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
Core Domains
• Osteopathic Principles and Practice (OPP) – Fryette's Principles,
Sacral Diagnosis, Viscerosomatic Reflexes, Chapman Reflexes,
Myofascial Release, HVLA, Counterstrain
• Cardiovascular System – Ischemic Heart Disease, Heart Failure,
Arrhythmias, Valvular Disease, Hypertension
• Pulmonary System – COPD, Asthma, Interstitial Lung Disease,
Pulmonary Embolism, Pneumonia
• Gastrointestinal System – Peptic Ulcer Disease, Inflammatory
Bowel Disease, Hepatobiliary Disorders, Esophageal Disorders
• Infectious Disease – Bacterial, Viral, Fungal, and Parasitic
Infections; HIV/AIDS; Antimicrobial Therapy
• Pharmacology – Pharmacokinetics, Pharmacodynamics,
Autonomic Pharmacology, Cardiovascular Drugs, Antimicrobials,
Endocrine Drugs
• Endocrine and Metabolic Disorders – Diabetes Mellitus, Thyroid
Disorders, Adrenal Disorders, Calcium and Bone Metabolism
• Neurology – Stroke, Seizures, Headaches, Neurodegenerative
Disorders, Peripheral Neuropathy
, • Renal and Genitourinary System – Acute Kidney Injury, Chronic
Kidney Disease, Glomerulonephritis, Urinary Tract Infections
• Hematology and Oncology – Anemia, Coagulation Disorders,
Leukemia, Lymphoma, Lung Cancer, Breast Cancer, Colorectal
Cancer
• Rheumatology and Immunology – Rheumatoid Arthritis, Systemic
Lupus Erythematosus, Vasculitis, Complement Deficiencies
• Biostatistics and Epidemiology – Study Design, Sensitivity,
Specificity, Predictive Values, Odds Ratio, Relative Risk
Introduction
This comprehensive COMSAE Phase 1 Form 114 examination is
designed to evaluate the osteopathic medical student's foundational
knowledge and clinical reasoning across the basic and clinical sciences.
It measures the candidate's ability to integrate osteopathic principles
with evidence-based medicine, interpret clinical presentations, and
apply diagnostic and therapeutic reasoning to patient care scenarios.
The exam consists of 176 single-best-answer, multiple-choice questions,
divided into four sections of 44 questions each, covering essential
domains including osteopathic manipulative treatment, pathophysiology,
pharmacology, microbiology, and clinical medicine. Success on this
examination demonstrates readiness for COMLEX-USA Level 1 and the
ability to apply osteopathic principles in clinical practice.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1-44)
1. A 45-year-old male presents with chronic low back pain. Physical
examination reveals a short left leg (apparent), 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
compared to the right. What is the most likely sacral diagnosis?
A. Left-on-left torsion
B. Right-on-right torsion
C. Left unilateral flexion
D. Right unilateral flexion
E. Left-on-right torsion
A. Left-on-left torsion
RATIONALE: In a sacral torsion, the side of the oblique axis is
named first, and the side of the base rotation is named second. A deep
sulcus on the right and shallow on the left indicates the base is rotated
anteriorly on the left. The ILA being posterior on the left indicates the
axis is on the left. Thus, left-on-left torsion.
2. A patient with COPD is in respiratory distress. You note
significant rib elevation and restricted motion on the left side during
inspiration. Using a direct technique, you apply a force to the
superior aspect of the left transverse process. Which rib dysfunction
is being treated?
A. Pump handle
B. Bucket handle
C. Caliper
D. Somatic dysfunction of rib 1
B. Bucket handle
RATIONALE: The bucket handle component of rib motion involves
lateral movement of the rib shaft. The dysfunctional transverse process
(the pivot point) is treated by applying a force to correct the lateral
motion.
, 3. A patient with a history of chronic bronchitis presents with an
acute exacerbation and dyspnea. On osteopathic structural exam,
you find restriction of the rib cage in the mid-to-lower thoracic
region with somatic dysfunction at T4-T6. Which viscerosomatic
reflex pattern is most likely?
A. Sympathetic via T1-T4 → upper GI
B. Sympathetic via T1-T5 → heart and lung
C. Sympathetic via T5-T9 → foregut
D. Parasympathetic via vagus → bronchioles
B. Sympathetic via T1-T5 → heart and lung
RATIONALE: Viscerosomatic reflexes related to pulmonary
pathology often involve sympathetic outflow from T1-T5, which
supplies the heart and lungs. Somatic dysfunction in this region may be
associated with underlying pulmonary disease.
4. A 45-year-old male presents with low back pain after lifting a box.
Standing flexion test shows superior movement of the right PSIS.
Which somatic dysfunction is most likely?
A. Right anterior innominate
B. Left anterior innominate
C. Right sacral torsion
D. Left sacral torsion
A. Right anterior innominate
RATIONALE: The standing flexion test is positive on the side of
iliosacral dysfunction. In a right anterior innominate, the right ASIS is
more inferior, causing a functional short right leg and positive standing
flexion test on the right.
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE |
STUVIA VERIFIED | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
Core Domains
• Osteopathic Principles and Practice (OPP) – Fryette's Principles,
Sacral Diagnosis, Viscerosomatic Reflexes, Chapman Reflexes,
Myofascial Release, HVLA, Counterstrain
• Cardiovascular System – Ischemic Heart Disease, Heart Failure,
Arrhythmias, Valvular Disease, Hypertension
• Pulmonary System – COPD, Asthma, Interstitial Lung Disease,
Pulmonary Embolism, Pneumonia
• Gastrointestinal System – Peptic Ulcer Disease, Inflammatory
Bowel Disease, Hepatobiliary Disorders, Esophageal Disorders
• Infectious Disease – Bacterial, Viral, Fungal, and Parasitic
Infections; HIV/AIDS; Antimicrobial Therapy
• Pharmacology – Pharmacokinetics, Pharmacodynamics,
Autonomic Pharmacology, Cardiovascular Drugs, Antimicrobials,
Endocrine Drugs
• Endocrine and Metabolic Disorders – Diabetes Mellitus, Thyroid
Disorders, Adrenal Disorders, Calcium and Bone Metabolism
• Neurology – Stroke, Seizures, Headaches, Neurodegenerative
Disorders, Peripheral Neuropathy
, • Renal and Genitourinary System – Acute Kidney Injury, Chronic
Kidney Disease, Glomerulonephritis, Urinary Tract Infections
• Hematology and Oncology – Anemia, Coagulation Disorders,
Leukemia, Lymphoma, Lung Cancer, Breast Cancer, Colorectal
Cancer
• Rheumatology and Immunology – Rheumatoid Arthritis, Systemic
Lupus Erythematosus, Vasculitis, Complement Deficiencies
• Biostatistics and Epidemiology – Study Design, Sensitivity,
Specificity, Predictive Values, Odds Ratio, Relative Risk
Introduction
This comprehensive COMSAE Phase 1 Form 114 examination is
designed to evaluate the osteopathic medical student's foundational
knowledge and clinical reasoning across the basic and clinical sciences.
It measures the candidate's ability to integrate osteopathic principles
with evidence-based medicine, interpret clinical presentations, and
apply diagnostic and therapeutic reasoning to patient care scenarios.
The exam consists of 176 single-best-answer, multiple-choice questions,
divided into four sections of 44 questions each, covering essential
domains including osteopathic manipulative treatment, pathophysiology,
pharmacology, microbiology, and clinical medicine. Success on this
examination demonstrates readiness for COMLEX-USA Level 1 and the
ability to apply osteopathic principles in clinical practice.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1-44)
1. A 45-year-old male presents with chronic low back pain. Physical
examination reveals a short left leg (apparent), 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
compared to the right. What is the most likely sacral diagnosis?
A. Left-on-left torsion
B. Right-on-right torsion
C. Left unilateral flexion
D. Right unilateral flexion
E. Left-on-right torsion
A. Left-on-left torsion
RATIONALE: In a sacral torsion, the side of the oblique axis is
named first, and the side of the base rotation is named second. A deep
sulcus on the right and shallow on the left indicates the base is rotated
anteriorly on the left. The ILA being posterior on the left indicates the
axis is on the left. Thus, left-on-left torsion.
2. A patient with COPD is in respiratory distress. You note
significant rib elevation and restricted motion on the left side during
inspiration. Using a direct technique, you apply a force to the
superior aspect of the left transverse process. Which rib dysfunction
is being treated?
A. Pump handle
B. Bucket handle
C. Caliper
D. Somatic dysfunction of rib 1
B. Bucket handle
RATIONALE: The bucket handle component of rib motion involves
lateral movement of the rib shaft. The dysfunctional transverse process
(the pivot point) is treated by applying a force to correct the lateral
motion.
, 3. A patient with a history of chronic bronchitis presents with an
acute exacerbation and dyspnea. On osteopathic structural exam,
you find restriction of the rib cage in the mid-to-lower thoracic
region with somatic dysfunction at T4-T6. Which viscerosomatic
reflex pattern is most likely?
A. Sympathetic via T1-T4 → upper GI
B. Sympathetic via T1-T5 → heart and lung
C. Sympathetic via T5-T9 → foregut
D. Parasympathetic via vagus → bronchioles
B. Sympathetic via T1-T5 → heart and lung
RATIONALE: Viscerosomatic reflexes related to pulmonary
pathology often involve sympathetic outflow from T1-T5, which
supplies the heart and lungs. Somatic dysfunction in this region may be
associated with underlying pulmonary disease.
4. A 45-year-old male presents with low back pain after lifting a box.
Standing flexion test shows superior movement of the right PSIS.
Which somatic dysfunction is most likely?
A. Right anterior innominate
B. Left anterior innominate
C. Right sacral torsion
D. Left sacral torsion
A. Right anterior innominate
RATIONALE: The standing flexion test is positive on the side of
iliosacral dysfunction. In a right anterior innominate, the right ASIS is
more inferior, causing a functional short right leg and positive standing
flexion test on the right.
