COMSAE Phase 1 Form 115 Style UP-TO-DATE 2026 EXAM QUESTIONS
AND 100% ACCURATE SOLUTIONS | Question And VERIFIED ANSWERS -
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SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(OPP/OMT)
Questions 1–20
Question 1
A 45-year-old patient presents with low back pain. On structural examination, you find a
restricted L3 segment. The segment rotates and side-bends to the same side (both to
the right) and is worse with flexion. According to Fryette's principles, this describes
which type of somatic dysfunction?
A) Type I (neutral mechanics)
B) Type II (non-neutral mechanics)
C) Type III (mixed mechanics)
D) Type IV (non-physiological mechanics)
Correct Answer: B
Rationale: Fryette's Type II mechanics describe a non-neutral somatic dysfunction
where a single vertebral segment is flexed or extended and rotates and side-bends to
the same side. The key feature is that the dysfunction is worse with flexion or extension
(non-neutral position). Type I involves neutral mechanics where a group of vertebrae
rotates and side-bends to the opposite side and is better in neutral.
Question 2
A patient with chronic gastritis presents with a tender point in the intercostal space at
the T5-T6 level on the right side. This is most consistent with which Chapman's reflex?
A) Gastric reflex
B) Hepatic reflex
C) Pancreatic reflex
D) Splenic reflex
,Correct Answer: A
Rationale: Chapman's reflexes are viscerosomatic reflex points that correspond to
specific organ systems. The gastric Chapman's reflex is located in the intercostal space
at T5-T6 on the right side. Hepatic reflexes are typically found at the right 5th-6th
intercostal space anteriorly. These reflexes are used in osteopathic diagnosis to identify
visceral dysfunction.
Question 3
A patient presents with a tender point in the right upper trapezius muscle. You perform
counterstrain treatment by passively positioning the patient into a position of ease.
Which of the following describes the correct counterstrain positioning?
A) Position the patient into the restrictive barrier
B) Position the patient away from the restrictive barrier (toward ease)
C) Apply high-velocity, low-amplitude thrust
D) Use submaximal isometric contraction
Correct Answer: B
Rationale: Counterstrain (Strain-Counterstrain) involves positioning the patient
toward the position of ease (away from the restrictive barrier) to treat tender points.
The practitioner monitors the tender point while moving the patient into the position
that reduces the tenderness. This is a indirect technique, unlike HVLA which is a direct
technique through the restrictive barrier.
Question 4
A patient presents with a sacral dysfunction. On examination, the right sacral base is
deep and the left sacral base is shallow. The patient has pain with forward bending.
Which of the following is the most likely diagnosis?
A) Right on right (R-on-R) torsion
B) Left on left (L-on-L) torsion
C) Right unilateral sacral flexion
D) Left unilateral sacral extension
,Correct Answer: C
Rationale: In unilateral sacral flexion, the sacral base on the affected side
is deep (posterior) and the contralateral side is shallow (anterior). The deep side is the
dysfunctional side. The patient typically has pain with forward bending (flexion). In
unilateral sacral extension, the affected side is shallow (anterior) and the patient has pain
with backward bending.
Question 5
A 28-year-old female presents with a 3-week history of headaches. On cranial
osteopathic examination, you note restricted motion of the sphenobasilar symphysis
(SBS) with a "wax paper" sensation. Which of the following best describes the "wax
paper" sensation?
A) A palpable cranial rhythmic impulse
B) A subtle, crinkly feel indicating a strain pattern
C) A boney crepitus indicating degenerative change
D) A vascular pulsation indicating increased intracranial pressure
Correct Answer: B
Rationale: In cranial osteopathy, the "wax paper" sensation is a subtle, crinkly feel
that indicates a strain pattern in the cranial membranes, particularly at the
sphenobasilar symphysis (SBS). This sensation is distinct from the normal cranial
rhythmic impulse (CRI) and suggests restriction in the cranial mechanism.
Question 6
A patient presents with a somatic dysfunction at T8. You decide to use Muscle Energy
Technique (MET). Which of the following describes the correct application of MET?
A) Use high-velocity thrust through the restrictive barrier
B) Position the patient into the restrictive barrier and apply submaximal isometric
contraction
C) Position the patient away from the restrictive barrier and apply maximal contraction
D) Use passive positioning only without patient effort
, Correct Answer: B
Rationale: Muscle Energy Technique (MET) involves positioning the patient into the
restrictive barrier and then having the patient perform a submaximal isometric
contraction (approximately 20% of maximal effort) against a counterforce. After the
contraction and relaxation phase, the joint is moved further into the new barrier. This is
a direct technique using the patient's own muscle energy.
Question 7
A patient with a history of gallbladder disease presents with a tender point in the right
infrascapular region. This Chapman's reflex point is most likely associated with which
organ?
A) Liver
B) Gallbladder
C) Stomach
D) Pancreas
Correct Answer: B
Rationale: The gallbladder Chapman's reflex is located in the right infrascapular
region. Chapman's reflexes are small, discrete, tender nodules found in specific
locations that correspond to visceral dysfunction. The gallbladder reflex is typically
found at the angle of the right scapula. The liver reflex is found more superiorly in the
right 5th-6th intercostal space.
Question 8
You are evaluating a patient with sacral dysfunction. The patient has a positive seated
flexion test on the left side. Which of the following is the most likely finding?
A) Left innominate anterior rotation
B) Right innominate anterior rotation
C) Left sacral torsion
D) Bilateral sacral dysfunction
Correct Answer: A
AND 100% ACCURATE SOLUTIONS | Question And VERIFIED ANSWERS -
INSTANT PDF DOWNLOAD
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(OPP/OMT)
Questions 1–20
Question 1
A 45-year-old patient presents with low back pain. On structural examination, you find a
restricted L3 segment. The segment rotates and side-bends to the same side (both to
the right) and is worse with flexion. According to Fryette's principles, this describes
which type of somatic dysfunction?
A) Type I (neutral mechanics)
B) Type II (non-neutral mechanics)
C) Type III (mixed mechanics)
D) Type IV (non-physiological mechanics)
Correct Answer: B
Rationale: Fryette's Type II mechanics describe a non-neutral somatic dysfunction
where a single vertebral segment is flexed or extended and rotates and side-bends to
the same side. The key feature is that the dysfunction is worse with flexion or extension
(non-neutral position). Type I involves neutral mechanics where a group of vertebrae
rotates and side-bends to the opposite side and is better in neutral.
Question 2
A patient with chronic gastritis presents with a tender point in the intercostal space at
the T5-T6 level on the right side. This is most consistent with which Chapman's reflex?
A) Gastric reflex
B) Hepatic reflex
C) Pancreatic reflex
D) Splenic reflex
,Correct Answer: A
Rationale: Chapman's reflexes are viscerosomatic reflex points that correspond to
specific organ systems. The gastric Chapman's reflex is located in the intercostal space
at T5-T6 on the right side. Hepatic reflexes are typically found at the right 5th-6th
intercostal space anteriorly. These reflexes are used in osteopathic diagnosis to identify
visceral dysfunction.
Question 3
A patient presents with a tender point in the right upper trapezius muscle. You perform
counterstrain treatment by passively positioning the patient into a position of ease.
Which of the following describes the correct counterstrain positioning?
A) Position the patient into the restrictive barrier
B) Position the patient away from the restrictive barrier (toward ease)
C) Apply high-velocity, low-amplitude thrust
D) Use submaximal isometric contraction
Correct Answer: B
Rationale: Counterstrain (Strain-Counterstrain) involves positioning the patient
toward the position of ease (away from the restrictive barrier) to treat tender points.
The practitioner monitors the tender point while moving the patient into the position
that reduces the tenderness. This is a indirect technique, unlike HVLA which is a direct
technique through the restrictive barrier.
Question 4
A patient presents with a sacral dysfunction. On examination, the right sacral base is
deep and the left sacral base is shallow. The patient has pain with forward bending.
Which of the following is the most likely diagnosis?
A) Right on right (R-on-R) torsion
B) Left on left (L-on-L) torsion
C) Right unilateral sacral flexion
D) Left unilateral sacral extension
,Correct Answer: C
Rationale: In unilateral sacral flexion, the sacral base on the affected side
is deep (posterior) and the contralateral side is shallow (anterior). The deep side is the
dysfunctional side. The patient typically has pain with forward bending (flexion). In
unilateral sacral extension, the affected side is shallow (anterior) and the patient has pain
with backward bending.
Question 5
A 28-year-old female presents with a 3-week history of headaches. On cranial
osteopathic examination, you note restricted motion of the sphenobasilar symphysis
(SBS) with a "wax paper" sensation. Which of the following best describes the "wax
paper" sensation?
A) A palpable cranial rhythmic impulse
B) A subtle, crinkly feel indicating a strain pattern
C) A boney crepitus indicating degenerative change
D) A vascular pulsation indicating increased intracranial pressure
Correct Answer: B
Rationale: In cranial osteopathy, the "wax paper" sensation is a subtle, crinkly feel
that indicates a strain pattern in the cranial membranes, particularly at the
sphenobasilar symphysis (SBS). This sensation is distinct from the normal cranial
rhythmic impulse (CRI) and suggests restriction in the cranial mechanism.
Question 6
A patient presents with a somatic dysfunction at T8. You decide to use Muscle Energy
Technique (MET). Which of the following describes the correct application of MET?
A) Use high-velocity thrust through the restrictive barrier
B) Position the patient into the restrictive barrier and apply submaximal isometric
contraction
C) Position the patient away from the restrictive barrier and apply maximal contraction
D) Use passive positioning only without patient effort
, Correct Answer: B
Rationale: Muscle Energy Technique (MET) involves positioning the patient into the
restrictive barrier and then having the patient perform a submaximal isometric
contraction (approximately 20% of maximal effort) against a counterforce. After the
contraction and relaxation phase, the joint is moved further into the new barrier. This is
a direct technique using the patient's own muscle energy.
Question 7
A patient with a history of gallbladder disease presents with a tender point in the right
infrascapular region. This Chapman's reflex point is most likely associated with which
organ?
A) Liver
B) Gallbladder
C) Stomach
D) Pancreas
Correct Answer: B
Rationale: The gallbladder Chapman's reflex is located in the right infrascapular
region. Chapman's reflexes are small, discrete, tender nodules found in specific
locations that correspond to visceral dysfunction. The gallbladder reflex is typically
found at the angle of the right scapula. The liver reflex is found more superiorly in the
right 5th-6th intercostal space.
Question 8
You are evaluating a patient with sacral dysfunction. The patient has a positive seated
flexion test on the left side. Which of the following is the most likely finding?
A) Left innominate anterior rotation
B) Right innominate anterior rotation
C) Left sacral torsion
D) Bilateral sacral dysfunction
Correct Answer: A
