2026 COMSAE 114 – 176 Latest
Questions and Verified Answers +
Detailed Study Guide | Guaranteed Pass |
Fully Updated & Trusted by DO Students
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1-44)
Q1. A 45-year-old male presents with low back pain after lifting a box. The
standing flexion test shows superior movement of the right PSIS. Which somatic
dysfunction is most likely?
A) Left anterior innominate
B) Right anterior innominate
C) Left posterior innominate
D) Right posterior innominate
E) Bilateral innominate rotation
Correct Answer: B
Rationale: The standing flexion test is positive on the side of iliosacral dysfunction. In a
right anterior innominate, the right ASIS is more inferior, causing a functional short right
leg and positive standing flexion test on the right.
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur:
,A) To the same side
B) To opposite sides
C) Only in flexion
D) Only in extension
E) Rotation without sidebending
Correct Answer: B
Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. Type II mechanics affect
single vertebrae in non-neutral positions where sidebending and rotation occur to the
same side.
Q3. A patient has a somatic dysfunction described as "left fibular head, posterior."
What motion is restricted?
A) Posterior glide
B) Anterior glide
C) Medial rotation
D) Lateral rotation
E) Superior glide
Correct Answer: B
Rationale: A posterior fibular head is fixed posteriorly, so anterior glide is restricted.
Treatment aims to restore anterior motion of the fibular head.
Q4. Which condition is an absolute contraindication to cervical HVLA thrust?
,A) Acute muscle spasm
B) Osteoporosis
C) Rheumatoid arthritis with atlantoaxial instability
D) Joint hypomobility
E) Vertebral artery insufficiency
Correct Answer: C
Rationale: Ligamentous laxity from rheumatoid arthritis, especially atlantoaxial
instability, is an absolute contraindication to HVLA due to risk of spinal cord injury.
Vertebral artery insufficiency is a relative contraindication.
Q5. A 28-year-old female presents with chronic headaches and cervical spine
tenderness. The OA joint is restricted in flexion and sidebending to the right. What
is the most appropriate OMT for this dysfunction?
A) Direct HVLA with patient supine, OA joint flexed, rotated left, sidebent right
B) Direct HVLA with patient supine, OA joint extended, rotated right, sidebent right
C) Indirect myofascial release only
D) Counterstrain at the suboccipital region
E) Articulatory technique in extension
Correct Answer: A
Rationale: The OA joint is a modified synovial joint. If restricted in flexion and
sidebending to the right, the restrictive barrier is in flexion and right sidebending. The
HVLA positioning should be: flex, rotate left (away from the sidebending), and sidebend
right (toward the barrier).
, Q6. A patient has a somatic dysfunction of the sacrum. The left sulcus is deeper
than the right, and the left ILA is more posterior than the right. What is the
diagnosis?
A) Left on Left torsion
B) Right on Right torsion
C) Left on Right torsion
D) Right on Left torsion
E) Bilateral sacral flexion
Correct Answer: C
Rationale: A deep sulcus and posterior ILA on the same side indicate a forward sacral
torsion about an oblique axis. The naming convention is "side of the deep sulcus" on
"side of the posterior ILA." Here, deep sulcus = left, posterior ILA = left, so Left on Left
torsion.
Q7. Which cranial technique is specifically designed to enhance the amplitude of
the cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Compression of the fourth ventricle (CV-4)
C) V-spread technique
D) Frontal lift
E) Parietal lift
Correct Answer: B
Rationale: Compression of the fourth ventricle (CV-4) is explicitly utilized to encourage
fluid movement, enhance CRI amplitude, and assist with autonomic nervous system
balancing.
Questions and Verified Answers +
Detailed Study Guide | Guaranteed Pass |
Fully Updated & Trusted by DO Students
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1-44)
Q1. A 45-year-old male presents with low back pain after lifting a box. The
standing flexion test shows superior movement of the right PSIS. Which somatic
dysfunction is most likely?
A) Left anterior innominate
B) Right anterior innominate
C) Left posterior innominate
D) Right posterior innominate
E) Bilateral innominate rotation
Correct Answer: B
Rationale: The standing flexion test is positive on the side of iliosacral dysfunction. In a
right anterior innominate, the right ASIS is more inferior, causing a functional short right
leg and positive standing flexion test on the right.
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur:
,A) To the same side
B) To opposite sides
C) Only in flexion
D) Only in extension
E) Rotation without sidebending
Correct Answer: B
Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. Type II mechanics affect
single vertebrae in non-neutral positions where sidebending and rotation occur to the
same side.
Q3. A patient has a somatic dysfunction described as "left fibular head, posterior."
What motion is restricted?
A) Posterior glide
B) Anterior glide
C) Medial rotation
D) Lateral rotation
E) Superior glide
Correct Answer: B
Rationale: A posterior fibular head is fixed posteriorly, so anterior glide is restricted.
Treatment aims to restore anterior motion of the fibular head.
Q4. Which condition is an absolute contraindication to cervical HVLA thrust?
,A) Acute muscle spasm
B) Osteoporosis
C) Rheumatoid arthritis with atlantoaxial instability
D) Joint hypomobility
E) Vertebral artery insufficiency
Correct Answer: C
Rationale: Ligamentous laxity from rheumatoid arthritis, especially atlantoaxial
instability, is an absolute contraindication to HVLA due to risk of spinal cord injury.
Vertebral artery insufficiency is a relative contraindication.
Q5. A 28-year-old female presents with chronic headaches and cervical spine
tenderness. The OA joint is restricted in flexion and sidebending to the right. What
is the most appropriate OMT for this dysfunction?
A) Direct HVLA with patient supine, OA joint flexed, rotated left, sidebent right
B) Direct HVLA with patient supine, OA joint extended, rotated right, sidebent right
C) Indirect myofascial release only
D) Counterstrain at the suboccipital region
E) Articulatory technique in extension
Correct Answer: A
Rationale: The OA joint is a modified synovial joint. If restricted in flexion and
sidebending to the right, the restrictive barrier is in flexion and right sidebending. The
HVLA positioning should be: flex, rotate left (away from the sidebending), and sidebend
right (toward the barrier).
, Q6. A patient has a somatic dysfunction of the sacrum. The left sulcus is deeper
than the right, and the left ILA is more posterior than the right. What is the
diagnosis?
A) Left on Left torsion
B) Right on Right torsion
C) Left on Right torsion
D) Right on Left torsion
E) Bilateral sacral flexion
Correct Answer: C
Rationale: A deep sulcus and posterior ILA on the same side indicate a forward sacral
torsion about an oblique axis. The naming convention is "side of the deep sulcus" on
"side of the posterior ILA." Here, deep sulcus = left, posterior ILA = left, so Left on Left
torsion.
Q7. Which cranial technique is specifically designed to enhance the amplitude of
the cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Compression of the fourth ventricle (CV-4)
C) V-spread technique
D) Frontal lift
E) Parietal lift
Correct Answer: B
Rationale: Compression of the fourth ventricle (CV-4) is explicitly utilized to encourage
fluid movement, enhance CRI amplitude, and assist with autonomic nervous system
balancing.
