COMSAE PHASE 1 FORM 115 EXAM
Updated Questions & Answers With Rationale
A+ Graded| Brand New Release!
This comprehensive 250-question practice exam is designed to prepare osteopathic
medical students for the COMSAE Phase 1 Form 115 Examination. The questions are
formatted with correct answers and short, high-yield rationales to reinforce critical
knowledge for the 2026/2027 exam cycle.
DOMAINS
1. Osteopathic Principles & Practice (OPP/OMM)
2. Anatomy & Embryology
3. Physiology
4. Biochemistry & Genetics
5. Microbiology & Immunology
6. Pathology
7. Pharmacology
8. Behavioral Science & Ethics
9. Clinical Systems (Cardiology, Pulmonology, Neurology, etc.)
10. Multisystem & Interdisciplinary Topics
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP/OMM)
1. 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
Correct Answer: C. T5 Flexed RR SR
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. Hence, rotation right and side-bending right yields a
diagnosis of "Flexed RR SR."
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
Correct Answer: C. Side-bending and rotation occur to opposite sides
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.
3. In muscle energy technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
,Correct Answer: B. Submaximal (approximately 20% of maximal) isometric
contraction
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by
the patient, followed by relaxation and repositioning to the new barrier. This
avoids muscle fatigue and injury.
4. A patient with a respiratory somatic dysfunction is diagnosed with an "exhaled
rib" on the left. This dysfunction is characterized by:
A) The rib is depressed and restricted in elevation
B) The rib is elevated and restricted in depression
C) The rib moves normally in both directions
D) The rib is restricted in both elevation and depression
Correct Answer: A. The rib is depressed and restricted in elevation
Rationale: An "exhaled rib" (exhalation dysfunction) is stuck in a depressed
(inferior) position and is restricted in its ability to elevate during inhalation. This is
the opposite of an "inhaled rib" (inhalation dysfunction), which is stuck in an
elevated position and restricted in depression.
5. A 24-year-old female presents to the clinic with persistent epigastric pain that
worsens after meals. She is diagnosed with a duodenal ulcer. A Chapman reflex
point associated with this condition is located at which of the following areas?
A) Left 5th intercostal space parasternally
B) Right 6th intercostal space parasternally
C) Left 6th intercostal space parasternally
D) Right 5th intercostal space parasternally
, Correct Answer: B. Right 6th intercostal space parasternally
Rationale: The Chapman reflex point for the duodenum is located at the right 6th
intercostal space near the sternum. Options A and C are incorrect because
duodenal and gallbladder reflex points are typically lateralized to the right side.
Option D is incorrect because the right 5th intercostal space corresponds to the liver
and gallbladder.
6. A 32-year-old pregnant female at 34 weeks gestation presents with severe
lower back pain. Physical examination shows a right-on-right forward sacral torsion.
Which of the following landmarks is most consistent with this diagnosis?
A) Positive spring test
B) Right seated flexion test, deep right sulcus, posterior left ILA
C) Right seated flexion test, deep left sulcus, posterior right ILA
D) Left seated flexion test, deep right sulcus, posterior left ILA
Correct Answer: C. Right seated flexion test, deep left sulcus, posterior right ILA
Rationale: In a right-on-right (forward) sacral torsion, the axis is on the right,
meaning the seated flexion test will be positive on the opposite side (right). The
sacrum rotates right, making the left sulcus deep and causing the right inferior
lateral angle (ILA) to back up or become posterior/inferior. Option A is incorrect
because forward torsions have a negative spring test. Options B and D do not
follow L-on-L or R-on-R rules.
7. A 45-year-old male with a history of alcohol abuse presents with severe
epigastric pain radiating to his back, accompanied by nausea and vomiting.
Laboratory values reveal markedly elevated serum lipase. An anterior Chapman
reflex point for this acute organ pathology is located at which of the following
sites?
Updated Questions & Answers With Rationale
A+ Graded| Brand New Release!
This comprehensive 250-question practice exam is designed to prepare osteopathic
medical students for the COMSAE Phase 1 Form 115 Examination. The questions are
formatted with correct answers and short, high-yield rationales to reinforce critical
knowledge for the 2026/2027 exam cycle.
DOMAINS
1. Osteopathic Principles & Practice (OPP/OMM)
2. Anatomy & Embryology
3. Physiology
4. Biochemistry & Genetics
5. Microbiology & Immunology
6. Pathology
7. Pharmacology
8. Behavioral Science & Ethics
9. Clinical Systems (Cardiology, Pulmonology, Neurology, etc.)
10. Multisystem & Interdisciplinary Topics
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP/OMM)
1. 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
Correct Answer: C. T5 Flexed RR SR
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. Hence, rotation right and side-bending right yields a
diagnosis of "Flexed RR SR."
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
Correct Answer: C. Side-bending and rotation occur to opposite sides
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.
3. In muscle energy technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
,Correct Answer: B. Submaximal (approximately 20% of maximal) isometric
contraction
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by
the patient, followed by relaxation and repositioning to the new barrier. This
avoids muscle fatigue and injury.
4. A patient with a respiratory somatic dysfunction is diagnosed with an "exhaled
rib" on the left. This dysfunction is characterized by:
A) The rib is depressed and restricted in elevation
B) The rib is elevated and restricted in depression
C) The rib moves normally in both directions
D) The rib is restricted in both elevation and depression
Correct Answer: A. The rib is depressed and restricted in elevation
Rationale: An "exhaled rib" (exhalation dysfunction) is stuck in a depressed
(inferior) position and is restricted in its ability to elevate during inhalation. This is
the opposite of an "inhaled rib" (inhalation dysfunction), which is stuck in an
elevated position and restricted in depression.
5. A 24-year-old female presents to the clinic with persistent epigastric pain that
worsens after meals. She is diagnosed with a duodenal ulcer. A Chapman reflex
point associated with this condition is located at which of the following areas?
A) Left 5th intercostal space parasternally
B) Right 6th intercostal space parasternally
C) Left 6th intercostal space parasternally
D) Right 5th intercostal space parasternally
, Correct Answer: B. Right 6th intercostal space parasternally
Rationale: The Chapman reflex point for the duodenum is located at the right 6th
intercostal space near the sternum. Options A and C are incorrect because
duodenal and gallbladder reflex points are typically lateralized to the right side.
Option D is incorrect because the right 5th intercostal space corresponds to the liver
and gallbladder.
6. A 32-year-old pregnant female at 34 weeks gestation presents with severe
lower back pain. Physical examination shows a right-on-right forward sacral torsion.
Which of the following landmarks is most consistent with this diagnosis?
A) Positive spring test
B) Right seated flexion test, deep right sulcus, posterior left ILA
C) Right seated flexion test, deep left sulcus, posterior right ILA
D) Left seated flexion test, deep right sulcus, posterior left ILA
Correct Answer: C. Right seated flexion test, deep left sulcus, posterior right ILA
Rationale: In a right-on-right (forward) sacral torsion, the axis is on the right,
meaning the seated flexion test will be positive on the opposite side (right). The
sacrum rotates right, making the left sulcus deep and causing the right inferior
lateral angle (ILA) to back up or become posterior/inferior. Option A is incorrect
because forward torsions have a negative spring test. Options B and D do not
follow L-on-L or R-on-R rules.
7. A 45-year-old male with a history of alcohol abuse presents with severe
epigastric pain radiating to his back, accompanied by nausea and vomiting.
Laboratory values reveal markedly elevated serum lipase. An anterior Chapman
reflex point for this acute organ pathology is located at which of the following
sites?
