COMLEX-USA / COMSAE LEVEL 2 (OMM SEMESTER 1) –
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 45-year-old patient presents with acute low back pain after lifting a heavy object. On
exam, the L5 is rotated right and sidebent right. What is the most likely somatic dysfunction
diagnosis?
A. Type II somatic dysfunction, L5 FRrSr
B. Type I somatic dysfunction, L5 neutral group dysfunction
C. Extended sacral dysfunction
D. Flexed lumbar dysfunction
════════════
Correct Answer: A. Type II somatic dysfunction, L5 FRrSr
Rationale:
Type II dysfunctions are non-neutral and occur at a single vertebral segment with rotation and
sidebending in the same direction (FRrSr or FSlSl). Acute lumbar pain after lifting suggests a
Type II dysfunction. Type I involves group curves, not single-segment findings. Sacral and
flexion dysfunctions do not match the described lumbar segment findings.
════════════
2. Which rib dysfunction is most likely when a patient has a posterior tender point and the rib
moves more freely during inhalation?
A. Exhalation dysfunction
B. Inhalation dysfunction
C. Bucket handle dysfunction
D. Pump handle dysfunction
════════════
Correct Answer: B. Inhalation dysfunction
Rationale:
,Ribs restricted in exhalation are typically posterior and tender, and they move more freely
during inhalation because they are stuck in exhalation. Inhalation dysfunctions move freely on
exhalation. Bucket and pump handle refer to motion patterns, not dysfunction diagnosis.
════════════
3. A patient with chronic headaches shows somatic dysfunction at the OA joint with
suboccipital muscle tension. What is the most appropriate OMT technique?
A. HVLA
B. Muscle energy
C. Lymphatic pump
D. Counterstrain
════════════
Correct Answer: D. Counterstrain
Rationale:
Counterstrain is ideal for tender points such as suboccipital tension. HVLA is contraindicated in
delicate cranial cervical regions. Muscle energy may help but is less direct for acute tender
point relief. Lymphatic pump is unrelated to OA dysfunction.
════════════
4. A newborn presents with right occipital flattening and torticollis. Which muscle is most
likely involved?
A. Splenius capitis
B. Sternocleidomastoid
C. Trapezius
D. Scalenes
════════════
Correct Answer: B. Sternocleidomastoid
Rationale:
Congenital muscular torticollis is most commonly due to sternocleidomastoid shortening,
leading to head tilt and occipital flattening. Other muscles may contribute to neck movement
but are not primary causes.
════════════
,5. Which physiologic effect is MOST associated with the thoracic inlet release technique?
A. Increased sympathetic tone
B. Improved venous and lymphatic drainage
C. Decreased diaphragmatic excursion
D. Reduced arterial perfusion
════════════
Correct Answer: B. Improved venous and lymphatic drainage
Rationale:
Thoracic inlet release improves lymphatic and venous flow by decreasing outlet restriction. It
reduces congestion and supports lymphatic return. It does not increase sympathetic tone or
reduce perfusion.
════════════
6. A patient presents with rib 1 inhalation dysfunction. Which muscle is most likely involved?
A. Diaphragm
B. Scalenes
C. Intercostals
D. Serratus anterior
════════════
Correct Answer: B. Scalenes
Rationale:
Scalenes elevate rib 1 during inspiration. Hypertonicity can hold rib 1 in inhalation
dysfunction. Diaphragm affects lower ribs, while intercostals and serratus anterior affect rib
expansion but not rib 1 dysfunction specifically.
════════════
7. Which Chapman point corresponds to acute appendicitis?
A. Right 5th intercostal space
B. Right 7th intercostal space
C. Left 2nd intercostal space
D. Umbilical region only
, ════════════
Correct Answer: B. Right 7th intercostal space
Rationale:
Appendix Chapman points are located at the right 7th intercostal space anteriorly. These
reflex points assist in diagnosing visceral dysfunctions. Other options correspond to different
organ systems.
════════════
8. A patient has a posterior fibular head. Which motion is restricted?
A. Plantarflexion and eversion
B. Dorsiflexion and inversion
C. Plantarflexion and inversion
D. Dorsiflexion and eversion
════════════
Correct Answer: D. Dorsiflexion and eversion
Rationale:
Posterior fibular head dysfunction restricts dorsiflexion and eversion due to fibular positional
restriction at the proximal tibiofibular joint. Other combinations do not match biomechanical
relationships.
════════════
9. Which autonomic effect is most likely with sympathetic facilitation at T1–T4?
A. Bradycardia
B. Bronchoconstriction
C. Increased heart rate
D. Decreased pupillary dilation
════════════
Correct Answer: C. Increased heart rate
Rationale:
Sympathetic input from T1–T4 increases cardiac activity including heart rate and contractility.
Parasympathetic effects would produce bradycardia and bronchoconstriction.
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 45-year-old patient presents with acute low back pain after lifting a heavy object. On
exam, the L5 is rotated right and sidebent right. What is the most likely somatic dysfunction
diagnosis?
A. Type II somatic dysfunction, L5 FRrSr
B. Type I somatic dysfunction, L5 neutral group dysfunction
C. Extended sacral dysfunction
D. Flexed lumbar dysfunction
════════════
Correct Answer: A. Type II somatic dysfunction, L5 FRrSr
Rationale:
Type II dysfunctions are non-neutral and occur at a single vertebral segment with rotation and
sidebending in the same direction (FRrSr or FSlSl). Acute lumbar pain after lifting suggests a
Type II dysfunction. Type I involves group curves, not single-segment findings. Sacral and
flexion dysfunctions do not match the described lumbar segment findings.
════════════
2. Which rib dysfunction is most likely when a patient has a posterior tender point and the rib
moves more freely during inhalation?
A. Exhalation dysfunction
B. Inhalation dysfunction
C. Bucket handle dysfunction
D. Pump handle dysfunction
════════════
Correct Answer: B. Inhalation dysfunction
Rationale:
,Ribs restricted in exhalation are typically posterior and tender, and they move more freely
during inhalation because they are stuck in exhalation. Inhalation dysfunctions move freely on
exhalation. Bucket and pump handle refer to motion patterns, not dysfunction diagnosis.
════════════
3. A patient with chronic headaches shows somatic dysfunction at the OA joint with
suboccipital muscle tension. What is the most appropriate OMT technique?
A. HVLA
B. Muscle energy
C. Lymphatic pump
D. Counterstrain
════════════
Correct Answer: D. Counterstrain
Rationale:
Counterstrain is ideal for tender points such as suboccipital tension. HVLA is contraindicated in
delicate cranial cervical regions. Muscle energy may help but is less direct for acute tender
point relief. Lymphatic pump is unrelated to OA dysfunction.
════════════
4. A newborn presents with right occipital flattening and torticollis. Which muscle is most
likely involved?
A. Splenius capitis
B. Sternocleidomastoid
C. Trapezius
D. Scalenes
════════════
Correct Answer: B. Sternocleidomastoid
Rationale:
Congenital muscular torticollis is most commonly due to sternocleidomastoid shortening,
leading to head tilt and occipital flattening. Other muscles may contribute to neck movement
but are not primary causes.
════════════
,5. Which physiologic effect is MOST associated with the thoracic inlet release technique?
A. Increased sympathetic tone
B. Improved venous and lymphatic drainage
C. Decreased diaphragmatic excursion
D. Reduced arterial perfusion
════════════
Correct Answer: B. Improved venous and lymphatic drainage
Rationale:
Thoracic inlet release improves lymphatic and venous flow by decreasing outlet restriction. It
reduces congestion and supports lymphatic return. It does not increase sympathetic tone or
reduce perfusion.
════════════
6. A patient presents with rib 1 inhalation dysfunction. Which muscle is most likely involved?
A. Diaphragm
B. Scalenes
C. Intercostals
D. Serratus anterior
════════════
Correct Answer: B. Scalenes
Rationale:
Scalenes elevate rib 1 during inspiration. Hypertonicity can hold rib 1 in inhalation
dysfunction. Diaphragm affects lower ribs, while intercostals and serratus anterior affect rib
expansion but not rib 1 dysfunction specifically.
════════════
7. Which Chapman point corresponds to acute appendicitis?
A. Right 5th intercostal space
B. Right 7th intercostal space
C. Left 2nd intercostal space
D. Umbilical region only
, ════════════
Correct Answer: B. Right 7th intercostal space
Rationale:
Appendix Chapman points are located at the right 7th intercostal space anteriorly. These
reflex points assist in diagnosing visceral dysfunctions. Other options correspond to different
organ systems.
════════════
8. A patient has a posterior fibular head. Which motion is restricted?
A. Plantarflexion and eversion
B. Dorsiflexion and inversion
C. Plantarflexion and inversion
D. Dorsiflexion and eversion
════════════
Correct Answer: D. Dorsiflexion and eversion
Rationale:
Posterior fibular head dysfunction restricts dorsiflexion and eversion due to fibular positional
restriction at the proximal tibiofibular joint. Other combinations do not match biomechanical
relationships.
════════════
9. Which autonomic effect is most likely with sympathetic facilitation at T1–T4?
A. Bradycardia
B. Bronchoconstriction
C. Increased heart rate
D. Decreased pupillary dilation
════════════
Correct Answer: C. Increased heart rate
Rationale:
Sympathetic input from T1–T4 increases cardiac activity including heart rate and contractility.
Parasympathetic effects would produce bradycardia and bronchoconstriction.
