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COMSAE PHASE 1 FORM 116 PRACTICE EXAM
2026 COMPLETE (135) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
COMSAE
Prepare for the COMSAE Phase 1 Form 116 with this comprehensive
practice exam designed to reinforce high-yield osteopathic medical
concepts and exam-focused content. This resource helps you review
essential topics, assess your knowledge, and identify areas that may need
additional attention before your assessment. Use it to strengthen your
clinical reasoning and build confidence through structured practice. An
excellent study companion for efficient and effective COMSAE Phase 1
exam preparation.
MULTIPLE CHOICE.
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1–15)
Question 1: A 32-year-old female presents with chronic
headaches and neck pain. On structural exam, 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 sidebending opposite
directions
• B. Flexed position, rotation and sidebending same direction
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• C. Extended position, rotation and sidebending opposite
directions
• D. Neutral position, rotation and sidebending same direction
Correct answer: A. Neutral position, rotation and sidebending
opposite directions
Rationale: Fryette's Type I mechanics occur in the neutral position,
where rotation and sidebending occur in opposite directions.
Question 2: A 55-year-old male with a history of COPD presents
with low back pain. On examination, you note a right-sided short
leg and a positive standing flexion test on the right. In the prone
position, the right ILA is more anterior than the left. What is the
most likely sacral diagnosis?
• A. Right on right sacral torsion
• B. Left on left sacral torsion
• C. Right unilateral sacral extension
• D. Left unilateral sacral flexion
Correct answer: C. Right unilateral sacral extension
Rationale: In unilateral sacral extension, the ILA on the affected
side is more anterior and superior, with a positive flexion test on the
same side.
Question 3: A patient presents with right-sided rib pain following
a motor vehicle accident. On examination, you find that the right
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6th rib is restricted in inhalation. Which muscle is primarily
responsible for this motion?
• A. External intercostals
• B. Internal intercostals
• C. Diaphragm
• D. Scalenes
Correct answer: C. Diaphragm
Rationale: The diaphragm is the primary muscle of inhalation. Rib
dysfunction in inhalation occurs when the rib is unable to move
upward and outward during inspiration.
Question 4: A patient with chronic neck pain has a restricted C5
segment that rotates more easily to the right and sidebends
more easily to the right. The restriction improves when the
patient extends the cervical spine. According to Fryette's
principles, what is the correct diagnosis?
• A. C5 Extended RR SR
• B. C5 Extended LR SL
• C. C5 Flexed RR SR
• D. C5 Neutral RR SR
Correct answer: A. C5 Extended RR SR
Rationale: When a segment improves in extension, it is diagnosed
as an Extended dysfunction. In Type II mechanics, rotation and
sidebending occur in the same direction.
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Question 5: A 45-year-old female presents with chronic low back
pain. On examination, you find that the L5 vertebra is restricted
in flexion, rotates more easily to the left, and sidebends more
easily to the left. According to Fryette's principles, how should
this dysfunction be documented?
• A. L5 Flexed RR SR
• B. L5 Flexed LR SL
• C. L5 Extended RR SR
• D. L5 Neutral LR SR
Correct answer: B. L5 Flexed LR SL
Rationale: Fryette's Type II (non-neutral) dysfunctions occur in
flexion or extension with rotation and sidebending in the same
direction. Since the segment is restricted in flexion with rotation left
(LR) and sidebending left (SL), the correct documentation is "L5
Flexed LR SL".
Question 6: According to Fryette's principles, which of the
following describes Type I somatic dysfunction?
• A. Vertebrae in neutral position with rotation and sidebending
in opposite directions
• B. Vertebrae in non-neutral position with rotation and
sidebending in the same direction
COMSAE PHASE 1 FORM 116 PRACTICE EXAM
2026 COMPLETE (135) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
COMSAE
Prepare for the COMSAE Phase 1 Form 116 with this comprehensive
practice exam designed to reinforce high-yield osteopathic medical
concepts and exam-focused content. This resource helps you review
essential topics, assess your knowledge, and identify areas that may need
additional attention before your assessment. Use it to strengthen your
clinical reasoning and build confidence through structured practice. An
excellent study companion for efficient and effective COMSAE Phase 1
exam preparation.
MULTIPLE CHOICE.
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1–15)
Question 1: A 32-year-old female presents with chronic
headaches and neck pain. On structural exam, 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 sidebending opposite
directions
• B. Flexed position, rotation and sidebending same direction
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• C. Extended position, rotation and sidebending opposite
directions
• D. Neutral position, rotation and sidebending same direction
Correct answer: A. Neutral position, rotation and sidebending
opposite directions
Rationale: Fryette's Type I mechanics occur in the neutral position,
where rotation and sidebending occur in opposite directions.
Question 2: A 55-year-old male with a history of COPD presents
with low back pain. On examination, you note a right-sided short
leg and a positive standing flexion test on the right. In the prone
position, the right ILA is more anterior than the left. What is the
most likely sacral diagnosis?
• A. Right on right sacral torsion
• B. Left on left sacral torsion
• C. Right unilateral sacral extension
• D. Left unilateral sacral flexion
Correct answer: C. Right unilateral sacral extension
Rationale: In unilateral sacral extension, the ILA on the affected
side is more anterior and superior, with a positive flexion test on the
same side.
Question 3: A patient presents with right-sided rib pain following
a motor vehicle accident. On examination, you find that the right
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6th rib is restricted in inhalation. Which muscle is primarily
responsible for this motion?
• A. External intercostals
• B. Internal intercostals
• C. Diaphragm
• D. Scalenes
Correct answer: C. Diaphragm
Rationale: The diaphragm is the primary muscle of inhalation. Rib
dysfunction in inhalation occurs when the rib is unable to move
upward and outward during inspiration.
Question 4: A patient with chronic neck pain has a restricted C5
segment that rotates more easily to the right and sidebends
more easily to the right. The restriction improves when the
patient extends the cervical spine. According to Fryette's
principles, what is the correct diagnosis?
• A. C5 Extended RR SR
• B. C5 Extended LR SL
• C. C5 Flexed RR SR
• D. C5 Neutral RR SR
Correct answer: A. C5 Extended RR SR
Rationale: When a segment improves in extension, it is diagnosed
as an Extended dysfunction. In Type II mechanics, rotation and
sidebending occur in the same direction.
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Question 5: A 45-year-old female presents with chronic low back
pain. On examination, you find that the L5 vertebra is restricted
in flexion, rotates more easily to the left, and sidebends more
easily to the left. According to Fryette's principles, how should
this dysfunction be documented?
• A. L5 Flexed RR SR
• B. L5 Flexed LR SL
• C. L5 Extended RR SR
• D. L5 Neutral LR SR
Correct answer: B. L5 Flexed LR SL
Rationale: Fryette's Type II (non-neutral) dysfunctions occur in
flexion or extension with rotation and sidebending in the same
direction. Since the segment is restricted in flexion with rotation left
(LR) and sidebending left (SL), the correct documentation is "L5
Flexed LR SL".
Question 6: According to Fryette's principles, which of the
following describes Type I somatic dysfunction?
• A. Vertebrae in neutral position with rotation and sidebending
in opposite directions
• B. Vertebrae in non-neutral position with rotation and
sidebending in the same direction
