, COMSAE Phase 1 Advanced Prep:
Master Osteopathic Principles & Clinical
Foundations Practice Questions &
Detailed Explanations
Subject: Osteopathic Medicine & Clinical Foundations (COMSAE Phase 1)
Question 1: A 45-year-old male presents with chronic low back pain. Physical examination
reveals a T10–T12 segment restriction that is neutral, sidebent left, and rotated left (N SLRL).
Which of the following is the most appropriate initial indirect osteopathic manipulative treatment
(OMT) to address this dysfunction?
A) Place the patient in a prone position and apply a high-velocity, low-amplitude (HVLA) thrust
to the T11 spinous process.
B) Position the patient in a way that minimizes tension on the affected segment, specifically
sidebending and rotating the torso toward the right.
C) Position the patient in a way that maximizes tension on the affected segment, specifically
sidebending and rotating the torso toward the left.
D) Use muscle energy technique (MET) by engaging the restrictive barrier and instructing the
patient to rotate to the left against resistance.
Correct Answer: B) Position the patient in a way that minimizes tension on the affected
segment, specifically sidebending and rotating the torso toward the right.
Explanation: In OMT, indirect techniques involve moving the dysfunctional segment toward the
position of ease. For a Neutral (Type I) somatic dysfunction that is N SLRL, the "ease" is found
by sidebending and rotating the segment toward the right (opposite the dysfunction). Option A is
a direct technique (HVLA). Option C describes a direct technique (moving into the barrier).
Option D is a direct technique (MET).
Question 2: A 62-year-old female with a history of hypertension is found to have a Chapman's
point in the 5th intercostal space on the left mid-mammary line. This point is most commonly
associated with which of the following viscera?
A) Stomach (acidity)
B) Stomach (peristalsis)
, C) Liver and Gallbladder
D) Myocardium
Correct Answer: A) Stomach (acidity)
Explanation: Chapman's points serve as diagnostic markers for visceral dysfunction. The 5th
intercostal space on the left is classic for stomach (acidity), whereas the 5th intercostal space on
the right is associated with the stomach (peristalsis). The liver and gallbladder are typically
found in the 6th intercostal space on the right.
Question 3: Which of the following best describes the physiological mechanism by which
Muscle Energy Technique (MET) achieves its therapeutic effect via post-isometric relaxation?
A) It triggers the Golgi tendon organ (GTO) to decrease alpha-motor neuron activity.
B) It utilizes the muscle spindle reflex to increase gamma-motor neuron firing.
C) It relies on the activation of the stretch reflex to contract the agonist muscle.
D) It involves rapid passive stretching of the muscle to override the myotatic reflex.
Correct Answer: A) It triggers the Golgi tendon organ (GTO) to decrease alpha-motor
neuron activity.
Explanation: MET utilizes the patient's own muscular effort. During the isometric phase, tension
increases, stimulating the Golgi tendon organ. The GTO reflexively inhibits the alpha-motor
neurons of the agonist muscle, leading to relaxation, which allows the physician to move the
segment further into the restrictive barrier.
Question 4: A patient presents with a sacral diagnosis of "Right-on-Right" sacral torsion. Which
of the following findings would be consistent with this diagnosis during the seated flexion test
and motion testing?
A) Positive seated flexion test on the left, deep sulcus on the left.
B) Positive seated flexion test on the right, posterior ILA on the left.
C) Positive seated flexion test on the right, deep sulcus on the right.
D) Positive seated flexion test on the left, posterior ILA on the right.
Correct Answer: B) Positive seated flexion test on the right, posterior ILA on the left.
Master Osteopathic Principles & Clinical
Foundations Practice Questions &
Detailed Explanations
Subject: Osteopathic Medicine & Clinical Foundations (COMSAE Phase 1)
Question 1: A 45-year-old male presents with chronic low back pain. Physical examination
reveals a T10–T12 segment restriction that is neutral, sidebent left, and rotated left (N SLRL).
Which of the following is the most appropriate initial indirect osteopathic manipulative treatment
(OMT) to address this dysfunction?
A) Place the patient in a prone position and apply a high-velocity, low-amplitude (HVLA) thrust
to the T11 spinous process.
B) Position the patient in a way that minimizes tension on the affected segment, specifically
sidebending and rotating the torso toward the right.
C) Position the patient in a way that maximizes tension on the affected segment, specifically
sidebending and rotating the torso toward the left.
D) Use muscle energy technique (MET) by engaging the restrictive barrier and instructing the
patient to rotate to the left against resistance.
Correct Answer: B) Position the patient in a way that minimizes tension on the affected
segment, specifically sidebending and rotating the torso toward the right.
Explanation: In OMT, indirect techniques involve moving the dysfunctional segment toward the
position of ease. For a Neutral (Type I) somatic dysfunction that is N SLRL, the "ease" is found
by sidebending and rotating the segment toward the right (opposite the dysfunction). Option A is
a direct technique (HVLA). Option C describes a direct technique (moving into the barrier).
Option D is a direct technique (MET).
Question 2: A 62-year-old female with a history of hypertension is found to have a Chapman's
point in the 5th intercostal space on the left mid-mammary line. This point is most commonly
associated with which of the following viscera?
A) Stomach (acidity)
B) Stomach (peristalsis)
, C) Liver and Gallbladder
D) Myocardium
Correct Answer: A) Stomach (acidity)
Explanation: Chapman's points serve as diagnostic markers for visceral dysfunction. The 5th
intercostal space on the left is classic for stomach (acidity), whereas the 5th intercostal space on
the right is associated with the stomach (peristalsis). The liver and gallbladder are typically
found in the 6th intercostal space on the right.
Question 3: Which of the following best describes the physiological mechanism by which
Muscle Energy Technique (MET) achieves its therapeutic effect via post-isometric relaxation?
A) It triggers the Golgi tendon organ (GTO) to decrease alpha-motor neuron activity.
B) It utilizes the muscle spindle reflex to increase gamma-motor neuron firing.
C) It relies on the activation of the stretch reflex to contract the agonist muscle.
D) It involves rapid passive stretching of the muscle to override the myotatic reflex.
Correct Answer: A) It triggers the Golgi tendon organ (GTO) to decrease alpha-motor
neuron activity.
Explanation: MET utilizes the patient's own muscular effort. During the isometric phase, tension
increases, stimulating the Golgi tendon organ. The GTO reflexively inhibits the alpha-motor
neurons of the agonist muscle, leading to relaxation, which allows the physician to move the
segment further into the restrictive barrier.
Question 4: A patient presents with a sacral diagnosis of "Right-on-Right" sacral torsion. Which
of the following findings would be consistent with this diagnosis during the seated flexion test
and motion testing?
A) Positive seated flexion test on the left, deep sulcus on the left.
B) Positive seated flexion test on the right, posterior ILA on the left.
C) Positive seated flexion test on the right, deep sulcus on the right.
D) Positive seated flexion test on the left, posterior ILA on the right.
Correct Answer: B) Positive seated flexion test on the right, posterior ILA on the left.
