Page 1 of 120
COMSAE Phase 1 Form 115 Exam COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR JUST RELEASED
COMSAE Phase 1 (Form 115) — Summarized Coverage
The COMSAE Phase 1 Form 115 is a NBOME self-assessment exam aligned with COMLEX Level 1,
testing integrated basic science knowledge with strong emphasis on clinical reasoning, OMM, and
multi-system vignette interpretation.
1. Osteopathic principles and OMM (TART, viscerosomatic reflexes, Chapman points)
2. Sympathetic (T1–L2) and parasympathetic (CN III, VII, IX, X; S2–S4) autonomic anatomy
3. Counterstrain, muscle energy, and HVLA technique principles
4. Rib dysfunctions (pump handle, bucket handle; inhalation vs exhalation)
5. Spinal mechanics (Fryette laws: Type I vs Type II dysfunctions)
6. Sacral dysfunctions (torsions, unilateral flexion/extension)
7. Innominate dysfunctions (rotation, inflare/outflare, shear patterns)
8. Cranial OMM basics (SBS strain patterns and cranial motion)
9. Lymphatic techniques (thoracic inlet, pedal pump, contraindications)
10. Cardiovascular system (murmurs, heart failure, shock, ECG interpretation)
11. Respiratory system (asthma, COPD, pneumonia, PE, ARDS, PFTs)
12. Renal physiology and pathology (AKI, nephritic vs nephrotic syndromes)
13. Acid-base disorders and compensation patterns
14. Endocrine disorders (diabetes, thyroid, adrenal, DKA vs HHS)
15. Gastrointestinal system (hepatitis, cirrhosis, pancreatitis, GI bleed)
16. Hematology (anemias, coagulation disorders, leukemia/lymphoma basics)
17. Neurology (stroke syndromes, seizures, spinal cord lesions)
18. Psychiatry (mood disorders, psychosis, substance use)
19. Microbiology (bacteria, viruses, fungi, parasites high-yield patterns)
20. Immunology (hypersensitivity types I–IV, complement, immunodeficiencies)
21. Pharmacology (antibiotics, autonomic drugs, cardiovascular, CNS drugs)
22. Biochemistry (metabolic pathways, enzyme disorders, vitamins)
23. Genetics (inheritance patterns, chromosomal abnormalities)
24. Pathology (cell injury, inflammation, neoplasia, thrombosis)
25. Biostatistics & epidemiology (RR, OR, sensitivity/specificity, study types)
26. Ethics & professionalism (consent, confidentiality, autonomy, legal issues)
27. Multi-system clinical integration (lab interpretation, diagnosis, management)
28. Next-best-step clinical decision-making scenarios
29. Emergency stabilization concepts (ABCs, shock, acute care responses)
30. High-yield pattern recognition across systems with heavy vignette-based reasoning
COMSAE Phase 1 (Form 115) — MCQ Practice Batch 1 (Questions 1–50)
, Page 2 of 120
1. A 24-year-old man presents with fever, productive cough, and right lower lobe pneumonia.
Osteopathic examination reveals tissue texture changes and ropiness at T5–T9 on the right. These
findings most likely represent which phenomenon?
A. Chapman reflex
B. Viscerosomatic reflex
C. Counterstrain dysfunction
D. Somatosomatic reflex
Answer: B
Rationale: Pulmonary pathology commonly produces viscerosomatic reflexes in the upper thoracic
sympathetic segments.
2. A physician diagnoses a thoracic vertebral dysfunction described as T6 FRRSR. Which Fryette
principle best explains this dysfunction?
A. Type I mechanics involving neutral group curve dysfunction
, Page 3 of 120
B. Type II mechanics involving flexion with rotation and sidebending to same side
C. Sacral torsion mechanics
D. Neutral mechanics with opposite rotation and sidebending
Answer: B
Rationale: Type II dysfunctions occur in flexed or extended vertebrae with rotation and sidebending
toward the same side.
3. A patient with asthma experiences bronchoconstriction mediated primarily through which
autonomic pathway?
A. Sympathetic fibers from T1–T4
B. Parasympathetic vagal stimulation
C. Lumbar sympathetic chain activation
D. Somatic phrenic nerve stimulation
Answer: B
Rationale: Parasympathetic vagal activity promotes bronchoconstriction and mucus secretion.
, Page 4 of 120
4. A 65-year-old smoker presents with progressive dyspnea and decreased FEV1/FVC ratio. Which
pulmonary function pattern is most consistent with COPD?
A. Increased FEV1/FVC ratio with low TLC
B. Reduced FEV1/FVC ratio with increased TLC
C. Normal residual volume with low diffusion capacity
D. Increased vital capacity with low residual volume
Answer: B
Rationale: Obstructive lung disease demonstrates decreased FEV1/FVC and air trapping with increased
TLC.
5. A patient develops diabetic ketoacidosis. Which acid-base abnormality is expected initially?
A. Metabolic alkalosis
B. Respiratory acidosis
COMSAE Phase 1 Form 115 Exam COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR JUST RELEASED
COMSAE Phase 1 (Form 115) — Summarized Coverage
The COMSAE Phase 1 Form 115 is a NBOME self-assessment exam aligned with COMLEX Level 1,
testing integrated basic science knowledge with strong emphasis on clinical reasoning, OMM, and
multi-system vignette interpretation.
1. Osteopathic principles and OMM (TART, viscerosomatic reflexes, Chapman points)
2. Sympathetic (T1–L2) and parasympathetic (CN III, VII, IX, X; S2–S4) autonomic anatomy
3. Counterstrain, muscle energy, and HVLA technique principles
4. Rib dysfunctions (pump handle, bucket handle; inhalation vs exhalation)
5. Spinal mechanics (Fryette laws: Type I vs Type II dysfunctions)
6. Sacral dysfunctions (torsions, unilateral flexion/extension)
7. Innominate dysfunctions (rotation, inflare/outflare, shear patterns)
8. Cranial OMM basics (SBS strain patterns and cranial motion)
9. Lymphatic techniques (thoracic inlet, pedal pump, contraindications)
10. Cardiovascular system (murmurs, heart failure, shock, ECG interpretation)
11. Respiratory system (asthma, COPD, pneumonia, PE, ARDS, PFTs)
12. Renal physiology and pathology (AKI, nephritic vs nephrotic syndromes)
13. Acid-base disorders and compensation patterns
14. Endocrine disorders (diabetes, thyroid, adrenal, DKA vs HHS)
15. Gastrointestinal system (hepatitis, cirrhosis, pancreatitis, GI bleed)
16. Hematology (anemias, coagulation disorders, leukemia/lymphoma basics)
17. Neurology (stroke syndromes, seizures, spinal cord lesions)
18. Psychiatry (mood disorders, psychosis, substance use)
19. Microbiology (bacteria, viruses, fungi, parasites high-yield patterns)
20. Immunology (hypersensitivity types I–IV, complement, immunodeficiencies)
21. Pharmacology (antibiotics, autonomic drugs, cardiovascular, CNS drugs)
22. Biochemistry (metabolic pathways, enzyme disorders, vitamins)
23. Genetics (inheritance patterns, chromosomal abnormalities)
24. Pathology (cell injury, inflammation, neoplasia, thrombosis)
25. Biostatistics & epidemiology (RR, OR, sensitivity/specificity, study types)
26. Ethics & professionalism (consent, confidentiality, autonomy, legal issues)
27. Multi-system clinical integration (lab interpretation, diagnosis, management)
28. Next-best-step clinical decision-making scenarios
29. Emergency stabilization concepts (ABCs, shock, acute care responses)
30. High-yield pattern recognition across systems with heavy vignette-based reasoning
COMSAE Phase 1 (Form 115) — MCQ Practice Batch 1 (Questions 1–50)
, Page 2 of 120
1. A 24-year-old man presents with fever, productive cough, and right lower lobe pneumonia.
Osteopathic examination reveals tissue texture changes and ropiness at T5–T9 on the right. These
findings most likely represent which phenomenon?
A. Chapman reflex
B. Viscerosomatic reflex
C. Counterstrain dysfunction
D. Somatosomatic reflex
Answer: B
Rationale: Pulmonary pathology commonly produces viscerosomatic reflexes in the upper thoracic
sympathetic segments.
2. A physician diagnoses a thoracic vertebral dysfunction described as T6 FRRSR. Which Fryette
principle best explains this dysfunction?
A. Type I mechanics involving neutral group curve dysfunction
, Page 3 of 120
B. Type II mechanics involving flexion with rotation and sidebending to same side
C. Sacral torsion mechanics
D. Neutral mechanics with opposite rotation and sidebending
Answer: B
Rationale: Type II dysfunctions occur in flexed or extended vertebrae with rotation and sidebending
toward the same side.
3. A patient with asthma experiences bronchoconstriction mediated primarily through which
autonomic pathway?
A. Sympathetic fibers from T1–T4
B. Parasympathetic vagal stimulation
C. Lumbar sympathetic chain activation
D. Somatic phrenic nerve stimulation
Answer: B
Rationale: Parasympathetic vagal activity promotes bronchoconstriction and mucus secretion.
, Page 4 of 120
4. A 65-year-old smoker presents with progressive dyspnea and decreased FEV1/FVC ratio. Which
pulmonary function pattern is most consistent with COPD?
A. Increased FEV1/FVC ratio with low TLC
B. Reduced FEV1/FVC ratio with increased TLC
C. Normal residual volume with low diffusion capacity
D. Increased vital capacity with low residual volume
Answer: B
Rationale: Obstructive lung disease demonstrates decreased FEV1/FVC and air trapping with increased
TLC.
5. A patient develops diabetic ketoacidosis. Which acid-base abnormality is expected initially?
A. Metabolic alkalosis
B. Respiratory acidosis
