COMSAE Phase 1 Form 114 Study Guide |
Complete Practice Exam with Questions,
Answers in Bold Italic, and Detailed
Explanations for Osteopathic Medical
Students
Section 1: Osteopathic Principles & Practice (OPP)
1. A 45-year-old male presents with low back pain after lifting a heavy box.
The standing flexion test shows superior movement of the right PSIS. Which
somatic dysfunction is most likely?
A) Left posterior innominate
B) Right sacral torsion on a left oblique axis
C) Bilateral innominate rotation
D) Right anterior innominate
,,,,answer,,,,: D
Rationale: A positive standing flexion test on the right suggests an iliosacral
dysfunction on that side. In a right anterior innominate, the right ASIS is
positioned anteriorly and inferiorly, creating a functional short leg and causing the
right PSIS to move superiorly during the test .
2. A patient has a somatic dysfunction described as "left fibular head,
posterior." What motion is restricted?
A) Anterior glide
B) Posterior glide
,C) Lateral glide
D) Medial glide
,,,,answer,,,,: A
Rationale: If the fibular head is fixed in a posterior position, the restricted motion
is the anterior glide. Treatment would aim to restore this motion .
3. According to Fryette’s first principle (Type I mechanics), when the spine is
in a neutral position, how do sidebending and rotation occur?
A) To the same side
B) Without rotation
C) Only in the lumbar spine
D) To opposite sides
,,,,answer,,,,: D
Rationale: Fryette’s first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. For example,
sidebending right is accompanied by rotation left .
4. According to Fryette’s second principle (Type II mechanics), when a single
vertebra is in a non-neutral (flexed or extended) position, how do sidebending
and rotation occur?
A) To the same side
B) To opposite sides
C) Without rotation
D) Only in the cervical spine
,,,,answer,,,,: A
Rationale: Fryette’s second principle (Type II mechanics) states that when a single
vertebral segment is in a non-neutral position, sidebending and rotation occur to
the same side .
,5. Which of the following is an absolute contraindication to the use of cervical
High-Velocity Low-Amplitude (HVLA) thrust?
A) Chronic neck pain
B) Muscle spasm
C) Rheumatoid arthritis with atlantoaxial instability
D) Tension headache
,,,,answer,,,,: C
Rationale: Rheumatoid arthritis can cause ligamentous laxity of the transverse
ligament, leading to atlantoaxial instability. HVLA thrust in this setting carries a
high risk of spinal cord injury .
6. A patient with asthma presents with rib dysfunction. What is the primary
physiologic goal of performing a rib-raising technique?
A) Increase rib excursion
B) Increase parasympathetic tone
C) Mobilize costovertebral joints
D) Decrease sympathetic outflow to the lungs
,,,,answer,,,,: D
Rationale: Rib raising applies gentle, sustained pressure to the costovertebral
joints, which inhibits the sympathetic chain ganglia. This reduces sympathetic
tone, helping to relieve bronchospasm .
7. A patient is diagnosed with a sacral torsion described as "L on L." In which
situation would the seated flexion test be positive?
A) On the left
B) On the right
C) On both sides
D) Negative in both seated and standing
,,,,answer,,,,: B
Rationale: In an L-on-L sacral torsion (forward torsion with a left oblique axis),
, the seated flexion test is positive on the opposite side, which is the right. The
standing flexion test would be positive on the same side as the axis (left) .
8. A patient with a sphenobasilar synchondrosis (SBS) dysfunction has
restriction in extension. Which of the following best describes the position of
the sphenoid and occiput in this dysfunction?
A) Sphenoid is extended, occiput is flexed
B) Sphenoid is flexed, occiput is extended
C) Both sphenoid and occiput are flexed
D) Both sphenoid and occiput are extended
,,,,answer,,,,: A
Rationale: In SBS extension dysfunction, the sphenoid is held in extension while
the occiput is held in flexion. The restriction is in the motion of extension .
9. A 45-year-old female presents with a chief complaint of pain and stiffness in
her right shoulder. On examination, she has limited range of motion in all
planes, especially abduction and external rotation. You decide to perform the
Spencer technique. This technique is a seven-step protocol for treating which
joint?
A) Knee
B) Hip
C) Ankle
D) Shoulder (glenohumeral)
,,,,answer,,,,: D
Rationale: The Spencer technique is a specific, seven-step OMT protocol designed
to address a wide range of shoulder dysfunctions, including adhesive capsulitis
("frozen shoulder") .
10. The Chapman reflex for the stomach is located anteriorly at which
intercostal space?
A) Left 5th
Complete Practice Exam with Questions,
Answers in Bold Italic, and Detailed
Explanations for Osteopathic Medical
Students
Section 1: Osteopathic Principles & Practice (OPP)
1. A 45-year-old male presents with low back pain after lifting a heavy box.
The standing flexion test shows superior movement of the right PSIS. Which
somatic dysfunction is most likely?
A) Left posterior innominate
B) Right sacral torsion on a left oblique axis
C) Bilateral innominate rotation
D) Right anterior innominate
,,,,answer,,,,: D
Rationale: A positive standing flexion test on the right suggests an iliosacral
dysfunction on that side. In a right anterior innominate, the right ASIS is
positioned anteriorly and inferiorly, creating a functional short leg and causing the
right PSIS to move superiorly during the test .
2. A patient has a somatic dysfunction described as "left fibular head,
posterior." What motion is restricted?
A) Anterior glide
B) Posterior glide
,C) Lateral glide
D) Medial glide
,,,,answer,,,,: A
Rationale: If the fibular head is fixed in a posterior position, the restricted motion
is the anterior glide. Treatment would aim to restore this motion .
3. According to Fryette’s first principle (Type I mechanics), when the spine is
in a neutral position, how do sidebending and rotation occur?
A) To the same side
B) Without rotation
C) Only in the lumbar spine
D) To opposite sides
,,,,answer,,,,: D
Rationale: Fryette’s first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. For example,
sidebending right is accompanied by rotation left .
4. According to Fryette’s second principle (Type II mechanics), when a single
vertebra is in a non-neutral (flexed or extended) position, how do sidebending
and rotation occur?
A) To the same side
B) To opposite sides
C) Without rotation
D) Only in the cervical spine
,,,,answer,,,,: A
Rationale: Fryette’s second principle (Type II mechanics) states that when a single
vertebral segment is in a non-neutral position, sidebending and rotation occur to
the same side .
,5. Which of the following is an absolute contraindication to the use of cervical
High-Velocity Low-Amplitude (HVLA) thrust?
A) Chronic neck pain
B) Muscle spasm
C) Rheumatoid arthritis with atlantoaxial instability
D) Tension headache
,,,,answer,,,,: C
Rationale: Rheumatoid arthritis can cause ligamentous laxity of the transverse
ligament, leading to atlantoaxial instability. HVLA thrust in this setting carries a
high risk of spinal cord injury .
6. A patient with asthma presents with rib dysfunction. What is the primary
physiologic goal of performing a rib-raising technique?
A) Increase rib excursion
B) Increase parasympathetic tone
C) Mobilize costovertebral joints
D) Decrease sympathetic outflow to the lungs
,,,,answer,,,,: D
Rationale: Rib raising applies gentle, sustained pressure to the costovertebral
joints, which inhibits the sympathetic chain ganglia. This reduces sympathetic
tone, helping to relieve bronchospasm .
7. A patient is diagnosed with a sacral torsion described as "L on L." In which
situation would the seated flexion test be positive?
A) On the left
B) On the right
C) On both sides
D) Negative in both seated and standing
,,,,answer,,,,: B
Rationale: In an L-on-L sacral torsion (forward torsion with a left oblique axis),
, the seated flexion test is positive on the opposite side, which is the right. The
standing flexion test would be positive on the same side as the axis (left) .
8. A patient with a sphenobasilar synchondrosis (SBS) dysfunction has
restriction in extension. Which of the following best describes the position of
the sphenoid and occiput in this dysfunction?
A) Sphenoid is extended, occiput is flexed
B) Sphenoid is flexed, occiput is extended
C) Both sphenoid and occiput are flexed
D) Both sphenoid and occiput are extended
,,,,answer,,,,: A
Rationale: In SBS extension dysfunction, the sphenoid is held in extension while
the occiput is held in flexion. The restriction is in the motion of extension .
9. A 45-year-old female presents with a chief complaint of pain and stiffness in
her right shoulder. On examination, she has limited range of motion in all
planes, especially abduction and external rotation. You decide to perform the
Spencer technique. This technique is a seven-step protocol for treating which
joint?
A) Knee
B) Hip
C) Ankle
D) Shoulder (glenohumeral)
,,,,answer,,,,: D
Rationale: The Spencer technique is a specific, seven-step OMT protocol designed
to address a wide range of shoulder dysfunctions, including adhesive capsulitis
("frozen shoulder") .
10. The Chapman reflex for the stomach is located anteriorly at which
intercostal space?
A) Left 5th
