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COMSAE 115 (PHASE 1 FORM 115) HIGH- YIELD
EXAM PREP
Original Curriculum-Aligned Practice Questions — 2026–2027
Target Audience: Second-Year Osteopathic Medical Students
Exam Format: 176–250 multiple-choice questions, 4 hours 30 minutes, 4 blocks
400 standard score (many schools require 450+)
Table of Contents
. Questions 1–208
- Section 1: Osteopathic Principles & Practice (Questions 1–30)
- Section 2: Foundational Biomedical Sciences (Questions 31–80)
- Section 3: Clinical Systems (Questions 81–170)
- Section 4: Behavioral Science, Biostatistics & Ethics (Questions 171–195)
- Section 5: Multisystem/Interdisciplinary Topics (Questions 196–208)
. Answer Key
. High-Yield Review Points
| Module/Topic | Learning Objectives | # Questions | Difficulty Mix |
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Questions
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP/OMT)
Questions 1–30
Question 1
Topic: Fryette's Mechanics – Type I
Learning objective: Apply Fryette's first principle to diagnose somatic dysfunction in a neutral
spine
Difficulty: Easy
A 28-year-old patient presents with chronic mid-thoracic pain. On structural examination, you
find multiple vertebral segments in the T4–T7 region with restriction. The spine is in a neutral
position. According to Fryette's first principle, which of the following statements is correct?
A. Sidebending and rotation occur to the same side
B. Sidebending occurs without rotation
C. Sidebending and rotation occur to opposite sides
D. Rotation occurs without sidebending
Correct answer: C. Sidebending and rotation occur to opposite sides
Detailed rationale: Fryette's first principle (Type I mechanics) describes motion in a neutral
spine (neither flexed nor extended). When multiple vertebral segments are in neutral,
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sidebending and rotation occur to opposite sides. For example, if the spine sidebends to the
right, the vertebrae rotate to the left. This is a fundamental concept in osteopathic diagnosis of
group dysfunctions.
Why the other answer is incorrect : A These describes Type II mechanics (non-neutral, single
segment), not Type I.
- **B:** Rotation and sidebending are coupled in spinal mechanics; they do not occur
independently in neutral mechanics.
- **D:** Rotation and sidebending are always coupled in Fryette's mechanics; one does not
occur without the other.
**Exam tip:** Remember: Type I = **I**nnocent (neutral) = **O**pposite (sidebending and
rotation opposite). Type II = **II**solated (single segment) = **S**ame (sidebending and
rotation same).
---
**Question 2**
**Topic:** Fryette's Mechanics – Type II
**Learning objective:** Diagnose Type II somatic dysfunction based on segmental findings
**Difficulty:** Moderate
A 34-year-old female presents with right-sided neck pain. Examination reveals a C5 segment
that is restricted in left rotation and left sidebending. The dysfunction worsens when the patient
extends her neck. What is the correct diagnosis?
A. C5 Neutral, rotated left, sidebent left
B. C5 Flexed, rotated left, sidebent left
C. C5 Extended, rotated left, sidebent left
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D. C5 Extended, rotated right, sidebent right
**Correct answer:** C. C5 Extended, rotated left, sidebent left
**Detailed rationale:** The dysfunction worsens with extension, indicating an extension
dysfunction. In Type II mechanics (single segment, non-neutral), rotation and sidebending occur
to the same side. Since the segment is restricted in left rotation and left sidebending, the
diagnosis is C5 Extended, rotated left, sidebent left.
**Why the other options are incorrect:**
- **A:** Neutral mechanics do not apply here as the dysfunction worsens in a non-neutral
position.
- **B:** The dysfunction worsens with extension, not flexion, so this cannot be a flexion
dysfunction.
- **D:** The rotation and sidebending are to the left, not the right.
**Exam tip:** When a dysfunction **worsens** in flexion = **extension** dysfunction. When
it **improves** in flexion = **flexion** dysfunction. In Type II, rotation and sidebending are to
the **same** side.
---
**Question 3**
**Topic:** Cranial Osteopathy – Primary Respiratory Mechanism
**Learning objective:** Identify phases of the cranial rhythmic impulse and associated bone
motions
**Difficulty:** Moderate
COMSAE 115 (PHASE 1 FORM 115) HIGH- YIELD
EXAM PREP
Original Curriculum-Aligned Practice Questions — 2026–2027
Target Audience: Second-Year Osteopathic Medical Students
Exam Format: 176–250 multiple-choice questions, 4 hours 30 minutes, 4 blocks
400 standard score (many schools require 450+)
Table of Contents
. Questions 1–208
- Section 1: Osteopathic Principles & Practice (Questions 1–30)
- Section 2: Foundational Biomedical Sciences (Questions 31–80)
- Section 3: Clinical Systems (Questions 81–170)
- Section 4: Behavioral Science, Biostatistics & Ethics (Questions 171–195)
- Section 5: Multisystem/Interdisciplinary Topics (Questions 196–208)
. Answer Key
. High-Yield Review Points
| Module/Topic | Learning Objectives | # Questions | Difficulty Mix |
,Page 2 of 244
Questions
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP/OMT)
Questions 1–30
Question 1
Topic: Fryette's Mechanics – Type I
Learning objective: Apply Fryette's first principle to diagnose somatic dysfunction in a neutral
spine
Difficulty: Easy
A 28-year-old patient presents with chronic mid-thoracic pain. On structural examination, you
find multiple vertebral segments in the T4–T7 region with restriction. The spine is in a neutral
position. According to Fryette's first principle, which of the following statements is correct?
A. Sidebending and rotation occur to the same side
B. Sidebending occurs without rotation
C. Sidebending and rotation occur to opposite sides
D. Rotation occurs without sidebending
Correct answer: C. Sidebending and rotation occur to opposite sides
Detailed rationale: Fryette's first principle (Type I mechanics) describes motion in a neutral
spine (neither flexed nor extended). When multiple vertebral segments are in neutral,
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sidebending and rotation occur to opposite sides. For example, if the spine sidebends to the
right, the vertebrae rotate to the left. This is a fundamental concept in osteopathic diagnosis of
group dysfunctions.
Why the other answer is incorrect : A These describes Type II mechanics (non-neutral, single
segment), not Type I.
- **B:** Rotation and sidebending are coupled in spinal mechanics; they do not occur
independently in neutral mechanics.
- **D:** Rotation and sidebending are always coupled in Fryette's mechanics; one does not
occur without the other.
**Exam tip:** Remember: Type I = **I**nnocent (neutral) = **O**pposite (sidebending and
rotation opposite). Type II = **II**solated (single segment) = **S**ame (sidebending and
rotation same).
---
**Question 2**
**Topic:** Fryette's Mechanics – Type II
**Learning objective:** Diagnose Type II somatic dysfunction based on segmental findings
**Difficulty:** Moderate
A 34-year-old female presents with right-sided neck pain. Examination reveals a C5 segment
that is restricted in left rotation and left sidebending. The dysfunction worsens when the patient
extends her neck. What is the correct diagnosis?
A. C5 Neutral, rotated left, sidebent left
B. C5 Flexed, rotated left, sidebent left
C. C5 Extended, rotated left, sidebent left
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D. C5 Extended, rotated right, sidebent right
**Correct answer:** C. C5 Extended, rotated left, sidebent left
**Detailed rationale:** The dysfunction worsens with extension, indicating an extension
dysfunction. In Type II mechanics (single segment, non-neutral), rotation and sidebending occur
to the same side. Since the segment is restricted in left rotation and left sidebending, the
diagnosis is C5 Extended, rotated left, sidebent left.
**Why the other options are incorrect:**
- **A:** Neutral mechanics do not apply here as the dysfunction worsens in a non-neutral
position.
- **B:** The dysfunction worsens with extension, not flexion, so this cannot be a flexion
dysfunction.
- **D:** The rotation and sidebending are to the left, not the right.
**Exam tip:** When a dysfunction **worsens** in flexion = **extension** dysfunction. When
it **improves** in flexion = **flexion** dysfunction. In Type II, rotation and sidebending are to
the **same** side.
---
**Question 3**
**Topic:** Cranial Osteopathy – Primary Respiratory Mechanism
**Learning objective:** Identify phases of the cranial rhythmic impulse and associated bone
motions
**Difficulty:** Moderate
