COMSAE PHASE 1 FORM 115 PRACTICE EXAM 300 ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
ALREADY GRADED A+ NEW!!!!!!!!!!!!!!!!!!!!!!!
This 300-question COMSAE Phase 1 practice exam provides comprehensive
coverage of osteopathic principles and clinical applications. Each question
presents a unique clinical vignette with four answer choices, a correct answer,
and a detailed rationale. Topics include Fryette's laws, somatic dysfunctions
at all spinal levels, sacral torsions, innominate rotations, rib dysfunctions,
muscle energy techniques, counterstrain, CV4, rib raising, thoracic pump,
doming of the diaphragm, sphenopalatine ganglion release, mesenteric lift,
pelvic floor release, coccygeal release, and viscerosomatic reflexes. Questions
also cover autonomic innervation, lymphatic techniques, contraindications,
and clinical correlations with asthma, COPD, sinusitis, prostatitis, migraines,
and lymphedema. No questions are repeated, ensuring a thorough and non-
redundant review for exam preparation.
1. A 45-year-old male presents with acute right upper quadrant pain radiating to
the right shoulder. On examination, you find a rib restriction at the right 7th rib.
Which of the following is the most likely associated visceral structure?
A) Liver
B) Spleen
C) Stomach
D) Kidney
Correct Answer: A
Rationale: The liver is located in the right upper quadrant and is associated with
the somatic innervation of the lower thoracic nerves. Rib dysfunction at the 7th rib
can reflect or contribute to hepatic somatic-visceral reflexes.
2. A 28-year-old female with asthma presents for osteopathic treatment. You
decide to perform a doming technique of the diaphragm. What is the primary goal
of this technique?
A) Increase thoracic kyphosis
,B) Decrease sympathetic tone to the lungs
C) Improve lymphatic drainage and respiratory excursion
D) Inhibit vagal nerve activity
Correct Answer: C
Rationale: Diaphragmatic doming is an indirect technique that enhances
diaphragmatic motion, which improves lymphatic flow, venous return, and
respiratory mechanics, particularly beneficial in patients with asthma or COPD.
3. During an osteopathic structural exam, you find that the patient's sacrum has a
left-on-left (L-on-L) torsion. According to the sacral motion model, which of the
following is true regarding the axis of rotation?
A) The axis is vertical through the center of the sacrum
B) The axis is horizontal at the level of S2
C) The axis is oblique from the left superior to right inferior
D) The axis is oblique from the right superior to left inferior
Correct Answer: C
Rationale: In a left-on-left sacral torsion, the sacrum rotates around an oblique axis
that runs from the left superior (upper pole) to the right inferior (lower pole). The
"left-on-left" designation means the base of the sacrum is rotated left around this
oblique axis.
4. A patient with chronic neck pain exhibits restricted rotation to the right and side-
bending to the right at the C2 level. The restriction is worse in flexion and
improves in extension. What is the correct diagnosis for this cervical dysfunction?
A) C2 Neutral RR RL
B) C2 Flexed RR SR
C) C2 Extended RR SR
D) C2 Extended RL SL
Correct Answer: C
Rationale: Since the dysfunction improves in extension, the segment is diagnosed
as Extended. According to Fryette's Second Law, in a non-neutral position such as
extension, rotation and side-bending occur to the same side. Therefore, rotation
right and side-bending right gives a diagnosis of Extended RR SR.
,5. A 60-year-old male with chronic obstructive pulmonary disease is treated with a
paraspinal inhibition technique at the T3-T6 levels. Which autonomic effect is
most directly targeted by this approach?
A) Increased vagal outflow to the bronchi
B) Decreased sympathetic outflow to the lungs
C) Increased sympathetic outflow to the heart
D) Decreased parasympathetic outflow to the gastrointestinal tract
Correct Answer: B
Rationale: The sympathetic outflow to the lungs originates from T2-T6. Paraspinal
inhibition at these levels reduces excessive sympathetic tone, promoting
bronchodilation and improved airflow in patients with obstructive lung disease.
6. A 22-year-old female with a history of recurrent urinary tract infections presents
with pelvic floor dysfunction. You note a tender point at the coccyx. Which of the
following is the most appropriate initial osteopathic treatment?
A) High-velocity low-amplitude thrust to the coccyx
B) Coccygeal release using gentle intrarectal or external mobilization
C) Muscle energy for the piriformis muscle
D) Counterstrain of the iliacus muscle
Correct Answer: B
Rationale: Coccygeal dysfunction is often treated with gentle mobilization
techniques to release the sacrococcygeal joint and surrounding ligaments. Direct
thrust is contraindicated due to the risk of fracture or exacerbation of pain, and
external or intrarectal release is the preferred initial approach.
7. A patient presents with a somatic dysfunction at the L2 segment. During flexion,
the segment rotates easily but resists extension. What is the most likely diagnosis?
A) L2 Neutral
B) L2 Flexed
C) L2 Extended
D) L2 Rotated without side-bending
Correct Answer: B
Rationale: If a segment rotates easily in flexion but resists extension, this indicates
that the segment is restricted in the extended position. By definition, the diagnosis
, is L2 Flexed, as the segment is held in flexion and cannot move fully into
extension.
8. In a patient with acute cervical strain after a motor vehicle accident, you
diagnose a right anterior dysfunction of C5. What is the most appropriate muscle
energy protocol for this dysfunction?
A) Patient rotates head left and extends, physician resists isometric contraction
B) Patient rotates head right and flexes, physician resists isometric contraction
C) Patient rotates head left and flexes, physician resists isometric contraction
D) Patient rotates head right and extends, physician resists isometric contraction
Correct Answer: B
Rationale: For a right anterior C5 (which is flexed and rotated right), the patient is
positioned away from the restrictive barrier (left rotation and flexion) and then
performs a gentle isometric contraction against physician resistance. After
relaxation, the segment is engaged into the new barrier.
9. A 55-year-old woman with breast cancer status post-mastectomy presents with
ipsilateral arm swelling. You consider osteopathic lymphatic techniques. Which of
the following techniques is most effective for promoting upper extremity
lymphatic drainage?
A) Thoracic pump
B) Doming of the diaphragm
C) Rib raising
D) Pedal pump
Correct Answer: A
Rationale: The thoracic pump creates negative and positive pressure changes
within the thorax, enhancing lymphatic return from the upper extremities and the
head and neck region. It is particularly useful in lymphedema following
mastectomy.
10. A patient presents with low back pain that worsens with standing and improves
with sitting. On examination, you find a positive seated flexion test on the left.
What does this finding indicate?
A) Left iliosacral dysfunction
B) Right iliosacral dysfunction
C) Bilateral sacroiliac dysfunction
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
ALREADY GRADED A+ NEW!!!!!!!!!!!!!!!!!!!!!!!
This 300-question COMSAE Phase 1 practice exam provides comprehensive
coverage of osteopathic principles and clinical applications. Each question
presents a unique clinical vignette with four answer choices, a correct answer,
and a detailed rationale. Topics include Fryette's laws, somatic dysfunctions
at all spinal levels, sacral torsions, innominate rotations, rib dysfunctions,
muscle energy techniques, counterstrain, CV4, rib raising, thoracic pump,
doming of the diaphragm, sphenopalatine ganglion release, mesenteric lift,
pelvic floor release, coccygeal release, and viscerosomatic reflexes. Questions
also cover autonomic innervation, lymphatic techniques, contraindications,
and clinical correlations with asthma, COPD, sinusitis, prostatitis, migraines,
and lymphedema. No questions are repeated, ensuring a thorough and non-
redundant review for exam preparation.
1. A 45-year-old male presents with acute right upper quadrant pain radiating to
the right shoulder. On examination, you find a rib restriction at the right 7th rib.
Which of the following is the most likely associated visceral structure?
A) Liver
B) Spleen
C) Stomach
D) Kidney
Correct Answer: A
Rationale: The liver is located in the right upper quadrant and is associated with
the somatic innervation of the lower thoracic nerves. Rib dysfunction at the 7th rib
can reflect or contribute to hepatic somatic-visceral reflexes.
2. A 28-year-old female with asthma presents for osteopathic treatment. You
decide to perform a doming technique of the diaphragm. What is the primary goal
of this technique?
A) Increase thoracic kyphosis
,B) Decrease sympathetic tone to the lungs
C) Improve lymphatic drainage and respiratory excursion
D) Inhibit vagal nerve activity
Correct Answer: C
Rationale: Diaphragmatic doming is an indirect technique that enhances
diaphragmatic motion, which improves lymphatic flow, venous return, and
respiratory mechanics, particularly beneficial in patients with asthma or COPD.
3. During an osteopathic structural exam, you find that the patient's sacrum has a
left-on-left (L-on-L) torsion. According to the sacral motion model, which of the
following is true regarding the axis of rotation?
A) The axis is vertical through the center of the sacrum
B) The axis is horizontal at the level of S2
C) The axis is oblique from the left superior to right inferior
D) The axis is oblique from the right superior to left inferior
Correct Answer: C
Rationale: In a left-on-left sacral torsion, the sacrum rotates around an oblique axis
that runs from the left superior (upper pole) to the right inferior (lower pole). The
"left-on-left" designation means the base of the sacrum is rotated left around this
oblique axis.
4. A patient with chronic neck pain exhibits restricted rotation to the right and side-
bending to the right at the C2 level. The restriction is worse in flexion and
improves in extension. What is the correct diagnosis for this cervical dysfunction?
A) C2 Neutral RR RL
B) C2 Flexed RR SR
C) C2 Extended RR SR
D) C2 Extended RL SL
Correct Answer: C
Rationale: Since the dysfunction improves in extension, the segment is diagnosed
as Extended. According to Fryette's Second Law, in a non-neutral position such as
extension, rotation and side-bending occur to the same side. Therefore, rotation
right and side-bending right gives a diagnosis of Extended RR SR.
,5. A 60-year-old male with chronic obstructive pulmonary disease is treated with a
paraspinal inhibition technique at the T3-T6 levels. Which autonomic effect is
most directly targeted by this approach?
A) Increased vagal outflow to the bronchi
B) Decreased sympathetic outflow to the lungs
C) Increased sympathetic outflow to the heart
D) Decreased parasympathetic outflow to the gastrointestinal tract
Correct Answer: B
Rationale: The sympathetic outflow to the lungs originates from T2-T6. Paraspinal
inhibition at these levels reduces excessive sympathetic tone, promoting
bronchodilation and improved airflow in patients with obstructive lung disease.
6. A 22-year-old female with a history of recurrent urinary tract infections presents
with pelvic floor dysfunction. You note a tender point at the coccyx. Which of the
following is the most appropriate initial osteopathic treatment?
A) High-velocity low-amplitude thrust to the coccyx
B) Coccygeal release using gentle intrarectal or external mobilization
C) Muscle energy for the piriformis muscle
D) Counterstrain of the iliacus muscle
Correct Answer: B
Rationale: Coccygeal dysfunction is often treated with gentle mobilization
techniques to release the sacrococcygeal joint and surrounding ligaments. Direct
thrust is contraindicated due to the risk of fracture or exacerbation of pain, and
external or intrarectal release is the preferred initial approach.
7. A patient presents with a somatic dysfunction at the L2 segment. During flexion,
the segment rotates easily but resists extension. What is the most likely diagnosis?
A) L2 Neutral
B) L2 Flexed
C) L2 Extended
D) L2 Rotated without side-bending
Correct Answer: B
Rationale: If a segment rotates easily in flexion but resists extension, this indicates
that the segment is restricted in the extended position. By definition, the diagnosis
, is L2 Flexed, as the segment is held in flexion and cannot move fully into
extension.
8. In a patient with acute cervical strain after a motor vehicle accident, you
diagnose a right anterior dysfunction of C5. What is the most appropriate muscle
energy protocol for this dysfunction?
A) Patient rotates head left and extends, physician resists isometric contraction
B) Patient rotates head right and flexes, physician resists isometric contraction
C) Patient rotates head left and flexes, physician resists isometric contraction
D) Patient rotates head right and extends, physician resists isometric contraction
Correct Answer: B
Rationale: For a right anterior C5 (which is flexed and rotated right), the patient is
positioned away from the restrictive barrier (left rotation and flexion) and then
performs a gentle isometric contraction against physician resistance. After
relaxation, the segment is engaged into the new barrier.
9. A 55-year-old woman with breast cancer status post-mastectomy presents with
ipsilateral arm swelling. You consider osteopathic lymphatic techniques. Which of
the following techniques is most effective for promoting upper extremity
lymphatic drainage?
A) Thoracic pump
B) Doming of the diaphragm
C) Rib raising
D) Pedal pump
Correct Answer: A
Rationale: The thoracic pump creates negative and positive pressure changes
within the thorax, enhancing lymphatic return from the upper extremities and the
head and neck region. It is particularly useful in lymphedema following
mastectomy.
10. A patient presents with low back pain that worsens with standing and improves
with sitting. On examination, you find a positive seated flexion test on the left.
What does this finding indicate?
A) Left iliosacral dysfunction
B) Right iliosacral dysfunction
C) Bilateral sacroiliac dysfunction
