1
COMSAE Phase 1 Form 115 :176 Question Test Bank All
questions with correct verified answers & detailed rationales
– graded A+ for the newest 2026 actual exam
COMSAE Phase 1 Form 115 Practice Test Bank
This practice test bank is written in the NBOME style and covers the high-yield topics from the COMSAE Phase 1
Form 115 blueprint. The content aligns with COMLEX-USA Level 1 content categories, including Osteopathic
Principles & Practice (OPP), Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology,
Behavioral Science, and Clinical Presentation. Use this as a primary study tool or as a diagnostic to identify your
weak areas before you take the official COMSAE assessment.
SECTION 1: Osteopathic Principles & Practice (OPP)
1. 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
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. Thus, rotation right (RR) and sidebending
right (SR) yields a diagnosis of "Flexed RR SR."
2. 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?
A) Sidebending and rotation occur to the same side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending
pg. 1
,2
: Correct Answer : C
Rationale: Fryette's First Principle (Type I mechanics) describes that when
multiple vertebral segments are in a neutral position, sidebending and rotation
occur in opposite directions. This is a key distinction from Type II mechanics
(non-neutral, single segment), where they move together.
3. In the seated flexion test, a finding of more than 2 cm of superior iliac crest
movement on the left compared to the right indicates:
A) A sacral base torsion on the right (R/R)
B) A sacral base torsion on the left (L/L)
C) A right unilateral sacral extension
D) A left unilateral sacral extension
: Correct Answer : B
Rationale: The seated flexion test is used to screen for iliosacral or sacroiliac
dysfunction. If the left superior iliac crest moves further cephalad than the right, it
suggests a sacral base torsion on the left (L/L). This finding indicates that the ilium
on the side with greater motion is likely sacral-fixated or hypomobile.
4. During muscle energy technique (MET), the patient’s contraction force should
be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
: Correct Answer : B
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by
the patient, followed by relaxation and repositioning to the new barrier. This
avoids muscle fatigue and injury while effectively treating somatic dysfunction.
5. A patient with a respiratory somatic dysfunction is diagnosed with an "exhaled
rib" on the left. This dysfunction is characterized by:
pg. 2
,3
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
: Correct Answer : B
Rationale: An "exhaled rib" is positioned inferiorly, limiting inspiration (elevation)
but allowing full expiration. Conversely, an "inhaled rib" is elevated and restricts
expiration.
6. 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:
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
: Correct Answer : B
Rationale: An anterior innominate is a Type I dysfunction; direct HVLA thrust
treats the restrictive barrier. Muscle energy can also be used, but the direction of
patient effort is specific (e.g., leg extended).
7. Where is the anterior Chapman reflex point for the tonsils located?
A) Between the 1st and 2nd ribs near the sternum
B) Angle of the mandible
C) 5th intercostal space, right midclavicular line
D) Tip of the right 12th rib
: Correct Answer : A
Rationale: The tonsil Chapman reflex is located anteriorly between the 1st and
2nd ribs near the sternum. Chapman reflexes are viscerosomatic reflexes used in
osteopathic diagnosis and treatment. The posterior tonsil reflex point is at the
angle of the mandible.
pg. 3
, 4
8. Which Chapman reflex point is associated with the appendix?
A) Anterior: 5th intercostal space, right midclavicular line
B) Anterior: Tip of right 12th rib
C) Posterior: L2-L3
D) Anterior: Umbilicus
: Correct Answer : B
Rationale: The appendix Chapman reflex is located anteriorly at the tip of the
right 12th rib. Posteriorly, it is at the transverse process of T12 or L1.
9. A patient with a left anterior innominate dysfunction has an increase in
standing flexion test on the left. What is the most appropriate osteopathic
treatment?
A) Isolate the left PSIS with the patient in a right sidelying position
B) Apply muscle energy to the right ilium with the patient’s left leg extended
C) Use an HVLA thrust on the left anterior innominate in the direction of
extension
D) Perform a direct thrust on the left innominate in the direction of extension
: Correct Answer : C
Rationale: Anterior innominate dysfunction is treated by directing the force
toward extension (i.e., moving the ilium posteriorly). The patient may be
positioned in left sidelying or supine with the left leg extended.
10. A patient presents with a forward-bent posture and difficulty standing
upright. The structural exam reveals a midline thoracic kyphosis. This patient’s
postural impairment is most likely due to an increase in what physiologic process?
A) Flexion of the thoracic spine
B) Extension of the thoracic spine
C) Rotation of the lumbar spine
D) Sidebending of the cervical spine
pg. 4
COMSAE Phase 1 Form 115 :176 Question Test Bank All
questions with correct verified answers & detailed rationales
– graded A+ for the newest 2026 actual exam
COMSAE Phase 1 Form 115 Practice Test Bank
This practice test bank is written in the NBOME style and covers the high-yield topics from the COMSAE Phase 1
Form 115 blueprint. The content aligns with COMLEX-USA Level 1 content categories, including Osteopathic
Principles & Practice (OPP), Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology,
Behavioral Science, and Clinical Presentation. Use this as a primary study tool or as a diagnostic to identify your
weak areas before you take the official COMSAE assessment.
SECTION 1: Osteopathic Principles & Practice (OPP)
1. 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
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. Thus, rotation right (RR) and sidebending
right (SR) yields a diagnosis of "Flexed RR SR."
2. 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?
A) Sidebending and rotation occur to the same side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending
pg. 1
,2
: Correct Answer : C
Rationale: Fryette's First Principle (Type I mechanics) describes that when
multiple vertebral segments are in a neutral position, sidebending and rotation
occur in opposite directions. This is a key distinction from Type II mechanics
(non-neutral, single segment), where they move together.
3. In the seated flexion test, a finding of more than 2 cm of superior iliac crest
movement on the left compared to the right indicates:
A) A sacral base torsion on the right (R/R)
B) A sacral base torsion on the left (L/L)
C) A right unilateral sacral extension
D) A left unilateral sacral extension
: Correct Answer : B
Rationale: The seated flexion test is used to screen for iliosacral or sacroiliac
dysfunction. If the left superior iliac crest moves further cephalad than the right, it
suggests a sacral base torsion on the left (L/L). This finding indicates that the ilium
on the side with greater motion is likely sacral-fixated or hypomobile.
4. During muscle energy technique (MET), the patient’s contraction force should
be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
: Correct Answer : B
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by
the patient, followed by relaxation and repositioning to the new barrier. This
avoids muscle fatigue and injury while effectively treating somatic dysfunction.
5. A patient with a respiratory somatic dysfunction is diagnosed with an "exhaled
rib" on the left. This dysfunction is characterized by:
pg. 2
,3
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
: Correct Answer : B
Rationale: An "exhaled rib" is positioned inferiorly, limiting inspiration (elevation)
but allowing full expiration. Conversely, an "inhaled rib" is elevated and restricts
expiration.
6. 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:
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
: Correct Answer : B
Rationale: An anterior innominate is a Type I dysfunction; direct HVLA thrust
treats the restrictive barrier. Muscle energy can also be used, but the direction of
patient effort is specific (e.g., leg extended).
7. Where is the anterior Chapman reflex point for the tonsils located?
A) Between the 1st and 2nd ribs near the sternum
B) Angle of the mandible
C) 5th intercostal space, right midclavicular line
D) Tip of the right 12th rib
: Correct Answer : A
Rationale: The tonsil Chapman reflex is located anteriorly between the 1st and
2nd ribs near the sternum. Chapman reflexes are viscerosomatic reflexes used in
osteopathic diagnosis and treatment. The posterior tonsil reflex point is at the
angle of the mandible.
pg. 3
, 4
8. Which Chapman reflex point is associated with the appendix?
A) Anterior: 5th intercostal space, right midclavicular line
B) Anterior: Tip of right 12th rib
C) Posterior: L2-L3
D) Anterior: Umbilicus
: Correct Answer : B
Rationale: The appendix Chapman reflex is located anteriorly at the tip of the
right 12th rib. Posteriorly, it is at the transverse process of T12 or L1.
9. A patient with a left anterior innominate dysfunction has an increase in
standing flexion test on the left. What is the most appropriate osteopathic
treatment?
A) Isolate the left PSIS with the patient in a right sidelying position
B) Apply muscle energy to the right ilium with the patient’s left leg extended
C) Use an HVLA thrust on the left anterior innominate in the direction of
extension
D) Perform a direct thrust on the left innominate in the direction of extension
: Correct Answer : C
Rationale: Anterior innominate dysfunction is treated by directing the force
toward extension (i.e., moving the ilium posteriorly). The patient may be
positioned in left sidelying or supine with the left leg extended.
10. A patient presents with a forward-bent posture and difficulty standing
upright. The structural exam reveals a midline thoracic kyphosis. This patient’s
postural impairment is most likely due to an increase in what physiologic process?
A) Flexion of the thoracic spine
B) Extension of the thoracic spine
C) Rotation of the lumbar spine
D) Sidebending of the cervical spine
pg. 4
