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COMSAE Phase 1 Form 115 Exam–ACTUAL
QUESTIONS AND ANSWERS LATEST UPDATE
THIS YEAR
COMSAE Phase 1 Form 115 (Based on COMLEX-USA Level 1 Blueprint)
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment Examination) Phase 1 Form 115 is
designed to assess readiness for COMLEX-USA Level 1. Below are the high-yield content areas covered
on this 176-question, 4-hour exam :
Osteopathic Principles & Practice (OPP/OMT) – ~12% of exam
• Fryette's principles (Type I neutral mechanics vs. Type II non-neutral mechanics)
• Sacral and innominate dysfunctions (anterior/posterior rotations, torsions)
• Chapman's reflexes (viscerosomatic reflex points by organ system)
• Cranial osteopathy (SBS motion, strain patterns, "wax paper" sensation)
• Muscle Energy Technique (MET) – submaximal isometric contraction, PIR
• Counterstrain (positioning toward ease, tender point treatment)
• HVLA (direct technique through restrictive barrier)
• Somatic dysfunction diagnosis using TART criteria
• Viscerosomatic reflexes (spinal levels corresponding to organ pathology)
Foundational Biomedical Sciences – ~25% of exam
• General pathology (cell injury, inflammation, neoplasia, hemodynamic disorders)
• Microbiology (bacteria, viruses, fungi, parasites, antimicrobials, resistance mechanisms)
• Immunology (hypersensitivity types, complement, autoimmunity, immunodeficiency)
• Biochemistry (metabolic pathways, enzyme kinetics, hormonal regulation)
• Medical genetics (Mendelian inheritance, chromosomal abnormalities, genetic testing)
• Pharmacology (PK/PD, autonomic, CNS, CV, endocrine, antimicrobial drugs)
Clinical Systems – ~45% of exam
• Cardiology (MI localization, heart failure murmurs, arrhythmias, hypertension)
• Pulmonology (pneumonia types, COPD, asthma, pulmonary embolism)
• Neurology (stroke localization, cranial nerves, brain herniation syndromes)
• Nephrology (AKI stages, acid-base disorders, electrolyte abnormalities)
• Gastroenterology (hepatitis, pancreatitis, inflammatory bowel disease)
• Endocrinology (thyroid disorders, diabetes, adrenal insufficiency)
• Infectious Disease (endocarditis, osteomyelitis, STIs, zoonoses)
• Musculoskeletal (fractures, arthritis, compartment syndrome)
Behavioral Science, Biostatistics & Ethics – ~10% of exam
• Biostatistics (sensitivity, specificity, PPV, NPV, RR, OR, NNT)
• Study design and interpretation (RCT, cohort, case-control)
• Ethical principles (autonomy, informed consent, confidentiality)
• Mental health diagnoses (panic disorder, depression, bipolar, schizophrenia)
• Patient-physician relationship and professionalism
Multisystem/Interdisciplinary Topics – ~8% of exam
• Geriatrics (falls, polypharmacy, cognitive decline)
• Pediatrics (developmental milestones, congenital conditions, rashes)
• Obstetrics (hypertension in pregnancy, STIs, complications)
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• Public health (screening guidelines, disease prevention)
Section 1: Osteopathic Principles & Practice (Questions 1-30)
1. A patient presents with a structural exam revealing a restricted T5 segment. The segment prefers
rotation to the right and side-bending to the right. It improves when the patient slumps forward into
spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answer: C – Because the dysfunction improves in flexion, the segment is diagnosed as Flexed. According
to Fryette's Second Law (Type II mechanics), when a single segment is in a non-neutral position (flexion
or extension), rotation and side-bending occur in the same direction. Hence, rotation right and side-
bending right yields a diagnosis of "Flexed RR SR" .
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2. According to Fryette's first principle (Type I mechanics), when the spine is in a neutral position
(neither flexed nor extended), which of the following occurs?
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Answer: C – Fryette's first principle (Type I mechanics) describes that when multiple vertebral segments
are in the neutral position, side-bending and rotation occur in opposite directions. This typically involves
group curves and multiple segments .
3. In Muscle Energy Technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
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Answer: B – MET uses a gentle, submaximal (approximately 20% of maximal effort), isometric
contraction by the patient, followed by relaxation and repositioning to the new barrier. This avoids
muscle fatigue, patient injury, and excessive guarding .
4. A patient with asthma has tenderness at the 2nd intercostal space, right parasternal region. This is a
Chapman's reflex for which organ?
A) Kidney
B) Lung
C) Liver
D) Stomach
Answer: B – The Chapman's reflex point for the lung is located in the second intercostal space on the
parasternal border. Viscerosomatic reflexes in this area are a key component of the osteopathic
structural exam in patients with pulmonary conditions .
5. A 50-year-old with chronic constipation has a tender point at the tip of the 12th rib on the right.
Which viscerosomatic reflex is most likely?
A) Colon
COMSAE Phase 1 Form 115 Exam–ACTUAL
QUESTIONS AND ANSWERS LATEST UPDATE
THIS YEAR
COMSAE Phase 1 Form 115 (Based on COMLEX-USA Level 1 Blueprint)
The COMSAE (Comprehensive Osteopathic Medical Self-Assessment Examination) Phase 1 Form 115 is
designed to assess readiness for COMLEX-USA Level 1. Below are the high-yield content areas covered
on this 176-question, 4-hour exam :
Osteopathic Principles & Practice (OPP/OMT) – ~12% of exam
• Fryette's principles (Type I neutral mechanics vs. Type II non-neutral mechanics)
• Sacral and innominate dysfunctions (anterior/posterior rotations, torsions)
• Chapman's reflexes (viscerosomatic reflex points by organ system)
• Cranial osteopathy (SBS motion, strain patterns, "wax paper" sensation)
• Muscle Energy Technique (MET) – submaximal isometric contraction, PIR
• Counterstrain (positioning toward ease, tender point treatment)
• HVLA (direct technique through restrictive barrier)
• Somatic dysfunction diagnosis using TART criteria
• Viscerosomatic reflexes (spinal levels corresponding to organ pathology)
Foundational Biomedical Sciences – ~25% of exam
• General pathology (cell injury, inflammation, neoplasia, hemodynamic disorders)
• Microbiology (bacteria, viruses, fungi, parasites, antimicrobials, resistance mechanisms)
• Immunology (hypersensitivity types, complement, autoimmunity, immunodeficiency)
• Biochemistry (metabolic pathways, enzyme kinetics, hormonal regulation)
• Medical genetics (Mendelian inheritance, chromosomal abnormalities, genetic testing)
• Pharmacology (PK/PD, autonomic, CNS, CV, endocrine, antimicrobial drugs)
Clinical Systems – ~45% of exam
• Cardiology (MI localization, heart failure murmurs, arrhythmias, hypertension)
• Pulmonology (pneumonia types, COPD, asthma, pulmonary embolism)
• Neurology (stroke localization, cranial nerves, brain herniation syndromes)
• Nephrology (AKI stages, acid-base disorders, electrolyte abnormalities)
• Gastroenterology (hepatitis, pancreatitis, inflammatory bowel disease)
• Endocrinology (thyroid disorders, diabetes, adrenal insufficiency)
• Infectious Disease (endocarditis, osteomyelitis, STIs, zoonoses)
• Musculoskeletal (fractures, arthritis, compartment syndrome)
Behavioral Science, Biostatistics & Ethics – ~10% of exam
• Biostatistics (sensitivity, specificity, PPV, NPV, RR, OR, NNT)
• Study design and interpretation (RCT, cohort, case-control)
• Ethical principles (autonomy, informed consent, confidentiality)
• Mental health diagnoses (panic disorder, depression, bipolar, schizophrenia)
• Patient-physician relationship and professionalism
Multisystem/Interdisciplinary Topics – ~8% of exam
• Geriatrics (falls, polypharmacy, cognitive decline)
• Pediatrics (developmental milestones, congenital conditions, rashes)
• Obstetrics (hypertension in pregnancy, STIs, complications)
, Page 2 of 155
• Public health (screening guidelines, disease prevention)
Section 1: Osteopathic Principles & Practice (Questions 1-30)
1. A patient presents with a structural exam revealing a restricted T5 segment. The segment prefers
rotation to the right and side-bending to the right. It improves when the patient slumps forward into
spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answer: C – Because the dysfunction improves in flexion, the segment is diagnosed as Flexed. According
to Fryette's Second Law (Type II mechanics), when a single segment is in a non-neutral position (flexion
or extension), rotation and side-bending occur in the same direction. Hence, rotation right and side-
bending right yields a diagnosis of "Flexed RR SR" .
, Page 3 of 155
2. According to Fryette's first principle (Type I mechanics), when the spine is in a neutral position
(neither flexed nor extended), which of the following occurs?
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Answer: C – Fryette's first principle (Type I mechanics) describes that when multiple vertebral segments
are in the neutral position, side-bending and rotation occur in opposite directions. This typically involves
group curves and multiple segments .
3. In Muscle Energy Technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
, Page 4 of 155
Answer: B – MET uses a gentle, submaximal (approximately 20% of maximal effort), isometric
contraction by the patient, followed by relaxation and repositioning to the new barrier. This avoids
muscle fatigue, patient injury, and excessive guarding .
4. A patient with asthma has tenderness at the 2nd intercostal space, right parasternal region. This is a
Chapman's reflex for which organ?
A) Kidney
B) Lung
C) Liver
D) Stomach
Answer: B – The Chapman's reflex point for the lung is located in the second intercostal space on the
parasternal border. Viscerosomatic reflexes in this area are a key component of the osteopathic
structural exam in patients with pulmonary conditions .
5. A 50-year-old with chronic constipation has a tender point at the tip of the 12th rib on the right.
Which viscerosomatic reflex is most likely?
A) Colon
