COMSAE Phase 1 Form 116 – The
Complete 176 Question Test Bank All
questions with correct verified answers &
detailed rationales verified based on
current NBOME standards and
COMLEX-USA Level 1 blueprint for the
2026 examination cycle
Question 1
A patient with chronic neck pain has a restricted C5 segment that rotates
more easily to the right and sidebends more easily to the right. The
restriction improves when the patient extends the cervical spine.
According to Fryette's principles, what is the correct diagnosis?
A) C5 Extended RR SR
B) C5 Extended RR SL
C) C5 Flexed RR SR
D) C5 Neutral RR SR
,,,answer,,,: A) C5 Extended RR SR
Rationale: According to Fryette's principles, when a segment improves
in extension, it is diagnosed as an Extended dysfunction. In Type II
(non-neutral) mechanics, rotation and sidebending occur in the same
direction. Thus, rotation right (RR) and sidebending right (SR) yields
"Extended RR SR". Type I mechanics involve neutral position where
rotation and sidebending occur in opposite directions. Type II mechanics
,involve non-neutral (flexed or extended) positions where rotation and
sidebending occur in the same direction.
Question 2
A patient with a history of recurrent urinary tract infections has
tenderness in the right lower quadrant at the tip of the 12th rib. This
Chapman reflex is associated with which organ?
A) Appendix
B) Right kidney
C) Right ureter
D) Right ovary
,,,answer,,,: B) Right kidney
Rationale: The kidney Chapman reflex is located at the tip of the 12th
rib. Chapman reflexes are small, tender nodules found in the deep fascia
that correspond to visceral dysfunction. The appendix Chapman reflex is
located in the right lower quadrant between the anterior superior iliac
spine and the umbilicus. The ureter reflex is located medial to the
anterior superior iliac spine. The ovary reflex is located on the pubic
ramus.
Question 3
A patient presents with a left sacral base that is posterior and inferior on
the left. The left ILA is anterior and superior. Which sacral torsion
pattern is this?
,A) Left on left sacral torsion
B) Right on left sacral torsion
C) Left on right sacral torsion
D) Bilateral sacral torsion
,,,answer,,,: A) Left on left sacral torsion
Rationale: In a left-on-left sacral torsion, the left sacral base is posterior
and inferior, while the left ILA (inferior lateral angle) is anterior and
superior. The naming convention for sacral torsions describes the side of
the deep sacral sulcus (first) and the side of the axis (second). A left-on-
left torsion means the deep sulcus is on the left and the axis of rotation is
on the left.
Question 4
Which of the following is a contraindication to High-Velocity Low-
Amplitude (HVLA) technique?
A) Acute muscle spasm
B) Joint hypomobility
C) Vertebral artery insufficiency
D) Somatic dysfunction
,,,answer,,,: C) Vertebral artery insufficiency
Rationale: Vertebral artery insufficiency is an absolute contraindication
to cervical HVLA techniques due to the risk of vertebrobasilar stroke.
Other contraindications include fracture, dislocation, malignancy,
infection, and severe osteoporosis. Acute muscle spasm (A) and joint
hypomobility (B) are actually indications for HVLA, not
, contraindications. Somatic dysfunction (D) is the primary indication for
HVLA.
Question 5
A patient with chronic respiratory issues presents with restricted rib
motion on the left side during inspiration. The ribs fail to elevate
properly. Which rib dysfunction is most likely?
A) Inhalation dysfunction of the left ribs
B) Exhalation dysfunction of the left ribs
C) Bucket handle dysfunction
D) Pump handle dysfunction
,,,answer,,,: A) Inhalation dysfunction of the left ribs
Rationale: Inhalation rib dysfunction occurs when ribs are restricted in
the elevated position and fail to descend properly during exhalation. The
ribs appear elevated and fail to depress during expiration. Exhalation
dysfunction (B) occurs when ribs are restricted in the depressed position.
Bucket handle (C) and pump handle (D) describe different planes of rib
motion, not specific dysfunctions.
Question 6
A patient with a history of asthma has tenderness over the spinous
processes of T1-T4 with associated paraspinal muscle hypertonicity.
This is most consistent with which viscerosomatic reflex?
Complete 176 Question Test Bank All
questions with correct verified answers &
detailed rationales verified based on
current NBOME standards and
COMLEX-USA Level 1 blueprint for the
2026 examination cycle
Question 1
A patient with chronic neck pain has a restricted C5 segment that rotates
more easily to the right and sidebends more easily to the right. The
restriction improves when the patient extends the cervical spine.
According to Fryette's principles, what is the correct diagnosis?
A) C5 Extended RR SR
B) C5 Extended RR SL
C) C5 Flexed RR SR
D) C5 Neutral RR SR
,,,answer,,,: A) C5 Extended RR SR
Rationale: According to Fryette's principles, when a segment improves
in extension, it is diagnosed as an Extended dysfunction. In Type II
(non-neutral) mechanics, rotation and sidebending occur in the same
direction. Thus, rotation right (RR) and sidebending right (SR) yields
"Extended RR SR". Type I mechanics involve neutral position where
rotation and sidebending occur in opposite directions. Type II mechanics
,involve non-neutral (flexed or extended) positions where rotation and
sidebending occur in the same direction.
Question 2
A patient with a history of recurrent urinary tract infections has
tenderness in the right lower quadrant at the tip of the 12th rib. This
Chapman reflex is associated with which organ?
A) Appendix
B) Right kidney
C) Right ureter
D) Right ovary
,,,answer,,,: B) Right kidney
Rationale: The kidney Chapman reflex is located at the tip of the 12th
rib. Chapman reflexes are small, tender nodules found in the deep fascia
that correspond to visceral dysfunction. The appendix Chapman reflex is
located in the right lower quadrant between the anterior superior iliac
spine and the umbilicus. The ureter reflex is located medial to the
anterior superior iliac spine. The ovary reflex is located on the pubic
ramus.
Question 3
A patient presents with a left sacral base that is posterior and inferior on
the left. The left ILA is anterior and superior. Which sacral torsion
pattern is this?
,A) Left on left sacral torsion
B) Right on left sacral torsion
C) Left on right sacral torsion
D) Bilateral sacral torsion
,,,answer,,,: A) Left on left sacral torsion
Rationale: In a left-on-left sacral torsion, the left sacral base is posterior
and inferior, while the left ILA (inferior lateral angle) is anterior and
superior. The naming convention for sacral torsions describes the side of
the deep sacral sulcus (first) and the side of the axis (second). A left-on-
left torsion means the deep sulcus is on the left and the axis of rotation is
on the left.
Question 4
Which of the following is a contraindication to High-Velocity Low-
Amplitude (HVLA) technique?
A) Acute muscle spasm
B) Joint hypomobility
C) Vertebral artery insufficiency
D) Somatic dysfunction
,,,answer,,,: C) Vertebral artery insufficiency
Rationale: Vertebral artery insufficiency is an absolute contraindication
to cervical HVLA techniques due to the risk of vertebrobasilar stroke.
Other contraindications include fracture, dislocation, malignancy,
infection, and severe osteoporosis. Acute muscle spasm (A) and joint
hypomobility (B) are actually indications for HVLA, not
, contraindications. Somatic dysfunction (D) is the primary indication for
HVLA.
Question 5
A patient with chronic respiratory issues presents with restricted rib
motion on the left side during inspiration. The ribs fail to elevate
properly. Which rib dysfunction is most likely?
A) Inhalation dysfunction of the left ribs
B) Exhalation dysfunction of the left ribs
C) Bucket handle dysfunction
D) Pump handle dysfunction
,,,answer,,,: A) Inhalation dysfunction of the left ribs
Rationale: Inhalation rib dysfunction occurs when ribs are restricted in
the elevated position and fail to descend properly during exhalation. The
ribs appear elevated and fail to depress during expiration. Exhalation
dysfunction (B) occurs when ribs are restricted in the depressed position.
Bucket handle (C) and pump handle (D) describe different planes of rib
motion, not specific dysfunctions.
Question 6
A patient with a history of asthma has tenderness over the spinous
processes of T1-T4 with associated paraspinal muscle hypertonicity.
This is most consistent with which viscerosomatic reflex?
