1
COMSAE Phase 1 Form 114 Actual Exam Prep | 120
High-Yield Questions with Verified Answers &
Detailed Rationales | Complete Review for COMLEX-
USA Level 1 | NBOME Osteopathic Medical
Knowledge Self-Assessment | Graded A+
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (Questions 1–30)
1. A 45-year-old male presents with low back pain after lifting a heavy box.
Standing flexion test shows superior movement of the right posterior superior
iliac spine (PSIS). Which somatic dysfunction is most likely?
A. Right anterior innominate
B. Left posterior innominate
C. Right sacral torsion on a left oblique axis
D. Bilateral innominate rotation
Correct Answer: A
Rationale: The standing flexion test is positive on the side of an iliosacral
dysfunction. Superior movement of the PSIS on the right indicates a right anterior
innominate rotation. In a right anterior innominate, the right ASIS is more inferior,
causing a functional short right leg and a positive standing flexion test on the right
.
2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur in which direction?
A. To the same side
B. To opposite sides
, 2
C. Rotation only without sidebending
D. Sidebending only without rotation
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. This applies to
groups of vertebrae in Type I mechanics .
3. A patient has a somatic dysfunction described as "left fibular head, posterior."
What motion is restricted?
A. Posterior glide of the fibular head
B. Anterior glide of the fibular head
C. Superior glide of the fibular head
D. Inferior glide of the fibular head
Correct Answer: B
Rationale: A posterior fibular head is fixed posteriorly, so anterior glide is
restricted. Treatment restores anterior motion. The diagnosis is named for the
position of the bone, and the restricted motion is the opposite direction of the
positional diagnosis .
4. Which condition is an absolute contraindication to cervical HVLA thrust?
A. Degenerative disc disease
B. Rheumatoid arthritis with atlantoaxial instability
C. Acute whiplash injury
D. Cervical radiculopathy
Correct Answer: B
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to risk of spinal cord injury
and neurological compromise .
, 3
5. A 28-year-old female presents with chronic headaches and cervical spine
tenderness. The occipitoatlantal (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 left, sidebent right
C. Muscle energy technique with the patient seated
D. Counterstrain at the suboccipital tender point
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.
HVLA positioning for this dysfunction should be: flex, rotate left (away from
restriction), sidebent right (toward barrier) .
6. 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 Right sacral torsion
B. Right on Left sacral torsion
C. Left on Left sacral torsion
D. Bilateral sacral flexion
Correct Answer: A
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." Therefore, a deep left sulcus and posterior
left ILA indicate a Left on Right torsion .
, 4
7. Which of the following cranial techniques is specifically designed to enhance
the amplitude of the cranial rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV-4)
C. V-spread technique
D. Frontal lift
Correct Answer: B
Rationale: Compression of the fourth ventricle (CV-4) is explicitly utilized to
encourage fluid movement, enhance the amplitude of the CRI, and assist with
autonomic nervous system balancing .
8. A 24-year-old male presents with acute lower back pain. The right L4
transverse process is more posterior than the left. The asymmetry normalizes in
extension. What is the correct somatic dysfunction diagnosis?
A. L4 Extended, Rotated Right, Sidebent Right
B. L4 Extended, Rotated Right, Sidebent Left
C. L4 Flexed, Rotated Right, Sidebent Right
D. L4 Flexed, Rotated Left, Sidebent Left
Correct Answer: A
Rationale: The asymmetry normalizes in extension, indicating an extension (E)
somatic dysfunction (Type II mechanics). Type II mechanics dictate rotation and
sidebending occur to the same side. Since the right transverse process is posterior,
the vertebra is rotated right (Rr) and sidebent right (Sr) .
9. A 40-year-old female with asthma complains of right upper back pain. On
inhalation, the right 3rd rib is elevated and moves poorly. What type of rib
dysfunction is this?
COMSAE Phase 1 Form 114 Actual Exam Prep | 120
High-Yield Questions with Verified Answers &
Detailed Rationales | Complete Review for COMLEX-
USA Level 1 | NBOME Osteopathic Medical
Knowledge Self-Assessment | Graded A+
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (Questions 1–30)
1. A 45-year-old male presents with low back pain after lifting a heavy box.
Standing flexion test shows superior movement of the right posterior superior
iliac spine (PSIS). Which somatic dysfunction is most likely?
A. Right anterior innominate
B. Left posterior innominate
C. Right sacral torsion on a left oblique axis
D. Bilateral innominate rotation
Correct Answer: A
Rationale: The standing flexion test is positive on the side of an iliosacral
dysfunction. Superior movement of the PSIS on the right indicates a right anterior
innominate rotation. In a right anterior innominate, the right ASIS is more inferior,
causing a functional short right leg and a positive standing flexion test on the right
.
2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur in which direction?
A. To the same side
B. To opposite sides
, 2
C. Rotation only without sidebending
D. Sidebending only without rotation
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. This applies to
groups of vertebrae in Type I mechanics .
3. A patient has a somatic dysfunction described as "left fibular head, posterior."
What motion is restricted?
A. Posterior glide of the fibular head
B. Anterior glide of the fibular head
C. Superior glide of the fibular head
D. Inferior glide of the fibular head
Correct Answer: B
Rationale: A posterior fibular head is fixed posteriorly, so anterior glide is
restricted. Treatment restores anterior motion. The diagnosis is named for the
position of the bone, and the restricted motion is the opposite direction of the
positional diagnosis .
4. Which condition is an absolute contraindication to cervical HVLA thrust?
A. Degenerative disc disease
B. Rheumatoid arthritis with atlantoaxial instability
C. Acute whiplash injury
D. Cervical radiculopathy
Correct Answer: B
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to risk of spinal cord injury
and neurological compromise .
, 3
5. A 28-year-old female presents with chronic headaches and cervical spine
tenderness. The occipitoatlantal (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 left, sidebent right
C. Muscle energy technique with the patient seated
D. Counterstrain at the suboccipital tender point
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.
HVLA positioning for this dysfunction should be: flex, rotate left (away from
restriction), sidebent right (toward barrier) .
6. 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 Right sacral torsion
B. Right on Left sacral torsion
C. Left on Left sacral torsion
D. Bilateral sacral flexion
Correct Answer: A
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." Therefore, a deep left sulcus and posterior
left ILA indicate a Left on Right torsion .
, 4
7. Which of the following cranial techniques is specifically designed to enhance
the amplitude of the cranial rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV-4)
C. V-spread technique
D. Frontal lift
Correct Answer: B
Rationale: Compression of the fourth ventricle (CV-4) is explicitly utilized to
encourage fluid movement, enhance the amplitude of the CRI, and assist with
autonomic nervous system balancing .
8. A 24-year-old male presents with acute lower back pain. The right L4
transverse process is more posterior than the left. The asymmetry normalizes in
extension. What is the correct somatic dysfunction diagnosis?
A. L4 Extended, Rotated Right, Sidebent Right
B. L4 Extended, Rotated Right, Sidebent Left
C. L4 Flexed, Rotated Right, Sidebent Right
D. L4 Flexed, Rotated Left, Sidebent Left
Correct Answer: A
Rationale: The asymmetry normalizes in extension, indicating an extension (E)
somatic dysfunction (Type II mechanics). Type II mechanics dictate rotation and
sidebending occur to the same side. Since the right transverse process is posterior,
the vertebra is rotated right (Rr) and sidebent right (Sr) .
9. A 40-year-old female with asthma complains of right upper back pain. On
inhalation, the right 3rd rib is elevated and moves poorly. What type of rib
dysfunction is this?
