COMSAE PHASE 1 FORM 114: COMPLETE 176
QUESTION TEST BANK | ALL QUESTIONS WITH
CORRECT VERIFIED ANSWERS & DETAILED
RATIONALES | GRADED A+ FOR THE NEWEST
2026 ACTUAL EXAM
CORE DOMAINS
• Osteopathic Principles and Practice (OPP/OMT)
• Anatomy and Embryology
• Physiology
• Biochemistry and Molecular Biology
• Pathology
• Pharmacology
• Microbiology and Immunology
• Behavioral Science
• Clinical Presentation Integration and Diagnostic Reasoning
INTRODUCTION
This comprehensive examination is designed as a high-yield self-
assessment tool for osteopathic medical students preparing for the
COMSAE Phase 1 and COMLEX-USA Level 1 examinations. The exam
evaluates foundational biomedical science knowledge and osteopathic
principles essential for clinical practice. It features 176 single-best-
answer, multiple-choice questions organized into four sections of 44
questions each, mirroring the official NBOME COMSAE Phase 1
format. Questions emphasize scientific understanding of disease
mechanisms, osteopathic manipulative treatment principles, and clinical
presentation integration. Success on this examination indicates
,readiness for COMLEX-USA Level 1 and a solid foundation in
osteopathic medical practice.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(OPP/OMT) – Questions 1–44
1. A 32-year-old female presents with chronic headaches and neck
pain. On structural examination, you find a Type I dysfunction at
C3-C5. According to Fryette's principles, which of the following best
describes this dysfunction?
A. Neutral position, rotation and side-bending occur to opposite
directions
B. Flexion or extension position, rotation and side-bending occur to
opposite directions
C. Neutral position, rotation and side-bending occur to the same
direction
D. Flexion or extension position, rotation and side-bending occur to the
same direction
A. Neutral position, rotation and side-bending occur to opposite
directions
RATIONALE: Fryette's first principle (Type I mechanics) states that
when the spine is in a neutral position, side-bending and rotation occur
in opposite directions. Type II mechanics occur in a non-neutral (flexion
or extension) position, where rotation and side-bending occur in the
same direction. The cervical spine from C2-C7 follows Fryette's
principles, with Type I being the more common dysfunction.
,2. 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. According to Fryette's principles, this
dysfunction is classified as:
A. Type I dysfunction
B. Type II dysfunction
C. Type III dysfunction
D. Neutral dysfunction
B. Type II dysfunction
RATIONALE: Fryette's second principle (Type II mechanics) states
that when the spine is in a non-neutral position (flexion or extension),
side-bending and rotation occur in the same direction. Since the T5
segment prefers rotation and side-bending to the same side (right), this is
a Type II dysfunction. The vertebral segment would be found to be
restricted in either flexion or extension, with rotation and side-bending
occurring together.
3. Which of the following conditions is an absolute contraindication
to cervical high-velocity, low-amplitude (HVLA) thrust?
A. Tension headache
B. Cervical radiculopathy
C. Rheumatoid arthritis with atlantoaxial instability
D. Chronic neck pain with muscle spasm
C. Rheumatoid arthritis with atlantoaxial instability
RATIONALE: Atlantoaxial instability in rheumatoid arthritis is an
absolute contraindication to cervical HVLA thrust due to the risk of
, spinal cord injury and vertebral artery compromise. Other
contraindications include Down syndrome with atlantoaxial instability,
recent cervical trauma or fracture, vertebral artery dissection, and severe
osteoporosis. Tension headaches, cervical radiculopathy, and chronic
neck pain with muscle spasm are not absolute contraindications.
4. A patient has a somatic dysfunction of the sacrum. On
examination, the right inferior lateral angle (ILA) is more posterior
than the left. The patient is asked to sit and then lean forward, and
the right ILA moves further posterior. This describes which sacral
dysfunction?
A. Left-on-left torsion
B. Right-on-right torsion
C. Left unilateral flexion
D. Right unilateral flexion
B. Right-on-right torsion
RATIONALE: In a right-on-right sacral torsion, the right ILA is
more posterior and moves further posterior with forward bending (the
seated flexion test is positive on the right). The axis of rotation is the
oblique axis on the opposite side. The naming convention describes the
side of the deeper sacral sulcus and the direction of rotation of the base.
5. A 45-year-old male presents with right upper quadrant
abdominal pain. On examination, you find a tender Chapman reflex
point at the right costochondral junction of the 6th rib. This reflex
point is most associated with dysfunction of which organ?
QUESTION TEST BANK | ALL QUESTIONS WITH
CORRECT VERIFIED ANSWERS & DETAILED
RATIONALES | GRADED A+ FOR THE NEWEST
2026 ACTUAL EXAM
CORE DOMAINS
• Osteopathic Principles and Practice (OPP/OMT)
• Anatomy and Embryology
• Physiology
• Biochemistry and Molecular Biology
• Pathology
• Pharmacology
• Microbiology and Immunology
• Behavioral Science
• Clinical Presentation Integration and Diagnostic Reasoning
INTRODUCTION
This comprehensive examination is designed as a high-yield self-
assessment tool for osteopathic medical students preparing for the
COMSAE Phase 1 and COMLEX-USA Level 1 examinations. The exam
evaluates foundational biomedical science knowledge and osteopathic
principles essential for clinical practice. It features 176 single-best-
answer, multiple-choice questions organized into four sections of 44
questions each, mirroring the official NBOME COMSAE Phase 1
format. Questions emphasize scientific understanding of disease
mechanisms, osteopathic manipulative treatment principles, and clinical
presentation integration. Success on this examination indicates
,readiness for COMLEX-USA Level 1 and a solid foundation in
osteopathic medical practice.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(OPP/OMT) – Questions 1–44
1. A 32-year-old female presents with chronic headaches and neck
pain. On structural examination, you find a Type I dysfunction at
C3-C5. According to Fryette's principles, which of the following best
describes this dysfunction?
A. Neutral position, rotation and side-bending occur to opposite
directions
B. Flexion or extension position, rotation and side-bending occur to
opposite directions
C. Neutral position, rotation and side-bending occur to the same
direction
D. Flexion or extension position, rotation and side-bending occur to the
same direction
A. Neutral position, rotation and side-bending occur to opposite
directions
RATIONALE: Fryette's first principle (Type I mechanics) states that
when the spine is in a neutral position, side-bending and rotation occur
in opposite directions. Type II mechanics occur in a non-neutral (flexion
or extension) position, where rotation and side-bending occur in the
same direction. The cervical spine from C2-C7 follows Fryette's
principles, with Type I being the more common dysfunction.
,2. 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. According to Fryette's principles, this
dysfunction is classified as:
A. Type I dysfunction
B. Type II dysfunction
C. Type III dysfunction
D. Neutral dysfunction
B. Type II dysfunction
RATIONALE: Fryette's second principle (Type II mechanics) states
that when the spine is in a non-neutral position (flexion or extension),
side-bending and rotation occur in the same direction. Since the T5
segment prefers rotation and side-bending to the same side (right), this is
a Type II dysfunction. The vertebral segment would be found to be
restricted in either flexion or extension, with rotation and side-bending
occurring together.
3. Which of the following conditions is an absolute contraindication
to cervical high-velocity, low-amplitude (HVLA) thrust?
A. Tension headache
B. Cervical radiculopathy
C. Rheumatoid arthritis with atlantoaxial instability
D. Chronic neck pain with muscle spasm
C. Rheumatoid arthritis with atlantoaxial instability
RATIONALE: Atlantoaxial instability in rheumatoid arthritis is an
absolute contraindication to cervical HVLA thrust due to the risk of
, spinal cord injury and vertebral artery compromise. Other
contraindications include Down syndrome with atlantoaxial instability,
recent cervical trauma or fracture, vertebral artery dissection, and severe
osteoporosis. Tension headaches, cervical radiculopathy, and chronic
neck pain with muscle spasm are not absolute contraindications.
4. A patient has a somatic dysfunction of the sacrum. On
examination, the right inferior lateral angle (ILA) is more posterior
than the left. The patient is asked to sit and then lean forward, and
the right ILA moves further posterior. This describes which sacral
dysfunction?
A. Left-on-left torsion
B. Right-on-right torsion
C. Left unilateral flexion
D. Right unilateral flexion
B. Right-on-right torsion
RATIONALE: In a right-on-right sacral torsion, the right ILA is
more posterior and moves further posterior with forward bending (the
seated flexion test is positive on the right). The axis of rotation is the
oblique axis on the opposite side. The naming convention describes the
side of the deeper sacral sulcus and the direction of rotation of the base.
5. A 45-year-old male presents with right upper quadrant
abdominal pain. On examination, you find a tender Chapman reflex
point at the right costochondral junction of the 6th rib. This reflex
point is most associated with dysfunction of which organ?
