COMSAE Phase 1 Form 114 Practice Questions
Section 1: Osteopathic Principles and Practice
(Questions 1-25)
**1. A patient has a right L4 transverse process that is more posterior than the left and this
asymmetry worsens with lumbar flexion but normalizes with extension. What is the correct somatic
dysfunction diagnosis for this patient?**
A) L4 neutral, rotated right, sidebent left
B) L4 flexed, rotated right, sidebent right
C) L4 extended, rotated right, sidebent right
D) L4 extended, rotated left, sidebent left
**Answer: C**
**Rationale:** The asymmetry that normalizes in extension indicates an extension somatic
dysfunction following Type II mechanics. In Type II mechanics, rotation and sidebending occur to the
same side, so right rotation pairs with right sidebending .
**2. According to Fryette's first principle of spinal mechanics, when the spine is in a neutral position,
how do sidebending and rotation relate to each other?**
A) Sidebending and rotation occur to the same side of the body
B) Sidebending and rotation occur to opposite sides of the body
C) Sidebending occurs without any rotation of the vertebrae
D) Rotation occurs only in the lumbar region of the spine
**Answer: B**
**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 to the right is
accompanied by rotation to the left .
**3. A patient presents with a left fibular head that is positioned posteriorly. Which motion is
restricted in this patient's fibular head?**
A) Anterior glide of the fibular head
B) Posterior glide of the fibular head
C) Lateral glide of the fibular head
D) Medial glide of the fibular head
,**Answer: A**
**Rationale:** When a fibular head is fixed in a posterior position, the anterior glide motion is
restricted. Treatment should focus on restoring the anterior glide to correct the somatic dysfunction .
**4. A patient has a positive left seated flexion test and a positive right standing flexion test. Which
sacral dysfunction is most likely present in this patient?**
A) Left-on-left sacral torsion
B) Right-on-left sacral torsion
C) Bilateral sacral flexion dysfunction
D) Unilateral sacral extension dysfunction
**Answer: A**
**Rationale:** In a left-on-left sacral torsion with a left oblique axis where the sacrum rotates right,
the standing flexion test is positive on the opposite side (right). The seated flexion test is positive on
the same side as the axis (left) .
**5. Which of the following conditions is considered an absolute contraindication to performing a
cervical high-velocity low-amplitude (HVLA) thrust technique?**
A) Acute muscle spasm in the cervical region
B) Rheumatoid arthritis with atlantoaxial instability
C) Chronic whiplash injury from a motor vehicle accident
D) Tension headache with cervical muscle tightness
**Answer: B**
**Rationale:** Rheumatoid arthritis with atlantoaxial instability is an absolute contraindication to
cervical HVLA thrust because the forceful manipulation could cause vertebral displacement or spinal
cord injury .
**6. What is the primary physiologic goal of performing rib raising technique on a patient with
asthma?**
A) To increase the overall excursion of the ribs during breathing
B) To decrease sympathetic outflow to the lungs and reduce bronchospasm
C) To increase parasympathetic tone to enhance bronchial dilation
D) To mobilize the costovertebral joints and improve rib motion
**Answer: B**
**Rationale:** Rib raising inhibits sympathetic ganglia, which helps reduce bronchospasm by
decreasing sympathetic tone to the lungs. This is a key osteopathic approach for managing asthma
symptoms .
,**7. Which position is used to treat a medial knee tender point located at the pes anserinus insertion
using counterstrain technique?**
A) Hip and knee flexion with abduction and external rotation
B) Hip and knee flexion with adduction and internal rotation of the tibia
C) Hip and knee extension with abduction and external rotation
D) Hip and knee extension with adduction and internal rotation of the tibia
**Answer: B**
**Rationale:** The medial knee tender point is treated with hip and knee flexion combined with
adduction and internal rotation of the tibia. This position shortens the involved tissue, which is the
fundamental principle of counterstrain treatment .
**8. The Spencer technique is an osteopathic manipulative treatment protocol specifically indicated
for which joint?**
A) Knee joint with osteoarthritis
B) Hip joint with decreased range of motion
C) Shoulder joint with adhesive capsulitis
D) Ankle joint after a sprain injury
**Answer: C**
**Rationale:** The Spencer technique is a seven-step OMT protocol designed specifically for shoulder
dysfunction, particularly adhesive capsulitis. It involves a series of direct and indirect techniques to
restore shoulder mobility .
**9. What is the correct hand placement for performing a craniosacral technique to release the
sphenobasilar synchondrosis?**
A) One hand on the occiput and the other hand on the sacrum
B) Both hands placed on the patient's temporal bones
C) One hand on the frontal bone and the other on the occipital bone
D) Both hands placed on the patient's parietal bones
**Answer: A**
**Rationale:** The sphenobasilar synchondrosis is the articulation between the sphenoid and
occipital bones. The technique involves placing one hand on the patient's occiput and the other on
the sacrum to assess and balance tension in the dural membranes .
**10. In a right pelvic side shift where the pelvis translates to the right, how does the lumbar spine
compensate mechanically?**
A) The lumbar spine rotates right and sidebends right
B) The lumbar spine rotates right and sidebends left
C) The lumbar spine rotates left and sidebends right
, D) The lumbar spine rotates left and sidebends left
**Answer: B**
**Rationale:** In a right pelvic side shift (pelvic translation to the right), the lumbar spine
compensates by rotating to the right and side-bending to the left due to weight-bearing mechanics of
the lumbopelvic region .
**11. Which osteopathic principle recognizes that the body has an inherent ability to heal itself and
regulate its own functions?**
A) The body is a unit in structure and function
B) Structure and function are reciprocally interrelated
C) The body possesses self-healing and self-regulatory mechanisms
D) Rational treatment is based on an understanding of these principles
**Answer: C**
**Rationale:** The osteopathic principle that "the body possesses self-healing and self-regulatory
mechanisms" recognizes the body's inherent ability to heal itself. The physician's role is to facilitate
this process by removing obstacles to health .
**12. Which Chapman's reflex point location is associated with the pulmonary system?**
A) Anterior intercostal spaces at the level of T2 through T5 near the sternum
B) Posterior iliac crests at the level of the sacroiliac joint
C) Medial epicondyles of the humerus bilaterally
D) Lateral epicondyles of the humerus bilaterally
**Answer: A**
**Rationale:** Pulmonary Chapman reflexes are located anteriorly in the intercostal spaces near the
sternum at the T2 to T5 level. These neurolymphatic reflex points are used diagnostically in
osteopathic practice .
**13. What is the appropriate treatment approach for an occipitoatlantal joint restriction using
osteopathic principles?**
A) Treat the restriction with a direct high-velocity thrust technique
B) Treat the restriction with an indirect myofascial release technique
C) Treat the restriction by balancing the dural membranes using cranial technique
D) Treat the restriction by stabilizing the cervical spine with muscle energy
**Answer: C**
**Rationale:** The occipitoatlantal joint is closely associated with the cranial base and the dura
mater. Restrictions in this area are often treated with cranial techniques, particularly balanced
membranous tension, which addresses the dural restrictions .
Section 1: Osteopathic Principles and Practice
(Questions 1-25)
**1. A patient has a right L4 transverse process that is more posterior than the left and this
asymmetry worsens with lumbar flexion but normalizes with extension. What is the correct somatic
dysfunction diagnosis for this patient?**
A) L4 neutral, rotated right, sidebent left
B) L4 flexed, rotated right, sidebent right
C) L4 extended, rotated right, sidebent right
D) L4 extended, rotated left, sidebent left
**Answer: C**
**Rationale:** The asymmetry that normalizes in extension indicates an extension somatic
dysfunction following Type II mechanics. In Type II mechanics, rotation and sidebending occur to the
same side, so right rotation pairs with right sidebending .
**2. According to Fryette's first principle of spinal mechanics, when the spine is in a neutral position,
how do sidebending and rotation relate to each other?**
A) Sidebending and rotation occur to the same side of the body
B) Sidebending and rotation occur to opposite sides of the body
C) Sidebending occurs without any rotation of the vertebrae
D) Rotation occurs only in the lumbar region of the spine
**Answer: B**
**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 to the right is
accompanied by rotation to the left .
**3. A patient presents with a left fibular head that is positioned posteriorly. Which motion is
restricted in this patient's fibular head?**
A) Anterior glide of the fibular head
B) Posterior glide of the fibular head
C) Lateral glide of the fibular head
D) Medial glide of the fibular head
,**Answer: A**
**Rationale:** When a fibular head is fixed in a posterior position, the anterior glide motion is
restricted. Treatment should focus on restoring the anterior glide to correct the somatic dysfunction .
**4. A patient has a positive left seated flexion test and a positive right standing flexion test. Which
sacral dysfunction is most likely present in this patient?**
A) Left-on-left sacral torsion
B) Right-on-left sacral torsion
C) Bilateral sacral flexion dysfunction
D) Unilateral sacral extension dysfunction
**Answer: A**
**Rationale:** In a left-on-left sacral torsion with a left oblique axis where the sacrum rotates right,
the standing flexion test is positive on the opposite side (right). The seated flexion test is positive on
the same side as the axis (left) .
**5. Which of the following conditions is considered an absolute contraindication to performing a
cervical high-velocity low-amplitude (HVLA) thrust technique?**
A) Acute muscle spasm in the cervical region
B) Rheumatoid arthritis with atlantoaxial instability
C) Chronic whiplash injury from a motor vehicle accident
D) Tension headache with cervical muscle tightness
**Answer: B**
**Rationale:** Rheumatoid arthritis with atlantoaxial instability is an absolute contraindication to
cervical HVLA thrust because the forceful manipulation could cause vertebral displacement or spinal
cord injury .
**6. What is the primary physiologic goal of performing rib raising technique on a patient with
asthma?**
A) To increase the overall excursion of the ribs during breathing
B) To decrease sympathetic outflow to the lungs and reduce bronchospasm
C) To increase parasympathetic tone to enhance bronchial dilation
D) To mobilize the costovertebral joints and improve rib motion
**Answer: B**
**Rationale:** Rib raising inhibits sympathetic ganglia, which helps reduce bronchospasm by
decreasing sympathetic tone to the lungs. This is a key osteopathic approach for managing asthma
symptoms .
,**7. Which position is used to treat a medial knee tender point located at the pes anserinus insertion
using counterstrain technique?**
A) Hip and knee flexion with abduction and external rotation
B) Hip and knee flexion with adduction and internal rotation of the tibia
C) Hip and knee extension with abduction and external rotation
D) Hip and knee extension with adduction and internal rotation of the tibia
**Answer: B**
**Rationale:** The medial knee tender point is treated with hip and knee flexion combined with
adduction and internal rotation of the tibia. This position shortens the involved tissue, which is the
fundamental principle of counterstrain treatment .
**8. The Spencer technique is an osteopathic manipulative treatment protocol specifically indicated
for which joint?**
A) Knee joint with osteoarthritis
B) Hip joint with decreased range of motion
C) Shoulder joint with adhesive capsulitis
D) Ankle joint after a sprain injury
**Answer: C**
**Rationale:** The Spencer technique is a seven-step OMT protocol designed specifically for shoulder
dysfunction, particularly adhesive capsulitis. It involves a series of direct and indirect techniques to
restore shoulder mobility .
**9. What is the correct hand placement for performing a craniosacral technique to release the
sphenobasilar synchondrosis?**
A) One hand on the occiput and the other hand on the sacrum
B) Both hands placed on the patient's temporal bones
C) One hand on the frontal bone and the other on the occipital bone
D) Both hands placed on the patient's parietal bones
**Answer: A**
**Rationale:** The sphenobasilar synchondrosis is the articulation between the sphenoid and
occipital bones. The technique involves placing one hand on the patient's occiput and the other on
the sacrum to assess and balance tension in the dural membranes .
**10. In a right pelvic side shift where the pelvis translates to the right, how does the lumbar spine
compensate mechanically?**
A) The lumbar spine rotates right and sidebends right
B) The lumbar spine rotates right and sidebends left
C) The lumbar spine rotates left and sidebends right
, D) The lumbar spine rotates left and sidebends left
**Answer: B**
**Rationale:** In a right pelvic side shift (pelvic translation to the right), the lumbar spine
compensates by rotating to the right and side-bending to the left due to weight-bearing mechanics of
the lumbopelvic region .
**11. Which osteopathic principle recognizes that the body has an inherent ability to heal itself and
regulate its own functions?**
A) The body is a unit in structure and function
B) Structure and function are reciprocally interrelated
C) The body possesses self-healing and self-regulatory mechanisms
D) Rational treatment is based on an understanding of these principles
**Answer: C**
**Rationale:** The osteopathic principle that "the body possesses self-healing and self-regulatory
mechanisms" recognizes the body's inherent ability to heal itself. The physician's role is to facilitate
this process by removing obstacles to health .
**12. Which Chapman's reflex point location is associated with the pulmonary system?**
A) Anterior intercostal spaces at the level of T2 through T5 near the sternum
B) Posterior iliac crests at the level of the sacroiliac joint
C) Medial epicondyles of the humerus bilaterally
D) Lateral epicondyles of the humerus bilaterally
**Answer: A**
**Rationale:** Pulmonary Chapman reflexes are located anteriorly in the intercostal spaces near the
sternum at the T2 to T5 level. These neurolymphatic reflex points are used diagnostically in
osteopathic practice .
**13. What is the appropriate treatment approach for an occipitoatlantal joint restriction using
osteopathic principles?**
A) Treat the restriction with a direct high-velocity thrust technique
B) Treat the restriction with an indirect myofascial release technique
C) Treat the restriction by balancing the dural membranes using cranial technique
D) Treat the restriction by stabilizing the cervical spine with muscle energy
**Answer: C**
**Rationale:** The occipitoatlantal joint is closely associated with the cranial base and the dura
mater. Restrictions in this area are often treated with cranial techniques, particularly balanced
membranous tension, which addresses the dural restrictions .
