COMSAE Form 113 (Version 3) Final
Prep Test With Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
Domain 1: Osteopathic Principles & Practices (OMM/OPP)
1. A 34-year-old male presents with chronic low back pain. You identify a
somatic dysfunction of the lumbar spine where the vertebral body is rotated to
the left of the midline and sidebent to the right. According to the Type I
(neutral) mechanics of Fryette’s Laws, this describes which dysfunction?
• A. E-N (Extended-Neutral)
• B. F-R (Flexed-Rotated)
• C. N-R (Neutral-Rotated)
• D. Type I dysfunction
• Rationale: Fryette’s Law I states that in neutral position (neither flexed nor
extended), sidebending and rotation occur in opposite directions. The
description "rotated left, sidebent right" is the classic definition of a Type I
(or neutral) somatic dysfunction .
2. A 45-year-old female with a history of asthma presents for OMT to improve
respiratory function. You wish to increase thoracic inlet diameter and
decrease respiratory rate via the parasympathetic nervous system. Which
technique is most specific for this goal?
• A. Lumbar paraspinal inhibition
• B. Rib raising
• C. Cervical ganglion release (Chapman’s points)
, • D. Sacral rocking
• Rationale: Rib raising specifically addresses the rib cage and thoracic spine
to treat sympathetic facilitation. However, Cervical ganglion release
(Anterior/Posterior) directly targets the vagus nerve (parasympathetic)
influence on the lungs and heart, reducing bronchospasm and anxiety.
Chapman’s points for the lungs are located in the 2nd intercostal space .
3. During a structural exam, you ask the patient to touch their left shoulder
with their right hand while you stabilize the left shoulder. You then apply
pressure to the right elbow, asking them to resist. This describes a muscle
energy treatment for which muscle?
• A. Pectoralis major
• B. Rhomboids
• C. Upper trapezius
• D. Teres major
• Rationale: This is the classic "90-90" position for the Upper Trapezius. The
patient reaches across the body (elevation and retraction), and you ask them
to resist depression (looking down toward the floor) to lengthen the tight
upper traps .
4. A patient presents with a right iliac crest that is higher than the left in the
standing position, but the PSIS is deeper on the right. The patient complains
of pain walking up stairs. This is most consistent with:
• A. Right anterior innominate
• B. Right posterior innominate
• C. Left anterior innominate
• D. Left superior shear
• Rationale: An anterior innominate results in the ASIS moving inferiorly and
anteriorly, and the PSIS moving superiorly (higher iliac crest). This tightens
the hip flexors and causes pain during hip extension (walking up stairs) .
5. A 28-year-old male fell while skateboarding, landing on an outstretched
hand. He has a visibly displaced wrist. The radial pulse is weak and he
, complains of numbness in the thumb and index finger. What is the priority
treatment?
• A. Closed reduction of the wrist
• B. Emergency reduction of the radiocarpal joint
• C. Carpal tunnel injection
• D. Ice and elevation
• Rationale: The loss of radial pulse with median nerve symptoms
(thumb/index numbness) indicates a severe distal radius fracture (or
perilunate dislocation) causing vascular compromise. This is an orthopedic
emergency requiring immediate reduction to restore perfusion .
6. A 60-year-old male has a somatic dysfunction of the sacrum. During flexion
testing (spring test), the right side of the sacrum moves freely, but the left side
feels restricted and "catches" first. This describes:
• A. Left torsion
• B. Left unilateral flexion
• C. Right unilateral flexion
• D. Bilateral flexion
• Rationale: The spring test is used for unilateral sacral flexion/extension. If
the right side moves well but the left side is stuck (catches), it is a unilateral
flexion on the left (L on L or L on R depending on oblique axis, but the
spring test indicates the side of restriction) .
7. A 30-year-old patient with chronic tension headaches has a restrictive
pattern in the cervical spine. You find that rotation to the left is 80 degrees,
but rotation to the right is only 40 degrees. There is no pain. This is best
described as:
• A. Motion restriction
• B. Ligamentous laxity
• C. Fryette’s Type II dysfunction
• D. Asymmetric range of motion
Prep Test With Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
Domain 1: Osteopathic Principles & Practices (OMM/OPP)
1. A 34-year-old male presents with chronic low back pain. You identify a
somatic dysfunction of the lumbar spine where the vertebral body is rotated to
the left of the midline and sidebent to the right. According to the Type I
(neutral) mechanics of Fryette’s Laws, this describes which dysfunction?
• A. E-N (Extended-Neutral)
• B. F-R (Flexed-Rotated)
• C. N-R (Neutral-Rotated)
• D. Type I dysfunction
• Rationale: Fryette’s Law I states that in neutral position (neither flexed nor
extended), sidebending and rotation occur in opposite directions. The
description "rotated left, sidebent right" is the classic definition of a Type I
(or neutral) somatic dysfunction .
2. A 45-year-old female with a history of asthma presents for OMT to improve
respiratory function. You wish to increase thoracic inlet diameter and
decrease respiratory rate via the parasympathetic nervous system. Which
technique is most specific for this goal?
• A. Lumbar paraspinal inhibition
• B. Rib raising
• C. Cervical ganglion release (Chapman’s points)
, • D. Sacral rocking
• Rationale: Rib raising specifically addresses the rib cage and thoracic spine
to treat sympathetic facilitation. However, Cervical ganglion release
(Anterior/Posterior) directly targets the vagus nerve (parasympathetic)
influence on the lungs and heart, reducing bronchospasm and anxiety.
Chapman’s points for the lungs are located in the 2nd intercostal space .
3. During a structural exam, you ask the patient to touch their left shoulder
with their right hand while you stabilize the left shoulder. You then apply
pressure to the right elbow, asking them to resist. This describes a muscle
energy treatment for which muscle?
• A. Pectoralis major
• B. Rhomboids
• C. Upper trapezius
• D. Teres major
• Rationale: This is the classic "90-90" position for the Upper Trapezius. The
patient reaches across the body (elevation and retraction), and you ask them
to resist depression (looking down toward the floor) to lengthen the tight
upper traps .
4. A patient presents with a right iliac crest that is higher than the left in the
standing position, but the PSIS is deeper on the right. The patient complains
of pain walking up stairs. This is most consistent with:
• A. Right anterior innominate
• B. Right posterior innominate
• C. Left anterior innominate
• D. Left superior shear
• Rationale: An anterior innominate results in the ASIS moving inferiorly and
anteriorly, and the PSIS moving superiorly (higher iliac crest). This tightens
the hip flexors and causes pain during hip extension (walking up stairs) .
5. A 28-year-old male fell while skateboarding, landing on an outstretched
hand. He has a visibly displaced wrist. The radial pulse is weak and he
, complains of numbness in the thumb and index finger. What is the priority
treatment?
• A. Closed reduction of the wrist
• B. Emergency reduction of the radiocarpal joint
• C. Carpal tunnel injection
• D. Ice and elevation
• Rationale: The loss of radial pulse with median nerve symptoms
(thumb/index numbness) indicates a severe distal radius fracture (or
perilunate dislocation) causing vascular compromise. This is an orthopedic
emergency requiring immediate reduction to restore perfusion .
6. A 60-year-old male has a somatic dysfunction of the sacrum. During flexion
testing (spring test), the right side of the sacrum moves freely, but the left side
feels restricted and "catches" first. This describes:
• A. Left torsion
• B. Left unilateral flexion
• C. Right unilateral flexion
• D. Bilateral flexion
• Rationale: The spring test is used for unilateral sacral flexion/extension. If
the right side moves well but the left side is stuck (catches), it is a unilateral
flexion on the left (L on L or L on R depending on oblique axis, but the
spring test indicates the side of restriction) .
7. A 30-year-old patient with chronic tension headaches has a restrictive
pattern in the cervical spine. You find that rotation to the left is 80 degrees,
but rotation to the right is only 40 degrees. There is no pain. This is best
described as:
• A. Motion restriction
• B. Ligamentous laxity
• C. Fryette’s Type II dysfunction
• D. Asymmetric range of motion
