COMSAE PHASE 1 FORM 114 EXAM
BANK – COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
SECTION 1: OSTEOPRINCIPLES & OMM (22
Questions)
1. A 45-year-old male presents with low back pain
after lifting a box. You diagnose an acute sacroiliac
(SI) joint dysfunction. To diagnose somatic
dysfunction of the SI joint using the standing flexion
test, a positive test is indicated by:
A) Anterior rotation of the ilium on the ipsilateral side
B) Posterior rotation of the ilium on the ipsilateral
side
C) Superior movement of the PSIS on the ipsilateral
side
D) Inferior movement of the PSIS on the contralateral
side
Correct answer: C
Rationale: In the standing flexion test, the examiner
places thumbs under the PSIS. As the patient bends
,forward, if the PSIS on one side moves superiorly
(upward) more than the other, it indicates iliosacral
dysfunction (often a fixed sacrum or ilium) on that
side .
2. A 30-year-old female with chronic headaches
undergoes OMM. You find that the right mastoid
process is posterior and inferior compared to the left.
Which of the following somatic dysfunctions best
describes this finding?
A) Right rotation, right sidebending (Type I)
B) Left rotation, right sidebending (Type II)
C) Right rotation, left sidebending (Type II)
D) Left rotation, left sidebending (Type I)
Correct answer: B
Rationale: The mastoid process moving posterior
indicates rotation to the opposite side. The mastoid
moving inferior indicates sidebending to the same
side (Type II mechanics: rotation and sidebending
occur in opposite directions). Here, right mastoid is
posterior/inferior → Rotation to the left, sidebending
to the right .
3. During a respiratory exam, you place your hands
on the patient's ribs to assess rib motion. You note
,that during inspiration, the right 6th rib moves
superiorly and anteriorly, but the left 6th rib remains
relatively fixed. This is most consistent with a
diagnosis of:
A) Inhalation dysfunction of the left rib
B) Exhalation dysfunction of the right rib
C) Pump handle dysfunction of the sternum
D) Bucket handle dysfunction of the left rib
Correct answer: B
Rationale: In inhalation dysfunction, the rib is stuck in
the elevated position (superior/anterior). In
exhalation dysfunction, the rib is stuck in the
depressed position. Since the left rib is not moving as
much, it is likely stuck in the depressed position
(exhalation) .
4. A patient presents with acute torticollis. You
diagnose a Type II somatic dysfunction of the cervical
spine at C3. According to Fryette's laws, which of the
following is true regarding Type II dysfunctions?
A) They occur in neutral mechanics
B) They involve multiple vertebrae
C) Rotation and sidebending occur in opposite
directions
, D) They are typically non-neutral mechanics involving
a single vertebral segment
Correct answer: D
Rationale: Fryette's Law II states that when the spine
is in non-neutral (flexion or extension), rotation and
sidebending occur in opposite directions, and this
typically involves a single vertebral segment .
5. You are treating a patient with chronic sinusitis.
You decide to use the Galbreath technique. This
technique primarily targets which of the following
bones?
A) Frontal and Sphenoid
B) Temporal and Parietal
C) Temporal and Mandible
D) Maxilla and Palatine
Correct answer: C
Rationale: The Galbreath technique is a myofascial
release technique used for Eustachian tube
dysfunction and sinusitis. It involves mobilizing the
temporal bone and mandible to facilitate drainage of
the middle ear and sinuses .
BANK – COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
SECTION 1: OSTEOPRINCIPLES & OMM (22
Questions)
1. A 45-year-old male presents with low back pain
after lifting a box. You diagnose an acute sacroiliac
(SI) joint dysfunction. To diagnose somatic
dysfunction of the SI joint using the standing flexion
test, a positive test is indicated by:
A) Anterior rotation of the ilium on the ipsilateral side
B) Posterior rotation of the ilium on the ipsilateral
side
C) Superior movement of the PSIS on the ipsilateral
side
D) Inferior movement of the PSIS on the contralateral
side
Correct answer: C
Rationale: In the standing flexion test, the examiner
places thumbs under the PSIS. As the patient bends
,forward, if the PSIS on one side moves superiorly
(upward) more than the other, it indicates iliosacral
dysfunction (often a fixed sacrum or ilium) on that
side .
2. A 30-year-old female with chronic headaches
undergoes OMM. You find that the right mastoid
process is posterior and inferior compared to the left.
Which of the following somatic dysfunctions best
describes this finding?
A) Right rotation, right sidebending (Type I)
B) Left rotation, right sidebending (Type II)
C) Right rotation, left sidebending (Type II)
D) Left rotation, left sidebending (Type I)
Correct answer: B
Rationale: The mastoid process moving posterior
indicates rotation to the opposite side. The mastoid
moving inferior indicates sidebending to the same
side (Type II mechanics: rotation and sidebending
occur in opposite directions). Here, right mastoid is
posterior/inferior → Rotation to the left, sidebending
to the right .
3. During a respiratory exam, you place your hands
on the patient's ribs to assess rib motion. You note
,that during inspiration, the right 6th rib moves
superiorly and anteriorly, but the left 6th rib remains
relatively fixed. This is most consistent with a
diagnosis of:
A) Inhalation dysfunction of the left rib
B) Exhalation dysfunction of the right rib
C) Pump handle dysfunction of the sternum
D) Bucket handle dysfunction of the left rib
Correct answer: B
Rationale: In inhalation dysfunction, the rib is stuck in
the elevated position (superior/anterior). In
exhalation dysfunction, the rib is stuck in the
depressed position. Since the left rib is not moving as
much, it is likely stuck in the depressed position
(exhalation) .
4. A patient presents with acute torticollis. You
diagnose a Type II somatic dysfunction of the cervical
spine at C3. According to Fryette's laws, which of the
following is true regarding Type II dysfunctions?
A) They occur in neutral mechanics
B) They involve multiple vertebrae
C) Rotation and sidebending occur in opposite
directions
, D) They are typically non-neutral mechanics involving
a single vertebral segment
Correct answer: D
Rationale: Fryette's Law II states that when the spine
is in non-neutral (flexion or extension), rotation and
sidebending occur in opposite directions, and this
typically involves a single vertebral segment .
5. You are treating a patient with chronic sinusitis.
You decide to use the Galbreath technique. This
technique primarily targets which of the following
bones?
A) Frontal and Sphenoid
B) Temporal and Parietal
C) Temporal and Mandible
D) Maxilla and Palatine
Correct answer: C
Rationale: The Galbreath technique is a myofascial
release technique used for Eustachian tube
dysfunction and sinusitis. It involves mobilizing the
temporal bone and mandible to facilitate drainage of
the middle ear and sinuses .
