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COMSAE Phase 1 Form 115 FINAL EXAM QUESTIONS AND
CORRECT VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR –
JUST RELEASED
COMSAE Phase 1 Form 115 – Comprehensive Practice Exam (176 Questions)
This practice set is designed for the COMSAE Phase 1 Form 115 administered by the NBOME
(National Board of Osteopathic Medical Examiners). The exam contains 176 items divided into
four sections of 44 questions each, all in single-best-answer multiple-choice format
Section 1: Osteopathic Principles & Practice (OPP) (Questions 1-35)
1. A patient presents with a structural exam revealing 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
Answer: C) T5 Flexed RR SR
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Rationale: Because the dysfunction improves in flexion, the segment is diagnosed as Flexed.
According to Fryette's Second Law (Type II mechanics), when a single segment is in a non-neutral
position (flexion or extension), rotation and sidebending occur in the same direction. Hence,
rotation right and sidebending right yields "Flexed RR SR" .
2. 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 moves normally in both directions
D) The rib is restricted in both elevation and depression
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. This is a common respiratory somatic dysfunction .
3. A patient with chronic low back pain has an anterior innominate rotation on the left with a
positive standing flexion test on the left. The most appropriate osteopathic treatment for this
dysfunction is:
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A) Muscle energy with the patient's right leg extended
B) High-velocity low-amplitude (HVLA) thrust in the direction of the barrier
C) Counterstrain of the posterior tender point
D) Myofascial release of the lumbar spine
Answer: B) HVLA thrust in the direction of the barrier
Rationale: An anterior innominate is a Type I dysfunction; direct HVLA thrust treats the
restrictive barrier. Muscle energy is also possible, but the question asks for the most appropriate
direct technique .
4. A 45-year-old patient presents with a Chapman reflex point over the right upper intercostal
space near the sternum. This Chapman point most likely indicates dysfunction of which organ?
A) Stomach
B) Gallbladder
C) Liver
D) Heart
Answer: B) Gallbladder
Rationale: Chapman points are reflex points that correlate with visceral dysfunction. The right
upper intercostal space near the sternum is a classic location for a gallbladder Chapman reflex .
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5. A patient has a diagnosis of Type II (non-neutral) vertebral somatic dysfunction. According to
Fryette's principles, which of the following is correct?
A) The dysfunctional segment has no rotation component
B) Rotation and sidebending occur in opposite directions
C) Rotation and sidebending occur in the same direction
D) The dysfunction is always an extended segment
Answer: C) Rotation and sidebending occur in the same direction
Rationale: Fryette's Second Law states that when a single vertebral segment is in a non-neutral
position (flexion or extension), rotation and sidebending occur to the same side .
6. A 25-year-old construction worker falls from a ladder and lands on his feet. He complains of
severe low back pain. Radiographs show an L2 vertebral compression fracture. The most
appropriate osteopathic treatment in the acute setting is:
A) HVLA thrust of the thoracic spine
B) Muscle energy of the lumbar spine
C) Counterstrain for lumbar tender points
D) No manipulative treatment until the fracture heals
Answer: D) No manipulative treatment until the fracture heals
COMSAE Phase 1 Form 115 FINAL EXAM QUESTIONS AND
CORRECT VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR –
JUST RELEASED
COMSAE Phase 1 Form 115 – Comprehensive Practice Exam (176 Questions)
This practice set is designed for the COMSAE Phase 1 Form 115 administered by the NBOME
(National Board of Osteopathic Medical Examiners). The exam contains 176 items divided into
four sections of 44 questions each, all in single-best-answer multiple-choice format
Section 1: Osteopathic Principles & Practice (OPP) (Questions 1-35)
1. A patient presents with a structural exam revealing 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
Answer: C) T5 Flexed RR SR
, Page 2 of 97
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed as Flexed.
According to Fryette's Second Law (Type II mechanics), when a single segment is in a non-neutral
position (flexion or extension), rotation and sidebending occur in the same direction. Hence,
rotation right and sidebending right yields "Flexed RR SR" .
2. 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 moves normally in both directions
D) The rib is restricted in both elevation and depression
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. This is a common respiratory somatic dysfunction .
3. A patient with chronic low back pain has an anterior innominate rotation on the left with a
positive standing flexion test on the left. The most appropriate osteopathic treatment for this
dysfunction is:
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A) Muscle energy with the patient's right leg extended
B) High-velocity low-amplitude (HVLA) thrust in the direction of the barrier
C) Counterstrain of the posterior tender point
D) Myofascial release of the lumbar spine
Answer: B) HVLA thrust in the direction of the barrier
Rationale: An anterior innominate is a Type I dysfunction; direct HVLA thrust treats the
restrictive barrier. Muscle energy is also possible, but the question asks for the most appropriate
direct technique .
4. A 45-year-old patient presents with a Chapman reflex point over the right upper intercostal
space near the sternum. This Chapman point most likely indicates dysfunction of which organ?
A) Stomach
B) Gallbladder
C) Liver
D) Heart
Answer: B) Gallbladder
Rationale: Chapman points are reflex points that correlate with visceral dysfunction. The right
upper intercostal space near the sternum is a classic location for a gallbladder Chapman reflex .
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5. A patient has a diagnosis of Type II (non-neutral) vertebral somatic dysfunction. According to
Fryette's principles, which of the following is correct?
A) The dysfunctional segment has no rotation component
B) Rotation and sidebending occur in opposite directions
C) Rotation and sidebending occur in the same direction
D) The dysfunction is always an extended segment
Answer: C) Rotation and sidebending occur in the same direction
Rationale: Fryette's Second Law states that when a single vertebral segment is in a non-neutral
position (flexion or extension), rotation and sidebending occur to the same side .
6. A 25-year-old construction worker falls from a ladder and lands on his feet. He complains of
severe low back pain. Radiographs show an L2 vertebral compression fracture. The most
appropriate osteopathic treatment in the acute setting is:
A) HVLA thrust of the thoracic spine
B) Muscle energy of the lumbar spine
C) Counterstrain for lumbar tender points
D) No manipulative treatment until the fracture heals
Answer: D) No manipulative treatment until the fracture heals
