COMSAE Phase 1 Form 112 Practice Exam
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your COMLEX Level 1 preparation with the ultimate study guide for the COMSAE Phase 1 Form
112 exam. This high-yield document features verified multiple-choice questions, accurate answers,
and comprehensive, step-by-step rationales. Master tricky NBOME-style topics including complex
OMM diagnostics, viscerosomatic levels, pathology, and neuroanatomy. Perfect for DO students
struggling with ambiguous stems or experiencing score drops. Download now to verify your
readiness and pass
1. A 45-year-old male presents with acute epigastric pain radiating to his back,
accompanied by nausea and vomiting. Laboratory values reveal markedly elevated
serum lipase. An osteopathic structural examination is performed. At which of the
following spinal levels would you most likely expect to find tissue texture changes
associated with a viscerosomatic reflex for this acute condition?
A) T1–T4
B) T5–T9
C) T10–T11
D) T12–L2
B) T5–T9
Rationale: The patient's clinical presentation is highly suggestive of acute
pancreatitis. The pancreas is a foregut organ, and its sympathetic innervation
originates from the T5–T9 spinal levels via the greater splanchnic nerve. Somatic
manifestations (tissue texture changes, hypertonicity) will manifest within this
corresponding spinal region. T1–T4 corresponds to the head and neck, heart, and
lungs. T10–T11 corresponds to midgut organs. T12–L2 corresponds to hindgut
structures.
2. A 32-year-old female accountant presents with deep, aching pain in her right buttock
that radiates down the posterior aspect of her right thigh to the level of the knee. She
notes the pain worsens after sitting at her desk for more than 30 minutes. Physical
examination reveals exquisite tenderness to deep palpation in the middle of the right
gluteal region, and internal rotation of the right hip reproduces her symptoms. Which
of the following muscles is most likely responsible for her condition?
A) Gluteus medius
B) Piriformis
C) Obturator internus
D) Tensor fasciae latae
, B) Piriformis
Rationale: The clinical vignette describes piriformis syndrome, where hypertrophy,
spasm, or inflammation of the piriformis muscle compresses the adjacent sciatic
nerve. The piriformis muscle originates on the anterior surface of the sacrum and
inserts on the greater trochanter of the femur. It acts as an external rotator of the hip
when the hip is extended. Pain exacerbated by prolonged sitting and passive internal
rotation (which stretches the spasmed muscle) are classic diagnostic indicators.
3. During an osteopathic structural examination of a 22-year-old athlete, the physician
notes that the patient's right anterior superior iliac spine (ASIS) is inferior compared
to the left, and the right posterior superior iliac spine (PSIS) is superior compared to
the left. A standing flexion test is positive on the right. Which of the following is the
most likely diagnosis?
A) Right posterior innominate rotation
B) Left anterior innominate rotation
C) Right anterior innominate rotation
D) Right superior innominate shear
C) Right anterior innominate rotation
Rationale: A positive standing flexion test localizes the somatic dysfunction to the
right sacroiliac joint. An innominate dysfunction is named by comparing the positional
landmarks of the ipsilateral side. An inferior ASIS paired with a superior PSIS on the
same side indicates that the right innominate bone has rotated anteriorly around a
transverse axis.
4. A physician is using muscle energy technique to treat a patient with a Type II lumbar
somatic dysfunction named L3 Flexed, Rotated Right, and Sidebent Right (
). To correctly position the patient for this post-isometric relaxation treatment, how
should the physician place the L3 segment relative to the restrictive barrier?
A) Flexed, rotated right, sidebent right
B) Extended, rotated left, sidebent left
C) Neutral, rotated right, sidebent left
D) Extended, rotated right, sidebent left
B) Extended, rotated left, sidebent left
Rationale: Muscle energy is a direct, active technique. Direct techniques require
positioning the patient's dysfunctional segment directly into its restrictive barrier
, across all planes of motion. Because the dysfunction has an ease of motion in
flexion, right rotation, and right sidebending, the restrictive barrier lies in the exact
opposite directions: extension, left rotation, and left sidebending.
5. A newborn infant is evaluated in the nursery due to poor feeding and difficulty
sucking. Structural examination reveals significant compression of the occipital
condyles. Which of the following cranial nerves is most likely compressed, leading to
the infant's nursing difficulties?
A) Cranial Nerve VII (Facial)
B) Cranial Nerve IX (Glossopharyngeal)
C) Cranial Nerve XI (Accessory)
D) Cranial Nerve XII (Hypoglossal)
D) Cranial Nerve XII (Hypoglossal)
Rationale: The hypoglossal nerve (CN XII) emerges from the medulla and exits the
cranium via the hypoglossal canal, which is located in the occipital bone immediately
adjacent to the occipital condyles. Condylar compression, often occurring during
parturition, can impinge upon CN XII, resulting in tongue uncoordination, a weak
suck, and subsequent feeding difficulties.
6. While evaluating a patient's craniosacral mechanism, an osteopathic physician notes
that during the flexion phase of the primary respiratory mechanism (PRM), the paired
bones of the cranium fail to move properly. Which of the following motions normally
occurs in paired bones during the flexion phase of the PRM?
A) Internal rotation
B) External rotation
C) Cephalad shifting
D) Compression
B) External rotation
Rationale: During the flexion phase of the primary respiratory mechanism, the
sphenobasilar synchondrosis (SBS) moves cephalad. This movement causes the
midline bones (occiput, sphenoid, ethmoid, vomer) to undergo flexion, while
simultaneously causing all paired bones (parietals, temporals, frontals, maxillae,
innominates) to undergo external rotation.
7. A 60-year-old male with chronic obstructive pulmonary disease (COPD) presents for
a routine check-up. The physician wishes to optimize the patient's diaphragmatic
excursion and improve lymphatic return. Which of the following structural regions
should be treated first to clear the main lymphatic drainage pathway before applying
distal lymphatic pump techniques?
A) Lumbar spine
B) Thoracic inlet
, C) Popliteal fossa
D) Pelvic diaphragm
B) Thoracic inlet
Rationale: According to osteopathic lymphatic treatment models, distal lymphatic
congestion cannot be efficiently cleared until proximal obstructions are removed. The
entire lymphatic system drains into the venous system at the subclavian veins via the
thoracic ducts, which pass directly through the thoracic inlet (superior thoracic
aperture). Therefore, the thoracic inlet must be treated first to open the pathway.
8. A 28-year-old female presents with lateral right knee pain that began after she
increased her running mileage for a marathon. Structural examination demonstrates
a positive Ober test on the right. If the physician utilizes a counterstrain protocol to
treat the associated tender point located on the lateral aspect of the right knee, what
is the correct positioning for treatment?
A) Hip flexion and internal rotation
B) Hip abduction and mild flexion
C) Hip adduction and extension
D) Knee flexion and external rotation
B) Hip abduction and mild flexion
Rationale: A positive Ober test indicates tightness of the iliotibial (IT) band or tensor
fasciae latae muscle. The counterstrain tender point for the IT band is located along
the lateral aspect of the thigh or knee. To treat a tender point using counterstrain, the
tissue must be placed into a position of ease (shortening the muscle). For the IT
band, this is achieved via passive hip abduction with a small degree of flexion.
9. A patient is diagnosed with a sacral somatic dysfunction. Structural evaluation shows
a positive seated flexion test on the left. The spring test is negative (indicating good
spring at the sacral base). Lumbar examination reveals that L5 is rotated to the right.
Which of the following is the most likely sacral diagnosis?
A) Left-on-Left forward sacral torsion
B) Right-on-Left backward sacral torsion
C) Right-on-Right forward sacral torsion
D) Left-on-Right backward sacral torsion
A) Left-on-Left forward sacral torsion
Rationale: A negative spring test means the sacral base is able to spring anteriorly,
pointing to a forward (flexed) sacral torsion (either Left-on-Left or Right-on-Right). A
positive seated flexion test on the left indicates the dysfunction is on the left side,
meaning the axis must be the opposite side (Right axis) or the dysfunction is a
unilateral shear. In a Left-on-Left torsion, the left sacral base moves anteriorly, L5
rotates to the opposite side of the sacral rotation (L5 rotates right when the sacrum
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your COMLEX Level 1 preparation with the ultimate study guide for the COMSAE Phase 1 Form
112 exam. This high-yield document features verified multiple-choice questions, accurate answers,
and comprehensive, step-by-step rationales. Master tricky NBOME-style topics including complex
OMM diagnostics, viscerosomatic levels, pathology, and neuroanatomy. Perfect for DO students
struggling with ambiguous stems or experiencing score drops. Download now to verify your
readiness and pass
1. A 45-year-old male presents with acute epigastric pain radiating to his back,
accompanied by nausea and vomiting. Laboratory values reveal markedly elevated
serum lipase. An osteopathic structural examination is performed. At which of the
following spinal levels would you most likely expect to find tissue texture changes
associated with a viscerosomatic reflex for this acute condition?
A) T1–T4
B) T5–T9
C) T10–T11
D) T12–L2
B) T5–T9
Rationale: The patient's clinical presentation is highly suggestive of acute
pancreatitis. The pancreas is a foregut organ, and its sympathetic innervation
originates from the T5–T9 spinal levels via the greater splanchnic nerve. Somatic
manifestations (tissue texture changes, hypertonicity) will manifest within this
corresponding spinal region. T1–T4 corresponds to the head and neck, heart, and
lungs. T10–T11 corresponds to midgut organs. T12–L2 corresponds to hindgut
structures.
2. A 32-year-old female accountant presents with deep, aching pain in her right buttock
that radiates down the posterior aspect of her right thigh to the level of the knee. She
notes the pain worsens after sitting at her desk for more than 30 minutes. Physical
examination reveals exquisite tenderness to deep palpation in the middle of the right
gluteal region, and internal rotation of the right hip reproduces her symptoms. Which
of the following muscles is most likely responsible for her condition?
A) Gluteus medius
B) Piriformis
C) Obturator internus
D) Tensor fasciae latae
, B) Piriformis
Rationale: The clinical vignette describes piriformis syndrome, where hypertrophy,
spasm, or inflammation of the piriformis muscle compresses the adjacent sciatic
nerve. The piriformis muscle originates on the anterior surface of the sacrum and
inserts on the greater trochanter of the femur. It acts as an external rotator of the hip
when the hip is extended. Pain exacerbated by prolonged sitting and passive internal
rotation (which stretches the spasmed muscle) are classic diagnostic indicators.
3. During an osteopathic structural examination of a 22-year-old athlete, the physician
notes that the patient's right anterior superior iliac spine (ASIS) is inferior compared
to the left, and the right posterior superior iliac spine (PSIS) is superior compared to
the left. A standing flexion test is positive on the right. Which of the following is the
most likely diagnosis?
A) Right posterior innominate rotation
B) Left anterior innominate rotation
C) Right anterior innominate rotation
D) Right superior innominate shear
C) Right anterior innominate rotation
Rationale: A positive standing flexion test localizes the somatic dysfunction to the
right sacroiliac joint. An innominate dysfunction is named by comparing the positional
landmarks of the ipsilateral side. An inferior ASIS paired with a superior PSIS on the
same side indicates that the right innominate bone has rotated anteriorly around a
transverse axis.
4. A physician is using muscle energy technique to treat a patient with a Type II lumbar
somatic dysfunction named L3 Flexed, Rotated Right, and Sidebent Right (
). To correctly position the patient for this post-isometric relaxation treatment, how
should the physician place the L3 segment relative to the restrictive barrier?
A) Flexed, rotated right, sidebent right
B) Extended, rotated left, sidebent left
C) Neutral, rotated right, sidebent left
D) Extended, rotated right, sidebent left
B) Extended, rotated left, sidebent left
Rationale: Muscle energy is a direct, active technique. Direct techniques require
positioning the patient's dysfunctional segment directly into its restrictive barrier
, across all planes of motion. Because the dysfunction has an ease of motion in
flexion, right rotation, and right sidebending, the restrictive barrier lies in the exact
opposite directions: extension, left rotation, and left sidebending.
5. A newborn infant is evaluated in the nursery due to poor feeding and difficulty
sucking. Structural examination reveals significant compression of the occipital
condyles. Which of the following cranial nerves is most likely compressed, leading to
the infant's nursing difficulties?
A) Cranial Nerve VII (Facial)
B) Cranial Nerve IX (Glossopharyngeal)
C) Cranial Nerve XI (Accessory)
D) Cranial Nerve XII (Hypoglossal)
D) Cranial Nerve XII (Hypoglossal)
Rationale: The hypoglossal nerve (CN XII) emerges from the medulla and exits the
cranium via the hypoglossal canal, which is located in the occipital bone immediately
adjacent to the occipital condyles. Condylar compression, often occurring during
parturition, can impinge upon CN XII, resulting in tongue uncoordination, a weak
suck, and subsequent feeding difficulties.
6. While evaluating a patient's craniosacral mechanism, an osteopathic physician notes
that during the flexion phase of the primary respiratory mechanism (PRM), the paired
bones of the cranium fail to move properly. Which of the following motions normally
occurs in paired bones during the flexion phase of the PRM?
A) Internal rotation
B) External rotation
C) Cephalad shifting
D) Compression
B) External rotation
Rationale: During the flexion phase of the primary respiratory mechanism, the
sphenobasilar synchondrosis (SBS) moves cephalad. This movement causes the
midline bones (occiput, sphenoid, ethmoid, vomer) to undergo flexion, while
simultaneously causing all paired bones (parietals, temporals, frontals, maxillae,
innominates) to undergo external rotation.
7. A 60-year-old male with chronic obstructive pulmonary disease (COPD) presents for
a routine check-up. The physician wishes to optimize the patient's diaphragmatic
excursion and improve lymphatic return. Which of the following structural regions
should be treated first to clear the main lymphatic drainage pathway before applying
distal lymphatic pump techniques?
A) Lumbar spine
B) Thoracic inlet
, C) Popliteal fossa
D) Pelvic diaphragm
B) Thoracic inlet
Rationale: According to osteopathic lymphatic treatment models, distal lymphatic
congestion cannot be efficiently cleared until proximal obstructions are removed. The
entire lymphatic system drains into the venous system at the subclavian veins via the
thoracic ducts, which pass directly through the thoracic inlet (superior thoracic
aperture). Therefore, the thoracic inlet must be treated first to open the pathway.
8. A 28-year-old female presents with lateral right knee pain that began after she
increased her running mileage for a marathon. Structural examination demonstrates
a positive Ober test on the right. If the physician utilizes a counterstrain protocol to
treat the associated tender point located on the lateral aspect of the right knee, what
is the correct positioning for treatment?
A) Hip flexion and internal rotation
B) Hip abduction and mild flexion
C) Hip adduction and extension
D) Knee flexion and external rotation
B) Hip abduction and mild flexion
Rationale: A positive Ober test indicates tightness of the iliotibial (IT) band or tensor
fasciae latae muscle. The counterstrain tender point for the IT band is located along
the lateral aspect of the thigh or knee. To treat a tender point using counterstrain, the
tissue must be placed into a position of ease (shortening the muscle). For the IT
band, this is achieved via passive hip abduction with a small degree of flexion.
9. A patient is diagnosed with a sacral somatic dysfunction. Structural evaluation shows
a positive seated flexion test on the left. The spring test is negative (indicating good
spring at the sacral base). Lumbar examination reveals that L5 is rotated to the right.
Which of the following is the most likely sacral diagnosis?
A) Left-on-Left forward sacral torsion
B) Right-on-Left backward sacral torsion
C) Right-on-Right forward sacral torsion
D) Left-on-Right backward sacral torsion
A) Left-on-Left forward sacral torsion
Rationale: A negative spring test means the sacral base is able to spring anteriorly,
pointing to a forward (flexed) sacral torsion (either Left-on-Left or Right-on-Right). A
positive seated flexion test on the left indicates the dysfunction is on the left side,
meaning the axis must be the opposite side (Right axis) or the dysfunction is a
unilateral shear. In a Left-on-Left torsion, the left sacral base moves anteriorly, L5
rotates to the opposite side of the sacral rotation (L5 rotates right when the sacrum
