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2026 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
Question 1
A 45-year-old male presents with low back pain after lifting a box. Standing
flexion test shows superior movement of the right PSIS. Which somatic
dysfunction is most likely?
A) Right posterior innominate
B) Right anterior innominate
C) Left anterior innominate
D) Left sacral torsion
Rationale & Explanation:
The standing flexion test is used to screen for iliosacral or sacral dysfunction.
Normally, both PSIS move equally superiorly as the patient bends forward. A
positive test occurs when one PSIS moves more cephalad than the other, indicating
restricted motion on that side.
• Superior movement of the right PSIS means the right ilium is relatively fixed
in a posterior position, limiting its normal inferior glide during flexion.
,2
However, the most common clinical correlation is an anterior
innominate on the same side, because an anteriorly rotated ilium
functionally shortens the leg and creates a positive test.
• In an anterior innominate: ASIS is more inferior, PSIS is more superior.
• In a posterior innominate: ASIS is more superior, PSIS is more inferior.
This patient’s superior PSIS suggests the ilium is fixed in anterior rotation.
Treatment includes muscle energy to correct the anterior innominate.
Question 2
A 28-year-old female with chronic headaches has OA joint restriction in flexion
and sidebending to the right. Which OMT is most appropriate?
A) HVLA thrust in the direction of restriction
B) Muscle energy for the suboccipitals
C) Counterstrain for the anterior tender point
D) Myofascial release of the scalenes
Rationale & Explanation:
The OA joint restriction in flexion and sidebending to the same side describes
a Type II somatic dysfunction (non-neutral) — restricted in one direction, free in
the opposite.
• For Type II dysfunctions, direct HVLA is appropriate to engage the
restrictive barrier and restore normal motion.
• The “direction of restriction” means applying a thrust that moves the OA
joint into further restriction (flexion + right sidebending) to “reset” the joint.
• Muscle energy can also be used but is typically chosen when HVLA is
contraindicated (e.g., osteoporosis, patient preference).
,3
• Counterstrain would move the joint into ease, not the restrictive barrier, so
it’s not the most direct for this active restriction.
Question 3
A 67-year-old man with hypertension presents with sudden tearing chest pain
radiating to the back. BP is 188/102 mmHg in the right arm and 160/88 mmHg in
the left. Most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Acute pericarditis
Rationale & Explanation:
Classic presentation of aortic dissection (Type A, involving ascending aorta):
• Sudden, severe “tearing” or “ripping” chest pain, often radiating to the back
or interscapular region.
• Blood pressure differential between arms (≥20 mmHg systolic difference)
suggests aortic arch involvement.
• Risk factors: hypertension, connective tissue disorders (Marfan, Ehlers-
Danlos), bicuspid aortic valve.
• Initial imaging: chest CT angiography or transesophageal echocardiogram.
• Emergent surgery if Type A; medical management (beta-blockers,
vasodilators) if Type B and uncomplicated.
Question 4
, 4
A 58-year-old man presents with crushing chest pain. ECG shows ST elevations in
leads V1–V4. Which coronary artery is occluded?
A) Right coronary artery
B) Left circumflex
C) Left anterior descending (LAD)
D) Posterior descending artery
Rationale & Explanation:
ST elevations in V1–V4 = anterior wall myocardial infarction.
• Anterior wall is supplied by the left anterior descending (LAD) artery.
• RCA: inferior wall (II, III, aVF).
• LCx: lateral wall (I, aVL, V5–V6).
• Posterior descending artery: usually branch of RCA, supplies posterior wall
(tall R waves in V1–V2, ST depression in anterior leads).
LAD occlusion is associated with larger infarct size, higher risk of heart
failure and cardiogenic shock.
Question 5
A patient with a 40-pack-year smoking history presents with chronic cough,
dyspnea, and a barrel-shaped chest. Spirometry shows an FEV1/FVC ratio of 60%.
Most likely diagnosis?
A) Asthma
B) COPD
C) Pulmonary fibrosis
D) Bronchiectasis
Rationale & Explanation:
2026 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
Question 1
A 45-year-old male presents with low back pain after lifting a box. Standing
flexion test shows superior movement of the right PSIS. Which somatic
dysfunction is most likely?
A) Right posterior innominate
B) Right anterior innominate
C) Left anterior innominate
D) Left sacral torsion
Rationale & Explanation:
The standing flexion test is used to screen for iliosacral or sacral dysfunction.
Normally, both PSIS move equally superiorly as the patient bends forward. A
positive test occurs when one PSIS moves more cephalad than the other, indicating
restricted motion on that side.
• Superior movement of the right PSIS means the right ilium is relatively fixed
in a posterior position, limiting its normal inferior glide during flexion.
,2
However, the most common clinical correlation is an anterior
innominate on the same side, because an anteriorly rotated ilium
functionally shortens the leg and creates a positive test.
• In an anterior innominate: ASIS is more inferior, PSIS is more superior.
• In a posterior innominate: ASIS is more superior, PSIS is more inferior.
This patient’s superior PSIS suggests the ilium is fixed in anterior rotation.
Treatment includes muscle energy to correct the anterior innominate.
Question 2
A 28-year-old female with chronic headaches has OA joint restriction in flexion
and sidebending to the right. Which OMT is most appropriate?
A) HVLA thrust in the direction of restriction
B) Muscle energy for the suboccipitals
C) Counterstrain for the anterior tender point
D) Myofascial release of the scalenes
Rationale & Explanation:
The OA joint restriction in flexion and sidebending to the same side describes
a Type II somatic dysfunction (non-neutral) — restricted in one direction, free in
the opposite.
• For Type II dysfunctions, direct HVLA is appropriate to engage the
restrictive barrier and restore normal motion.
• The “direction of restriction” means applying a thrust that moves the OA
joint into further restriction (flexion + right sidebending) to “reset” the joint.
• Muscle energy can also be used but is typically chosen when HVLA is
contraindicated (e.g., osteoporosis, patient preference).
,3
• Counterstrain would move the joint into ease, not the restrictive barrier, so
it’s not the most direct for this active restriction.
Question 3
A 67-year-old man with hypertension presents with sudden tearing chest pain
radiating to the back. BP is 188/102 mmHg in the right arm and 160/88 mmHg in
the left. Most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Acute pericarditis
Rationale & Explanation:
Classic presentation of aortic dissection (Type A, involving ascending aorta):
• Sudden, severe “tearing” or “ripping” chest pain, often radiating to the back
or interscapular region.
• Blood pressure differential between arms (≥20 mmHg systolic difference)
suggests aortic arch involvement.
• Risk factors: hypertension, connective tissue disorders (Marfan, Ehlers-
Danlos), bicuspid aortic valve.
• Initial imaging: chest CT angiography or transesophageal echocardiogram.
• Emergent surgery if Type A; medical management (beta-blockers,
vasodilators) if Type B and uncomplicated.
Question 4
, 4
A 58-year-old man presents with crushing chest pain. ECG shows ST elevations in
leads V1–V4. Which coronary artery is occluded?
A) Right coronary artery
B) Left circumflex
C) Left anterior descending (LAD)
D) Posterior descending artery
Rationale & Explanation:
ST elevations in V1–V4 = anterior wall myocardial infarction.
• Anterior wall is supplied by the left anterior descending (LAD) artery.
• RCA: inferior wall (II, III, aVF).
• LCx: lateral wall (I, aVL, V5–V6).
• Posterior descending artery: usually branch of RCA, supplies posterior wall
(tall R waves in V1–V2, ST depression in anterior leads).
LAD occlusion is associated with larger infarct size, higher risk of heart
failure and cardiogenic shock.
Question 5
A patient with a 40-pack-year smoking history presents with chronic cough,
dyspnea, and a barrel-shaped chest. Spirometry shows an FEV1/FVC ratio of 60%.
Most likely diagnosis?
A) Asthma
B) COPD
C) Pulmonary fibrosis
D) Bronchiectasis
Rationale & Explanation:
