COMSAE Phase 1 Form 114 Study Guide | Complete Practice Exam with Questions, Answers in Bold Italic, and Detailed Explanations for Osteopathic Medical Students

COMSAE Phase 1 Form 114 Study Guide |
Complete Practice Exam with Questions, Answers
in Bold Italic, and Detailed Explanations for
Osteopathic Medical Students


Question 1: OPP – Innominate Diagnosis
A 45-year-old male presents with low back pain after lifting. The standing flexion
test shows superior movement of the right PSIS. Which somatic dysfunction is
most likely?
• A) Right anterior innominate
• B) Left posterior innominate
• C) Right sacral torsion on a left oblique axis
• D) Bilateral innominate rotation
Correct Answer: A) Right anterior innominate
Rationale: A positive standing flexion test on the right suggests iliosacral
dysfunction on that side. For a right anterior innominate, the right ASIS is
positioned anteriorly and inferiorly, creating a functional short right leg and a
positive standing flexion test on the right .


Question 2: OPP – Fryette's Principles
According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur:
• A) To the same side

, • B) To opposite sides
• C) Without rotation
• D) Only in the lumbar spine
Correct Answer: B) To opposite sides
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 .


Question 3: OPP – Cranial Technique
Which cranial technique is specifically designed to enhance the amplitude of the
cranial rhythmic impulse (CRI)?
• A) Venous sinus traction
• B) Bulb compression (CV4)
• C) V-spread technique
• D) Frontal lift
Correct Answer: B) Bulb compression (CV4)
Rationale: Compression of the fourth ventricle (CV4) is explicitly utilized to
encourage fluid movement, enhance the amplitude of the CRI, and assist with
autonomic nervous system balancing . Other techniques target specific sutural
restrictions or venous drainage.


Question 4: OPP – Counterstrain
A 45-year-old female presents with pain along the medial aspect of her right
knee. Palpation reveals a tender point on the medial surface of the tibia,
approximately 2 cm below the joint line, at the insertion of the pes anserinus.
Which position is used for counterstrain treatment?

, • A) Flexion, abduction, external rotation
• B) Flexion, adduction, internal rotation
• C) Extension, abduction, external rotation
• D) Extension, adduction, internal rotation
Correct Answer: B) Flexion, adduction, internal rotation
Rationale: The medial knee tender point (often associated with the pes anserinus)
is treated with hip/knee flexion, adduction, and internal rotation of the tibia to
shorten the involved muscles and release the tender point .


Question 5: Cardiology – Atrial Fibrillation
A 70-year-old with atrial fibrillation is at the highest risk for thrombus formation
in which location?
• A) Right ventricle
• B) Left atrial appendage
• C) Pulmonary artery
• D) Coronary sinus
Correct Answer: B) Left atrial appendage
Rationale: In atrial fibrillation, ineffective atrial contractions lead to blood stasis,
most commonly in the Left Atrial Appendage (LAA). This predisposes to thrombus
formation and increases the risk of systemic embolic stroke .


Question 6: Pulmonology – PE
A patient with sudden onset of sharp chest pain and dyspnea after a long flight
most likely has:
• A) Asthma exacerbation

, • B) Spontaneous pneumothorax
• C) Pulmonary embolism
• D) Acute bronchitis
Correct Answer: C) Pulmonary embolism
Rationale: The combination of prolonged immobilization (long flight), sudden
dyspnea, and pleuritic chest pain is highly suggestive of a Pulmonary Embolism
(PE), often originating from a Deep Vein Thrombosis (DVT) .


Question 7: Neurology – Cranial Nerves
Which cranial nerve is responsible for taste sensation from the posterior one-
third of the tongue?
• A) Facial nerve (VII)
• B) Glossopharyngeal nerve (IX)
• C) Vagus nerve (X)
• D) Trigeminal nerve (V)
Correct Answer: B) Glossopharyngeal nerve (IX)
Rationale: The glossopharyngeal nerve (CN IX) provides taste sensation to the
posterior one-third of the tongue. The facial nerve (CN VII) provides taste to the
anterior two-thirds .


Question 8: Pharmacology – ACE Inhibitors
A patient with hypertension is started on an ACE inhibitor. Which physiological
change is expected?
• A) Increased aldosterone
• B) Decreased bradykinin