COMSAE Phase 1 Form 114 Mastery Blueprint: 300+ High-Yield COMLEX-Style
Practice Questions with Detailed Osteopathic Rationales
Conquer your board preparation with this premium, high-density study guide engineered specifically for
osteopathic medical students tackling the COMSAE Phase 1 Form 114. Every high-yield question features
an explicitly verified answer key paired with an exhaustive breakdown covering foundational pathology,
high-alert pharmacology, and advanced Osteopathic Principles and Practice (OPP/OMM) viscerosomatic
relationships. Structured with crisp visual anchors and punchy, scannable explanations, this digital
masterclass is optimized to ensure maximum retention while acting as a top-tier asset to pull immediate
buyer traffic to your storefront.
Question 1
A 24-year-old male presents with a cough, fever, and a rustic sputum color for the past
three days. Physical examination reveals increased tactile fremitus, dullness to
percussion, and bronchial breath sounds over the right lower lung field. Osteopathic
structural examination shows tissue texture changes and somatic dysfunction from T2
to T4 on the right. Viscerosomatic reflex signaling from this pathology travels through
which nervous system pathways?
A) Vagus nerve to the celiac ganglion
B) Greater splanchnic nerve to the superior mesenteric ganglion
C) Sympathetic postganglionic fibers via the cardiopulmonary splanchnic nerves
D) Pelvic splanchnic nerves to the inferior mesenteric plexus [1]
Answer: C) Sympathetic postganglionic fibers via the cardiopulmonary
splanchnic nerves
Explanation: The patient exhibits classic signs of lobar pneumonia, which causes a
viscerosomatic reflex originating from the lung parenchymal tissue. Sympathetic
innervation to the lungs arises from the T1 to T4 spinal levels. The preganglionic fibers
synapse in the cervical and upper thoracic sympathetic chain ganglia, and the
postganglionic fibers travel via the cardiopulmonary splanchnic nerves to the pulmonary
plexus. Somatic dysfunctions at T2–T4 are the direct paraspinal musculoskeletal
manifestations of this viscerosomatic activity. [1]
Question 2
A 45-year-old female presents to the clinic complaining of chronic, burning epigastric
pain that worsens 2 to 3 hours after eating. An upper endoscopy reveals a well-
demarcated ulceration in the proximal duodenum. Osteopathic examination reveals a
prominent paraspinal tissue texture change at the T5–T9 levels bilaterally. Intermittent
palpatory pressure over which myofascial structure serves as the anterior counterstrain
,point representing this localized visceral organ?
A) On the right side of the xiphoid process
B) On the left side of the xiphoid process
C) On the right alba line between the xiphoid and umbilicus
D) On the left alba line between the xiphoid and umbilicus
Answer: C) On the right alba line between the xiphoid and umbilicus
Explanation: The clinical picture is indicative of a duodenal ulcer. The anterior tender
point for the duodenum is located on the right side of the linea alba, halfway between
the xiphoid process and the umbilicus. Somatic dysfunction at T5–T9 represents the
corresponding viscerosomatic reflex pathway mediated through the celiac ganglion.
Anterior tender points for the stomach are typically found on the left side of the midline
or near the xiphoid.
Question 3
A 62-year-old female presents with severe pain in her right knee that worsens with
weight-bearing and improves with rest. Physical examination reveals crepitus, a mild
joint effusion, and a decreased range of motion. Structural examination demonstrates a
prominent right lateral pelvic tilt, an anteriorly rotated right innominate, and a restricted
fibular head. During normal gait sequencing, which mechanical barrier limits posterior
translation of the fibular head?
A) Ankle dorsiflexion and foot inversion
B) Ankle plantarflexion and foot eversion
C) External rotation of the tibia
D) Extension of the hip joint
Answer: B) Ankle plantarflexion and foot eversion
Explanation: The proximal fibular head moves forward (anteriorly) with ankle
dorsiflexion and eversion/abduction, while it moves backward (posteriorly) with ankle
plantarflexion and inversion/adduction. When an anatomical restriction blocks posterior
translation of the fibular head, the dynamic range of motion into ankle plantarflexion and
accompanying foot eversion triggers mechanical tension.
Question 4
A 34-year-old pregnant female at 32 weeks gestation presents with low back pain and
bilateral lower extremity edema. Structural examination demonstrates a marked lumbar
lordosis, a forward pelvic tilt, and a restricted thoracic diaphragm. An osteopathic
physician decides to perform the lymphatic pump technique to reduce lower extremity
fluid volume. Which structural landmark or tissue state serves as an absolute
contraindication to executing this lymphatic pump technique?
A) Mild localized pedal edema
B) Active deep vein thrombosis in the lower extremity
,C) Increased thoracic cage compliance
D) Decreased cranial rhythmic impulse
Answer: B) Active deep vein thrombosis in the lower extremity
Explanation: Executing a lymphatic pump technique is strictly contraindicated in patients
with an active deep vein thrombosis (DVT) because the mechanical fluid pressure
waves can dislodge the thrombus, turning it into a life-threatening pulmonary embolism.
Localized edema is an indication for the technique, whereas cranial rhythm status or
standard pregnancy lordosis are not contraindications.
Question 5
A 52-year-old male with a history of alcohol abuse presents with severe, sharp
epigastric pain that radiates directly to his back, accompanied by nausea and vomiting.
Laboratory analysis reveals elevated serum lipase and amylase levels. Osteopathic
examination reveals acute paraspinal tissue changes from T5 to T9. Somatic
dysfunctions in this region correspond to hypersympathetic activity passing through
which autonomic collateral ganglion?
A) Celiac ganglion
B) Superior mesenteric ganglion
C) Inferior mesenteric ganglion
D) Otic ganglion
*Answer: A) Celiac ganglion
Explanation: The clinical presentation is diagnostic of acute pancreatitis. Upper
gastrointestinal tract viscera (including the stomach, liver, gallbladder, spleen, and
portions of the pancreas and duodenum) receive sympathetic preganglionic fibers from
the T5–T9 spinal levels. These fibers travel via the greater splanchnic nerve to synapse
directly within the celiac ganglion. Somatic dysfunctions from T5 to T9 are the
musculoskeletal reflections of this viscerosomatic loop.
Question 6
A 19-year-old female college student presents to the emergency department with a
severe headache, photophobia, and a rigid neck. Physical examination reveals a
temperature of 102.8°F and a positive Kernig sign. Lumbar puncture demonstrates
cloudy cerebrospinal fluid with elevated neutrophils, low glucose, and high protein.
Which cell layer of the protective meninges is primarily involved in the purulent
inflammatory exudate of this disease?
A) Dura mater
B) Arachnoid mater and pia mater
C) Subdural potential space
D) Endosteal layer
, Answer: B) Arachnoid mater and pia mater
Explanation: Acute bacterial meningitis is an inflammatory process centered within the
subarachnoid space and leptomeninges, which consist of the arachnoid mater and the
underlying pia mater. The purulent exudate accumulates within this fluid highway,
tracking along the brain and spinal cord surfaces.
Question 7
A 28-year-old female runner presents with localized pain over the lateral aspect of her
right knee that worsens during heel-strike and descending hills. Physical examination
reveals tenderness over the lateral femoral epicondyle when the knee is flexed at 30
degrees. Structural examination reveals a right uncompensated posterior innominate
rotation. Tightness in which myofascial structure is the primary cause of this patient's
knee pain?
A) Tensor fasciae latae and iliotibial band
B) Biceps femoris long head
C) Rectus femoris muscle tendon
D) Tibialis anterior muscle belly
Answer: A) Tensor fasciae latae and iliotibial band
Explanation: The patient has iliotibial band (ITB) friction syndrome, a common overuse
injury in runners. Friction occurs as the ITB slides over the lateral femoral epicondyle at
roughly 30 degrees of knee flexion. The ITB is a continuation of the fascial insertions of
the tensor fasciae latae and gluteus maximus muscles; tightness here shifts tracking
forces, leading to lateral knee pain.
Question 8
A 3-week-old infant is brought to the pediatrician due to persistent projectile, non-bilious
vomiting immediately following every feeding. Physical examination reveals a palpable,
olive-shaped mass in the right upper quadrant of the abdomen. Which developmental
mechanism is responsible for this infant's congenital pathology?
A) Incomplete recanalization of the embryonic duodenal lumen
B) Hypertrophy of the circular smooth muscle layer of the pylorus
C) Failure of the lateral body folds to fuse at the midline
D) Defective rotation of the ventral pancreatic bud matrix [1]
Answer: B) Hypertrophy of the circular smooth muscle layer of the pylorus
Explanation: The infant has hypertrophic pyloric stenosis, characterized by non-bilious
projectile vomiting and a palpable "olive" mass in the epigastric region. The pathology is
caused by hypertrophy of the circular smooth muscle layers of the pyloric sphincter,
which obstructs gastric emptying.
Practice Questions with Detailed Osteopathic Rationales
Conquer your board preparation with this premium, high-density study guide engineered specifically for
osteopathic medical students tackling the COMSAE Phase 1 Form 114. Every high-yield question features
an explicitly verified answer key paired with an exhaustive breakdown covering foundational pathology,
high-alert pharmacology, and advanced Osteopathic Principles and Practice (OPP/OMM) viscerosomatic
relationships. Structured with crisp visual anchors and punchy, scannable explanations, this digital
masterclass is optimized to ensure maximum retention while acting as a top-tier asset to pull immediate
buyer traffic to your storefront.
Question 1
A 24-year-old male presents with a cough, fever, and a rustic sputum color for the past
three days. Physical examination reveals increased tactile fremitus, dullness to
percussion, and bronchial breath sounds over the right lower lung field. Osteopathic
structural examination shows tissue texture changes and somatic dysfunction from T2
to T4 on the right. Viscerosomatic reflex signaling from this pathology travels through
which nervous system pathways?
A) Vagus nerve to the celiac ganglion
B) Greater splanchnic nerve to the superior mesenteric ganglion
C) Sympathetic postganglionic fibers via the cardiopulmonary splanchnic nerves
D) Pelvic splanchnic nerves to the inferior mesenteric plexus [1]
Answer: C) Sympathetic postganglionic fibers via the cardiopulmonary
splanchnic nerves
Explanation: The patient exhibits classic signs of lobar pneumonia, which causes a
viscerosomatic reflex originating from the lung parenchymal tissue. Sympathetic
innervation to the lungs arises from the T1 to T4 spinal levels. The preganglionic fibers
synapse in the cervical and upper thoracic sympathetic chain ganglia, and the
postganglionic fibers travel via the cardiopulmonary splanchnic nerves to the pulmonary
plexus. Somatic dysfunctions at T2–T4 are the direct paraspinal musculoskeletal
manifestations of this viscerosomatic activity. [1]
Question 2
A 45-year-old female presents to the clinic complaining of chronic, burning epigastric
pain that worsens 2 to 3 hours after eating. An upper endoscopy reveals a well-
demarcated ulceration in the proximal duodenum. Osteopathic examination reveals a
prominent paraspinal tissue texture change at the T5–T9 levels bilaterally. Intermittent
palpatory pressure over which myofascial structure serves as the anterior counterstrain
,point representing this localized visceral organ?
A) On the right side of the xiphoid process
B) On the left side of the xiphoid process
C) On the right alba line between the xiphoid and umbilicus
D) On the left alba line between the xiphoid and umbilicus
Answer: C) On the right alba line between the xiphoid and umbilicus
Explanation: The clinical picture is indicative of a duodenal ulcer. The anterior tender
point for the duodenum is located on the right side of the linea alba, halfway between
the xiphoid process and the umbilicus. Somatic dysfunction at T5–T9 represents the
corresponding viscerosomatic reflex pathway mediated through the celiac ganglion.
Anterior tender points for the stomach are typically found on the left side of the midline
or near the xiphoid.
Question 3
A 62-year-old female presents with severe pain in her right knee that worsens with
weight-bearing and improves with rest. Physical examination reveals crepitus, a mild
joint effusion, and a decreased range of motion. Structural examination demonstrates a
prominent right lateral pelvic tilt, an anteriorly rotated right innominate, and a restricted
fibular head. During normal gait sequencing, which mechanical barrier limits posterior
translation of the fibular head?
A) Ankle dorsiflexion and foot inversion
B) Ankle plantarflexion and foot eversion
C) External rotation of the tibia
D) Extension of the hip joint
Answer: B) Ankle plantarflexion and foot eversion
Explanation: The proximal fibular head moves forward (anteriorly) with ankle
dorsiflexion and eversion/abduction, while it moves backward (posteriorly) with ankle
plantarflexion and inversion/adduction. When an anatomical restriction blocks posterior
translation of the fibular head, the dynamic range of motion into ankle plantarflexion and
accompanying foot eversion triggers mechanical tension.
Question 4
A 34-year-old pregnant female at 32 weeks gestation presents with low back pain and
bilateral lower extremity edema. Structural examination demonstrates a marked lumbar
lordosis, a forward pelvic tilt, and a restricted thoracic diaphragm. An osteopathic
physician decides to perform the lymphatic pump technique to reduce lower extremity
fluid volume. Which structural landmark or tissue state serves as an absolute
contraindication to executing this lymphatic pump technique?
A) Mild localized pedal edema
B) Active deep vein thrombosis in the lower extremity
,C) Increased thoracic cage compliance
D) Decreased cranial rhythmic impulse
Answer: B) Active deep vein thrombosis in the lower extremity
Explanation: Executing a lymphatic pump technique is strictly contraindicated in patients
with an active deep vein thrombosis (DVT) because the mechanical fluid pressure
waves can dislodge the thrombus, turning it into a life-threatening pulmonary embolism.
Localized edema is an indication for the technique, whereas cranial rhythm status or
standard pregnancy lordosis are not contraindications.
Question 5
A 52-year-old male with a history of alcohol abuse presents with severe, sharp
epigastric pain that radiates directly to his back, accompanied by nausea and vomiting.
Laboratory analysis reveals elevated serum lipase and amylase levels. Osteopathic
examination reveals acute paraspinal tissue changes from T5 to T9. Somatic
dysfunctions in this region correspond to hypersympathetic activity passing through
which autonomic collateral ganglion?
A) Celiac ganglion
B) Superior mesenteric ganglion
C) Inferior mesenteric ganglion
D) Otic ganglion
*Answer: A) Celiac ganglion
Explanation: The clinical presentation is diagnostic of acute pancreatitis. Upper
gastrointestinal tract viscera (including the stomach, liver, gallbladder, spleen, and
portions of the pancreas and duodenum) receive sympathetic preganglionic fibers from
the T5–T9 spinal levels. These fibers travel via the greater splanchnic nerve to synapse
directly within the celiac ganglion. Somatic dysfunctions from T5 to T9 are the
musculoskeletal reflections of this viscerosomatic loop.
Question 6
A 19-year-old female college student presents to the emergency department with a
severe headache, photophobia, and a rigid neck. Physical examination reveals a
temperature of 102.8°F and a positive Kernig sign. Lumbar puncture demonstrates
cloudy cerebrospinal fluid with elevated neutrophils, low glucose, and high protein.
Which cell layer of the protective meninges is primarily involved in the purulent
inflammatory exudate of this disease?
A) Dura mater
B) Arachnoid mater and pia mater
C) Subdural potential space
D) Endosteal layer
, Answer: B) Arachnoid mater and pia mater
Explanation: Acute bacterial meningitis is an inflammatory process centered within the
subarachnoid space and leptomeninges, which consist of the arachnoid mater and the
underlying pia mater. The purulent exudate accumulates within this fluid highway,
tracking along the brain and spinal cord surfaces.
Question 7
A 28-year-old female runner presents with localized pain over the lateral aspect of her
right knee that worsens during heel-strike and descending hills. Physical examination
reveals tenderness over the lateral femoral epicondyle when the knee is flexed at 30
degrees. Structural examination reveals a right uncompensated posterior innominate
rotation. Tightness in which myofascial structure is the primary cause of this patient's
knee pain?
A) Tensor fasciae latae and iliotibial band
B) Biceps femoris long head
C) Rectus femoris muscle tendon
D) Tibialis anterior muscle belly
Answer: A) Tensor fasciae latae and iliotibial band
Explanation: The patient has iliotibial band (ITB) friction syndrome, a common overuse
injury in runners. Friction occurs as the ITB slides over the lateral femoral epicondyle at
roughly 30 degrees of knee flexion. The ITB is a continuation of the fascial insertions of
the tensor fasciae latae and gluteus maximus muscles; tightness here shifts tracking
forces, leading to lateral knee pain.
Question 8
A 3-week-old infant is brought to the pediatrician due to persistent projectile, non-bilious
vomiting immediately following every feeding. Physical examination reveals a palpable,
olive-shaped mass in the right upper quadrant of the abdomen. Which developmental
mechanism is responsible for this infant's congenital pathology?
A) Incomplete recanalization of the embryonic duodenal lumen
B) Hypertrophy of the circular smooth muscle layer of the pylorus
C) Failure of the lateral body folds to fuse at the midline
D) Defective rotation of the ventral pancreatic bud matrix [1]
Answer: B) Hypertrophy of the circular smooth muscle layer of the pylorus
Explanation: The infant has hypertrophic pyloric stenosis, characterized by non-bilious
projectile vomiting and a palpable "olive" mass in the epigastric region. The pathology is
caused by hypertrophy of the circular smooth muscle layers of the pyloric sphincter,
which obstructs gastric emptying.
