COMSAE Phase 1 Form 115:
Comprehensive Practice Examination
Complete Osteopathic Medical Self-
Assessment Study Guide with Board-Style
Questions and Detailed
Explanations/Instant download Pdf
Question 1
A 35-year-old with chronic low back pain has a right posterior
innominate rotation. Which muscle is likely shortened?
A) Left quadratus lumborum
B) Right hamstrings
C) Right iliopsoas
D) Left gluteus maximus
Answers: B
Rationale: A posterior innominate rotation is a shear of the ilium in
which the ilium moves posteriorly on the sacrum. In this dysfunction, the
ipsilateral hamstrings are shortened, whereas the iliopsoas is typically
shortened in an anterior innominate. This pattern is essential for
diagnosing sacroiliac dysfunctions and selecting the appropriate muscle-
energy treatment .
Question 2
,A patient presents with a structural exam revealing a restricted T5
segment. The segment prefers rotation to the right and side-bending to
the right. It improves when the patient slumps forward into spinal
flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answers: C
Rationale: Because the dysfunction improves in flexion, the segment is
diagnosed as Flexed. According to Fryette's Second Law (Type II
mechanics), when a single segment is in a non-neutral position (flexion
or extension), rotation and side-bending occur in the same direction.
Hence, rotation right and side-bending right yields a diagnosis of "Flexed
RR SR" .
Question 3
According to Fryette's first principle (Type I mechanics), when the spine is
in a neutral position (neither flexed nor extended), which of the following
occurs?
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Answers: C
,Rationale: Fryette's first principle (Type I mechanics) describes that when
multiple vertebral segments are in neutral position, side-bending and
rotation occur in opposite directions. This typically occurs in group
curves and involves multiple vertebral segments .
Question 4
In muscle energy technique (MET), the patient's contraction force should
be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
Answers: B
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric
contraction by the patient, followed by relaxation and repositioning to
the new barrier. This avoids muscle fatigue and injury. The patient
contracts against a counterforce provided by the physician .
Question 5
A patient with right lateral bending of the lumbar spine with rotation to
the left. According to Fryette, this is a:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Neutral dysfunction
, Answers: A
Rationale: In Fryette's Type I (neutral) mechanics, side-bending and
rotation occur to opposite sides. Right lateral bending with left rotation
is the classic Type I pattern. This typically occurs in group curves and
involves multiple vertebral segments .
Question 6
A 50-year-old with chronic constipation has a tender point at the tip of
the 12th rib on the right. Which viscerosomatic reflex is most likely?
A) Colon
B) Stomach
C) Gallbladder
D) Appendix
Answers: A
Rationale: Viscerosomatic reflexes for the colon are located at T10–L1,
often presenting as tenderness at the 11th or 12th ribs. Chronic
constipation suggests colonic dysfunction, and the spinal levels involved
correspond to the sympathetic innervation of the colon .
Question 7
In counterstrain, you find a tender point at the anterior medial knee.
Which muscle is likely the primary dysfunction?
A) Vastus lateralis
B) Sartorius
Comprehensive Practice Examination
Complete Osteopathic Medical Self-
Assessment Study Guide with Board-Style
Questions and Detailed
Explanations/Instant download Pdf
Question 1
A 35-year-old with chronic low back pain has a right posterior
innominate rotation. Which muscle is likely shortened?
A) Left quadratus lumborum
B) Right hamstrings
C) Right iliopsoas
D) Left gluteus maximus
Answers: B
Rationale: A posterior innominate rotation is a shear of the ilium in
which the ilium moves posteriorly on the sacrum. In this dysfunction, the
ipsilateral hamstrings are shortened, whereas the iliopsoas is typically
shortened in an anterior innominate. This pattern is essential for
diagnosing sacroiliac dysfunctions and selecting the appropriate muscle-
energy treatment .
Question 2
,A patient presents with a structural exam revealing a restricted T5
segment. The segment prefers rotation to the right and side-bending to
the right. It improves when the patient slumps forward into spinal
flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answers: C
Rationale: Because the dysfunction improves in flexion, the segment is
diagnosed as Flexed. According to Fryette's Second Law (Type II
mechanics), when a single segment is in a non-neutral position (flexion
or extension), rotation and side-bending occur in the same direction.
Hence, rotation right and side-bending right yields a diagnosis of "Flexed
RR SR" .
Question 3
According to Fryette's first principle (Type I mechanics), when the spine is
in a neutral position (neither flexed nor extended), which of the following
occurs?
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Answers: C
,Rationale: Fryette's first principle (Type I mechanics) describes that when
multiple vertebral segments are in neutral position, side-bending and
rotation occur in opposite directions. This typically occurs in group
curves and involves multiple vertebral segments .
Question 4
In muscle energy technique (MET), the patient's contraction force should
be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
Answers: B
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric
contraction by the patient, followed by relaxation and repositioning to
the new barrier. This avoids muscle fatigue and injury. The patient
contracts against a counterforce provided by the physician .
Question 5
A patient with right lateral bending of the lumbar spine with rotation to
the left. According to Fryette, this is a:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Neutral dysfunction
, Answers: A
Rationale: In Fryette's Type I (neutral) mechanics, side-bending and
rotation occur to opposite sides. Right lateral bending with left rotation
is the classic Type I pattern. This typically occurs in group curves and
involves multiple vertebral segments .
Question 6
A 50-year-old with chronic constipation has a tender point at the tip of
the 12th rib on the right. Which viscerosomatic reflex is most likely?
A) Colon
B) Stomach
C) Gallbladder
D) Appendix
Answers: A
Rationale: Viscerosomatic reflexes for the colon are located at T10–L1,
often presenting as tenderness at the 11th or 12th ribs. Chronic
constipation suggests colonic dysfunction, and the spinal levels involved
correspond to the sympathetic innervation of the colon .
Question 7
In counterstrain, you find a tender point at the anterior medial knee.
Which muscle is likely the primary dysfunction?
A) Vastus lateralis
B) Sartorius
