2026 COMSAE 114 – 176 Latest Questions and Verified
Answers + Detailed Study Guide | Guaranteed Pass | Fully
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Question 1
A 45-year-old patient presents with low back pain that worsens with forward
flexion and improves with extension. On examination, you note a somatic
dysfunction at L3 characterized by a restriction of motion in flexion, rotation, and
sidebending to the same side. According to Fryette's laws, which of the following
best describes this dysfunction?
A. Type I dysfunction with neutral mechanics
B. Type II dysfunction with non-neutral mechanics
C. Type III dysfunction with combined mechanics
D. Type IV dysfunction with rotational mechanics
Correct Answer: B – Type II dysfunction with non-neutral mechanics
Rationale: Fryette's Laws describe spinal motion mechanics. Type II
dysfunction (also called non-neutral mechanics) occurs when the vertebrae
are flexed or extended and exhibit restriction of motion in rotation and
sidebending to the same side. The key feature of Type II is that rotation and
sidebending occur in the same direction (e.g., rotation right and sidebending
right). This is in contrast to Type I (neutral mechanics), where rotation and
sidebending occur in opposite directions. Type III and Type IV are not recognized
Fryette classifications.
Question 2
During a structural examination, you identify a Chapman's reflex point located at
the end of the 12th rib on the right side. This point is most commonly associated
with dysfunction of which organ?
,A. Liver
B. Gallbladder
C. Kidney
D. Spleen
Correct Answer: C – Kidney
Rationale: Chapman's reflexes are viscerosomatic reflex points that correspond to
specific organs. The Chapman's point for the kidney is located at the end of the
12th rib on the ipsilateral side. The liver reflex point is typically found in the right
intercostal spaces. The gallbladder point is in the right 5th–6th intercostal space.
The spleen point is on the left 7th–8th intercostal space.
Question 3
A patient presents with a somatic dysfunction of the sacrum characterized by a
deep sulcus on the left and a shallow sulcus on the right. The inferior lateral angle
(ILA) is more posterior on the left. This presentation is consistent with which
sacral torsion?
A. Left-on-left torsion
B. Left-on-right torsion
C. Right-on-left torsion
D. Right-on-right torsion
Correct Answer: A – Left-on-left torsion
Rationale: In a left-on-left sacral torsion, the sacrum rotates to the left on a left
oblique axis. The findings include:
• Deep sulcus on the left
• Shallow sulcus on the right
• ILA more posterior on the left
The naming convention for sacral torsions is based on the side of the deep sulcus
first, then the side of the more posterior ILA. So "left-on-left" means deep sulcus
on the left and posterior ILA on the left.
,Question 4
A patient presents with a tender point in the right iliacus muscle. According to the
principles of counterstrain, what is the appropriate treatment position?
A. Flexion, adduction, and internal rotation of the right hip
B. Extension, abduction, and external rotation of the right hip
C. Flexion, abduction, and external rotation of the right hip
D. Extension, adduction, and internal rotation of the right hip
Correct Answer: C – Flexion, abduction, and external rotation of the right hip
Rationale: In counterstrain, the treatment position is the position of comfort—
the position that reduces the tension on the dysfunctional muscle and resolves
the tender point. For the iliacus muscle, the treatment position typically
involves flexion, abduction, and external rotation of the hip. This position
shortens the muscle and relieves strain.
Question 5
A 55-year-old patient presents with chronic headaches and a history of cervical
spine dysfunction. You note restricted motion in the upper cervical spine with a
left rotation restriction. Which of the following is the most appropriate
osteopathic manipulative treatment (OMT) technique to address this restriction?
A. High-velocity, low-amplitude (HVLA) thrust to the left
B. Muscle energy technique (MET) with isometric contraction
C. Counterstrain with tender point localization
D. Myofascial release with sustained pressure
Correct Answer: B – Muscle energy technique (MET) with isometric contraction
Rationale: Muscle energy technique (MET) is a direct OMT technique that uses
the patient's isometric contraction against a counterforce to improve range of
motion. For cervical restrictions, MET is effective and safe. HVLA would be
appropriate but carries more risk in the cervical spine. Counterstrain is an indirect
, technique that positions the patient in the direction of ease. Myofascial release is
a broad soft tissue technique.
ANATOMY & EMBRYOLOGY
Question 6
A 45-year-old patient presents with hoarseness and difficulty swallowing. On
examination, you note paralysis of the left vocal cord. Which of the following
nerves is most likely affected?
A. Left vagus nerve
B. Left recurrent laryngeal nerve
C. Left hypoglossal nerve
D. Left glossopharyngeal nerve
Correct Answer: B – Left recurrent laryngeal nerve
Rationale: The recurrent laryngeal nerve (a branch of the vagus nerve) innervates
all intrinsic muscles of the larynx except the cricothyroid. Injury to this nerve
causes vocal cord paralysis and hoarseness. The left recurrent laryngeal nerve has
a longer course (looping around the aortic arch) and is more susceptible to injury.
The hypoglossal nerve (CN XII) controls tongue movement. The glossopharyngeal
nerve (CN IX) controls swallowing and taste.
Question 7
A 30-year-old patient presents with weakness in dorsiflexion and foot drop.
Which of the following nerves is most likely affected?
A. Common peroneal nerve
B. Tibial nerve
C. Femoral nerve
D. Sciatic nerve
Correct Answer: A – Common peroneal nerve
Answers + Detailed Study Guide | Guaranteed Pass | Fully
Updated & Trusted by DO Students
Question 1
A 45-year-old patient presents with low back pain that worsens with forward
flexion and improves with extension. On examination, you note a somatic
dysfunction at L3 characterized by a restriction of motion in flexion, rotation, and
sidebending to the same side. According to Fryette's laws, which of the following
best describes this dysfunction?
A. Type I dysfunction with neutral mechanics
B. Type II dysfunction with non-neutral mechanics
C. Type III dysfunction with combined mechanics
D. Type IV dysfunction with rotational mechanics
Correct Answer: B – Type II dysfunction with non-neutral mechanics
Rationale: Fryette's Laws describe spinal motion mechanics. Type II
dysfunction (also called non-neutral mechanics) occurs when the vertebrae
are flexed or extended and exhibit restriction of motion in rotation and
sidebending to the same side. The key feature of Type II is that rotation and
sidebending occur in the same direction (e.g., rotation right and sidebending
right). This is in contrast to Type I (neutral mechanics), where rotation and
sidebending occur in opposite directions. Type III and Type IV are not recognized
Fryette classifications.
Question 2
During a structural examination, you identify a Chapman's reflex point located at
the end of the 12th rib on the right side. This point is most commonly associated
with dysfunction of which organ?
,A. Liver
B. Gallbladder
C. Kidney
D. Spleen
Correct Answer: C – Kidney
Rationale: Chapman's reflexes are viscerosomatic reflex points that correspond to
specific organs. The Chapman's point for the kidney is located at the end of the
12th rib on the ipsilateral side. The liver reflex point is typically found in the right
intercostal spaces. The gallbladder point is in the right 5th–6th intercostal space.
The spleen point is on the left 7th–8th intercostal space.
Question 3
A patient presents with a somatic dysfunction of the sacrum characterized by a
deep sulcus on the left and a shallow sulcus on the right. The inferior lateral angle
(ILA) is more posterior on the left. This presentation is consistent with which
sacral torsion?
A. Left-on-left torsion
B. Left-on-right torsion
C. Right-on-left torsion
D. Right-on-right torsion
Correct Answer: A – Left-on-left torsion
Rationale: In a left-on-left sacral torsion, the sacrum rotates to the left on a left
oblique axis. The findings include:
• Deep sulcus on the left
• Shallow sulcus on the right
• ILA more posterior on the left
The naming convention for sacral torsions is based on the side of the deep sulcus
first, then the side of the more posterior ILA. So "left-on-left" means deep sulcus
on the left and posterior ILA on the left.
,Question 4
A patient presents with a tender point in the right iliacus muscle. According to the
principles of counterstrain, what is the appropriate treatment position?
A. Flexion, adduction, and internal rotation of the right hip
B. Extension, abduction, and external rotation of the right hip
C. Flexion, abduction, and external rotation of the right hip
D. Extension, adduction, and internal rotation of the right hip
Correct Answer: C – Flexion, abduction, and external rotation of the right hip
Rationale: In counterstrain, the treatment position is the position of comfort—
the position that reduces the tension on the dysfunctional muscle and resolves
the tender point. For the iliacus muscle, the treatment position typically
involves flexion, abduction, and external rotation of the hip. This position
shortens the muscle and relieves strain.
Question 5
A 55-year-old patient presents with chronic headaches and a history of cervical
spine dysfunction. You note restricted motion in the upper cervical spine with a
left rotation restriction. Which of the following is the most appropriate
osteopathic manipulative treatment (OMT) technique to address this restriction?
A. High-velocity, low-amplitude (HVLA) thrust to the left
B. Muscle energy technique (MET) with isometric contraction
C. Counterstrain with tender point localization
D. Myofascial release with sustained pressure
Correct Answer: B – Muscle energy technique (MET) with isometric contraction
Rationale: Muscle energy technique (MET) is a direct OMT technique that uses
the patient's isometric contraction against a counterforce to improve range of
motion. For cervical restrictions, MET is effective and safe. HVLA would be
appropriate but carries more risk in the cervical spine. Counterstrain is an indirect
, technique that positions the patient in the direction of ease. Myofascial release is
a broad soft tissue technique.
ANATOMY & EMBRYOLOGY
Question 6
A 45-year-old patient presents with hoarseness and difficulty swallowing. On
examination, you note paralysis of the left vocal cord. Which of the following
nerves is most likely affected?
A. Left vagus nerve
B. Left recurrent laryngeal nerve
C. Left hypoglossal nerve
D. Left glossopharyngeal nerve
Correct Answer: B – Left recurrent laryngeal nerve
Rationale: The recurrent laryngeal nerve (a branch of the vagus nerve) innervates
all intrinsic muscles of the larynx except the cricothyroid. Injury to this nerve
causes vocal cord paralysis and hoarseness. The left recurrent laryngeal nerve has
a longer course (looping around the aortic arch) and is more susceptible to injury.
The hypoglossal nerve (CN XII) controls tongue movement. The glossopharyngeal
nerve (CN IX) controls swallowing and taste.
Question 7
A 30-year-old patient presents with weakness in dorsiflexion and foot drop.
Which of the following nerves is most likely affected?
A. Common peroneal nerve
B. Tibial nerve
C. Femoral nerve
D. Sciatic nerve
Correct Answer: A – Common peroneal nerve
