COMSAE Phase 1 Form 116 Practice Exam – 176
Questions (New Version) LATEST UPDATE THIS
YEAR-JUST RELEASED.pdf
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1–44)
1. A 32-year-old female presents with chronic headaches and neck pain. On structural
exam, you find a Type I dysfunction at C3-C5. According to Fryette's principles,
which of the following best describes this dysfunction?
A) Neutral position, rotation and sidebending opposite directions
B) Flexed position, rotation and sidebending same direction
C) Extended position, rotation and sidebending opposite directions
D) Neutral position, rotation and sidebending same direction
Answer: A) Neutral position, rotation and sidebending opposite directions
: Fryette's Type I mechanics occur in the neutral position, where rotation and sidebending
occur in opposite directions. Type II mechanics occur in flexion or extension where rotation
and sidebending occur in the same direction.
2. A 55-year-old male with a history of COPD presents with low back pain. On
examination, you note a right-sided short leg and a positive standing flexion test on
,the right. In the prone position, the right ILA is more anterior than the left. What is the
most likely sacral diagnosis?
A) Right on right sacral torsion
B) Left on left sacral torsion
C) Right unilateral sacral extension
D) Left unilateral sacral flexion
Answer: C) Right unilateral sacral extension
: In unilateral sacral extension, the ILA on the affected side is more anterior and superior,
with a positive flexion test on the same side. This is the opposite of unilateral flexion where
the ILA is posterior.
3. A patient presents with right-sided rib pain following a motor vehicle accident. On
examination, you find that the right 6th rib is restricted in inhalation. Which muscle is
primarily responsible for this motion?
A) External intercostals
B) Internal intercostals
C) Diaphragm
D) Scalenes
Answer: C) Diaphragm
: The diaphragm is the primary muscle of inhalation. Rib dysfunction in inhalation occurs
when the rib is unable to move upward and outward during inspiration.
4. Which of the following Chapman's points is associated with the adrenal glands?
,A) 2nd intercostal space, midclavicular line, bilaterally
B) 10th rib, 1 inch lateral to the costochondral junction, bilaterally
C) 12th rib, 1 inch lateral to the spinous processes, bilaterally
D) Pubic symphysis, superior surface
Answer: C) 12th rib, 1 inch lateral to the spinous processes, bilaterally
: The Chapman's point for the adrenal glands is located at the 12th rib, approximately 1 inch
lateral to the spinous processes bilaterally. The gallbladder point is at the 5th-6th intercostal
space on the right.
5. A 28-year-old female presents with right-sided pelvic pain. On examination, you
find a tender point at the right pubic ramus. This Chapman's point is associated with
which organ?
A) Ovary
B) Uterus
C) Bladder
D) Appendix
Answer: A) Ovary
: The Chapman's point for the ovary is located on the pubic ramus on the ipsilateral side.
The uterine point is on the sacrum, and the bladder point is around the umbilicus.
6. A patient presents with acute torticollis after sleeping in an awkward position. You
diagnose a right cervical Type II dysfunction at C4-C5. What is the correct naming for
this dysfunction?
, A) C4 E R(L) S(L)
B) C4 F R(R) S(R)
C) C4 N R(R) S(L)
D) C4 E R(R) S(R)
Answer: B) C4 F R(R) S(R)
: Type II dysfunctions are named for the position of ease (flexion or extension) and the
direction of rotation and sidebending (same direction). In right cervical dysfunction with
flexion, the vertebra is flexed, rotated right, and sidebent right.
7. Which of the following is an absolute contraindication to cervical HVLA thrust
techniques?
A) Acute whiplash injury
B) Cervical radiculopathy
C) Vertebral artery insufficiency
D) Muscle spasm
Answer: C) Vertebral artery insufficiency
: Vertebral artery insufficiency is an absolute contraindication to cervical HVLA due to the
risk of vertebrobasilar stroke. Pre-manipulative testing for vertebrobasilar insufficiency (VBI)
should be performed prior to cervical manipulation. Acute whiplash, radiculopathy, and
muscle spasm are not absolute contraindications.
8. A 42-year-old female with a history of migraines undergoes osteopathic
manipulative treatment. You perform the CV-4 technique. Which of the following is
the primary physiological effect of this technique?
Questions (New Version) LATEST UPDATE THIS
YEAR-JUST RELEASED.pdf
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM (Questions 1–44)
1. A 32-year-old female presents with chronic headaches and neck pain. On structural
exam, you find a Type I dysfunction at C3-C5. According to Fryette's principles,
which of the following best describes this dysfunction?
A) Neutral position, rotation and sidebending opposite directions
B) Flexed position, rotation and sidebending same direction
C) Extended position, rotation and sidebending opposite directions
D) Neutral position, rotation and sidebending same direction
Answer: A) Neutral position, rotation and sidebending opposite directions
: Fryette's Type I mechanics occur in the neutral position, where rotation and sidebending
occur in opposite directions. Type II mechanics occur in flexion or extension where rotation
and sidebending occur in the same direction.
2. A 55-year-old male with a history of COPD presents with low back pain. On
examination, you note a right-sided short leg and a positive standing flexion test on
,the right. In the prone position, the right ILA is more anterior than the left. What is the
most likely sacral diagnosis?
A) Right on right sacral torsion
B) Left on left sacral torsion
C) Right unilateral sacral extension
D) Left unilateral sacral flexion
Answer: C) Right unilateral sacral extension
: In unilateral sacral extension, the ILA on the affected side is more anterior and superior,
with a positive flexion test on the same side. This is the opposite of unilateral flexion where
the ILA is posterior.
3. A patient presents with right-sided rib pain following a motor vehicle accident. On
examination, you find that the right 6th rib is restricted in inhalation. Which muscle is
primarily responsible for this motion?
A) External intercostals
B) Internal intercostals
C) Diaphragm
D) Scalenes
Answer: C) Diaphragm
: The diaphragm is the primary muscle of inhalation. Rib dysfunction in inhalation occurs
when the rib is unable to move upward and outward during inspiration.
4. Which of the following Chapman's points is associated with the adrenal glands?
,A) 2nd intercostal space, midclavicular line, bilaterally
B) 10th rib, 1 inch lateral to the costochondral junction, bilaterally
C) 12th rib, 1 inch lateral to the spinous processes, bilaterally
D) Pubic symphysis, superior surface
Answer: C) 12th rib, 1 inch lateral to the spinous processes, bilaterally
: The Chapman's point for the adrenal glands is located at the 12th rib, approximately 1 inch
lateral to the spinous processes bilaterally. The gallbladder point is at the 5th-6th intercostal
space on the right.
5. A 28-year-old female presents with right-sided pelvic pain. On examination, you
find a tender point at the right pubic ramus. This Chapman's point is associated with
which organ?
A) Ovary
B) Uterus
C) Bladder
D) Appendix
Answer: A) Ovary
: The Chapman's point for the ovary is located on the pubic ramus on the ipsilateral side.
The uterine point is on the sacrum, and the bladder point is around the umbilicus.
6. A patient presents with acute torticollis after sleeping in an awkward position. You
diagnose a right cervical Type II dysfunction at C4-C5. What is the correct naming for
this dysfunction?
, A) C4 E R(L) S(L)
B) C4 F R(R) S(R)
C) C4 N R(R) S(L)
D) C4 E R(R) S(R)
Answer: B) C4 F R(R) S(R)
: Type II dysfunctions are named for the position of ease (flexion or extension) and the
direction of rotation and sidebending (same direction). In right cervical dysfunction with
flexion, the vertebra is flexed, rotated right, and sidebent right.
7. Which of the following is an absolute contraindication to cervical HVLA thrust
techniques?
A) Acute whiplash injury
B) Cervical radiculopathy
C) Vertebral artery insufficiency
D) Muscle spasm
Answer: C) Vertebral artery insufficiency
: Vertebral artery insufficiency is an absolute contraindication to cervical HVLA due to the
risk of vertebrobasilar stroke. Pre-manipulative testing for vertebrobasilar insufficiency (VBI)
should be performed prior to cervical manipulation. Acute whiplash, radiculopathy, and
muscle spasm are not absolute contraindications.
8. A 42-year-old female with a history of migraines undergoes osteopathic
manipulative treatment. You perform the CV-4 technique. Which of the following is
the primary physiological effect of this technique?
