COMSAE Phase 1 Form 115 Exam Prep 2026- 200 Practice
Questions & Detailed Answers | Verified Answers with
Rationales | Instant PDF Download
1. A 24yearold male presents with acute onset of severe right lower quadrant pain, nausea, and fever.
Physical exam reveals McBurney's point tenderness. Which structure is most likely inflamed?
A) Cecum
B) Appendix
C) Ileum
D) Sigmoid colon
Correct Answer: B
Rationale: Acute appendicitis classically presents with periumbilical pain migrating to the right lower
quadrant (McBurney's point), nausea, fever, and localized tenderness. The appendix is a blindended
tube arising from the cecum; inflammation causes localized peritonitis at McBurney's point.
2. A patient presents with a structural exam revealing a restricted T5 segment. The segment prefers
rotation to the right and sidebending 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
Correct Answer: C
,Rationale: 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 nonneutral position (flexion
or extension), rotation and sidebending occur in the same direction. Hence, rotation right and
sidebending right yields a diagnosis of "Flexed RR SR."
3. 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) Sidebending and rotation occur to the same side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending
Correct Answer: C
Rationale: Fryette's first principle (Type I mechanics) describes that when multiple vertebral segments
are in neutral position, sidebending and rotation occur in opposite directions.
4. 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
Correct Answer: B
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by the patient, followed
by relaxation and repositioning to the new barrier. This avoids muscle fatigue and injury.
,5. Which osteopathic manipulative treatment (OMT) technique is most appropriate for a patient with
acute lumbar strain and paraspinal muscle spasm?
A) Highvelocity lowamplitude (HVLA) thrust
B) Muscle energy technique
C) Myofascial release
D) Lymphatic pump technique
Correct Answer: C
Rationale: Myofascial release is gentle, sustained pressure to release fascial restrictions and muscle
spasm, ideal for acute musculoskeletal pain. HVLA is contraindicated in acute injury; muscle energy
requires active patient participation; lymphatic pump addresses fluid dynamics.
6. A 25yearold man presents with acute onset of shortness of breath and chest pain after a long flight.
He has no significant past medical history. Vital signs: BP 110/70 mm Hg, HR 110 bpm, RR 24/min, SpO₂
90% on room air. A CTA chest reveals a filling defect in the right main pulmonary artery. Which of the
following is the most appropriate initial management?
A) Thrombolytics
B) Anticoagulation with heparin
C) Embolectomy
D) Inferior vena cava filter placement
Correct Answer: B
Rationale: The patient has a pulmonary embolism (PE) with hemodynamic stability (BP >90, no signs of
shock). Initial management is anticoagulation with heparin. Thrombolytics are reserved for massive PE
, with hemodynamic instability. Embolectomy is considered if thrombolytics fail or are contraindicated.
IVC filters are for patients with contraindications to anticoagulation.
7. A 22yearold woman presents with fatigue and pallor. Labs show Hb 9 g/dL, MCV 70 fL, ferritin low.
What is the diagnosis?
A) Thalassemia
B) Iron deficiency anemia
C) Anemia of chronic disease
D) B12 deficiency
Correct Answer: B
Rationale: Microcytic anemia (low MCV) with low ferritin is classic for iron deficiency anemia.
Thalassemia also causes microcytic anemia but ferritin is typically normal or elevated. Anemia of chronic
disease is normocytic or mildly microcytic with normal or elevated ferritin.
8. A patient with sudden severe headache described as "worst of life" likely has:
A) Migraine
B) Subarachnoid hemorrhage
C) Tension headache
D) Cluster headache
Correct Answer: B
Rationale: Thunderclap headache—sudden, severe, "worst of life"—strongly suggests subarachnoid
hemorrhage. This requires emergent neuroimaging (noncontrast head CT) and possibly lumbar
puncture.
Questions & Detailed Answers | Verified Answers with
Rationales | Instant PDF Download
1. A 24yearold male presents with acute onset of severe right lower quadrant pain, nausea, and fever.
Physical exam reveals McBurney's point tenderness. Which structure is most likely inflamed?
A) Cecum
B) Appendix
C) Ileum
D) Sigmoid colon
Correct Answer: B
Rationale: Acute appendicitis classically presents with periumbilical pain migrating to the right lower
quadrant (McBurney's point), nausea, fever, and localized tenderness. The appendix is a blindended
tube arising from the cecum; inflammation causes localized peritonitis at McBurney's point.
2. A patient presents with a structural exam revealing a restricted T5 segment. The segment prefers
rotation to the right and sidebending 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
Correct Answer: C
,Rationale: 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 nonneutral position (flexion
or extension), rotation and sidebending occur in the same direction. Hence, rotation right and
sidebending right yields a diagnosis of "Flexed RR SR."
3. 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) Sidebending and rotation occur to the same side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending
Correct Answer: C
Rationale: Fryette's first principle (Type I mechanics) describes that when multiple vertebral segments
are in neutral position, sidebending and rotation occur in opposite directions.
4. 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
Correct Answer: B
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by the patient, followed
by relaxation and repositioning to the new barrier. This avoids muscle fatigue and injury.
,5. Which osteopathic manipulative treatment (OMT) technique is most appropriate for a patient with
acute lumbar strain and paraspinal muscle spasm?
A) Highvelocity lowamplitude (HVLA) thrust
B) Muscle energy technique
C) Myofascial release
D) Lymphatic pump technique
Correct Answer: C
Rationale: Myofascial release is gentle, sustained pressure to release fascial restrictions and muscle
spasm, ideal for acute musculoskeletal pain. HVLA is contraindicated in acute injury; muscle energy
requires active patient participation; lymphatic pump addresses fluid dynamics.
6. A 25yearold man presents with acute onset of shortness of breath and chest pain after a long flight.
He has no significant past medical history. Vital signs: BP 110/70 mm Hg, HR 110 bpm, RR 24/min, SpO₂
90% on room air. A CTA chest reveals a filling defect in the right main pulmonary artery. Which of the
following is the most appropriate initial management?
A) Thrombolytics
B) Anticoagulation with heparin
C) Embolectomy
D) Inferior vena cava filter placement
Correct Answer: B
Rationale: The patient has a pulmonary embolism (PE) with hemodynamic stability (BP >90, no signs of
shock). Initial management is anticoagulation with heparin. Thrombolytics are reserved for massive PE
, with hemodynamic instability. Embolectomy is considered if thrombolytics fail or are contraindicated.
IVC filters are for patients with contraindications to anticoagulation.
7. A 22yearold woman presents with fatigue and pallor. Labs show Hb 9 g/dL, MCV 70 fL, ferritin low.
What is the diagnosis?
A) Thalassemia
B) Iron deficiency anemia
C) Anemia of chronic disease
D) B12 deficiency
Correct Answer: B
Rationale: Microcytic anemia (low MCV) with low ferritin is classic for iron deficiency anemia.
Thalassemia also causes microcytic anemia but ferritin is typically normal or elevated. Anemia of chronic
disease is normocytic or mildly microcytic with normal or elevated ferritin.
8. A patient with sudden severe headache described as "worst of life" likely has:
A) Migraine
B) Subarachnoid hemorrhage
C) Tension headache
D) Cluster headache
Correct Answer: B
Rationale: Thunderclap headache—sudden, severe, "worst of life"—strongly suggests subarachnoid
hemorrhage. This requires emergent neuroimaging (noncontrast head CT) and possibly lumbar
puncture.
