COMSAE Phase 1 Form 114 Test Bank | 200+ Practice
Questions with Bold Italic Answers & Rationales –
NBOME Osteopathic Medical Knowledge Self-
Assessment Prep.
This comprehensive test bank is designed to mirror the NBOME COMSAE Phase 1 Form
114 blueprint. Each question includes the correct answer in bold italic followed by a
detailed italicized rationale explaining the clinical reasoning, osteopathic principles, and
high-yield concepts tested on COMLEX-USA Level 1.
Exam Overview
Component Details
Exam Name COMSAE Phase 1 Form 114
Format Computer-Based, Multiple Choice, Clinical Presentations
Content OPP, Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology,
Areas Behavioral Science
Purpose Self-assessment for COMLEX-USA Level 1 readiness
Section 1: Osteopathic Principles and Practice (OPP) –
1. A 45-year-old male presents with low back pain after lifting a box. You diagnose
an acute sacroiliac (SI) joint dysfunction. To diagnose somatic dysfunction of the
SI joint using the standing flexion test, a positive test is indicated by:
,A) Anterior rotation of the ilium on the ipsilateral side
B) Posterior rotation of the ilium on the ipsilateral side
C) Superior movement of the PSIS on the ipsilateral side
D) Inferior movement of the PSIS on the contralateral side
Rationale: In the standing flexion test, the examiner places thumbs under the PSIS. As the
patient bends forward, if the PSIS on one side moves superiorly (upward) more than the
other, it indicates iliosacral dysfunction (often a fixed sacrum or ilium) on that side.
2. A 30-year-old female with chronic headaches undergoes OMM. You find that
the right mastoid process is posterior and inferior compared to the left. Which of
the following somatic dysfunctions best describes this finding?
A) Right rotation, right sidebending (Type I)
B) Left rotation, right sidebending (Type II)
C) Right rotation, left sidebending (Type II)
D) Left rotation, left sidebending (Type I)
Rationale: The mastoid process moving posterior indicates rotation to the opposite side.
The mastoid moving inferior indicates sidebending to the same side. This describes Type II
mechanics: rotation and sidebending occur in opposite directions. Here, right mastoid is
posterior/inferior → Rotation to the left, sidebending to the right.
3. According to Fryette's first principle (Type I mechanics), when multiple vertebral
segments are in a neutral position, which of the following occurs?
A) Sidebending and rotation occur to the same side
B) Sidebending and rotation occur to opposite sides
,C) Rotation occurs without sidebending
D) Sidebending occurs without rotation
Rationale: Fryette's first principle describes that when the spine is in neutral position,
sidebending and rotation occur in opposite directions. This applies to group (multiple
vertebrae) dysfunctions. Type II mechanics (non-neutral) have sidebending and rotation to
the same side.
4. A patient with COPD presents with dyspnea and decreased thoracic excursion.
Which OMT technique is most appropriate to improve lymphatic drainage and
respiratory function?
A) Cervical traction
B) Thoracic inlet release and lymphatic pump technique
C) Lumbar roll
D) Sacral decompression
Rationale: Lymphatic pump techniques and thoracic inlet release enhance lymphatic flow
and respiratory function, particularly beneficial in COPD patients with impaired clearance.
The thoracic inlet is a key area for lymphatic drainage.
5. Which of the following is an absolute contraindication to high-velocity, low-
amplitude (HVLA) manipulation of the cervical spine?
A) Cervical muscle spasm
B) Rheumatoid arthritis with cervical instability
C) Occipital headache
D) History of whiplash
, Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to risk of spinal cord injury. Muscle
spasm and whiplash are relative contraindications, not absolute.
6. A patient presents with a somatic dysfunction of the left fibular head that is
"posterior." This dysfunction will demonstrate a restriction in which direction?
A) Anterior glide
B) Posterior glide
C) Lateral glide
D) Medial glide
Rationale: A "posterior fibular head" means the fibula is fixed in a posterior position
relative to the tibia; therefore, its motion toward the anterior direction is restricted.
Treatment aims to restore anterior glide.
7. The Chapman reflex point at the tip of the right 12th rib is associated with
which organ?
A) Stomach
B) Liver
C) Appendix
D) Cecum
*Rationale: Chapman's reflexes for the colon are located at the tips of the 11th and
12th ribs. The right 12th rib corresponds to the cecum/appendix region. *
Questions with Bold Italic Answers & Rationales –
NBOME Osteopathic Medical Knowledge Self-
Assessment Prep.
This comprehensive test bank is designed to mirror the NBOME COMSAE Phase 1 Form
114 blueprint. Each question includes the correct answer in bold italic followed by a
detailed italicized rationale explaining the clinical reasoning, osteopathic principles, and
high-yield concepts tested on COMLEX-USA Level 1.
Exam Overview
Component Details
Exam Name COMSAE Phase 1 Form 114
Format Computer-Based, Multiple Choice, Clinical Presentations
Content OPP, Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology,
Areas Behavioral Science
Purpose Self-assessment for COMLEX-USA Level 1 readiness
Section 1: Osteopathic Principles and Practice (OPP) –
1. A 45-year-old male presents with low back pain after lifting a box. You diagnose
an acute sacroiliac (SI) joint dysfunction. To diagnose somatic dysfunction of the
SI joint using the standing flexion test, a positive test is indicated by:
,A) Anterior rotation of the ilium on the ipsilateral side
B) Posterior rotation of the ilium on the ipsilateral side
C) Superior movement of the PSIS on the ipsilateral side
D) Inferior movement of the PSIS on the contralateral side
Rationale: In the standing flexion test, the examiner places thumbs under the PSIS. As the
patient bends forward, if the PSIS on one side moves superiorly (upward) more than the
other, it indicates iliosacral dysfunction (often a fixed sacrum or ilium) on that side.
2. A 30-year-old female with chronic headaches undergoes OMM. You find that
the right mastoid process is posterior and inferior compared to the left. Which of
the following somatic dysfunctions best describes this finding?
A) Right rotation, right sidebending (Type I)
B) Left rotation, right sidebending (Type II)
C) Right rotation, left sidebending (Type II)
D) Left rotation, left sidebending (Type I)
Rationale: The mastoid process moving posterior indicates rotation to the opposite side.
The mastoid moving inferior indicates sidebending to the same side. This describes Type II
mechanics: rotation and sidebending occur in opposite directions. Here, right mastoid is
posterior/inferior → Rotation to the left, sidebending to the right.
3. According to Fryette's first principle (Type I mechanics), when multiple vertebral
segments are in a neutral position, which of the following occurs?
A) Sidebending and rotation occur to the same side
B) Sidebending and rotation occur to opposite sides
,C) Rotation occurs without sidebending
D) Sidebending occurs without rotation
Rationale: Fryette's first principle describes that when the spine is in neutral position,
sidebending and rotation occur in opposite directions. This applies to group (multiple
vertebrae) dysfunctions. Type II mechanics (non-neutral) have sidebending and rotation to
the same side.
4. A patient with COPD presents with dyspnea and decreased thoracic excursion.
Which OMT technique is most appropriate to improve lymphatic drainage and
respiratory function?
A) Cervical traction
B) Thoracic inlet release and lymphatic pump technique
C) Lumbar roll
D) Sacral decompression
Rationale: Lymphatic pump techniques and thoracic inlet release enhance lymphatic flow
and respiratory function, particularly beneficial in COPD patients with impaired clearance.
The thoracic inlet is a key area for lymphatic drainage.
5. Which of the following is an absolute contraindication to high-velocity, low-
amplitude (HVLA) manipulation of the cervical spine?
A) Cervical muscle spasm
B) Rheumatoid arthritis with cervical instability
C) Occipital headache
D) History of whiplash
, Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to risk of spinal cord injury. Muscle
spasm and whiplash are relative contraindications, not absolute.
6. A patient presents with a somatic dysfunction of the left fibular head that is
"posterior." This dysfunction will demonstrate a restriction in which direction?
A) Anterior glide
B) Posterior glide
C) Lateral glide
D) Medial glide
Rationale: A "posterior fibular head" means the fibula is fixed in a posterior position
relative to the tibia; therefore, its motion toward the anterior direction is restricted.
Treatment aims to restore anterior glide.
7. The Chapman reflex point at the tip of the right 12th rib is associated with
which organ?
A) Stomach
B) Liver
C) Appendix
D) Cecum
*Rationale: Chapman's reflexes for the colon are located at the tips of the 11th and
12th ribs. The right 12th rib corresponds to the cecum/appendix region. *
