COMSAE Exam Practice Questions and Answers (2026 Edition) Exam Overview
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COMSAE Practice Questions and Answers (2026 Edition)
Exam Overview
The Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE)
is a three-phase series developed by the NBOME to help osteopathic medical
students and residents gauge their knowledge base before taking COMLEX-USA
examinations .
Phase 1: 176 items, divided into 4 sections of 44 questions each
Phase 2: 160 items, divided into 4 sections of 40 questions each
Phase 3: 200 questions, divided into 4 sections of 50 questions each
All COMSAE examinations use single-best-answer multiple-choice format and may
include images, videos, or visual exhibits . The cost is $60 per form for
students/residents and $55 per form for COM purchases .
SECTION 1: OSTEOPATHIC MANIPULATIVE MEDICINE (OMM)
1. A 24-year-old male presents with acute lower back pain after lifting heavy
boxes. Physical examination reveals a right-standing flexion test positive 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
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 .
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)
Answer: A
Rationale: Somatic dysfunctions are named for their position of comfort (what
they "like" to do). Because symmetry improves in flexion, the vertebra is flexed
(F). The spinous process rotates to the right, so the naming is T5 F R(R) S(R) .
3. Which bone articulates with the acetabulum to form the hip joint?
A) Tibia
B) Fibula
C) Femur
D) Patella
Answer: C
Rationale: The femoral head articulates with the acetabulum of the os coxae to
form the hip joint .
, 4. A 23-year-old man presents with right arm pain after a fall. He cannot extend
his wrist. What nerve is most likely injured?
A) Median
B) Ulnar
C) Radial
D) Axillary
Answer: C
Rationale: The radial nerve innervates the triceps, brachioradialis, and all
wrist/finger extensors. Injury causes "wrist drop" (inability to extend the wrist).
An injury to the radial nerve in the spiral groove of the humerus is a classic
complication of a mid-shaft humeral fracture .
5. Which nerve is compressed in carpal tunnel syndrome?
A) Ulnar nerve
B) Median nerve
Feature Deta,.
COMSAE Practice Questions and Answers (2026 Edition)
Exam Overview
The Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE)
is a three-phase series developed by the NBOME to help osteopathic medical
students and residents gauge their knowledge base before taking COMLEX-USA
examinations .
Phase 1: 176 items, divided into 4 sections of 44 questions each
Phase 2: 160 items, divided into 4 sections of 40 questions each
Phase 3: 200 questions, divided into 4 sections of 50 questions each
All COMSAE examinations use single-best-answer multiple-choice format and may
include images, videos, or visual exhibits . The cost is $60 per form for
students/residents and $55 per form for COM purchases .
SECTION 1: OSTEOPATHIC MANIPULATIVE MEDICINE (OMM)
1. A 24-year-old male presents with acute lower back pain after lifting heavy
boxes. Physical examination reveals a right-standing flexion test positive 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
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 .
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)
Answer: A
Rationale: Somatic dysfunctions are named for their position of comfort (what
they "like" to do). Because symmetry improves in flexion, the vertebra is flexed
(F). The spinous process rotates to the right, so the naming is T5 F R(R) S(R) .
3. Which bone articulates with the acetabulum to form the hip joint?
A) Tibia
B) Fibula
C) Femur
D) Patella
Answer: C
Rationale: The femoral head articulates with the acetabulum of the os coxae to
form the hip joint .
, 4. A 23-year-old man presents with right arm pain after a fall. He cannot extend
his wrist. What nerve is most likely injured?
A) Median
B) Ulnar
C) Radial
D) Axillary
Answer: C
Rationale: The radial nerve innervates the triceps, brachioradialis, and all
wrist/finger extensors. Injury causes "wrist drop" (inability to extend the wrist).
An injury to the radial nerve in the spiral groove of the humerus is a classic
complication of a mid-shaft humeral fracture .
5. Which nerve is compressed in carpal tunnel syndrome?
A) Ulnar nerve
B) Median nerve
