COMSAE Phase 1 Form 115 Practice
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Section 1: Osteopathic Principles & Practice (OPP)
Q1. 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
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. Hence, rotation right and sidebending
right yields a diagnosis of “Flexed RR SR.”
Q2. 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 is rotated externally
• D) The rib is rotated internally
Correct Answer: B
Rationale: An “exhaled rib” is stuck in the exhalation (depressed) position. It is
located inferiorly relative to its counterpart and is restricted in the ability to elevate
during inhalation. Treatment involves engaging the rib at the end of exhalation and
applying a thrust through inhalation.
Q3. 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
Correct Answer: C
Rationale: Fryette’s first principle (Type I mechanics) describes that when multiple
vertebral segments are in neutral position, sidebending and rotation occur
in opposite directions. This is a key distinction from Type II mechanics, where
they move together.
Q4. 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 normal finding
, Correct Answer: A
Rationale: In the seated flexion test, the side that moves more cephalad indicates
the side of the deep sacral sulcus (the axis of a sacral torsion). More movement on
the left means the deep sulcus is on the right, which corresponds to an R/R (right
axis, right rotated) torsion.
Q5. Which of the following is an absolute contraindication to high-velocity,
low-amplitude (HVLA) manipulation of the cervical spine?
• A) Cervical muscle spasm
• B) Rheumatoid arthritis with cervical instability
• C) Occipital headache
• D) History of whiplash
Correct Answer: B
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to the risk of spinal cord
injury. Muscle spasm and whiplash are relative contraindications, not absolute.
Q6. A patient presents with a somatic dysfunction of the left fibular head that
is “posterior.” This dysfunction will demonstrate a restriction in which
direction?
• A) Anterior glide
• B) Posterior glide
• C) Lateral glide
• D) Medial glide
Correct Answer: A
Rationale: A “posterior fibular head” means the fibula is fixed in a posterior
position relative to the tibia; therefore, its motion toward the anterior direction is
restricted. Treatment aims to restore anterior glide.
, Q7. The Chapman reflex point at the tip of the right 12th rib is associated
with which organ?
• A) Stomach
• B) Liver
• C) Appendix
• D) Cecum
Correct Answer: D
Rationale: Chapman’s reflexes for the colon are located at the tips of the 11th and
12th ribs. The right 12th rib corresponds to the cecum/appendix region. The tonsil
Chapman reflex is located anteriorly between the 1st and 2nd ribs near the
sternum.
Q8. In 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 against the physician’s counterforce, followed by relaxation and
repositioning to the new barrier. This avoids muscle fatigue and injury.
Q9. A patient with COPD presents with dyspnea and decreased thoracic
excursion. Which OMT technique is most appropriate to improve lymphatic
drainage and respiratory function?
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Section 1: Osteopathic Principles & Practice (OPP)
Q1. 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
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. Hence, rotation right and sidebending
right yields a diagnosis of “Flexed RR SR.”
Q2. 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 is rotated externally
• D) The rib is rotated internally
Correct Answer: B
Rationale: An “exhaled rib” is stuck in the exhalation (depressed) position. It is
located inferiorly relative to its counterpart and is restricted in the ability to elevate
during inhalation. Treatment involves engaging the rib at the end of exhalation and
applying a thrust through inhalation.
Q3. 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
Correct Answer: C
Rationale: Fryette’s first principle (Type I mechanics) describes that when multiple
vertebral segments are in neutral position, sidebending and rotation occur
in opposite directions. This is a key distinction from Type II mechanics, where
they move together.
Q4. 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 normal finding
, Correct Answer: A
Rationale: In the seated flexion test, the side that moves more cephalad indicates
the side of the deep sacral sulcus (the axis of a sacral torsion). More movement on
the left means the deep sulcus is on the right, which corresponds to an R/R (right
axis, right rotated) torsion.
Q5. Which of the following is an absolute contraindication to high-velocity,
low-amplitude (HVLA) manipulation of the cervical spine?
• A) Cervical muscle spasm
• B) Rheumatoid arthritis with cervical instability
• C) Occipital headache
• D) History of whiplash
Correct Answer: B
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to the risk of spinal cord
injury. Muscle spasm and whiplash are relative contraindications, not absolute.
Q6. A patient presents with a somatic dysfunction of the left fibular head that
is “posterior.” This dysfunction will demonstrate a restriction in which
direction?
• A) Anterior glide
• B) Posterior glide
• C) Lateral glide
• D) Medial glide
Correct Answer: A
Rationale: A “posterior fibular head” means the fibula is fixed in a posterior
position relative to the tibia; therefore, its motion toward the anterior direction is
restricted. Treatment aims to restore anterior glide.
, Q7. The Chapman reflex point at the tip of the right 12th rib is associated
with which organ?
• A) Stomach
• B) Liver
• C) Appendix
• D) Cecum
Correct Answer: D
Rationale: Chapman’s reflexes for the colon are located at the tips of the 11th and
12th ribs. The right 12th rib corresponds to the cecum/appendix region. The tonsil
Chapman reflex is located anteriorly between the 1st and 2nd ribs near the
sternum.
Q8. In 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 against the physician’s counterforce, followed by relaxation and
repositioning to the new barrier. This avoids muscle fatigue and injury.
Q9. A patient with COPD presents with dyspnea and decreased thoracic
excursion. Which OMT technique is most appropriate to improve lymphatic
drainage and respiratory function?
