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COMSAE Phase 1 ASA 111i – The Complete 176 Question
Test Bank All Questions with Correct Verified Answers
& Detailed Rationales | Newest 2026 Actual Exam
About the COMSAE Phase 1: This examination mirrors the COMLEX-USA Level 1 blueprint and assesses
foundational medical knowledge, clinical reasoning, and osteopathic principles. The ASA 111i form includes an
answer key and is available for student purchase.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Questions 1–50
Q1. A 45-year-old woman presents with epigastric burning and bloating after
meals for several months. On osteopathic structural exam, you find tenderness
and increased tissue texture at the right T6–T8 paraspinal region. Which
viscerosomatic reflex best explains this finding?
A) Stomach
B) Gallbladder
C) Pancreas
D) Liver
: Correct Answer : A) Stomach
Rationale: Viscerosomatic reflexes map spinal cord levels to organs. The stomach
corresponds to T6–T9, often on the right side. Gallbladder (T7–T9) also presents
on the right, but the epigastric symptoms point specifically to the stomach.
Recognizing spinal levels for common organs is essential for COMSAE.
Q2. A 34-year-old male has chronic abdominal pain and fatty stools. Physical
examination reveals an anterior Chapman reflex point at the right 7th
intercostal space near the costochondral junction. Which organ is most likely
associated?
A) Kidney
pg. 1
,2
B) Pancreas
C) Ovary
D) Appendix
: Correct Answer : B) Pancreas
Rationale: The anterior Chapman point for the pancreas is the right 7th
intercostal space near the costochondral junction; the posterior point is between
T7 and T8 on the right.
Q3. Osteopathic structural examination of a 28-year-old female reveals a
positive seated flexion test on the left side. The left sacral sulcus is deep, and
the left inferior lateral angle (ILA) is prominent posteriorly and inferiorly. What
is the most likely diagnosis?
A) L on L forward sacral torsion
B) R on L backward sacral torsion
C) Left unilateral sacral flexion
D) Left unilateral sacral extension
: Correct Answer : C) Left unilateral sacral flexion
Rationale: In unilateral sacral shears (flexions or extensions), the positive seated
flexion test identifies the dysfunctional side. In unilateral flexion, the deep sacral
sulcus and the posterior/inferior ILA are on the same side. In sacral torsions, the
deep sulcus and posterior/inferior ILA are on opposite sides.
Q4. A patient with a structural exam reveals a restricted T5 segment. The
segment prefers rotation to the right and sidebending to the right. It improves
when the patient slumps forward into spinal flexion. What is the correct
diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
: Correct Answer : C) T5 Flexed RR SR
pg. 2
,3
Rationale: As the dysfunction improves in flexion, the segment is in Flexion.
Rotation and sidebending are to the same side (right) per Fryette’s Second Law.
The correct notation is Flexed, Rotated Right, Sidebent Right.
Q5. A patient with a respiratory somatic dysfunction is diagnosed with an
“exhaled rib” on the left. This dysfunction is characterized by:
A) The rib is elevated and restricted in depression
B) The rib is depressed (inferiorly) and restricted in elevation
C) The rib is elevated and restricted in elevation
D) The rib is depressed and restricted in depression
: Correct Answer : B) The rib is depressed (inferiorly) and restricted in
elevation
Rationale: An “exhaled rib” is positioned inferiorly, limiting inspiration (elevation)
but allowing full expiration. An “inhalation rib” is elevated and restricted in
depression.
Q6. A patient has low back pain with a right short leg in the supine position that
equalizes when sitting. The most likely diagnosis is:
A) Structural short right leg
B) Anterior innominate rotation on the left
C) Anterior innominate rotation on the right
D) Iliosacral shear
: Correct Answer : C) Anterior innominate rotation on the right
Rationale: A functional short leg that resolves when sitting indicates a pelvic
rotation rather than a true anatomic leg length discrepancy. Anterior innominate
rotation on the right typically presents with a functional short leg in supine that
equalizes in the seated position.
Q7. According to Fryette’s first principle (Type I mechanics), when the spine is in
a neutral position (neither flexed nor extended), which of the following occurs?
pg. 3
, 4
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
: Correct Answer : C) Side-bending and rotation occur to opposite sides
Rationale: Fryette’s first law describes that when multiple vertebral segments are
in neutral, side-bending is accompanied by rotation in the opposite direction. This
is a key difference from Type II mechanics.
Q8. A 35-year-old with chronic low back pain has a somatic dysfunction of the
lumbar spine characterized by ease of side-bending to the right and restriction
of side-bending to the left. According to Fryette’s laws, this most likely
represents:
A) Type I dysfunction (neutral mechanics)
B) Type II dysfunction (non-neutral mechanics)
C) Type III dysfunction (somatic dysfunction)
D) A normal functional spinal unit
: Correct Answer : B) Type II dysfunction (non-neutral mechanics)
Rationale: Fryette’s second law states that when the spine is in a non-neutral
position (flexed or extended), side-bending and rotation occur in opposite
directions. Restriction of side-bending to the left indicates a Type II dysfunction.
Q9. A 28-year-old presents with acute torticollis after sleeping in an awkward
position. Cervical examination shows the head rotated to the left and side-bent
to the right. The most likely diagnosis is:
A) Right rotated, right side-bent somatic dysfunction
B) Left rotated, left side-bent somatic dysfunction
C) Left rotated, right side-bent somatic dysfunction
D) Right rotated, left side-bent somatic dysfunction
: Correct Answer : D) Right rotated, left side-bent somatic dysfunction
pg. 4
COMSAE Phase 1 ASA 111i – The Complete 176 Question
Test Bank All Questions with Correct Verified Answers
& Detailed Rationales | Newest 2026 Actual Exam
About the COMSAE Phase 1: This examination mirrors the COMLEX-USA Level 1 blueprint and assesses
foundational medical knowledge, clinical reasoning, and osteopathic principles. The ASA 111i form includes an
answer key and is available for student purchase.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Questions 1–50
Q1. A 45-year-old woman presents with epigastric burning and bloating after
meals for several months. On osteopathic structural exam, you find tenderness
and increased tissue texture at the right T6–T8 paraspinal region. Which
viscerosomatic reflex best explains this finding?
A) Stomach
B) Gallbladder
C) Pancreas
D) Liver
: Correct Answer : A) Stomach
Rationale: Viscerosomatic reflexes map spinal cord levels to organs. The stomach
corresponds to T6–T9, often on the right side. Gallbladder (T7–T9) also presents
on the right, but the epigastric symptoms point specifically to the stomach.
Recognizing spinal levels for common organs is essential for COMSAE.
Q2. A 34-year-old male has chronic abdominal pain and fatty stools. Physical
examination reveals an anterior Chapman reflex point at the right 7th
intercostal space near the costochondral junction. Which organ is most likely
associated?
A) Kidney
pg. 1
,2
B) Pancreas
C) Ovary
D) Appendix
: Correct Answer : B) Pancreas
Rationale: The anterior Chapman point for the pancreas is the right 7th
intercostal space near the costochondral junction; the posterior point is between
T7 and T8 on the right.
Q3. Osteopathic structural examination of a 28-year-old female reveals a
positive seated flexion test on the left side. The left sacral sulcus is deep, and
the left inferior lateral angle (ILA) is prominent posteriorly and inferiorly. What
is the most likely diagnosis?
A) L on L forward sacral torsion
B) R on L backward sacral torsion
C) Left unilateral sacral flexion
D) Left unilateral sacral extension
: Correct Answer : C) Left unilateral sacral flexion
Rationale: In unilateral sacral shears (flexions or extensions), the positive seated
flexion test identifies the dysfunctional side. In unilateral flexion, the deep sacral
sulcus and the posterior/inferior ILA are on the same side. In sacral torsions, the
deep sulcus and posterior/inferior ILA are on opposite sides.
Q4. A patient with a structural exam reveals a restricted T5 segment. The
segment prefers rotation to the right and sidebending to the right. It improves
when the patient slumps forward into spinal flexion. What is the correct
diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
: Correct Answer : C) T5 Flexed RR SR
pg. 2
,3
Rationale: As the dysfunction improves in flexion, the segment is in Flexion.
Rotation and sidebending are to the same side (right) per Fryette’s Second Law.
The correct notation is Flexed, Rotated Right, Sidebent Right.
Q5. A patient with a respiratory somatic dysfunction is diagnosed with an
“exhaled rib” on the left. This dysfunction is characterized by:
A) The rib is elevated and restricted in depression
B) The rib is depressed (inferiorly) and restricted in elevation
C) The rib is elevated and restricted in elevation
D) The rib is depressed and restricted in depression
: Correct Answer : B) The rib is depressed (inferiorly) and restricted in
elevation
Rationale: An “exhaled rib” is positioned inferiorly, limiting inspiration (elevation)
but allowing full expiration. An “inhalation rib” is elevated and restricted in
depression.
Q6. A patient has low back pain with a right short leg in the supine position that
equalizes when sitting. The most likely diagnosis is:
A) Structural short right leg
B) Anterior innominate rotation on the left
C) Anterior innominate rotation on the right
D) Iliosacral shear
: Correct Answer : C) Anterior innominate rotation on the right
Rationale: A functional short leg that resolves when sitting indicates a pelvic
rotation rather than a true anatomic leg length discrepancy. Anterior innominate
rotation on the right typically presents with a functional short leg in supine that
equalizes in the seated position.
Q7. According to Fryette’s first principle (Type I mechanics), when the spine is in
a neutral position (neither flexed nor extended), which of the following occurs?
pg. 3
, 4
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
: Correct Answer : C) Side-bending and rotation occur to opposite sides
Rationale: Fryette’s first law describes that when multiple vertebral segments are
in neutral, side-bending is accompanied by rotation in the opposite direction. This
is a key difference from Type II mechanics.
Q8. A 35-year-old with chronic low back pain has a somatic dysfunction of the
lumbar spine characterized by ease of side-bending to the right and restriction
of side-bending to the left. According to Fryette’s laws, this most likely
represents:
A) Type I dysfunction (neutral mechanics)
B) Type II dysfunction (non-neutral mechanics)
C) Type III dysfunction (somatic dysfunction)
D) A normal functional spinal unit
: Correct Answer : B) Type II dysfunction (non-neutral mechanics)
Rationale: Fryette’s second law states that when the spine is in a non-neutral
position (flexed or extended), side-bending and rotation occur in opposite
directions. Restriction of side-bending to the left indicates a Type II dysfunction.
Q9. A 28-year-old presents with acute torticollis after sleeping in an awkward
position. Cervical examination shows the head rotated to the left and side-bent
to the right. The most likely diagnosis is:
A) Right rotated, right side-bent somatic dysfunction
B) Left rotated, left side-bent somatic dysfunction
C) Left rotated, right side-bent somatic dysfunction
D) Right rotated, left side-bent somatic dysfunction
: Correct Answer : D) Right rotated, left side-bent somatic dysfunction
pg. 4
