COMSAE Practice Test

The COMSAE is taken by osteopathic medical students and residents to check their knowledge base. This page gives you free practice sets by body system and discipline, three worked questions with full explanations, a study plan, and the format, fee and scoring facts published by the NBOME.

COMSAE Exam at a Glance

What changed for COMSAE in 2026

• Oct 27, 2026: Eligibility changed to Osteopathic medical students and residents (previously Osteopathic medical students (Phase 1: 3 forms, Phase 2: 2 forms) and residents (Phase 3: 1 form)).^[3]
• Oct 27, 2026: Exam fee changed to $60 per form (individual); $55 per form (bulk for COMs) (previously $60 per form (individual, with answer key); $55 per form bulk for COMs).^[2]
• Oct 27, 2026: Delivery changed to Online via NBOME Portal (self-paced or timed); COM secure-browser forms require COM-provided proctors (previously Online via NBOME Portal; COM secure-browser forms are timed only and need COM-provided proctors).^[1]
• Oct 27, 2026: Time limit changed to 4 hours (timed mode); self-paced mode also available (previously 4 hours maximum in timed mode; untimed mode also available).^[1]
• Oct 27, 2026: Score release changed to Immediately upon completion (previously Immediately after completion (score report + performance profile)).^[4]
• Oct 27, 2026: Retake policy changed to No limit on repurchasing forms (previously No limit on repurchasing a form).^[2]
• Oct 27, 2026: Validity changed to 90 days from purchase (previously Purchased form available for 90 days).^[2]

What the COMSAE is and how it works

According to National Board of Osteopathic Medical Examiners, “The COMSAE Phase 1 examination contains 176 items, divided into four sections of 44 questions each.”^[1]

The COMSAE is a phased series of self-assessment exams run by the National Board of Osteopathic Medical Examiners (NBOME). Osteopathic medical students and residents use it to gauge their knowledge base before they sit each Level of the licensing series.

Question counts depend on the phase. Phase 1 has 176 questions in 4 sections of 44. Phase 2 has 160 questions in 4 sections of 40. Phase 3 has 200 questions in 4 sections of 50.

The exam is delivered online through the NBOME Portal, either self-paced or timed. Timed mode allows a maximum of 4 hours. Forms that use a secure browser require proctors provided by your college of osteopathic medicine (COM).

You get your results immediately after finishing. The score report gives a numerical standard score for the total test and a graphic profile of your performance.

Individual forms with answer keys cost $60 each. COMs that buy in bulk pay $55 per form. A purchased form stays available for 90 days, and there is no limit on how many forms you can buy again.

This page does not list an official content outline, so check the NBOME site for the current details of the form you plan to buy. The practice sets below are written by us and are not real exam questions.

Worked examples: how to reason through COMSAE questions

These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.

Example 1

Question: A 16-year-old presents with open and closed comedones, papules, and pustules on the face. Which mechanism is most responsible for the pathogenesis of acne vulgaris?

1. Autoimmune destruction of sebaceous glands
2. Follicular plugging with keratin and sebum combined with Cutibacterium acnes proliferation
3. Staphylococcus aureus superficial skin infection
4. IgE-mediated mast cell degranulation in the dermis

Answer: B. Follicular plugging with keratin and sebum combined with Cutibacterium acnes proliferation

Explanation:

The correct answer describes the core process of acne: follicles become plugged with keratin and sebum, and Cutibacterium acnes multiplies in that plugged environment, which drives inflammation. That explains the mix of comedones, papules and pustules.

Autoimmune destruction of sebaceous glands is wrong because acne involves blocked, inflamed glands, not an immune attack that removes them. A superficial Staphylococcus aureus infection fits impetigo or a bacterial folliculitis, not comedonal acne. IgE-mediated mast cell degranulation belongs to allergic and urticarial reactions, which produce wheals rather than comedones.

Rule to remember: comedones point to follicular plugging, and the inflammatory lesions follow from sebum and bacterial overgrowth. Choose the option that combines both.

Example 2

Question: A 45-year-old male presents with acute, colicky right upper quadrant pain that is exacerbated by fatty meals. On osteopathic structural exam, you note tissue texture changes and paraspinal hypertonicity from T5 to T9 on the right. Which of the following anterior Chapman's points would most likely be present in this patient?

1. In the 2nd intercostal space near the sternum on the right
2. In the 5th intercostal space from the mid-mammary line to the sternum on the left
3. In the 6th intercostal space on the right at the mid-mammary line
4. On the tip of the twelfth rib on the right

Answer: C. In the 6th intercostal space on the right at the mid-mammary line

Explanation:

Colicky right upper quadrant pain that worsens after fatty meals points to biliary disease. The paraspinal findings from T5 to T9 on the right fit the viscerosomatic reflex for the gallbladder, so the matching anterior Chapman's point is in the 6th intercostal space on the right at the mid-mammary line.

The 2nd intercostal space near the sternum on the right is the myocardial point, so it does not match a biliary picture. The 5th intercostal space on the left is the stomach point, and the wrong side and organ both rule it out. The point at the tip of the rib on the right belongs to the appendix, not the gallbladder.

Rule to remember: match the organ to its spinal level first, then confirm the side and location of its anterior point.

Example 3

Question: A 72-year-old male presents with exertional dyspnea and a harsh, crescendo-decrescendo systolic murmur best heard at the right upper sternal border. Which of the following physical exam findings would be most consistent with severe aortic stenosis?

1. A brisk, collapsing carotid pulse
2. A widely split S2 that increases with inspiration
3. A low-amplitude and delayed carotid upstroke
4. A holosystolic murmur radiating to the axilla

Answer: C. A low-amplitude and delayed carotid upstroke

Explanation:

A harsh crescendo-decrescendo systolic murmur at the right upper sternal border with exertional dyspnea suggests aortic stenosis. Severe obstruction of left ventricular outflow produces a low-amplitude, delayed carotid upstroke, called pulsus parvus et tardus.

A brisk, collapsing carotid pulse belongs to aortic regurgitation, where blood runs back into the ventricle. A widely split S2 that increases with inspiration is linked to pulmonic stenosis or right bundle branch block, which affect the right side of the heart. A holosystolic murmur radiating to the axilla describes mitral regurgitation, a different valve and a different murmur shape.

Rule to remember: stenosis gives a weak, slow pulse, while regurgitation gives a bounding one.

How to use these practice tests

Start with the official material. Read the NBOME pages on format and scoring so you know how your phase is built and whether you will take it self-paced or timed. Then pick a starting point with our broad sets, such as Basic Biomedical Sciences, Clinical Disciplines and Osteopathic Principles and Practice, and note which areas feel weakest.

Next, work through the system sets where you lost marks, for example cardiovascular and hematologic, pharmacology or musculoskeletal. Read every explanation, including those for options you got right, and write down the rule behind each miss.

Because a purchased form stays available for a limited time, schedule it when your review is mostly done. Before then, practise in long, timed blocks with the practice test so the pacing feels familiar. After you get your score report, go back to the weakest areas and repeat.

Sources & last verified

1. National Board of Osteopathic Medical Examiners — time limit, number of questions, delivery (official source). “A maximum of four hours is allowed to complete the COMSAE examination, resulting in per-item pacing comparable to that of COMLEX-USA.” Verified Oct 27, 2026.
2. National Board of Osteopathic Medical Examiners — exam fee, retake policy, validity (official source). “COMSAEs purchased in bulk by COMs are $55 per form. Individual COMSAEs with answer keys are $60 per form.” Verified Oct 27, 2026 · source checked Oct 25, 2026.
3. National Board of Osteopathic Medical Examiners — eligibility (official source). “The Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) is a three-phase series used by osteopathic medical students and residents to gauge a candidate’s knowledge base in…” Verified Oct 27, 2026.
4. National Board of Osteopathic Medical Examiners — score release (official source). “After completing a COMSAE, a candidate will receive a Score Report and Performance Profile, which provides a three-digit numerical standard score for the total test…” Verified Oct 27, 2026.

How we verify: editorial & fact-checking policy. Report an error: contact us.