COMSAE PHASE 1 FORM 110 EXAM 2026–
2027 – COMPLETE 200 PRACTICE
QUESTIONS & DETAILED ANSWERS STUDY
GUIDE FOR OSTEOPATHIC MEDICAL BOARD
PREP (HIGH-YIELD REVIEW)
• This 200-question practice guide mirrors the COMSAE Phase 1 blueprint — each
question features five answer choices, a bolded correct answer, and a clear EXPERT
RATIONALE to reinforce understanding.
• Study tip: Attempt each question independently before checking the answer, then
read the EXPERT RATIONALE carefully to solidify the concept and recognize
patterns on exam day.
COMSAE PHASE 1 FORM 110 — 200 PRACTICE QUESTIONS
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Q1. A 45-year-old male presents with low back pain. On examination, the L3
vertebra is found to be rotated right and side-bent right, and this position is
more pronounced in flexion. How is this somatic dysfunction classified?
A. Neutral, Rotated Right, Side-bent Right (NRrSr)
B. Flexion, Rotated Right, Side-bent Right (FRrSr)
C. Extension, Rotated Right, Side-bent Right (ERrSr)
D. Neutral, Rotated Left, Side-bent Right (NRlSr)
E. Flexion, Rotated Left, Side-bent Left (FRlSl)
Correct Answer: B. Flexion, Rotated Right, Side-bent Right (FRrSr)
EXPERT RATIONALE: When a vertebral dysfunction is more prominent in
flexion, it is classified as a Type II (non-neutral) dysfunction. In Type II mechanics,
,rotation and side-bending occur to the SAME side. Since both rotation and side-
bending are to the right and the position is worse in flexion, this is FRrSr.
Q2. A physician applies a high-velocity low-amplitude (HVLA) thrust to a
thoracic vertebra. The underlying physiologic principle behind HVLA is best
described as:
A. Activating the Golgi tendon organ to cause muscle relaxation
B. Restoring normal joint mechanics by moving the segment through its restrictive
barrier
C. Using patient's own muscle contraction to reset proprioceptors
D. Applying slow sustained pressure to fatigue myofascial tissues
E. Stimulating the sympathetic nervous system to reduce inflammation
Correct Answer: B. Restoring normal joint mechanics by moving the
segment through its restrictive barrier
EXPERT RATIONALE: HVLA works by taking the dysfunctional segment to its
restrictive barrier and applying a quick, low-amplitude thrust to restore normal
range of motion. It does not primarily work through the Golgi tendon organ (that is
muscle energy) or myofascial fatigue (that is myofascial release).
Q3. During a counterstrain technique, the physician positions the patient to
shorten the muscle containing the tender point. The position of comfort is
held for how long?
A. 30 seconds
B. 60 seconds
C. 90 seconds
D. 120 seconds
E. 180 seconds
, Correct Answer: C. 90 seconds
EXPERT RATIONALE: Counterstrain (Jones technique) requires holding the
position of comfort — which shortens the affected muscle — for 90 seconds. This
allows the abnormal proprioceptive activity to normalize. After 90 seconds, the
patient is passively and slowly returned to neutral.
Q4. A patient has a positive standing flexion test on the right. This indicates a
somatic dysfunction involving which structure?
A. Left innominate
B. Right innominate or sacrum on the right
C. Lumbar vertebrae L4–L5
D. Left sacroiliac joint
E. Bilateral iliac crests
Correct Answer: B. Right innominate or sacrum on the right
EXPERT RATIONALE: The standing flexion test assesses iliosacral (innominate)
motion. A positive test (ASIS moves more superiorly on the ipsilateral side during
forward bending) indicates a somatic dysfunction of the innominate or sacrum on
the SAME side as the positive test.
Q5. A 38-year-old woman presents with tension headaches. Palpation reveals
a tender point at the occiput. Which osteopathic technique would be most
appropriate for addressing cranial dysfunction in this patient?
A. HVLA thrust to C1
B. Muscle energy technique
C. Craniosacral therapy (CV4 technique)
D. Lymphatic pump technique
E. Counterstrain of the suboccipital muscles only
, Correct Answer: C. Craniosacral therapy (CV4 technique)
EXPERT RATIONALE: The CV4 (compression of the fourth ventricle) technique is
a craniosacral technique used to treat headaches, reduce sympathetic tone, and
promote relaxation. It involves applying gentle compression to the occiput to
influence the primary respiratory mechanism (PRM).
Q6. Which of the following best describes the concept of "facilitated segment"
in osteopathic medicine?
A. A spinal segment with decreased sympathetic outflow due to somatic
dysfunction
B. A spinal segment with lowered threshold for neural firing due to sustained
afferent input
C. A vertebra locked in extension causing radiculopathy
D. A segment that has undergone complete denervation
E. A segment where parasympathetic tone is dominant
Correct Answer: B. A spinal segment with lowered threshold for neural
firing due to sustained afferent input
EXPERT RATIONALE: A facilitated segment occurs when a spinal cord level
becomes hyperexcitable due to sustained afferent bombardment from somatic or
visceral structures. This results in a lower threshold for firing and can manifest as
hyperalgesia, muscle spasm, and viscerosomatic reflexes.
Q7. A 52-year-old man with known coronary artery disease presents with
chest pain. Palpation reveals tissue texture changes at T1–T5 on the left. This
finding is best explained by which reflex?
A. Somatovisceral reflex
B. Viscerosomatic reflex
C. Viscerovisceral reflex
2027 – COMPLETE 200 PRACTICE
QUESTIONS & DETAILED ANSWERS STUDY
GUIDE FOR OSTEOPATHIC MEDICAL BOARD
PREP (HIGH-YIELD REVIEW)
• This 200-question practice guide mirrors the COMSAE Phase 1 blueprint — each
question features five answer choices, a bolded correct answer, and a clear EXPERT
RATIONALE to reinforce understanding.
• Study tip: Attempt each question independently before checking the answer, then
read the EXPERT RATIONALE carefully to solidify the concept and recognize
patterns on exam day.
COMSAE PHASE 1 FORM 110 — 200 PRACTICE QUESTIONS
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Q1. A 45-year-old male presents with low back pain. On examination, the L3
vertebra is found to be rotated right and side-bent right, and this position is
more pronounced in flexion. How is this somatic dysfunction classified?
A. Neutral, Rotated Right, Side-bent Right (NRrSr)
B. Flexion, Rotated Right, Side-bent Right (FRrSr)
C. Extension, Rotated Right, Side-bent Right (ERrSr)
D. Neutral, Rotated Left, Side-bent Right (NRlSr)
E. Flexion, Rotated Left, Side-bent Left (FRlSl)
Correct Answer: B. Flexion, Rotated Right, Side-bent Right (FRrSr)
EXPERT RATIONALE: When a vertebral dysfunction is more prominent in
flexion, it is classified as a Type II (non-neutral) dysfunction. In Type II mechanics,
,rotation and side-bending occur to the SAME side. Since both rotation and side-
bending are to the right and the position is worse in flexion, this is FRrSr.
Q2. A physician applies a high-velocity low-amplitude (HVLA) thrust to a
thoracic vertebra. The underlying physiologic principle behind HVLA is best
described as:
A. Activating the Golgi tendon organ to cause muscle relaxation
B. Restoring normal joint mechanics by moving the segment through its restrictive
barrier
C. Using patient's own muscle contraction to reset proprioceptors
D. Applying slow sustained pressure to fatigue myofascial tissues
E. Stimulating the sympathetic nervous system to reduce inflammation
Correct Answer: B. Restoring normal joint mechanics by moving the
segment through its restrictive barrier
EXPERT RATIONALE: HVLA works by taking the dysfunctional segment to its
restrictive barrier and applying a quick, low-amplitude thrust to restore normal
range of motion. It does not primarily work through the Golgi tendon organ (that is
muscle energy) or myofascial fatigue (that is myofascial release).
Q3. During a counterstrain technique, the physician positions the patient to
shorten the muscle containing the tender point. The position of comfort is
held for how long?
A. 30 seconds
B. 60 seconds
C. 90 seconds
D. 120 seconds
E. 180 seconds
, Correct Answer: C. 90 seconds
EXPERT RATIONALE: Counterstrain (Jones technique) requires holding the
position of comfort — which shortens the affected muscle — for 90 seconds. This
allows the abnormal proprioceptive activity to normalize. After 90 seconds, the
patient is passively and slowly returned to neutral.
Q4. A patient has a positive standing flexion test on the right. This indicates a
somatic dysfunction involving which structure?
A. Left innominate
B. Right innominate or sacrum on the right
C. Lumbar vertebrae L4–L5
D. Left sacroiliac joint
E. Bilateral iliac crests
Correct Answer: B. Right innominate or sacrum on the right
EXPERT RATIONALE: The standing flexion test assesses iliosacral (innominate)
motion. A positive test (ASIS moves more superiorly on the ipsilateral side during
forward bending) indicates a somatic dysfunction of the innominate or sacrum on
the SAME side as the positive test.
Q5. A 38-year-old woman presents with tension headaches. Palpation reveals
a tender point at the occiput. Which osteopathic technique would be most
appropriate for addressing cranial dysfunction in this patient?
A. HVLA thrust to C1
B. Muscle energy technique
C. Craniosacral therapy (CV4 technique)
D. Lymphatic pump technique
E. Counterstrain of the suboccipital muscles only
, Correct Answer: C. Craniosacral therapy (CV4 technique)
EXPERT RATIONALE: The CV4 (compression of the fourth ventricle) technique is
a craniosacral technique used to treat headaches, reduce sympathetic tone, and
promote relaxation. It involves applying gentle compression to the occiput to
influence the primary respiratory mechanism (PRM).
Q6. Which of the following best describes the concept of "facilitated segment"
in osteopathic medicine?
A. A spinal segment with decreased sympathetic outflow due to somatic
dysfunction
B. A spinal segment with lowered threshold for neural firing due to sustained
afferent input
C. A vertebra locked in extension causing radiculopathy
D. A segment that has undergone complete denervation
E. A segment where parasympathetic tone is dominant
Correct Answer: B. A spinal segment with lowered threshold for neural
firing due to sustained afferent input
EXPERT RATIONALE: A facilitated segment occurs when a spinal cord level
becomes hyperexcitable due to sustained afferent bombardment from somatic or
visceral structures. This results in a lower threshold for firing and can manifest as
hyperalgesia, muscle spasm, and viscerosomatic reflexes.
Q7. A 52-year-old man with known coronary artery disease presents with
chest pain. Palpation reveals tissue texture changes at T1–T5 on the left. This
finding is best explained by which reflex?
A. Somatovisceral reflex
B. Viscerosomatic reflex
C. Viscerovisceral reflex
