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.
The COMSAE takes about 4 hours and costs $60[1][2] (National Board of Osteopathic Medical Examiners, verified Oct 27, 2026).
Numbers in brackets link to the official sources listed under Sources & last verified. Dates that have passed are removed automatically.
| Item | Detail | Source · Verified |
|---|---|---|
| Number of questions (Phase 1) | 176 questions (4 sections of 44)[1] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Number of questions (Phase 2) | 160 questions (4 sections of 40)[1] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Number of questions (Phase 3) | 200 questions (4 sections of 50)[1] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Time limit | 4 hours (timed mode); self-paced mode also available[1] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Exam fee | $60 per form (individual); $55 per form (bulk for COMs)[2] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Retake policy | No limit on repurchasing forms[2] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Validity | 90 days from purchase[2] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Delivery | Online via NBOME Portal (self-paced or timed); COM secure-browser forms require COM-provided proctors[1] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Eligibility | Osteopathic medical students and residents[3] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
| Score release | Immediately upon completion[4] | National Board of Osteopathic Medical Examiners · Oct 27, 2026 |
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.
Prepare for the COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination exam with our free practice test modules. Each quiz covers key topics to help you pass on your first try.
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.
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?
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.
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?
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.
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?
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.
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.
Individual COMSAE forms with answer keys cost $60 per form. Colleges of osteopathic medicine that buy in bulk pay $55 per form. Check the NBOME frequently asked questions page for the current price before you buy, since fees are set by the NBOME and can change.
Timed mode allows a maximum of 4 hours, which gives per-item pacing comparable to COMLEX-USA. A self-paced mode is also available. Both are delivered online through the NBOME Portal, so choose the mode that fits how you want to practise.
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. Confirm the layout of your form on the NBOME examination format page.
Yes. The NBOME states there is no limit on how many forms you can buy again. After you purchase a form, it remains available for 90 days. Each new attempt needs a new purchase, so plan your review between attempts.
You receive a Score Report and Performance Profile immediately after you complete the exam. It includes a numerical standard score for the total test and a graphic view of how you performed across content categories.
The COMSAE is meant for osteopathic medical students and residents who want to gauge their knowledge base before taking a licensing exam level. Forms that run on a secure browser need proctors provided by your college of osteopathic medicine.
How we verify: editorial & fact-checking policy. Report an error: contact us.