COMSAE Phase 1 – Form ASA 109 (High-Yield
Osteopathic Structural Analysis Set) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
1. During structural examination, the physician notes that
the right ASIS is inferior and the right PSIS is superior. Which
innominate dysfunction is most likely present?
A. Right posterior innominate rotation
B. Right anterior innominate rotation
C. Left anterior innominate rotation
D. Right inflare
An anterior innominate rotation causes the ASIS to move
inferiorly and the PSIS to move superiorly on the affected side.
This is one of the most commonly tested pelvic dysfunctions in
osteopathic medicine.
2. A patient has a left-on-left sacral torsion. Which sacral
axis is involved?
A. Right oblique axis
B. Transverse axis
C. Vertical axis
D. Left oblique axis
,In sacral torsions, the first term indicates the direction of
sacral rotation and the second term identifies the oblique
axis. Therefore, a left-on-left torsion rotates left on a left
oblique axis.
3. Which rib is considered atypical because it has only one
facet on its head?
A. Rib 2
B. Rib 3
C. Rib 6
D. Rib 1
Ribs 1, 10, 11, and 12 are atypical. Rib 1 has a single facet
and unique anatomical relationships important in thoracic
outlet syndromes.
4. The standing flexion test is positive on the right and the
seated flexion test is negative. Which region is most likely
dysfunctional?
A. Sacrum
B. Lumbar spine
C. Innominate/Pelvis
D. Thoracic spine
The standing flexion test evaluates innominate motion. A
positive standing test with a negative seated test generally
indicates pelvic dysfunction rather than sacral dysfunction.
,5. A vertebra that is flexed, rotated right, and sidebent right
demonstrates which type of dysfunction?
A. Type I
B. Neutral dysfunction
C. Type II dysfunction
D. Sacral dysfunction
Type II dysfunctions involve a single vertebral segment that is
flexed or extended, with rotation and sidebending occurring
to the same side.
6. Fryette's first principle applies to which spinal region?
A. Sacral segments only
B. Cervical spine only
C. Thoracic and lumbar spine in neutral
D. Cranial bones
Fryette's first principle states that in a neutral spine,
sidebending and rotation occur to opposite sides. This applies
primarily to thoracic and lumbar regions.
7. Which landmark is used to diagnose sacral sulcus depth?
A. Inferior lateral angle
B. ASIS
C. PSIS
D. Sacral base
, The sacral sulcus is formed adjacent to the sacral base.
Asymmetry of the sulci is a key component in diagnosing
sacral dysfunctions.
8. A patient presents with inhalation dysfunction of rib 5.
The rib is most restricted in:
A. Inspiration
B. Expiration
C. Sidebending
D. Rotation
An inhalation dysfunction means the rib is stuck elevated.
Therefore, it cannot move effectively downward during
exhalation, making expiration the restricted motion.
9. The OA joint normally permits the greatest amount of:
A. Rotation
B. Sidebending
C. Translation
D. Flexion and extension
The atlanto-occipital joint primarily functions as a nodding
joint, allowing significant flexion and extension.
10. The atlantoaxial joint provides approximately what
percentage of cervical rotation?
Osteopathic Structural Analysis Set) (2026
Edition): Comprehensive Multiple-Choice
Questions, Answers, and Detailed Rationales
1. During structural examination, the physician notes that
the right ASIS is inferior and the right PSIS is superior. Which
innominate dysfunction is most likely present?
A. Right posterior innominate rotation
B. Right anterior innominate rotation
C. Left anterior innominate rotation
D. Right inflare
An anterior innominate rotation causes the ASIS to move
inferiorly and the PSIS to move superiorly on the affected side.
This is one of the most commonly tested pelvic dysfunctions in
osteopathic medicine.
2. A patient has a left-on-left sacral torsion. Which sacral
axis is involved?
A. Right oblique axis
B. Transverse axis
C. Vertical axis
D. Left oblique axis
,In sacral torsions, the first term indicates the direction of
sacral rotation and the second term identifies the oblique
axis. Therefore, a left-on-left torsion rotates left on a left
oblique axis.
3. Which rib is considered atypical because it has only one
facet on its head?
A. Rib 2
B. Rib 3
C. Rib 6
D. Rib 1
Ribs 1, 10, 11, and 12 are atypical. Rib 1 has a single facet
and unique anatomical relationships important in thoracic
outlet syndromes.
4. The standing flexion test is positive on the right and the
seated flexion test is negative. Which region is most likely
dysfunctional?
A. Sacrum
B. Lumbar spine
C. Innominate/Pelvis
D. Thoracic spine
The standing flexion test evaluates innominate motion. A
positive standing test with a negative seated test generally
indicates pelvic dysfunction rather than sacral dysfunction.
,5. A vertebra that is flexed, rotated right, and sidebent right
demonstrates which type of dysfunction?
A. Type I
B. Neutral dysfunction
C. Type II dysfunction
D. Sacral dysfunction
Type II dysfunctions involve a single vertebral segment that is
flexed or extended, with rotation and sidebending occurring
to the same side.
6. Fryette's first principle applies to which spinal region?
A. Sacral segments only
B. Cervical spine only
C. Thoracic and lumbar spine in neutral
D. Cranial bones
Fryette's first principle states that in a neutral spine,
sidebending and rotation occur to opposite sides. This applies
primarily to thoracic and lumbar regions.
7. Which landmark is used to diagnose sacral sulcus depth?
A. Inferior lateral angle
B. ASIS
C. PSIS
D. Sacral base
, The sacral sulcus is formed adjacent to the sacral base.
Asymmetry of the sulci is a key component in diagnosing
sacral dysfunctions.
8. A patient presents with inhalation dysfunction of rib 5.
The rib is most restricted in:
A. Inspiration
B. Expiration
C. Sidebending
D. Rotation
An inhalation dysfunction means the rib is stuck elevated.
Therefore, it cannot move effectively downward during
exhalation, making expiration the restricted motion.
9. The OA joint normally permits the greatest amount of:
A. Rotation
B. Sidebending
C. Translation
D. Flexion and extension
The atlanto-occipital joint primarily functions as a nodding
joint, allowing significant flexion and extension.
10. The atlantoaxial joint provides approximately what
percentage of cervical rotation?
