COMSAE 114 EXAM – NATIONAL BOARD OF
OSTEOPATHIC MEDICAL EXAMINERS (NBOME)
Comprehensive Review | Questions & Verified
Answers with Rationales | Latest Edition
Question 1
A 45-year-old male presents with acute low back pain after lifting heavy
objects. The standing flexion test shows superior movement of the right PSIS.
The 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: A positive standing flexion test on the right suggests dysfunction
on that side. Superior movement of the PSIS correlates with anterior
innominate dysfunction, where the ASIS is positioned anteriorly and
inferiorly, creating a functional short leg. In an anterior innominate
dysfunction, the innominate rotates anteriorly on the sacrum, causing the PSIS
to move superiorly. This is the most common innominate dysfunction seen in
clinical practice and is often associated with heavy lifting or bending activities.
Question 2
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) Without rotation
D) Only in the lumbar spine
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. For
example, sidebending right is accompanied by rotation left. This principle
applies to the neutral position and is fundamental to understanding somatic
dysfunction diagnosis and treatment. Type I mechanics typically involve
multiple vertebrae and are often associated with postural adaptations.
Question 3
A patient has a somatic dysfunction described as "L4 extended, rotated right,
sidebent right." According to Fryette's principles, which type of mechanical
dysfunction is this?
A) Type I (neutral) mechanics
B) Type II (non-neutral) mechanics
C) Both Type I and Type II
D) Neither Type I nor Type II
Correct Answer: B
Rationale: Type II mechanics dictate that in a non-neutral position (flexed or
extended), sidebending and rotation occur to the same side. Since the
dysfunction is described as "extended" (a non-neutral position) with rotation
and sidebending to the same side (right/right), this is a Type II dysfunction.
This is the opposite of Type I mechanics, which occurs in neutral position with
sidebending and rotation to opposite sides.
Question 4
Which of the following cranial techniques is specifically designed to amplify
the amplitude of the cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Bulb compression (CV4)
C) V-spread technique
D) Frontal lift
Correct Answer: B
,Rationale: Compression of the fourth ventricle (CV4) is specifically designed
to amplify the amplitude of the cranial rhythmic impulse (CRI), enhance
cerebrospinal fluid movement, and achieve autonomic nervous system
balancing. This osteopathic cranial technique applies gentle compression to
the occipital condyles to influence the motion of the cranial bones and the
cerebrospinal fluid. The CV4 technique is one of the most important and
commonly used cranial techniques in OMT. Venous sinus traction targets
venous drainage, the V-spread technique addresses soft tissue restrictions,
and frontal lift addresses frontal bone restriction; none primarily amplify the
CRI.
Question 5
A patient presents with low back pain. On examination, you note that the right
transverse process is more posterior than the left. The asymmetry normalizes
in extension and worsens in flexion. What is the correct diagnosis using the "E
RrSr" convention?
A) L4 flexed, rotated right, sidebent right
B) L4 flexed, rotated left, sidebent left
C) L4 extended, rotated right, sidebent right
D) L4 extended, rotated left, sidebent left
Correct Answer: C
Rationale: The asymmetry normalizes in extension, indicating the
dysfunction is in extension (Type II mechanics). Type II mechanics dictates
that rotation and sidebending occur to the same side. Since the right
transverse process is posterior, the vertebra is rotated right and sidebent
right. The diagnosis is E RrSr (extended, rotated right, sidebent right). In Type
II mechanics, the dysfunction is not in the position of ease (the position where
the asymmetry resolves); rather, the asymmetry resolves in the position
opposite the dysfunction.
Question 6
, A patient presents with visceral symptoms that correlate with specific spinal
segments. According to osteopathic principles, which reflex describes the
relationship between visceral disease and somatic dysfunction?
A) Somatovisceral reflex
B) Viscerosomatic reflex
C) Viscerovisceral reflex
D) Somatosomatic reflex
Correct Answer: B
Rationale: A viscerosomatic reflex describes the phenomenon where visceral
disease or dysfunction produces somatic changes such as tenderness,
hypertonicity, or segmental dysfunction. This reflex occurs because visceral
nerves and somatic afferent nerves converge on the same spinal cord
segments. When visceral pathology stimulates afferent nerves, the resulting
reflex can cause somatic dysfunction in the corresponding spinal segments.
This is a key concept in osteopathic medicine explaining how visceral
pathology can present with musculoskeletal symptoms.
Question 7
A 32-year-old female presents with chronic headaches. On cranial
examination, you note restricted motion of the sphenobasilar synchondrosis
(SBS). Which of the following is the most appropriate initial treatment?
A) Muscle energy of the cervical spine
B) CV4 compression
C) V-spread technique
D) Direct myofascial release of the temporalis
Correct Answer: B
Rationale: The CV4 (compression of the fourth ventricle) technique is
specifically designed to address restrictions in the cranial mechanism,
including the sphenobasilar synchondrosis. It enhances the amplitude of the
cranial rhythmic impulse and can be effective in treating cranial dysfunction
that may be contributing to chronic headaches. While muscle energy of the
cervical spine may be appropriate for cervicogenic headaches, the SBS
OSTEOPATHIC MEDICAL EXAMINERS (NBOME)
Comprehensive Review | Questions & Verified
Answers with Rationales | Latest Edition
Question 1
A 45-year-old male presents with acute low back pain after lifting heavy
objects. The standing flexion test shows superior movement of the right PSIS.
The 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: A positive standing flexion test on the right suggests dysfunction
on that side. Superior movement of the PSIS correlates with anterior
innominate dysfunction, where the ASIS is positioned anteriorly and
inferiorly, creating a functional short leg. In an anterior innominate
dysfunction, the innominate rotates anteriorly on the sacrum, causing the PSIS
to move superiorly. This is the most common innominate dysfunction seen in
clinical practice and is often associated with heavy lifting or bending activities.
Question 2
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) Without rotation
D) Only in the lumbar spine
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. For
example, sidebending right is accompanied by rotation left. This principle
applies to the neutral position and is fundamental to understanding somatic
dysfunction diagnosis and treatment. Type I mechanics typically involve
multiple vertebrae and are often associated with postural adaptations.
Question 3
A patient has a somatic dysfunction described as "L4 extended, rotated right,
sidebent right." According to Fryette's principles, which type of mechanical
dysfunction is this?
A) Type I (neutral) mechanics
B) Type II (non-neutral) mechanics
C) Both Type I and Type II
D) Neither Type I nor Type II
Correct Answer: B
Rationale: Type II mechanics dictate that in a non-neutral position (flexed or
extended), sidebending and rotation occur to the same side. Since the
dysfunction is described as "extended" (a non-neutral position) with rotation
and sidebending to the same side (right/right), this is a Type II dysfunction.
This is the opposite of Type I mechanics, which occurs in neutral position with
sidebending and rotation to opposite sides.
Question 4
Which of the following cranial techniques is specifically designed to amplify
the amplitude of the cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Bulb compression (CV4)
C) V-spread technique
D) Frontal lift
Correct Answer: B
,Rationale: Compression of the fourth ventricle (CV4) is specifically designed
to amplify the amplitude of the cranial rhythmic impulse (CRI), enhance
cerebrospinal fluid movement, and achieve autonomic nervous system
balancing. This osteopathic cranial technique applies gentle compression to
the occipital condyles to influence the motion of the cranial bones and the
cerebrospinal fluid. The CV4 technique is one of the most important and
commonly used cranial techniques in OMT. Venous sinus traction targets
venous drainage, the V-spread technique addresses soft tissue restrictions,
and frontal lift addresses frontal bone restriction; none primarily amplify the
CRI.
Question 5
A patient presents with low back pain. On examination, you note that the right
transverse process is more posterior than the left. The asymmetry normalizes
in extension and worsens in flexion. What is the correct diagnosis using the "E
RrSr" convention?
A) L4 flexed, rotated right, sidebent right
B) L4 flexed, rotated left, sidebent left
C) L4 extended, rotated right, sidebent right
D) L4 extended, rotated left, sidebent left
Correct Answer: C
Rationale: The asymmetry normalizes in extension, indicating the
dysfunction is in extension (Type II mechanics). Type II mechanics dictates
that rotation and sidebending occur to the same side. Since the right
transverse process is posterior, the vertebra is rotated right and sidebent
right. The diagnosis is E RrSr (extended, rotated right, sidebent right). In Type
II mechanics, the dysfunction is not in the position of ease (the position where
the asymmetry resolves); rather, the asymmetry resolves in the position
opposite the dysfunction.
Question 6
, A patient presents with visceral symptoms that correlate with specific spinal
segments. According to osteopathic principles, which reflex describes the
relationship between visceral disease and somatic dysfunction?
A) Somatovisceral reflex
B) Viscerosomatic reflex
C) Viscerovisceral reflex
D) Somatosomatic reflex
Correct Answer: B
Rationale: A viscerosomatic reflex describes the phenomenon where visceral
disease or dysfunction produces somatic changes such as tenderness,
hypertonicity, or segmental dysfunction. This reflex occurs because visceral
nerves and somatic afferent nerves converge on the same spinal cord
segments. When visceral pathology stimulates afferent nerves, the resulting
reflex can cause somatic dysfunction in the corresponding spinal segments.
This is a key concept in osteopathic medicine explaining how visceral
pathology can present with musculoskeletal symptoms.
Question 7
A 32-year-old female presents with chronic headaches. On cranial
examination, you note restricted motion of the sphenobasilar synchondrosis
(SBS). Which of the following is the most appropriate initial treatment?
A) Muscle energy of the cervical spine
B) CV4 compression
C) V-spread technique
D) Direct myofascial release of the temporalis
Correct Answer: B
Rationale: The CV4 (compression of the fourth ventricle) technique is
specifically designed to address restrictions in the cranial mechanism,
including the sphenobasilar synchondrosis. It enhances the amplitude of the
cranial rhythmic impulse and can be effective in treating cranial dysfunction
that may be contributing to chronic headaches. While muscle energy of the
cervical spine may be appropriate for cervicogenic headaches, the SBS
