COMSAE Phase 1 Form 111 Practice Exam
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Master your COMLEX-USA Level 1 prep with this comprehensive study guide for the NBOME COMSAE
Phase 1 Form 111 practice exam. This resource features high-yield multiple-choice questions
complete with bolded correct answers and detailed, in-depth rationales. Perfect for medical
students targeting a 400+ passing score. Deeply reviews essential high-yield topics including
pelvic/sacral somatic dysfunctions, autonomic Chapman reflex points, counterstrain setups,
microbiology, and pathology
1. 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
Rationale: The correct answer is B. The Chapman reflex point for the duodenum is
located at the right 6th intercostal space near the sternum. Option 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.
2. 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
Rationale: The correct answer is C. 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.
3. 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?
A) Right 5th intercostal space
B) Right 7th intercostal space
C) Left 7th intercostal space
D) Left 5th intercostal space
Rationale: The correct answer is B. The patient has acute pancreatitis. The anterior
Chapman reflex point for the pancreas is located at the right 7th intercostal space
near the sternum. Options A, C, and D correspond to other abdominal viscera, such
as the liver or spleen.
4. A 19-year-old collegiate runner presents with localized pain over the lateral
aspect of her right knee. Examination reveals a tender point just posterior to the
tensor fasciae latae muscle. To treat this using counterstrain, how should the
physician position the patient's hip?
A) Extension, adduction, internal rotation
B) Flexion, abduction, external rotation
C) Flexion, abduction, internal rotation
D) Extension, abduction, external rotation
Rationale: The correct answer is C. This patient has an iliotibial (IT) band or tensor
fasciae latae tender point. The counterstrain setup for this localized dysfunction
requires hip flexion, abduction, and internal rotation to effectively shorten the tissue.
Options A, B, and D fail to properly approximate the muscle origin and insertion.
5. A 62-year-old male presents with urinary frequency, urgency, and a weak
stream. Digital rectal examination reveals a smooth, enlarged prostate. An anterior
Chapman point for this organ can be palpated along which structural landmark?
A) Posterior IT band
B) Lower ribs near the midaxillary line
C) Lateral collagenous tissue of the posterior IT band
D) Anterior aspect of the pubic bone near the symphysis
Rationale: The correct answer is C. The anterior Chapman reflex point for the
prostate gland is located along the posterior aspect of the iliotibial (IT) band. Option
D describes the bladder or urethra point, while options A and B do not correspond to
the prostatic reflex landscape.
6. A 28-year-old female presents with severe pelvic pain. Structural examination
reveals a right innominate posterior rotation. Which of the following muscle groups
should be targeted during a post-isometric relaxation muscle energy technique to
correct this dysfunction?
,A) Hamstrings
B) Rectus femoris
C) Gluteus maximus
D) Piriformis
Rationale: The correct answer is B. A posterior innominate rotation means the
anterior superior iliac spine (ASIS) is superior and the posterior superior iliac spine
(PSIS) is inferior. To pull the innominate anteriorly using post-isometric relaxation,
the physician must utilize the hip flexors, primarily the rectus femoris. Option A is
used for an anterior innominate rotation.
7. A 35-year-old male presents following a motor vehicle collision. Structural
exam reveals a cranial dysfunction where the sphenoid and occiput have rotated in
opposite directions around a common vertical axis. This structural finding describes
which type of cranial strain pattern?
A) Vertical strain
B) Sidebending/Rotation
C) Torsion
D) Lateral strain
Rationale: The correct answer is C. A cranial torsion involves the sphenoid and
occiput rotating in opposite directions about a single anterior-posterior (AP) axis.
Option B involves rotation around vertical and AP axes, while options A and D
describe parallel displacements around horizontal or vertical axes.
8. A 52-year-old female presents with constant, throbbing pain in her right upper
quadrant that radiates to her right scapula. She notes that the pain is worse after
eating fried foods. A structural exam would most likely reveal somatic dysfunction at
which of the following spinal levels?
A) T1-T4
B) T5-T9
C) T10-T11
D) T12-L2
Rationale: The correct answer is B. The patient's symptoms are highly suggestive of
acute cholecystitis or biliary colic. Upper gastrointestinal structures, including the
stomach, liver, gallbladder, duodenum, and pancreas, receive sympathetic
innervation from the T5-T9 spinal segments via the greater splanchnic nerve.
9. A 70-year-old female with a history of chronic constipation presents for an
evaluation. A structural exam reveals restricted mobility of her descending colon. At
which vertebral level would you expect to find matching tissue texture changes and
sympathetic hypersensitivity?
, A) T5-T9
B) T10-T11
C) T12-L2
D) L3-L5
Rationale: The correct answer is C. The left colon, descending colon, sigmoid colon,
and rectum receive their sympathetic innervation from the lower thoracolumbar
segments (T12-L2) via the inferior mesenteric ganglion. Options A and B innervate
upper and mid-GI tract structures.
10. A 22-year-old male presents with a cough and thick yellowish sputum for
three days. Auscultation reveals crackles in the right lower lung field. Somatic
dysfunction associated with this localized pulmonary infection would most likely
manifest at which spinal level?
A) T1-T4
B) T2-T7
C) T8-T10
D) T11-L1
Rationale: The correct answer is B. Viscerosomatic reflexes for the lungs and
pulmonary structures travel via sympathetic pathways back to the T2-T7 spinal cord
segments. Option A is too narrow and specific to upper thoracic/head structures, and
options C and D represent abdominal systems.
11. A 30-year-old male presents with deep lower back pain after lifting a heavy
box. Physical examination demonstrates a left seated flexion test, a deep left sacral
sulcus, and a left inferior lateral angle (ILA) that is anterior. What is the correct sacral
diagnosis?
A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Right-on-left sacral torsion
D) Left sacral unilateral flexion
Rationale: The correct answer is D. In a unilateral sacral flexion, the seated flexion
test is positive on the side of the lesion (left). The sulcus on that same side is deep,
and the ILA on that side moves posterior and inferior. However, if the opposite ILA is
described as anterior/superior, this signifies a unilateral shear or flexion pattern
matching a single side. Option A would feature a deep right sulcus and a posterior
left ILA.
12. A 14-year-old female presents for a routine sports physical. Visual inspection
reveals an asymmetric rib hump when she bends forward. Radiographs reveal a
scoliotic curve with a Cobb angle of 18 degrees. Which of the following management
plans is most appropriate?
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Master your COMLEX-USA Level 1 prep with this comprehensive study guide for the NBOME COMSAE
Phase 1 Form 111 practice exam. This resource features high-yield multiple-choice questions
complete with bolded correct answers and detailed, in-depth rationales. Perfect for medical
students targeting a 400+ passing score. Deeply reviews essential high-yield topics including
pelvic/sacral somatic dysfunctions, autonomic Chapman reflex points, counterstrain setups,
microbiology, and pathology
1. 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
Rationale: The correct answer is B. The Chapman reflex point for the duodenum is
located at the right 6th intercostal space near the sternum. Option 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.
2. 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
Rationale: The correct answer is C. 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.
3. 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?
A) Right 5th intercostal space
B) Right 7th intercostal space
C) Left 7th intercostal space
D) Left 5th intercostal space
Rationale: The correct answer is B. The patient has acute pancreatitis. The anterior
Chapman reflex point for the pancreas is located at the right 7th intercostal space
near the sternum. Options A, C, and D correspond to other abdominal viscera, such
as the liver or spleen.
4. A 19-year-old collegiate runner presents with localized pain over the lateral
aspect of her right knee. Examination reveals a tender point just posterior to the
tensor fasciae latae muscle. To treat this using counterstrain, how should the
physician position the patient's hip?
A) Extension, adduction, internal rotation
B) Flexion, abduction, external rotation
C) Flexion, abduction, internal rotation
D) Extension, abduction, external rotation
Rationale: The correct answer is C. This patient has an iliotibial (IT) band or tensor
fasciae latae tender point. The counterstrain setup for this localized dysfunction
requires hip flexion, abduction, and internal rotation to effectively shorten the tissue.
Options A, B, and D fail to properly approximate the muscle origin and insertion.
5. A 62-year-old male presents with urinary frequency, urgency, and a weak
stream. Digital rectal examination reveals a smooth, enlarged prostate. An anterior
Chapman point for this organ can be palpated along which structural landmark?
A) Posterior IT band
B) Lower ribs near the midaxillary line
C) Lateral collagenous tissue of the posterior IT band
D) Anterior aspect of the pubic bone near the symphysis
Rationale: The correct answer is C. The anterior Chapman reflex point for the
prostate gland is located along the posterior aspect of the iliotibial (IT) band. Option
D describes the bladder or urethra point, while options A and B do not correspond to
the prostatic reflex landscape.
6. A 28-year-old female presents with severe pelvic pain. Structural examination
reveals a right innominate posterior rotation. Which of the following muscle groups
should be targeted during a post-isometric relaxation muscle energy technique to
correct this dysfunction?
,A) Hamstrings
B) Rectus femoris
C) Gluteus maximus
D) Piriformis
Rationale: The correct answer is B. A posterior innominate rotation means the
anterior superior iliac spine (ASIS) is superior and the posterior superior iliac spine
(PSIS) is inferior. To pull the innominate anteriorly using post-isometric relaxation,
the physician must utilize the hip flexors, primarily the rectus femoris. Option A is
used for an anterior innominate rotation.
7. A 35-year-old male presents following a motor vehicle collision. Structural
exam reveals a cranial dysfunction where the sphenoid and occiput have rotated in
opposite directions around a common vertical axis. This structural finding describes
which type of cranial strain pattern?
A) Vertical strain
B) Sidebending/Rotation
C) Torsion
D) Lateral strain
Rationale: The correct answer is C. A cranial torsion involves the sphenoid and
occiput rotating in opposite directions about a single anterior-posterior (AP) axis.
Option B involves rotation around vertical and AP axes, while options A and D
describe parallel displacements around horizontal or vertical axes.
8. A 52-year-old female presents with constant, throbbing pain in her right upper
quadrant that radiates to her right scapula. She notes that the pain is worse after
eating fried foods. A structural exam would most likely reveal somatic dysfunction at
which of the following spinal levels?
A) T1-T4
B) T5-T9
C) T10-T11
D) T12-L2
Rationale: The correct answer is B. The patient's symptoms are highly suggestive of
acute cholecystitis or biliary colic. Upper gastrointestinal structures, including the
stomach, liver, gallbladder, duodenum, and pancreas, receive sympathetic
innervation from the T5-T9 spinal segments via the greater splanchnic nerve.
9. A 70-year-old female with a history of chronic constipation presents for an
evaluation. A structural exam reveals restricted mobility of her descending colon. At
which vertebral level would you expect to find matching tissue texture changes and
sympathetic hypersensitivity?
, A) T5-T9
B) T10-T11
C) T12-L2
D) L3-L5
Rationale: The correct answer is C. The left colon, descending colon, sigmoid colon,
and rectum receive their sympathetic innervation from the lower thoracolumbar
segments (T12-L2) via the inferior mesenteric ganglion. Options A and B innervate
upper and mid-GI tract structures.
10. A 22-year-old male presents with a cough and thick yellowish sputum for
three days. Auscultation reveals crackles in the right lower lung field. Somatic
dysfunction associated with this localized pulmonary infection would most likely
manifest at which spinal level?
A) T1-T4
B) T2-T7
C) T8-T10
D) T11-L1
Rationale: The correct answer is B. Viscerosomatic reflexes for the lungs and
pulmonary structures travel via sympathetic pathways back to the T2-T7 spinal cord
segments. Option A is too narrow and specific to upper thoracic/head structures, and
options C and D represent abdominal systems.
11. A 30-year-old male presents with deep lower back pain after lifting a heavy
box. Physical examination demonstrates a left seated flexion test, a deep left sacral
sulcus, and a left inferior lateral angle (ILA) that is anterior. What is the correct sacral
diagnosis?
A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Right-on-left sacral torsion
D) Left sacral unilateral flexion
Rationale: The correct answer is D. In a unilateral sacral flexion, the seated flexion
test is positive on the side of the lesion (left). The sulcus on that same side is deep,
and the ILA on that side moves posterior and inferior. However, if the opposite ILA is
described as anterior/superior, this signifies a unilateral shear or flexion pattern
matching a single side. Option A would feature a deep right sulcus and a posterior
left ILA.
12. A 14-year-old female presents for a routine sports physical. Visual inspection
reveals an asymmetric rib hump when she bends forward. Radiographs reveal a
scoliotic curve with a Cobb angle of 18 degrees. Which of the following management
plans is most appropriate?
