COMSAE PHASE 1 FORM 114 QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026/2027
Q&A | INSTANT DOWNLOAD PDF
Core Domains
Osteopathic Principles and Practice (OPP/OMT)
Anatomy and Embryology
Physiology and Pathophysiology
Biochemistry and Molecular Biology
Microbiology and Immunology
Pathology and Histology
Pharmacology and Toxicology
Cardiovascular System
Respiratory System
Gastrointestinal and Renal Systems
Neurological System and Psychiatry
Endocrine and Metabolic System
Musculoskeletal System and Rheumatology
Hematology and Oncology
Behavioral Science, Biostatistics, and Medical Ethics
Multisystem Integration and Clinical Decision-Making
Introduction
This comprehensive examination assesses the foundational biomedical science
knowledge and osteopathic principles required for success on the COMSAE
Phase 1 Form 114. It evaluates mastery of anatomy, physiology, biochemistry,
microbiology, immunology, pathology, pharmacology, and osteopathic
manipulative medicine through single-best-answer, multiple-choice questions
organized into four sections of 44 questions each. The exam emphasizes
,integration of basic science mechanisms with clinical presentations, laboratory
findings, and diagnostic reasoning. Candidates must demonstrate competency
in identifying disease pathophysiology, interpreting diagnostic studies,
applying osteopathic principles, and understanding pharmacologic
mechanisms. This assessment prepares osteopathic medical students for the
COMLEX-USA Level 1 while reinforcing evidence-based clinical decision-
making.
Section One: Questions 1–100
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. Left posterior innominate
B. Right anterior innominate
C. Right sacral torsion on a left oblique axis
D. Bilateral innominate rotation
B. 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 anteriorly and inferiorly, creating a functional short right leg and a
positive standing flexion test on the right.
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
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.
3. Which cranial technique is specifically designed to enhance the
amplitude of the cranial rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV4)
C. V-spread technique
D. Frontal lift
B. Bulb compression (CV4)
Rationale: Compression of the fourth ventricle (CV4) is explicitly utilized to
encourage fluid movement, enhance the amplitude of the CRI, and assist with
autonomic nervous system balancing.
4. A 45-year-old female presents with pain along the medial aspect of
her right knee. Palpation reveals a tender point on the medial surface
of the tibia, approximately 2 cm below the joint line. Which position is
used for counterstrain treatment?
A. Flexion, Abduction, External Rotation
B. Flexion, Adduction, Internal Rotation
C. Extension, Abduction, External Rotation
D. Extension, Adduction, Internal Rotation
B. Flexion, Adduction, Internal Rotation
Rationale: The medial knee tender point is treated with hip/knee flexion,
adduction, and internal rotation of the tibia to shorten the affected muscle and
reduce the tender point.
5. A 28-year-old female presents with a distinct, migratory, butterfly-
shaped rash across her cheeks and nasal bridge that worsens after sun
exposure. Laboratory testing reveals positive antinuclear antibodies
, (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. What
is the most likely diagnosis?
A. Dermatomyositis
B. Systemic lupus erythematosus
C. Rosacea
D. Seborrheic dermatitis
B. Systemic lupus erythematosus
Rationale: SLE is a chronic autoimmune disease characterized by a malar
(butterfly) rash that exhibits photosensitivity. The presence of highly specific
antibodies like anti-dsDNA confirms the diagnosis.
6. A 62-year-old male with a history of chronic smoking presents with
an emergency onset of severe, tearing chest pain that radiates directly
to his back between his scapulae. His blood pressure is 180/100 mmHg
in the right arm and 140/85 mmHg in the left arm. What is the most
immediate life-threatening condition to suspect?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
D. Tension pneumothorax
B. Acute aortic dissection
Rationale: A tearing or ripping chest pain radiating to the back, coupled with
an asymmetric blood pressure differential between the upper extremities (>20
mmHg variation), is highly indicative of an acute aortic dissection.
7. During an osteopathic structural exam for a patient with suspected
acute appendicitis, the physician looks for a Chapman's reflex point.
Where is the anterior Chapman's reflex point for the appendix located?
A. At the tip of the right 12th rib
B. At the tip of the right 11th rib
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026/2027
Q&A | INSTANT DOWNLOAD PDF
Core Domains
Osteopathic Principles and Practice (OPP/OMT)
Anatomy and Embryology
Physiology and Pathophysiology
Biochemistry and Molecular Biology
Microbiology and Immunology
Pathology and Histology
Pharmacology and Toxicology
Cardiovascular System
Respiratory System
Gastrointestinal and Renal Systems
Neurological System and Psychiatry
Endocrine and Metabolic System
Musculoskeletal System and Rheumatology
Hematology and Oncology
Behavioral Science, Biostatistics, and Medical Ethics
Multisystem Integration and Clinical Decision-Making
Introduction
This comprehensive examination assesses the foundational biomedical science
knowledge and osteopathic principles required for success on the COMSAE
Phase 1 Form 114. It evaluates mastery of anatomy, physiology, biochemistry,
microbiology, immunology, pathology, pharmacology, and osteopathic
manipulative medicine through single-best-answer, multiple-choice questions
organized into four sections of 44 questions each. The exam emphasizes
,integration of basic science mechanisms with clinical presentations, laboratory
findings, and diagnostic reasoning. Candidates must demonstrate competency
in identifying disease pathophysiology, interpreting diagnostic studies,
applying osteopathic principles, and understanding pharmacologic
mechanisms. This assessment prepares osteopathic medical students for the
COMLEX-USA Level 1 while reinforcing evidence-based clinical decision-
making.
Section One: Questions 1–100
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. Left posterior innominate
B. Right anterior innominate
C. Right sacral torsion on a left oblique axis
D. Bilateral innominate rotation
B. 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 anteriorly and inferiorly, creating a functional short right leg and a
positive standing flexion test on the right.
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
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.
3. Which cranial technique is specifically designed to enhance the
amplitude of the cranial rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV4)
C. V-spread technique
D. Frontal lift
B. Bulb compression (CV4)
Rationale: Compression of the fourth ventricle (CV4) is explicitly utilized to
encourage fluid movement, enhance the amplitude of the CRI, and assist with
autonomic nervous system balancing.
4. A 45-year-old female presents with pain along the medial aspect of
her right knee. Palpation reveals a tender point on the medial surface
of the tibia, approximately 2 cm below the joint line. Which position is
used for counterstrain treatment?
A. Flexion, Abduction, External Rotation
B. Flexion, Adduction, Internal Rotation
C. Extension, Abduction, External Rotation
D. Extension, Adduction, Internal Rotation
B. Flexion, Adduction, Internal Rotation
Rationale: The medial knee tender point is treated with hip/knee flexion,
adduction, and internal rotation of the tibia to shorten the affected muscle and
reduce the tender point.
5. A 28-year-old female presents with a distinct, migratory, butterfly-
shaped rash across her cheeks and nasal bridge that worsens after sun
exposure. Laboratory testing reveals positive antinuclear antibodies
, (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. What
is the most likely diagnosis?
A. Dermatomyositis
B. Systemic lupus erythematosus
C. Rosacea
D. Seborrheic dermatitis
B. Systemic lupus erythematosus
Rationale: SLE is a chronic autoimmune disease characterized by a malar
(butterfly) rash that exhibits photosensitivity. The presence of highly specific
antibodies like anti-dsDNA confirms the diagnosis.
6. A 62-year-old male with a history of chronic smoking presents with
an emergency onset of severe, tearing chest pain that radiates directly
to his back between his scapulae. His blood pressure is 180/100 mmHg
in the right arm and 140/85 mmHg in the left arm. What is the most
immediate life-threatening condition to suspect?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
D. Tension pneumothorax
B. Acute aortic dissection
Rationale: A tearing or ripping chest pain radiating to the back, coupled with
an asymmetric blood pressure differential between the upper extremities (>20
mmHg variation), is highly indicative of an acute aortic dissection.
7. During an osteopathic structural exam for a patient with suspected
acute appendicitis, the physician looks for a Chapman's reflex point.
Where is the anterior Chapman's reflex point for the appendix located?
A. At the tip of the right 12th rib
B. At the tip of the right 11th rib
