COMSAE Phase 1 Form 114 Actual Exam: 176 Questions
with Verified Answers and Detailed Rationales (2026
Edition, Graded A+) LATEST UPDATE THIS YEAR.PDF
INSTANT DOWNLOAD PDF
Study Tips & Strategy
1. Know the NBOME Blueprint: The exam emphasizes Osteopathic Principles & Practice (20-
25%), General Medicine (25-30%), Pathology (15-20%), Pharmacology (10-15%),
and Microbiology/Immunology (10-15%) .
2. Master OMM/OPP: Expect high-yield questions on Fryette's principles, Chapman reflexes,
viscerosomatic reflexes, cranial OMM, and sacral diagnosis .
3. Practice Clinical Vignettes: The COMSAE uses vignette-based questions that require integrated
clinical reasoning. Focus on classic presentations of common diseases .
4. Time Management: The exam has 176 questions in 4 sections of 44 questions each. Practice
pacing to complete each section within the time limit .
5. Review ABGs and Acid-Base: Respiratory acidosis/alkalosis and metabolic acidosis/alkalosis are
frequently tested
Exam Overview
The COMSAE Phase 1 (Comprehensive Osteopathic Medical Self-Assessment
Examination) is an online practice exam that mirrors the COMLEX-USA Level 1 in
structure, content, and difficulty. It is used by osteopathic medical students to
assess readiness for the licensing exam .
Exam Details at a Glance :
Number of Questions: 176
Sections: 4 sections of 44 questions each
Format: Single-best-answer, multiple-choice
, Features: May include images, video exhibits (headphones required for
some forms)
Provider: NBOME (National Board of Osteopathic Medical Examiners)
Section 1: Osteopathic Principles & Practice (Questions 1-30)
1. A 24-year-old male presents with acute lower back pain after lifting heavy
boxes. Physical examination reveals that the right L4 transverse process is more
posterior than the left. The asymmetry worsens during lumbar flexion and
normalizes during lumbar extension. What is the correct somatic dysfunction
diagnosis?
A) L4 Neutral, Rotated Right, Sidebent Left
B) L4 Flexed, Rotated Left, Sidebent Left
C) L4 Extended, Rotated Right, Sidebent Right
D) L4 Extended, Rotated Left, Sidebent Left
E) L4 Neutral, Rotated Left, Sidebent Right
Rationale: The asymmetry normalizes in extension, indicating an extension
dysfunction (Type II mechanics). Type II mechanics dictate that rotation and
sidebending occur to the same side. Because the right transverse process is
posterior, the vertebra is rotated right and sidebent right, giving the diagnosis E
RrSr .
,2. A patient has restricted left rotation of the lumbar spine, with pain and
muscle spasm. The seated flexion test is negative. Which Fryette principle
describes the expected coupling pattern?
A) Type I: sidebending and rotation occur to opposite sides
B) Type I: sidebending and rotation occur to the same side
C) Type II: sidebending and rotation occur to opposite sides
D) Type II: sidebending and rotation occur to the same side
Rationale: Fryette Type I (neutral mechanics) applies to groups of vertebrae;
sidebending and rotation occur to opposite sides .
3. A patient has C3 that translates easier to the left and more symmetrically in
extension. What is the somatic dysfunction diagnosis?
A) C3 E RrSr
B) C3 F RrSr
C) C3 E RlSl
D) C3 F RlSl
E) C3 neutral
Rationale: The diagnosis follows the convention: E = Extension, Rr = Rotated right,
Sr = Sidebent right. C3 translates easier to the left and more symmetrically in
extension, indicating the dysfunction is in extension, with rotation and
sidebending to the right .
, 4. Which of the following cranial techniques is specifically designed to enhance
the amplitude of the cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Bulb compression (CV4)
C) V-spread technique
D) Frontal lift
E) Parietal lift
Rationale: Compression of the fourth ventricle (CV4) is explicitly utilized to
encourage fluid movement, enhance the amplitude of the CRI, and assist with
autonomic nervous system balancing .
5. A patient presents with low back pain that worsens with lumbar extension
and improves with flexion. On examination, there is a prominent right PSIS and
a short right leg in the supine position, with the leg length equalizing when
seated. Which somatic dysfunction is most likely?
A) Left anterior innominate
B) Right anterior innominate
C) Left posterior innominate
D) Right posterior innominate
E) Bilateral innominate rotation
with Verified Answers and Detailed Rationales (2026
Edition, Graded A+) LATEST UPDATE THIS YEAR.PDF
INSTANT DOWNLOAD PDF
Study Tips & Strategy
1. Know the NBOME Blueprint: The exam emphasizes Osteopathic Principles & Practice (20-
25%), General Medicine (25-30%), Pathology (15-20%), Pharmacology (10-15%),
and Microbiology/Immunology (10-15%) .
2. Master OMM/OPP: Expect high-yield questions on Fryette's principles, Chapman reflexes,
viscerosomatic reflexes, cranial OMM, and sacral diagnosis .
3. Practice Clinical Vignettes: The COMSAE uses vignette-based questions that require integrated
clinical reasoning. Focus on classic presentations of common diseases .
4. Time Management: The exam has 176 questions in 4 sections of 44 questions each. Practice
pacing to complete each section within the time limit .
5. Review ABGs and Acid-Base: Respiratory acidosis/alkalosis and metabolic acidosis/alkalosis are
frequently tested
Exam Overview
The COMSAE Phase 1 (Comprehensive Osteopathic Medical Self-Assessment
Examination) is an online practice exam that mirrors the COMLEX-USA Level 1 in
structure, content, and difficulty. It is used by osteopathic medical students to
assess readiness for the licensing exam .
Exam Details at a Glance :
Number of Questions: 176
Sections: 4 sections of 44 questions each
Format: Single-best-answer, multiple-choice
, Features: May include images, video exhibits (headphones required for
some forms)
Provider: NBOME (National Board of Osteopathic Medical Examiners)
Section 1: Osteopathic Principles & Practice (Questions 1-30)
1. A 24-year-old male presents with acute lower back pain after lifting heavy
boxes. Physical examination reveals that the right L4 transverse process is more
posterior than the left. The asymmetry worsens during lumbar flexion and
normalizes during lumbar extension. What is the correct somatic dysfunction
diagnosis?
A) L4 Neutral, Rotated Right, Sidebent Left
B) L4 Flexed, Rotated Left, Sidebent Left
C) L4 Extended, Rotated Right, Sidebent Right
D) L4 Extended, Rotated Left, Sidebent Left
E) L4 Neutral, Rotated Left, Sidebent Right
Rationale: The asymmetry normalizes in extension, indicating an extension
dysfunction (Type II mechanics). Type II mechanics dictate that rotation and
sidebending occur to the same side. Because the right transverse process is
posterior, the vertebra is rotated right and sidebent right, giving the diagnosis E
RrSr .
,2. A patient has restricted left rotation of the lumbar spine, with pain and
muscle spasm. The seated flexion test is negative. Which Fryette principle
describes the expected coupling pattern?
A) Type I: sidebending and rotation occur to opposite sides
B) Type I: sidebending and rotation occur to the same side
C) Type II: sidebending and rotation occur to opposite sides
D) Type II: sidebending and rotation occur to the same side
Rationale: Fryette Type I (neutral mechanics) applies to groups of vertebrae;
sidebending and rotation occur to opposite sides .
3. A patient has C3 that translates easier to the left and more symmetrically in
extension. What is the somatic dysfunction diagnosis?
A) C3 E RrSr
B) C3 F RrSr
C) C3 E RlSl
D) C3 F RlSl
E) C3 neutral
Rationale: The diagnosis follows the convention: E = Extension, Rr = Rotated right,
Sr = Sidebent right. C3 translates easier to the left and more symmetrically in
extension, indicating the dysfunction is in extension, with rotation and
sidebending to the right .
, 4. Which of the following cranial techniques is specifically designed to enhance
the amplitude of the cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Bulb compression (CV4)
C) V-spread technique
D) Frontal lift
E) Parietal lift
Rationale: Compression of the fourth ventricle (CV4) is explicitly utilized to
encourage fluid movement, enhance the amplitude of the CRI, and assist with
autonomic nervous system balancing .
5. A patient presents with low back pain that worsens with lumbar extension
and improves with flexion. On examination, there is a prominent right PSIS and
a short right leg in the supine position, with the leg length equalizing when
seated. Which somatic dysfunction is most likely?
A) Left anterior innominate
B) Right anterior innominate
C) Left posterior innominate
D) Right posterior innominate
E) Bilateral innominate rotation
