ALL COMSAE ACTUAL EXAM 2025-2026
Comprehensive Osteopathic Medical Self-Assessment
Preparation 150 Questions | Verified Answers with
Detailed Explanations | Graded A+ Aligned with NBOME
Standards | Latest Most Tested Questions
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OMM)
Questions 1–25
Question 1
A patient presents with low back pain and a diagnosis of a right on right (R/R) sacral torsion.
Regarding the seated flexion test, which statement is correct?
A) The right inferior lateral angle (ILA) is posterior
B) The left ILA is anterior
C) The left ilium moves more cephalad than the right
D) The right ilium moves more cephalad than the left
Correct answer: C
Rationale: In an R/R sacral torsion (axis on right, sacral base rotated right), the deep sulcus is
on the right. The seated flexion test shows greater cephalad motion of the ilium opposite the
deep sulcus, so the left ilium moves more. The ILA opposite the axis (left) is posterior .
Question 2
,According to Fryette's second principle (Type II mechanics), when the spine is in a non-neutral
position (flexion or extension), what occurs?
A) Rotation and sidebending are to opposite sides
B) Rotation and sidebending are to the same side
C) Rotation occurs without sidebending
D) Sidebending occurs without rotation
Correct answer: B
Rationale: Fryette's second principle describes a single vertebral segment in a non-neutral
(flexion or extension) position. In this case, sidebending and rotation occur in the same
direction. This is high-yield for COMLEX OMM questions .
Question 3
A patient struck the back of the head presents with headaches and difficulty concentrating.
OMM exam reveals restricted motion at the sphenobasilar synchondrosis (SBS) with no flexion
or extension. What is the most likely strain pattern?
A) Superior strain
B) Lateral strain
C) SBS compression
D) Torsion strain
Correct answer: C
Rationale: Direct trauma to the occiput often causes SBS compression, which decreases the
cranial rhythmic impulse .
Question 4
After being hit under the chin, a patient develops headaches. OMM exam shows one greater
wing of the sphenoid superior while the opposite side of the occiput is inferior. What is the
diagnosis?
A) Torsion strain
B) Vertical strain
C) SBS compression
D) Lateral strain
,Correct answer: A
Rationale: A blow under the chin on one side typically causes a torsion strain pattern at the SBS
.
Question 5
A blow to the side of the head produces cranial findings where both greater wings of the
sphenoid move anteriorly on one side and posteriorly on the other. What is this pattern?
A) Torsion strain
B) Lateral strain
C) Superior strain
D) Inferior strain
Correct answer: B
Rationale: Trauma to the side of the head causes lateral strain, where the sphenoid and occiput
rotate in the same direction .
Question 6
During a cranial examination, a physician notes that the sphenobasilar synchondrosis (SBS) is
"flexed." What does this mean in cranial osteopathic terms?
A) The sphenoid rotates anteriorly and the occiput rotates posteriorly
B) The sphenoid rotates posteriorly and the occiput rotates anteriorly
C) The lateral angles of the sphenoid move superiorly and the occipital squama moves inferiorly
D) The SBS is locked in a neutral position
Correct answer: B
Rationale: In cranial flexion, the sphenoid rotates posteriorly and the occiput rotates anteriorly
(relative to the SBS), narrowing the SBS angle. In extension, the opposite occurs .
Question 7
, A patient with a Type I (neutral) group dysfunction of the lumbar spine at L1-L3 has a
sidebending restriction to the right. What is the correct diagnosis?
A) L1-L3 rotated right, sidebent right (Type II)
B) L1-L3 rotated left, sidebent right (Type I)
C) L1-L3 rotated right, sidebent left (Type I)
D) L1-L3 neutral rotation only
Correct answer: B
Rationale: Type I mechanics (neutral spine, multiple segments) dictate that sidebending and
rotation are opposite. Therefore, sidebending right is coupled with rotation left .
Question 8
A patient with chronic asthma is found to have restricted rib elevation on the right. Which OMT
technique is most appropriate to improve rib motion?
A) Inhibitory pressure to the suboccipital muscles
B) Still technique to the thoracic spine
C) Direct HVLA thrust to the right rib (exhaled rib)
D) Counterstrain for the right scalenes
Correct answer: C
Rationale: An exhaled rib (stuck inferiorly) is treated with a direct HVLA thrust during exhalation
to engage the restrictive barrier. This restores rib elevation during inhalation, improving
respiratory mechanics in asthma .
Question 9
A patient with chronic low back pain and a right short leg presents for OMM treatment. During
the initial structural exam, the seated flexion test is positive on the right. The physician suspects
a sacral dysfunction. Which side does the deep sulcus indicate in a right-on-right torsion?
A) Deep sulcus is on the right (ipsilateral to the torsion)
B) Deep sulcus is on the left (contralateral)
C) Sulci are equal
D) Sulcus depth is not relevant in torsions
Comprehensive Osteopathic Medical Self-Assessment
Preparation 150 Questions | Verified Answers with
Detailed Explanations | Graded A+ Aligned with NBOME
Standards | Latest Most Tested Questions
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OMM)
Questions 1–25
Question 1
A patient presents with low back pain and a diagnosis of a right on right (R/R) sacral torsion.
Regarding the seated flexion test, which statement is correct?
A) The right inferior lateral angle (ILA) is posterior
B) The left ILA is anterior
C) The left ilium moves more cephalad than the right
D) The right ilium moves more cephalad than the left
Correct answer: C
Rationale: In an R/R sacral torsion (axis on right, sacral base rotated right), the deep sulcus is
on the right. The seated flexion test shows greater cephalad motion of the ilium opposite the
deep sulcus, so the left ilium moves more. The ILA opposite the axis (left) is posterior .
Question 2
,According to Fryette's second principle (Type II mechanics), when the spine is in a non-neutral
position (flexion or extension), what occurs?
A) Rotation and sidebending are to opposite sides
B) Rotation and sidebending are to the same side
C) Rotation occurs without sidebending
D) Sidebending occurs without rotation
Correct answer: B
Rationale: Fryette's second principle describes a single vertebral segment in a non-neutral
(flexion or extension) position. In this case, sidebending and rotation occur in the same
direction. This is high-yield for COMLEX OMM questions .
Question 3
A patient struck the back of the head presents with headaches and difficulty concentrating.
OMM exam reveals restricted motion at the sphenobasilar synchondrosis (SBS) with no flexion
or extension. What is the most likely strain pattern?
A) Superior strain
B) Lateral strain
C) SBS compression
D) Torsion strain
Correct answer: C
Rationale: Direct trauma to the occiput often causes SBS compression, which decreases the
cranial rhythmic impulse .
Question 4
After being hit under the chin, a patient develops headaches. OMM exam shows one greater
wing of the sphenoid superior while the opposite side of the occiput is inferior. What is the
diagnosis?
A) Torsion strain
B) Vertical strain
C) SBS compression
D) Lateral strain
,Correct answer: A
Rationale: A blow under the chin on one side typically causes a torsion strain pattern at the SBS
.
Question 5
A blow to the side of the head produces cranial findings where both greater wings of the
sphenoid move anteriorly on one side and posteriorly on the other. What is this pattern?
A) Torsion strain
B) Lateral strain
C) Superior strain
D) Inferior strain
Correct answer: B
Rationale: Trauma to the side of the head causes lateral strain, where the sphenoid and occiput
rotate in the same direction .
Question 6
During a cranial examination, a physician notes that the sphenobasilar synchondrosis (SBS) is
"flexed." What does this mean in cranial osteopathic terms?
A) The sphenoid rotates anteriorly and the occiput rotates posteriorly
B) The sphenoid rotates posteriorly and the occiput rotates anteriorly
C) The lateral angles of the sphenoid move superiorly and the occipital squama moves inferiorly
D) The SBS is locked in a neutral position
Correct answer: B
Rationale: In cranial flexion, the sphenoid rotates posteriorly and the occiput rotates anteriorly
(relative to the SBS), narrowing the SBS angle. In extension, the opposite occurs .
Question 7
, A patient with a Type I (neutral) group dysfunction of the lumbar spine at L1-L3 has a
sidebending restriction to the right. What is the correct diagnosis?
A) L1-L3 rotated right, sidebent right (Type II)
B) L1-L3 rotated left, sidebent right (Type I)
C) L1-L3 rotated right, sidebent left (Type I)
D) L1-L3 neutral rotation only
Correct answer: B
Rationale: Type I mechanics (neutral spine, multiple segments) dictate that sidebending and
rotation are opposite. Therefore, sidebending right is coupled with rotation left .
Question 8
A patient with chronic asthma is found to have restricted rib elevation on the right. Which OMT
technique is most appropriate to improve rib motion?
A) Inhibitory pressure to the suboccipital muscles
B) Still technique to the thoracic spine
C) Direct HVLA thrust to the right rib (exhaled rib)
D) Counterstrain for the right scalenes
Correct answer: C
Rationale: An exhaled rib (stuck inferiorly) is treated with a direct HVLA thrust during exhalation
to engage the restrictive barrier. This restores rib elevation during inhalation, improving
respiratory mechanics in asthma .
Question 9
A patient with chronic low back pain and a right short leg presents for OMM treatment. During
the initial structural exam, the seated flexion test is positive on the right. The physician suspects
a sacral dysfunction. Which side does the deep sulcus indicate in a right-on-right torsion?
A) Deep sulcus is on the right (ipsilateral to the torsion)
B) Deep sulcus is on the left (contralateral)
C) Sulci are equal
D) Sulcus depth is not relevant in torsions
