COMSAE PHASE 1 FORM 114 Actual
EXAM – 176 QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM
UPDATE | STUVIA VERIFIED | EXAM PREP
| STUDY GUIDE | PRACTICE TEST
🧬 Section 1: Osteopathic Principles & Practice (OPP) (Q1–20)
1. A 45-year-old male presents with low back pain after lifting a box. You
diagnose an acute sacroiliac (SI) joint dysfunction. To diagnose somatic
dysfunction of the SI joint using the standing flexion test, a positive test is
indicated by?
•A) Anterior rotation of the ilium on the ipsilateral side
• B) Posterior rotation of the ilium on the ipsilateral side
• C) Superior movement of the PSIS on the ipsilateral side
• D) Inferior movement of the PSIS on the contralateral side
✅ Answer: C
In the standing flexion test, the examiner places thumbs under the PSIS. As the
patient bends forward, if the PSIS on one side moves superiorly (upward)
more than the other, it indicates iliosacral dysfunction on that side. This is a
key finding in sacroiliac joint somatic dysfunction.
2. A 30-year-old female with chronic headaches undergoes OMM. You find
that the right mastoid process is posterior and inferior compared to the left.
Which somatic dysfunction best describes this finding?
, •A) Right rotation, right sidebending (Type I)
• B) Left rotation, right sidebending (Type II)
• C) Right rotation, left sidebending (Type II)
• D) Left rotation, left sidebending (Type I)
✅ Answer: C
The mastoid process is part of the occiput. A posterior and inferior mastoid
indicates the occiput is rotated toward the same side (right rotation) and
sidebent away (left sidebending). This is a Type II dysfunction (rotation and
sidebending to opposite sides) and is a common finding in tension-type
headaches.
3. A 55-year-old male with a history of chronic low back pain presents with a
"hollow back" appearance. You diagnose an anterior pelvic tilt. Which muscles
are likely shortened?
•A) Hamstrings and gluteus maximus
• B) Iliopsoas and erector spinae
• C) Rectus abdominis and gluteus maximus
• D) Hamstrings and rectus abdominis
✅ Answer: B
An anterior pelvic tilt is characterized by shortened hip flexors (iliopsoas) and
lumbar extensors (erector spinae). This posture is common in individuals
who sit for prolonged periods, leading to increased lumbar lordosis.
4. During a Chapman's reflex examination, you palpate a small, smooth, firm
nodule in the intercostal space of the 2nd rib on the right side. Which organ is
most likely involved?
• A) Liver
• B) Gallbladder
• C) Kidney
• D) Spleen
,✅ Answer: B
Chapman's reflexes are palpable gangliform nodules that correlate with
visceral dysfunction. The gallbladder reflex is located in the 2nd intercostal
space on the right side. Palpation of this nodule suggests gallbladder
pathology such as cholecystitis or cholelithiasis.
5. A 28-year-old female presents with right-sided pleuritic chest pain and
dyspnea. After ruling out pulmonary embolism, you suspect a rib dysfunction.
You find that the right 5th rib is restricted in inhalation. Which of the
following best describes the motion of this rib?
•A) Pump handle
• B) Bucket handle
• C) Caliper motion
• D) No motion
✅ Answer: B
Ribs 4–10 move primarily in a bucket handle motion, increasing the
transverse diameter of the thorax during inhalation. Pump handle motion
(increase in AP diameter) is more prominent in ribs 1–3. Caliper motion
describes the movement of ribs 11–12.
6. A 65-year-old male with chronic obstructive pulmonary disease (COPD)
presents for OMT. You note that his thoracic spine has a decreased range of
motion in extension. This is likely due to which of the following?
•A) Increased thoracic kyphosis
• B) Decreased lumbar lordosis
• C) Scoliosis
• D) Ankylosing spondylitis
✅ Answer: A
COPD often leads to hyperinflation of the lungs, which causes increased
thoracic kyphosis. This "barrel chest" deformity limits thoracic extension and
, can impair respiratory mechanics. OMT to improve thoracic mobility is often
beneficial in these patients.
7. A 32-year-old male presents with low back pain after a motor vehicle
accident. You perform a seated flexion test and find that the left PSIS moves
superiorly more than the right. This indicates dysfunction of which of the
following?
•A) Left sacroiliac joint
• B) Right sacroiliac joint
• C) Lumbosacral junction
• D) Pubic symphysis
✅ Answer: A
A positive seated flexion test (PSIS moves superiorly on the affected side)
indicates somatic dysfunction of the sacroiliac joint on that side. The test
should be performed with the patient seated to lock the hips and isolate
sacroiliac motion.
8. While treating a patient with chronic headaches, you find tenderness at the
suboccipital triangle. Which of the following muscles is NOT part of this
triangle?
•A) Rectus capitis posterior major
• B) Rectus capitis posterior minor
• C) Obliquus capitis superior
• D) Obliquus capitis inferior
✅ Answer: B
The suboccipital triangle is formed by the rectus capitis posterior major,
obliquus capitis superior, and obliquus capitis inferior. The rectus capitis
posterior minor lies superior and medial to the triangle and is not a border.
The suboccipital triangle is clinically significant as it contains the vertebral
artery and suboccipital nerve (C1).
EXAM – 176 QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM
UPDATE | STUVIA VERIFIED | EXAM PREP
| STUDY GUIDE | PRACTICE TEST
🧬 Section 1: Osteopathic Principles & Practice (OPP) (Q1–20)
1. A 45-year-old male presents with low back pain after lifting a box. You
diagnose an acute sacroiliac (SI) joint dysfunction. To diagnose somatic
dysfunction of the SI joint using the standing flexion test, a positive test is
indicated by?
•A) Anterior rotation of the ilium on the ipsilateral side
• B) Posterior rotation of the ilium on the ipsilateral side
• C) Superior movement of the PSIS on the ipsilateral side
• D) Inferior movement of the PSIS on the contralateral side
✅ Answer: C
In the standing flexion test, the examiner places thumbs under the PSIS. As the
patient bends forward, if the PSIS on one side moves superiorly (upward)
more than the other, it indicates iliosacral dysfunction on that side. This is a
key finding in sacroiliac joint somatic dysfunction.
2. A 30-year-old female with chronic headaches undergoes OMM. You find
that the right mastoid process is posterior and inferior compared to the left.
Which somatic dysfunction best describes this finding?
, •A) Right rotation, right sidebending (Type I)
• B) Left rotation, right sidebending (Type II)
• C) Right rotation, left sidebending (Type II)
• D) Left rotation, left sidebending (Type I)
✅ Answer: C
The mastoid process is part of the occiput. A posterior and inferior mastoid
indicates the occiput is rotated toward the same side (right rotation) and
sidebent away (left sidebending). This is a Type II dysfunction (rotation and
sidebending to opposite sides) and is a common finding in tension-type
headaches.
3. A 55-year-old male with a history of chronic low back pain presents with a
"hollow back" appearance. You diagnose an anterior pelvic tilt. Which muscles
are likely shortened?
•A) Hamstrings and gluteus maximus
• B) Iliopsoas and erector spinae
• C) Rectus abdominis and gluteus maximus
• D) Hamstrings and rectus abdominis
✅ Answer: B
An anterior pelvic tilt is characterized by shortened hip flexors (iliopsoas) and
lumbar extensors (erector spinae). This posture is common in individuals
who sit for prolonged periods, leading to increased lumbar lordosis.
4. During a Chapman's reflex examination, you palpate a small, smooth, firm
nodule in the intercostal space of the 2nd rib on the right side. Which organ is
most likely involved?
• A) Liver
• B) Gallbladder
• C) Kidney
• D) Spleen
,✅ Answer: B
Chapman's reflexes are palpable gangliform nodules that correlate with
visceral dysfunction. The gallbladder reflex is located in the 2nd intercostal
space on the right side. Palpation of this nodule suggests gallbladder
pathology such as cholecystitis or cholelithiasis.
5. A 28-year-old female presents with right-sided pleuritic chest pain and
dyspnea. After ruling out pulmonary embolism, you suspect a rib dysfunction.
You find that the right 5th rib is restricted in inhalation. Which of the
following best describes the motion of this rib?
•A) Pump handle
• B) Bucket handle
• C) Caliper motion
• D) No motion
✅ Answer: B
Ribs 4–10 move primarily in a bucket handle motion, increasing the
transverse diameter of the thorax during inhalation. Pump handle motion
(increase in AP diameter) is more prominent in ribs 1–3. Caliper motion
describes the movement of ribs 11–12.
6. A 65-year-old male with chronic obstructive pulmonary disease (COPD)
presents for OMT. You note that his thoracic spine has a decreased range of
motion in extension. This is likely due to which of the following?
•A) Increased thoracic kyphosis
• B) Decreased lumbar lordosis
• C) Scoliosis
• D) Ankylosing spondylitis
✅ Answer: A
COPD often leads to hyperinflation of the lungs, which causes increased
thoracic kyphosis. This "barrel chest" deformity limits thoracic extension and
, can impair respiratory mechanics. OMT to improve thoracic mobility is often
beneficial in these patients.
7. A 32-year-old male presents with low back pain after a motor vehicle
accident. You perform a seated flexion test and find that the left PSIS moves
superiorly more than the right. This indicates dysfunction of which of the
following?
•A) Left sacroiliac joint
• B) Right sacroiliac joint
• C) Lumbosacral junction
• D) Pubic symphysis
✅ Answer: A
A positive seated flexion test (PSIS moves superiorly on the affected side)
indicates somatic dysfunction of the sacroiliac joint on that side. The test
should be performed with the patient seated to lock the hips and isolate
sacroiliac motion.
8. While treating a patient with chronic headaches, you find tenderness at the
suboccipital triangle. Which of the following muscles is NOT part of this
triangle?
•A) Rectus capitis posterior major
• B) Rectus capitis posterior minor
• C) Obliquus capitis superior
• D) Obliquus capitis inferior
✅ Answer: B
The suboccipital triangle is formed by the rectus capitis posterior major,
obliquus capitis superior, and obliquus capitis inferior. The rectus capitis
posterior minor lies superior and medial to the triangle and is not a border.
The suboccipital triangle is clinically significant as it contains the vertebral
artery and suboccipital nerve (C1).
