Page 1 of 116
COMSAE Phase 1 Form 113 — Exam ACTUAL
QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR
COMSAE Phase 1 Form 113 — Exam Coverage (Summarized Point Form)
1. Osteopathic Principles, OMM, and somatic dysfunction (TART criteria, viscerosomatic reflexes)
2. Sympathetic (T1–L2) and parasympathetic (CN III, VII, IX, X; S2–S4) autonomic levels
3. Chapman reflex points and organ-system correlations
4. Counterstrain technique principles and tender point treatment positions
5. Muscle energy technique (direct/indirect barriers, post-isometric relaxation)
6. HVLA technique indications, mechanics, and contraindications (fracture, RA, osteoporosis,
malignancy)
7. Myofascial release (direct vs indirect approaches)
8. Rib dysfunctions (inhalation vs exhalation; pump handle, bucket handle mechanics)
9. Spine mechanics: Fryette laws (Type I vs Type II dysfunctions)
10. Lumbar and thoracic somatic dysfunction diagnosis patterns
11. Sacral dysfunctions (torsions, unilateral flexion/extension, springing test concepts)
12. Innominate dysfunctions (anterior/posterior rotation, inflare/outflare, shear)
13. Cranial OMM basics (SBS strain patterns, torsions, sidebending-rotation)
14. Lymphatic techniques (thoracic inlet, pedal pump) and contraindications
15. Cardiovascular physiology and pathology (cardiac cycle, HF, murmurs, shock)
16. ECG interpretation and arrhythmias (AF, SVT, AV blocks, VT)
17. Respiratory system (asthma, COPD, pneumonia, PE, ARDS, PFT interpretation)
18. Renal physiology and pathology (GFR, AKI, nephritic vs nephrotic syndromes)
19. Acid-base disorders and compensation (anion gap vs non-anion gap)
20. Endocrine disorders (diabetes, thyroid disease, adrenal pathology, DKA/HHS)
21. Gastrointestinal system (hepatitis, cirrhosis, pancreatitis, GI bleeding)
22. Hematology (anemias, coagulation disorders, leukemia/lymphoma basics)
23. Neurology (stroke syndromes, seizures, spinal cord lesions)
24. Psychiatry (depression, bipolar, schizophrenia, substance use)
25. Infectious disease microbiology (bacteria, viruses, fungi, parasites basics)
26. Immunology (hypersensitivity types I–IV, complement, immunodeficiencies)
27. Pharmacology (antibiotics, cardiovascular drugs, endocrine drugs, CNS drugs)
28. Biochemistry (metabolic pathways, enzyme defects, vitamin deficiencies)
29. Genetics (inheritance patterns, chromosomal disorders, enzyme deficiencies)
30. Integrated clinical reasoning (multi-system vignettes, diagnosis + next best step management,
lab interpretation, OMM integration)
COMSAE Phase 1 Form 113 — Practice Questions (Batch 1: Questions 1–50)
, Page 2 of 116
Q1. A patient presents with tissue texture changes, asymmetry, restriction of motion, and tenderness at
T5–T7. These findings are collectively known as which osteopathic concept?
A. Fryette mechanics
B. TART findings
C. Chapman reflexes
D. Facilitation syndrome
Answer: B
Rationale: TART stands for tissue texture changes, asymmetry, restriction, and tenderness used to
diagnose somatic dysfunction.
Q2. A patient with gallbladder disease is most likely to demonstrate viscerosomatic reflex changes at
which spinal levels?
A. T1–T4
B. T5–T9
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C. T10–L2
D. S2–S4
Answer: B
Rationale: Gallbladder sympathetic innervation commonly corresponds to T5–T9 spinal segments.
Q3. Parasympathetic innervation to the descending colon and pelvic organs originates primarily from
which spinal levels?
A. T1–T4
B. T10–L2
C. S2–S4
D. C1–C4
Answer: C
Rationale: Pelvic splanchnic nerves from S2–S4 provide parasympathetic innervation to distal bowel and
pelvic organs.
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Q4. A patient has tenderness at the right fifth intercostal space near the sternum. Which organ is most
associated with this Chapman point?
A. Stomach acidity
B. Liver/gallbladder
C. Colon
D. Kidney
Answer: B
Rationale: Right fifth and sixth intercostal spaces are associated with liver and gallbladder Chapman
points.
Q5. Counterstrain treatment for an anterior tender point generally involves which positioning principle?
A. Positioning into pain and resistance
B. Positioning into ease and comfort
C. Applying rapid thrust techniques
D. Engaging restrictive barrier directly
COMSAE Phase 1 Form 113 — Exam ACTUAL
QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR
COMSAE Phase 1 Form 113 — Exam Coverage (Summarized Point Form)
1. Osteopathic Principles, OMM, and somatic dysfunction (TART criteria, viscerosomatic reflexes)
2. Sympathetic (T1–L2) and parasympathetic (CN III, VII, IX, X; S2–S4) autonomic levels
3. Chapman reflex points and organ-system correlations
4. Counterstrain technique principles and tender point treatment positions
5. Muscle energy technique (direct/indirect barriers, post-isometric relaxation)
6. HVLA technique indications, mechanics, and contraindications (fracture, RA, osteoporosis,
malignancy)
7. Myofascial release (direct vs indirect approaches)
8. Rib dysfunctions (inhalation vs exhalation; pump handle, bucket handle mechanics)
9. Spine mechanics: Fryette laws (Type I vs Type II dysfunctions)
10. Lumbar and thoracic somatic dysfunction diagnosis patterns
11. Sacral dysfunctions (torsions, unilateral flexion/extension, springing test concepts)
12. Innominate dysfunctions (anterior/posterior rotation, inflare/outflare, shear)
13. Cranial OMM basics (SBS strain patterns, torsions, sidebending-rotation)
14. Lymphatic techniques (thoracic inlet, pedal pump) and contraindications
15. Cardiovascular physiology and pathology (cardiac cycle, HF, murmurs, shock)
16. ECG interpretation and arrhythmias (AF, SVT, AV blocks, VT)
17. Respiratory system (asthma, COPD, pneumonia, PE, ARDS, PFT interpretation)
18. Renal physiology and pathology (GFR, AKI, nephritic vs nephrotic syndromes)
19. Acid-base disorders and compensation (anion gap vs non-anion gap)
20. Endocrine disorders (diabetes, thyroid disease, adrenal pathology, DKA/HHS)
21. Gastrointestinal system (hepatitis, cirrhosis, pancreatitis, GI bleeding)
22. Hematology (anemias, coagulation disorders, leukemia/lymphoma basics)
23. Neurology (stroke syndromes, seizures, spinal cord lesions)
24. Psychiatry (depression, bipolar, schizophrenia, substance use)
25. Infectious disease microbiology (bacteria, viruses, fungi, parasites basics)
26. Immunology (hypersensitivity types I–IV, complement, immunodeficiencies)
27. Pharmacology (antibiotics, cardiovascular drugs, endocrine drugs, CNS drugs)
28. Biochemistry (metabolic pathways, enzyme defects, vitamin deficiencies)
29. Genetics (inheritance patterns, chromosomal disorders, enzyme deficiencies)
30. Integrated clinical reasoning (multi-system vignettes, diagnosis + next best step management,
lab interpretation, OMM integration)
COMSAE Phase 1 Form 113 — Practice Questions (Batch 1: Questions 1–50)
, Page 2 of 116
Q1. A patient presents with tissue texture changes, asymmetry, restriction of motion, and tenderness at
T5–T7. These findings are collectively known as which osteopathic concept?
A. Fryette mechanics
B. TART findings
C. Chapman reflexes
D. Facilitation syndrome
Answer: B
Rationale: TART stands for tissue texture changes, asymmetry, restriction, and tenderness used to
diagnose somatic dysfunction.
Q2. A patient with gallbladder disease is most likely to demonstrate viscerosomatic reflex changes at
which spinal levels?
A. T1–T4
B. T5–T9
, Page 3 of 116
C. T10–L2
D. S2–S4
Answer: B
Rationale: Gallbladder sympathetic innervation commonly corresponds to T5–T9 spinal segments.
Q3. Parasympathetic innervation to the descending colon and pelvic organs originates primarily from
which spinal levels?
A. T1–T4
B. T10–L2
C. S2–S4
D. C1–C4
Answer: C
Rationale: Pelvic splanchnic nerves from S2–S4 provide parasympathetic innervation to distal bowel and
pelvic organs.
, Page 4 of 116
Q4. A patient has tenderness at the right fifth intercostal space near the sternum. Which organ is most
associated with this Chapman point?
A. Stomach acidity
B. Liver/gallbladder
C. Colon
D. Kidney
Answer: B
Rationale: Right fifth and sixth intercostal spaces are associated with liver and gallbladder Chapman
points.
Q5. Counterstrain treatment for an anterior tender point generally involves which positioning principle?
A. Positioning into pain and resistance
B. Positioning into ease and comfort
C. Applying rapid thrust techniques
D. Engaging restrictive barrier directly
