COMSAE Phase 1 Form 113 Practice
Exam Questions and Answers with
Rationales 2026 2027 Osteopathic Board
Review Graded A+ Just Released
TABLE OF CONTENTS
Section 1 Osteopathic Principles and Practice Questions 1 to 30
Section 2 Gross Anatomy and Embryology Questions 31 to 55
Section 3 Physiology and Pathophysiology Questions 56 to 80
Section 4 Pharmacology and Therapeutics Questions 81 to 105
Section 5 Microbiology and Immunology Questions 106 to 125
Section 6 Behavioral Science and Public Health Questions 126 to 140
Section 7 Biochemistry and Cellular Biology Questions 141 to 155
Section 8 Clinical Diagnosis and Management Questions 156 to 200
SECTION 1 OSTEOPATHIC PRINCIPLES AND PRACTICE
Question 1
,A 24 year old male presents with acute lower back pain after lifting
heavy boxes. Physical examination reveals a positive standing flexion
test on the right. In the prone position the right ASIS is superior and the
right PSIS is inferior. What is the most likely diagnosis
A. Right anterior innominate rotation
B. Right posterior innominate rotation
C. Left superior innominate shear
D. Right superior innominate shear
Correct Answer B
Rationale A positive standing flexion test localizes the side of somatic
dysfunction to the right. A posterior innominate rotation is characterized
by an ASIS that is superior and a PSIS that is inferior on the affected
side. This occurs when the innominate bone rotates posteriorly relative
to the sacrum.
Question 2
A patient is diagnosed with a somatic dysfunction of the 5th thoracic
vertebra. Palpation reveals that the T5 spinous process is rotated right.
The rotation abnormality worsens during lumbar and thoracic extension
but symmetry improves during flexion. How should this dysfunction be
named
,A. T5 F R(R) S(R)
B. T5 E R(L) S(L)
C. T5 F R(L) S(L)
D. T5 E R(R) S(R)
Correct Answer A
Rationale Somatic dysfunctions are named for their position of comfort.
Because symmetry improves in flexion the vertebra is flexed or F. The
spinous process rotates to the right which means the vertebral body
rotates to the left. In standard osteopathic naming when the spinous
process goes right the rotation is named as R(R).
Question 3
A patient presents with a right sacral base that is anterior and a left ILA
that is posterior and inferior. The spring test is negative. What is the
sacral diagnosis
A. Right on right torsion
B. Left on left torsion
C. Right unilateral flexion
D. Left unilateral flexion
, Correct Answer D
Rationale A negative spring test indicates a forward or physiologic sacral
torsion. The left ILA is posterior and inferior and the right sacral base is
anterior which is characteristic of a left unilateral flexion or left on left
torsion.
Question 4
A 45 year old male presents with acute lower back pain after lifting a
heavy box. On physical exam there is a hypertonic muscle segment at
T10 to T11. Which nerve root is most likely responsible for the
sympathetic innervation to the organ associated with these levels
A. Greater splanchnic nerve
B. Lesser splanchnic nerve
C. Least splanchnic nerve
D. Lumbar splanchnic nerve
Correct Answer B
Rationale The T10 to T11 spinal levels provide sympathetic innervation
to the mid gastrointestinal tract including the small intestine right colon
kidneys and upper ureters via the lesser splanchnic nerve.
Exam Questions and Answers with
Rationales 2026 2027 Osteopathic Board
Review Graded A+ Just Released
TABLE OF CONTENTS
Section 1 Osteopathic Principles and Practice Questions 1 to 30
Section 2 Gross Anatomy and Embryology Questions 31 to 55
Section 3 Physiology and Pathophysiology Questions 56 to 80
Section 4 Pharmacology and Therapeutics Questions 81 to 105
Section 5 Microbiology and Immunology Questions 106 to 125
Section 6 Behavioral Science and Public Health Questions 126 to 140
Section 7 Biochemistry and Cellular Biology Questions 141 to 155
Section 8 Clinical Diagnosis and Management Questions 156 to 200
SECTION 1 OSTEOPATHIC PRINCIPLES AND PRACTICE
Question 1
,A 24 year old male presents with acute lower back pain after lifting
heavy boxes. Physical examination reveals a positive standing flexion
test on the right. In the prone position the right ASIS is superior and the
right PSIS is inferior. What is the most likely diagnosis
A. Right anterior innominate rotation
B. Right posterior innominate rotation
C. Left superior innominate shear
D. Right superior innominate shear
Correct Answer B
Rationale A positive standing flexion test localizes the side of somatic
dysfunction to the right. A posterior innominate rotation is characterized
by an ASIS that is superior and a PSIS that is inferior on the affected
side. This occurs when the innominate bone rotates posteriorly relative
to the sacrum.
Question 2
A patient is diagnosed with a somatic dysfunction of the 5th thoracic
vertebra. Palpation reveals that the T5 spinous process is rotated right.
The rotation abnormality worsens during lumbar and thoracic extension
but symmetry improves during flexion. How should this dysfunction be
named
,A. T5 F R(R) S(R)
B. T5 E R(L) S(L)
C. T5 F R(L) S(L)
D. T5 E R(R) S(R)
Correct Answer A
Rationale Somatic dysfunctions are named for their position of comfort.
Because symmetry improves in flexion the vertebra is flexed or F. The
spinous process rotates to the right which means the vertebral body
rotates to the left. In standard osteopathic naming when the spinous
process goes right the rotation is named as R(R).
Question 3
A patient presents with a right sacral base that is anterior and a left ILA
that is posterior and inferior. The spring test is negative. What is the
sacral diagnosis
A. Right on right torsion
B. Left on left torsion
C. Right unilateral flexion
D. Left unilateral flexion
, Correct Answer D
Rationale A negative spring test indicates a forward or physiologic sacral
torsion. The left ILA is posterior and inferior and the right sacral base is
anterior which is characteristic of a left unilateral flexion or left on left
torsion.
Question 4
A 45 year old male presents with acute lower back pain after lifting a
heavy box. On physical exam there is a hypertonic muscle segment at
T10 to T11. Which nerve root is most likely responsible for the
sympathetic innervation to the organ associated with these levels
A. Greater splanchnic nerve
B. Lesser splanchnic nerve
C. Least splanchnic nerve
D. Lumbar splanchnic nerve
Correct Answer B
Rationale The T10 to T11 spinal levels provide sympathetic innervation
to the mid gastrointestinal tract including the small intestine right colon
kidneys and upper ureters via the lesser splanchnic nerve.
