COMSAE-100 2026/2027 Simulated Exam: 100 High-Yield
USMLE/COMLEX-Style Questions with Answers and
Rationales – Basic Sciences, Clinical Medicine, and
Osteopathic Principles Review
Section 1: Osteopathic Principles and Practice (OMM) —
Questions 1–10
1.
A 45-year-old male presents with acute low back pain and muscle spasm. On exam, you
note a somatic dysfunction at L2-L4 with tissue texture changes. Which osteopathic
manipulative technique is most appropriate?
A. HVLA
B. Muscle energy
C. Counterstrain
D. Myofascial release
Correct Answer: C
Rationale: Counterstrain is a gentle, indirect technique used for acute somatic
dysfunction with muscle spasm. HVLA is contraindicated in acute spasm.
High-Yield Takeaway: Counterstrain = indirect, gentle, acute spasm.
2.
A positive seated flexion test on the right indicates:
A. Right sacral torsion
B. Left sacral torsion
C. Right innominate rotation
D. Left innominate rotation
,Correct Answer: A
Rationale: A positive seated flexion test on the right indicates a right sacral torsion
(sacrum rotates right on a left oblique axis).
High-Yield Takeaway: Seated flexion test = sacral torsion.
3.
The Chapman reflex for the lung is located:
A. Anteriorly at the 2nd intercostal space
B. Posteriorly at T3-T4
C. Anteriorly at the 6th intercostal space
D. Posteriorly at T10-T12
Correct Answer: B
Rationale: Lung Chapman reflexes are located anteriorly at the 2nd intercostal space
and posteriorly at T3-T4.
High-Yield Takeaway: Lung Chapman = T3-T4 posterior.
4.
Which of the following is a contraindication to HVLA?
A. Muscle spasm
B. Vertebral fracture
C. Mild osteoarthritis
D. Chronic somatic dysfunction
Correct Answer: B
Rationale: HVLA is absolutely contraindicated in vertebral fracture, severe osteoporosis,
and metastatic disease.
High-Yield Takeaway: HVLA contraindications = fracture, osteoporosis, metastasis.
,5.
A patient with pneumonia would most likely have a viscerosomatic reflex at which level?
A. T1-T4
B. T5-T9
C. T10-T12
D. L1-L2
Correct Answer: A
Rationale: Lung viscerosomatic reflexes are located at T1-T4 (sympathetic) and C3-C5
(parasympathetic).
High-Yield Takeaway: Lung viscerosomatic = T1-T4.
6.
Which of the following describes a Fryette Type II somatic dysfunction?
A. Sidebending and rotation in opposite directions
B. Sidebending and rotation in the same direction
C. Neutral mechanics
D. Named for the sidebending
Correct Answer: B
Rationale: Fryette Type II: flexed or extended, sidebending and rotation same direction.
High-Yield Takeaway: Type II = same direction.
7.
A 30-year-old female presents with headache and neck pain. You find C2 rotated right.
Which motion is restricted?
A. Right rotation
B. Left rotation
, C. Flexion
D. Extension
Correct Answer: B
Rationale: If C2 is rotated right, left rotation is restricted because the vertebra is stuck in
right rotation.
High-Yield Takeaway: Restricted motion is opposite the direction of rotation.
8.
Which of the following is the primary respiratory mechanism (PRM) component?
A. Motility of the CNS
B. Mobility of the sacrum
C. Motion of the cranial bones
D. All of the above
Correct Answer: D
Rationale: The PRM includes CNS motility, cranial bone motion, sacral motion, and
fluctuation of CSF.
High-Yield Takeaway: PRM = CNS motility + cranial motion + sacral motion + CSF.
9.
A patient has a positive Thomas test. This indicates:
A. Hip flexor tightness
B. Hamstring tightness
C. Iliotibial band tightness
D. Rectus femoris weakness
Correct Answer: A
Rationale: The Thomas test assesses hip flexor tightness (iliopsoas, rectus femoris).
High-Yield Takeaway: Thomas test = hip flexor tightness.
USMLE/COMLEX-Style Questions with Answers and
Rationales – Basic Sciences, Clinical Medicine, and
Osteopathic Principles Review
Section 1: Osteopathic Principles and Practice (OMM) —
Questions 1–10
1.
A 45-year-old male presents with acute low back pain and muscle spasm. On exam, you
note a somatic dysfunction at L2-L4 with tissue texture changes. Which osteopathic
manipulative technique is most appropriate?
A. HVLA
B. Muscle energy
C. Counterstrain
D. Myofascial release
Correct Answer: C
Rationale: Counterstrain is a gentle, indirect technique used for acute somatic
dysfunction with muscle spasm. HVLA is contraindicated in acute spasm.
High-Yield Takeaway: Counterstrain = indirect, gentle, acute spasm.
2.
A positive seated flexion test on the right indicates:
A. Right sacral torsion
B. Left sacral torsion
C. Right innominate rotation
D. Left innominate rotation
,Correct Answer: A
Rationale: A positive seated flexion test on the right indicates a right sacral torsion
(sacrum rotates right on a left oblique axis).
High-Yield Takeaway: Seated flexion test = sacral torsion.
3.
The Chapman reflex for the lung is located:
A. Anteriorly at the 2nd intercostal space
B. Posteriorly at T3-T4
C. Anteriorly at the 6th intercostal space
D. Posteriorly at T10-T12
Correct Answer: B
Rationale: Lung Chapman reflexes are located anteriorly at the 2nd intercostal space
and posteriorly at T3-T4.
High-Yield Takeaway: Lung Chapman = T3-T4 posterior.
4.
Which of the following is a contraindication to HVLA?
A. Muscle spasm
B. Vertebral fracture
C. Mild osteoarthritis
D. Chronic somatic dysfunction
Correct Answer: B
Rationale: HVLA is absolutely contraindicated in vertebral fracture, severe osteoporosis,
and metastatic disease.
High-Yield Takeaway: HVLA contraindications = fracture, osteoporosis, metastasis.
,5.
A patient with pneumonia would most likely have a viscerosomatic reflex at which level?
A. T1-T4
B. T5-T9
C. T10-T12
D. L1-L2
Correct Answer: A
Rationale: Lung viscerosomatic reflexes are located at T1-T4 (sympathetic) and C3-C5
(parasympathetic).
High-Yield Takeaway: Lung viscerosomatic = T1-T4.
6.
Which of the following describes a Fryette Type II somatic dysfunction?
A. Sidebending and rotation in opposite directions
B. Sidebending and rotation in the same direction
C. Neutral mechanics
D. Named for the sidebending
Correct Answer: B
Rationale: Fryette Type II: flexed or extended, sidebending and rotation same direction.
High-Yield Takeaway: Type II = same direction.
7.
A 30-year-old female presents with headache and neck pain. You find C2 rotated right.
Which motion is restricted?
A. Right rotation
B. Left rotation
, C. Flexion
D. Extension
Correct Answer: B
Rationale: If C2 is rotated right, left rotation is restricted because the vertebra is stuck in
right rotation.
High-Yield Takeaway: Restricted motion is opposite the direction of rotation.
8.
Which of the following is the primary respiratory mechanism (PRM) component?
A. Motility of the CNS
B. Mobility of the sacrum
C. Motion of the cranial bones
D. All of the above
Correct Answer: D
Rationale: The PRM includes CNS motility, cranial bone motion, sacral motion, and
fluctuation of CSF.
High-Yield Takeaway: PRM = CNS motility + cranial motion + sacral motion + CSF.
9.
A patient has a positive Thomas test. This indicates:
A. Hip flexor tightness
B. Hamstring tightness
C. Iliotibial band tightness
D. Rectus femoris weakness
Correct Answer: A
Rationale: The Thomas test assesses hip flexor tightness (iliopsoas, rectus femoris).
High-Yield Takeaway: Thomas test = hip flexor tightness.
