[COMSAE PHASE 1 FORM 114 PRACTICE EXAM] –
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 & OMM (Questions 1–15)
Q1. Which of the following best describes the somatic dysfunction concept in
osteopathic medicine?
• A) A specific disease process affecting the spinal cord
• B) Impaired or altered function of the musculoskeletal system and related
neural, vascular, and lymphatic elements
• C) A psychiatric condition manifesting as physical symptoms
• D) An autoimmune disorder targeting muscle tissue
Somatic dysfunction is defined as impaired or altered function of the somatic
(body framework) system, including skeletal, arthrodial, and myofascial structures,
and their related vascular, lymphatic, and neural elements. It is diagnosed using
TART (Tissue texture abnormality, Asymmetry, Range of motion restriction,
Tenderness) .
Q2. A patient presents with a tender point at the right medial scapular border.
On examination, the right scapula is positioned superiorly compared to the left.
What is the most likely somatic dysfunction?
• A) Right scapula depression
• B) Right scapula elevation
, • C) Right scapula abduction
• D) Right scapula adduction
Scapular elevation is diagnosed when one scapula sits higher than the
contralateral side. The tender point at the medial border (often at the levator
scapulae or rhomboid attachment) supports this finding. Treatment would focus
on restoring normal scapular motion .
Q3. According to the Fryette's principles of spinal motion, in the neutral position
(neither flexion nor extension), sidebending and rotation occur:
• A) To the opposite side
• B) To the same side
• C) Independently of each other
• D) Only in the cervical spine
*Fryette's 1st principle (Type I mechanics) applies to the neutral position:
sidebending and rotation occur to the opposite side. Wait – I need to correct this:
Type I (neutral mechanics): sidebending and rotation occur to opposite sides. Type
II (non-neutral, flexion/extension): sidebending and rotation occur to the same
side. The correct answer depends on Type I vs Type II. For neutral position,
sidebending and rotation occur to opposite sides.*
CORRECTED Q3: According to Fryette's principles, in a neutral position,
sidebending and rotation occur to:
• A) Opposite sides
• B) The same side
• C) Only the right side
• D) Only the left side
*Fryette's 1st principle (Type I): When the spine is in neutral (neither flexed nor
extended), sidebending and rotation occur to opposite sides. This applies to
,groups of vertebrae. Type II (non-neutral): sidebending and rotation occur to the
same side and involve a single vertebra .*
Q4. A patient has a lumbar somatic dysfunction diagnosed as E S R L (Extended,
Sidebent Right, Rotated Left). According to Fryette's principles, this is an
example of:
• A) Type I dysfunction (neutral mechanics)
• B) Type II dysfunction (non-neutral mechanics)
• C) Both Type I and Type II
• D) Neither Type I nor Type II
Type II mechanics apply when the spine is in a non-neutral position (flexion or
extension). The notation "E S R L" indicates Extended (non-neutral), Sidebent Right,
Rotated Left – which demonstrates sidebending and rotation to opposite sides in
extension, consistent with Type II mechanics .
Q5. The "5th vital sign" in osteopathic medicine is:
• A) Blood pressure
• B) Heart rate
• C) The lymphatic pump
• D) Respiratory rate
The lymphatic pump is often referred to as the "5th vital sign" in osteopathic
medicine. The thoracic pump and abdominal pump techniques enhance lymphatic
flow, supporting immune function and fluid balance .
Q6. A patient with chronic otitis media may benefit from which osteopathic
technique to promote lymphatic drainage from the middle ear?
• A) High-velocity low-amplitude (HVLA) to the cervical spine
• B) Galbreath technique (mastoid pump)
• C) Still technique
, • D) Counterstrain of the sternocleidomastoid
The Galbreath technique (mastoid pump) involves applying gentle pumping
pressure over the mastoid process to enhance lymphatic drainage from the middle
ear via the Eustachian tube. It is commonly used for otitis media and Eustachian
tube dysfunction .
Q7. A patient presents with restricted cervical rotation to the right, and the
restriction is worse when the neck is flexed. This is an example of:
• A) Type I dysfunction
• B) Type II dysfunction
• C) Non-neutral dysfunction only
• D) Neutral dysfunction only
When restriction worsens in flexion or extension, the dysfunction is Type II (non-
neutral). The diagnosis would specify whether the spine is flexed or extended, and
sidebending and rotation occur to the same side .
Q8. The tender point for the anterior scalene muscle is located:
• A) At the medial epicondyle
• B) Just superior to the clavicle near the scalene tubercle
• C) At the mastoid process
• D) Along the sternal border
*The anterior scalene tender point is located just superior to the clavicle near the
scalene tubercle on the first rib. This muscle attaches to the transverse processes
of C3-C6 and the first rib, and its tender point reflects this attachment .*
Q9. The mandibular tender point is located:
• A) At the angle of the mandible
• B) On the chin
• C) Under the chin, one fingerbreadth lateral to the midline
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 & OMM (Questions 1–15)
Q1. Which of the following best describes the somatic dysfunction concept in
osteopathic medicine?
• A) A specific disease process affecting the spinal cord
• B) Impaired or altered function of the musculoskeletal system and related
neural, vascular, and lymphatic elements
• C) A psychiatric condition manifesting as physical symptoms
• D) An autoimmune disorder targeting muscle tissue
Somatic dysfunction is defined as impaired or altered function of the somatic
(body framework) system, including skeletal, arthrodial, and myofascial structures,
and their related vascular, lymphatic, and neural elements. It is diagnosed using
TART (Tissue texture abnormality, Asymmetry, Range of motion restriction,
Tenderness) .
Q2. A patient presents with a tender point at the right medial scapular border.
On examination, the right scapula is positioned superiorly compared to the left.
What is the most likely somatic dysfunction?
• A) Right scapula depression
• B) Right scapula elevation
, • C) Right scapula abduction
• D) Right scapula adduction
Scapular elevation is diagnosed when one scapula sits higher than the
contralateral side. The tender point at the medial border (often at the levator
scapulae or rhomboid attachment) supports this finding. Treatment would focus
on restoring normal scapular motion .
Q3. According to the Fryette's principles of spinal motion, in the neutral position
(neither flexion nor extension), sidebending and rotation occur:
• A) To the opposite side
• B) To the same side
• C) Independently of each other
• D) Only in the cervical spine
*Fryette's 1st principle (Type I mechanics) applies to the neutral position:
sidebending and rotation occur to the opposite side. Wait – I need to correct this:
Type I (neutral mechanics): sidebending and rotation occur to opposite sides. Type
II (non-neutral, flexion/extension): sidebending and rotation occur to the same
side. The correct answer depends on Type I vs Type II. For neutral position,
sidebending and rotation occur to opposite sides.*
CORRECTED Q3: According to Fryette's principles, in a neutral position,
sidebending and rotation occur to:
• A) Opposite sides
• B) The same side
• C) Only the right side
• D) Only the left side
*Fryette's 1st principle (Type I): When the spine is in neutral (neither flexed nor
extended), sidebending and rotation occur to opposite sides. This applies to
,groups of vertebrae. Type II (non-neutral): sidebending and rotation occur to the
same side and involve a single vertebra .*
Q4. A patient has a lumbar somatic dysfunction diagnosed as E S R L (Extended,
Sidebent Right, Rotated Left). According to Fryette's principles, this is an
example of:
• A) Type I dysfunction (neutral mechanics)
• B) Type II dysfunction (non-neutral mechanics)
• C) Both Type I and Type II
• D) Neither Type I nor Type II
Type II mechanics apply when the spine is in a non-neutral position (flexion or
extension). The notation "E S R L" indicates Extended (non-neutral), Sidebent Right,
Rotated Left – which demonstrates sidebending and rotation to opposite sides in
extension, consistent with Type II mechanics .
Q5. The "5th vital sign" in osteopathic medicine is:
• A) Blood pressure
• B) Heart rate
• C) The lymphatic pump
• D) Respiratory rate
The lymphatic pump is often referred to as the "5th vital sign" in osteopathic
medicine. The thoracic pump and abdominal pump techniques enhance lymphatic
flow, supporting immune function and fluid balance .
Q6. A patient with chronic otitis media may benefit from which osteopathic
technique to promote lymphatic drainage from the middle ear?
• A) High-velocity low-amplitude (HVLA) to the cervical spine
• B) Galbreath technique (mastoid pump)
• C) Still technique
, • D) Counterstrain of the sternocleidomastoid
The Galbreath technique (mastoid pump) involves applying gentle pumping
pressure over the mastoid process to enhance lymphatic drainage from the middle
ear via the Eustachian tube. It is commonly used for otitis media and Eustachian
tube dysfunction .
Q7. A patient presents with restricted cervical rotation to the right, and the
restriction is worse when the neck is flexed. This is an example of:
• A) Type I dysfunction
• B) Type II dysfunction
• C) Non-neutral dysfunction only
• D) Neutral dysfunction only
When restriction worsens in flexion or extension, the dysfunction is Type II (non-
neutral). The diagnosis would specify whether the spine is flexed or extended, and
sidebending and rotation occur to the same side .
Q8. The tender point for the anterior scalene muscle is located:
• A) At the medial epicondyle
• B) Just superior to the clavicle near the scalene tubercle
• C) At the mastoid process
• D) Along the sternal border
*The anterior scalene tender point is located just superior to the clavicle near the
scalene tubercle on the first rib. This muscle attaches to the transverse processes
of C3-C6 and the first rib, and its tender point reflects this attachment .*
Q9. The mandibular tender point is located:
• A) At the angle of the mandible
• B) On the chin
• C) Under the chin, one fingerbreadth lateral to the midline
