1
COMSAE FORM 110 | COMPLETE PRACTICE EXAM
— COMLEX LEVEL 1 REVIEW | 90 REAL EXAM-
STYLE QUESTIONS
With Full Answer Key & Step-by-Step Explanations
✓ 90 Most Tested, Most Difficult Questions — Matching COMSAE Form 110 Format
✓ Multiple Choice with Rotated Distractors on Every Question
✓ All Questions Categorized by Topic, Body System, and Difficulty
✓ Correct Answers Highlighted in Green — Verified Answer Key
✓ Detailed Step-by-Step Explanations with Pathophysiology & High-Yield Pearls
✓ Covers: OMT | Cardiology | Neurology | Pathology | Biochemistry | Pharmacology
✓ Covers: Psychiatry | Pulmonology | GI | Renal | Endocrine | Heme/Onc | ID
✓ Ideal for COMLEX Level 1, COMLEX Level 2, and USMLE Step 1 Preparation
American Association of Colleges of Osteopathic Medicine — Exam Preparation Series
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
,2
TOPIC DISTRIBUTION
TOPIC AREA QUESTIONS DIFFICULTY
Osteopathic Principles / OMT 7 HIGH
Osteopathic Principles / Chapman Points 1 HIGH
Osteopathic Principles / Still Point 1 HIGH
Cardiology 4 HIGH
Cardiology / Pharmacology 1 HIGH
Pulmonology 4 HIGH
Gastroenterology 4 HIGH
Gastroenterology / OMT Connection 1 HIGH
Nephrology 3 HIGH
Neurology 6 HIGH
Neurology / OMT 1 HIGH
Endocrinology 3 HIGH
Hematology 4 HIGH
Musculoskeletal 2 HIGH
Psychiatry 4 HIGH
Infectious Disease 3 HIGH
Pharmacology 5 HIGH
Embryology 1 HIGH
Anatomy 1 HIGH
Anatomy / OMT Connection 1 HIGH
Biochemistry 2 HIGH
Physiology 3 HIGH
Microbiology 3 HIGH
Pathology 3 HIGH
Obstetrics 1 HIGH
Gynecology 1 HIGH
Pediatrics 2 HIGH
Dermatology 2 HIGH
Urology 1 HIGH
Immunology 1 HIGH
Ophthalmology 1 HIGH
Osteopathic Principles / FPR 1 HIGH
Osteopathic Principles / Lymphatics 1 HIGH
Osteopathic Principles / Soft Tissue 1 HIGH
Cardiology / Pharm 1 HIGH
Biochemistry / Genetics 1 HIGH
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
,3
TOPIC AREA QUESTIONS DIFFICULTY
Anatomy / OMT 1 HIGH
Osteopathic / OMT 1 HIGH
Oncology 1 HIGH
OMT / Lymphatics 1 HIGH
Osteopathic / Physical Exam 1 HIGH
OMT / Viscerosomatic Reflexes 1 HIGH
Biochemistry / Cell Biology 1 HIGH
Osteopathic / Whole-Body Integration 1 HIGH
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
, 4
Q1 Osteopathic Principles / OMT | MSK HIGH FORM 110
A 45-year-old male presents with low back pain. On examination, the L3 vertebra is found to have a
somatic dysfunction. When the patient flexes forward, the transverse process on the right is more
posterior. When the patient extends backward, the transverse process on the right remains more
posterior. This dysfunction is BEST described as:
A. L3 FRSR (Flexion, Rotated Right, Side-bent Right) — neutral group dysfunction
B. L3 ERSR (Extension, Rotated Right, Side-bent Right) — non-neutral dysfunction
C. L3 ERSL (Extension, Rotated Left, Side-bent Left) — non-neutral dysfunction
D. L3 FRSL (Flexion, Rotated Left, Side-bent Left) — neutral group dysfunction
E. L3 NSR (Neutral, Side-bent Right, Rotated Left) — Fryette Type I
✔ ANSWER: STEP-BY-STEP EXPLANATION: In non-neutral (Type II Fryette) dysfunctions, the
B vertebra is most restricted in ONE position (flexion or extension). The transverse process
that is most POSTERIOR = the side of rotation. Here, the RIGHT transverse process is
posterior in BOTH flex and extend, but if it is most restricted in extension (the position that
exaggerates or reveals the asymmetry), this is ERSR. In ERSR: the segment is held in
extension, rotated right, side-bent right. Key: Type II dysfunctions — rotation and side-
bending occur to the SAME side. The posterior TP = the side of both rotation and
sidebending.
Q2 Osteopathic Principles / OMT | MSK HIGH FORM 110
A 38-year-old woman has a sacral somatic dysfunction. The inferior aspect of the sacrum (apex) is
found to be rotated toward the left, and the sacral base is rotated toward the right. The left sacral
sulcus is deep and the right inferior lateral angle (ILA) is posterior and inferior. This is BEST
described as:
A. Left-on-left sacral torsion (forward torsion)
B. Right-on-left sacral torsion (backward torsion)
C. Left-on-right sacral torsion (backward torsion)
D. Right-on-right sacral torsion (forward torsion)
E. Bilateral sacral flexion
✔ ANSWER: STEP-BY-STEP EXPLANATION: Sacral torsion nomenclature: [Oblique axis side]-on-
C [Oblique axis side]. The axis is named by the side the sacral BASE rotates TOWARD. Left-
on-right: the base rotates LEFT on a RIGHT oblique axis. Backward torsions: the sacrum
rotates OPPOSITE to the axis (e.g., left on right = the top/base rotates left, but the axis is
right). Deep sulcus = the base is posterior on that side. Right ILA posterior/inferior = apex
tilts toward the right and down. Left deep sulcus (base posterior left) + right ILA posterior =
left-on-right backward torsion. The diagnosis follows the DEEP SULCUS side (left) on the
opposite axis (right).
Q3 Osteopathic Principles / OMT | MSK HIGH FORM 110
During an OMT treatment, a physician uses counterstrain technique on a tender point located in the
anterior cervical region at the C4 level. The physician positions the patient to MAXIMIZE tenderness
relief. To treat an ANTERIOR cervical counterstrain tender point, the optimal position is:
A. Cervical extension, ipsilateral rotation, ipsilateral side-bending
B. Cervical flexion, ipsilateral rotation, ipsilateral side-bending
C. Cervical extension, contralateral rotation, ipsilateral side-bending
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
COMSAE FORM 110 | COMPLETE PRACTICE EXAM
— COMLEX LEVEL 1 REVIEW | 90 REAL EXAM-
STYLE QUESTIONS
With Full Answer Key & Step-by-Step Explanations
✓ 90 Most Tested, Most Difficult Questions — Matching COMSAE Form 110 Format
✓ Multiple Choice with Rotated Distractors on Every Question
✓ All Questions Categorized by Topic, Body System, and Difficulty
✓ Correct Answers Highlighted in Green — Verified Answer Key
✓ Detailed Step-by-Step Explanations with Pathophysiology & High-Yield Pearls
✓ Covers: OMT | Cardiology | Neurology | Pathology | Biochemistry | Pharmacology
✓ Covers: Psychiatry | Pulmonology | GI | Renal | Endocrine | Heme/Onc | ID
✓ Ideal for COMLEX Level 1, COMLEX Level 2, and USMLE Step 1 Preparation
American Association of Colleges of Osteopathic Medicine — Exam Preparation Series
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
,2
TOPIC DISTRIBUTION
TOPIC AREA QUESTIONS DIFFICULTY
Osteopathic Principles / OMT 7 HIGH
Osteopathic Principles / Chapman Points 1 HIGH
Osteopathic Principles / Still Point 1 HIGH
Cardiology 4 HIGH
Cardiology / Pharmacology 1 HIGH
Pulmonology 4 HIGH
Gastroenterology 4 HIGH
Gastroenterology / OMT Connection 1 HIGH
Nephrology 3 HIGH
Neurology 6 HIGH
Neurology / OMT 1 HIGH
Endocrinology 3 HIGH
Hematology 4 HIGH
Musculoskeletal 2 HIGH
Psychiatry 4 HIGH
Infectious Disease 3 HIGH
Pharmacology 5 HIGH
Embryology 1 HIGH
Anatomy 1 HIGH
Anatomy / OMT Connection 1 HIGH
Biochemistry 2 HIGH
Physiology 3 HIGH
Microbiology 3 HIGH
Pathology 3 HIGH
Obstetrics 1 HIGH
Gynecology 1 HIGH
Pediatrics 2 HIGH
Dermatology 2 HIGH
Urology 1 HIGH
Immunology 1 HIGH
Ophthalmology 1 HIGH
Osteopathic Principles / FPR 1 HIGH
Osteopathic Principles / Lymphatics 1 HIGH
Osteopathic Principles / Soft Tissue 1 HIGH
Cardiology / Pharm 1 HIGH
Biochemistry / Genetics 1 HIGH
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
,3
TOPIC AREA QUESTIONS DIFFICULTY
Anatomy / OMT 1 HIGH
Osteopathic / OMT 1 HIGH
Oncology 1 HIGH
OMT / Lymphatics 1 HIGH
Osteopathic / Physical Exam 1 HIGH
OMT / Viscerosomatic Reflexes 1 HIGH
Biochemistry / Cell Biology 1 HIGH
Osteopathic / Whole-Body Integration 1 HIGH
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
, 4
Q1 Osteopathic Principles / OMT | MSK HIGH FORM 110
A 45-year-old male presents with low back pain. On examination, the L3 vertebra is found to have a
somatic dysfunction. When the patient flexes forward, the transverse process on the right is more
posterior. When the patient extends backward, the transverse process on the right remains more
posterior. This dysfunction is BEST described as:
A. L3 FRSR (Flexion, Rotated Right, Side-bent Right) — neutral group dysfunction
B. L3 ERSR (Extension, Rotated Right, Side-bent Right) — non-neutral dysfunction
C. L3 ERSL (Extension, Rotated Left, Side-bent Left) — non-neutral dysfunction
D. L3 FRSL (Flexion, Rotated Left, Side-bent Left) — neutral group dysfunction
E. L3 NSR (Neutral, Side-bent Right, Rotated Left) — Fryette Type I
✔ ANSWER: STEP-BY-STEP EXPLANATION: In non-neutral (Type II Fryette) dysfunctions, the
B vertebra is most restricted in ONE position (flexion or extension). The transverse process
that is most POSTERIOR = the side of rotation. Here, the RIGHT transverse process is
posterior in BOTH flex and extend, but if it is most restricted in extension (the position that
exaggerates or reveals the asymmetry), this is ERSR. In ERSR: the segment is held in
extension, rotated right, side-bent right. Key: Type II dysfunctions — rotation and side-
bending occur to the SAME side. The posterior TP = the side of both rotation and
sidebending.
Q2 Osteopathic Principles / OMT | MSK HIGH FORM 110
A 38-year-old woman has a sacral somatic dysfunction. The inferior aspect of the sacrum (apex) is
found to be rotated toward the left, and the sacral base is rotated toward the right. The left sacral
sulcus is deep and the right inferior lateral angle (ILA) is posterior and inferior. This is BEST
described as:
A. Left-on-left sacral torsion (forward torsion)
B. Right-on-left sacral torsion (backward torsion)
C. Left-on-right sacral torsion (backward torsion)
D. Right-on-right sacral torsion (forward torsion)
E. Bilateral sacral flexion
✔ ANSWER: STEP-BY-STEP EXPLANATION: Sacral torsion nomenclature: [Oblique axis side]-on-
C [Oblique axis side]. The axis is named by the side the sacral BASE rotates TOWARD. Left-
on-right: the base rotates LEFT on a RIGHT oblique axis. Backward torsions: the sacrum
rotates OPPOSITE to the axis (e.g., left on right = the top/base rotates left, but the axis is
right). Deep sulcus = the base is posterior on that side. Right ILA posterior/inferior = apex
tilts toward the right and down. Left deep sulcus (base posterior left) + right ILA posterior =
left-on-right backward torsion. The diagnosis follows the DEEP SULCUS side (left) on the
opposite axis (right).
Q3 Osteopathic Principles / OMT | MSK HIGH FORM 110
During an OMT treatment, a physician uses counterstrain technique on a tender point located in the
anterior cervical region at the C4 level. The physician positions the patient to MAXIMIZE tenderness
relief. To treat an ANTERIOR cervical counterstrain tender point, the optimal position is:
A. Cervical extension, ipsilateral rotation, ipsilateral side-bending
B. Cervical flexion, ipsilateral rotation, ipsilateral side-bending
C. Cervical extension, contralateral rotation, ipsilateral side-bending
COMLEX Level 1 | COMSAE Form 110 Practice Exam | Osteopathic Medicine Comprehensive Assessment | For Educational Use Only
