study purposes aligned to NBOME COMSAE/COMLEX blueprint. It does NOT contain actual
confidential NBOME COMSAE Form 110 items and is not affiliated with NBOME. Use for educational
review only. Form 110 comprises 176 questions divided into 4 sections of 44.
Answer Format & STRICT RANDOMIZATION PROTOCOL
All correct answers appear in bold and cyan, accompanied by concise rationales explaining clinical
reasoning, OPP principles, and why alternative options are less appropriate. Placement of correct
choice (A, B, C, or D) is strictly and unpredictably randomized with even distribution (44 each) and
no 3 consecutive identical letters to guarantee authentic simulation.
--- SECTION 1 - Questions 1 to 44 ---
Question 1: Which nerve provides parasympathetic innervation to the parotid gland via otic
ganglion?
A. Facial nerve CN VII via chorda tympani
B. Trigeminal nerve V3 only
C. Hypoglossal nerve CN XII
D. Glossopharyngeal nerve (CN IX) via tympanic nerve and lesser petrosal nerve
Correct Answer: D – Glossopharyngeal nerve (CN IX) via tympanic nerve and lesser petrosal
nerve
Rationale: CN IX carries parasympathetic from inferior salivatory nucleus -> tympanic nerve -> lesser petrosal -
> otic ganglion -> auriculotemporal nerve to parotid. CN VII to submandibular/sublingual/lacrimal. CN III to
ciliary. Trigeminal sensory not parasympathetic.
Question 2: Somatic dysfunction with vertebra rotated right and sidebent right is described
as:
, A. Physiologic normal motion
B. Only muscle spasm without joint component
C. Neutral with rotation and sidebending opposite - type I
D. Non-neutral with rotation and sidebending to same side - typical for lumbar/thoracic type II
Correct Answer: D – Non-neutral with rotation and sidebending to same side - typical for
lumbar/thoracic type II
Rationale: Fryette: Type II single segment dysfunction - non-neutral mechanics, RS and SB same side,
restriction opposite. Type I group curve neutral, R and SB opposite.
Question 3: Chapman's point for appendix is located:
A. Clavicle bilateral
B. Left anterior thigh only
C. Right anterior - tip of 12th rib extending toward umbilicus, and posterior near right T11-T12
transverse process region
D. Posterior sacrum only
Correct Answer: C – Right anterior - tip of 12th rib extending toward umbilicus, and posterior
near right T11-T12 transverse process region
Rationale: Chapman's reflex anterior appendix at right 12th rib tip near lateral abdominal, posterior at T11-T12
intertransverse. Indicates visceral dysfunction via lymphatic/neuro.
Question 4: Counterstrain tender point for anterior Knee: quadriceps?
A. Treat with extension only
B. Posterior point only never anterior
C. Anterior tender point inferior pole patella region, treat with knee flexion, tender point position
of comfort ~90 sec
D. No tender point exists for knee
Correct Answer: C – Anterior tender point inferior pole patella region, treat with knee flexion,
tender point position of comfort ~90 sec
Rationale: Anterior knee counterstrain often inferior patella region treat with knee flexion (shortening
quadriceps). Posterior knee with extension.
,Question 5: Muscle energy technique for forward sacral torsion left-on-left (L on L) includes:
A. Cranial technique only
B. No patient effort, passive only
C. High velocity thrust only at L5
D. Patient in supine, practitioner resists isometric contraction of deep sacral muscles using lower
extremity as lever
Correct Answer: D – Patient in supine, practitioner resists isometric contraction of deep sacral
muscles using lower extremity as lever
Rationale: Muscle energy uses patient voluntary isometric contraction against practitioner resistance to
reposition sacrum, correct sacral torsion. HVLA contraindicated in osteoporosis, RA, Down syndrome
atlantoaxial etc.
Question 6: High velocity low amplitude (HVLA) contraindication includes:
A. Somatic dysfunction in healthy adult
B. Down syndrome with atlantoaxial instability, severe osteoporosis, fracture, tumor, infection,
vertebrobasilar insufficiency for cervical
C. Acute low back pain without red flags
D. Mild muscle spasm without neurologic deficit
Correct Answer: B – Down syndrome with atlantoaxial instability, severe osteoporosis,
fracture, tumor, infection, vertebrobasilar insufficiency for cervical
Rationale: HVLA absolute/relative contraindications: unstable atlantoaxial, severe osteoporosis, fracture,
infection, tumor, hematoma, anticoagulation severe, vertebrobasilar signs for cervical.
Question 7: Sacrum: Right unilateral sacral flexion (anterior sacrum) is:
A. Not a real sacral diagnosis
B. Bilateral flexion from respiratory motion only
C. Right sacral base moves anterior and inferior relative to ilium, deep sulcus on right, restriction
extension
D. Right base posterior
Correct Answer: C – Right sacral base moves anterior and inferior relative to ilium, deep
sulcus on right, restriction extension
, Rationale: Anterior sacrum base anterior deeper sulcus, ILA posterior inferior. Restriction posterior extension.
Treat muscle energy.
Question 8: Cranial strain pattern with sphenoid and occiput rotating opposite directions
around parallel axes is:
A. Extension pattern
B. Torsion - twist around AP axis, named for sphenoid side high
C. Compression pattern
D. Flexion pattern
Correct Answer: B – Torsion - twist around AP axis, named for sphenoid side high
Rationale: Cranial: flexion sphenoid and occiput flex together, extension extend together, torsion opposite
rotation around AP axis, sidebending/rotation around vertical/AP. Torsion named for high side of sphenoid.
Question 9: Anatomy: thoracic duct drains into venous system at:
A. Junction of right subclavian and right jugular
B. Inferior vena cava
C. Right atrium directly
D. Junction of left subclavian and left internal jugular veins (left venous angle)
Correct Answer: D – Junction of left subclavian and left internal jugular veins (left venous
angle)
Rationale: Thoracic duct left lymphatic drains left side body and both legs, enters left venous angle. Right
lymphatic duct drains right upper quadrant into right venous angle.
Question 10: Brachial plexus injury of C5-C6 (Erb palsy) presents as:
A. Winged scapula only
B. Foot drop
C. Waiter's tip: arm adducted internally rotated, extended elbow, pronated forearm due to loss of
deltoid, biceps, brachialis, supinator
D. Claw hand C8-T1
Correct Answer: C – Waiter's tip: arm adducted internally rotated, extended elbow, pronated
forearm due to loss of deltoid, biceps, brachialis, supinator
