COMSAE Phase 1,2,3 Form 114 – The Complete Question Test Bank All
questions with correct verified answers & detailed rationales verified
based on current NBOME standards and COMLEX-USA Level 1
blueprint for the 2026 examination cycle
,DOMAIN 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Questions 1-30: Somatic Dysfunction & Spinal Mechanics
1. A 24-year-old male presents with acute lower back pain after
lifting heavy boxes. Physical examination reveals that the right L4
transverse process is more posterior than the left. The asymmetry
normalizes in extension. What is the correct somatic dysfunction?
A. L4 Neutral, Rotated Right, Sidebent Left
B. L4 Flexed, Rotated Left, Sidebent Left
C. L4 Extended, Rotated Right, Sidebent Right
D. L4 Extended, Rotated Left, Sidebent Left
E. L4 Neutral, Rotated Left, Sidebent Right
,,,answer,,,: C. L4 Extended, Rotated Right, Sidebent Right
Rationale: The asymmetry normalizes in extension, indicating an
extension (E) somatic dysfunction. This is a Type II somatic dysfunction
(non-neutral mechanics), meaning rotation and sidebending occur to the
same side. Since the right transverse process is posterior, the vertebra is
rotated right and sidebent right. Type I mechanics (neutral) involve
rotation opposite sidebending. Flexion dysfunctions would worsen in
extension. The "E" dysfunction follows the rule: "E = R and S to the
same side" .
2. A 45-year-old male presents with chronic low back pain. During
the osteopathic structural exam, you find that the patient's right
iliac crest is superior to the left in the standing position, and the
right ASIS is inferior to the left. What is the correct diagnosis?
A. Right innominate posterior rotation
B. Left innominate anterior rotation
,C. Right innominate anterior rotation
D. Left innominate posterior rotation
E. Bilateral iliac crest dysfunction
,,,answer,,,: C. Right innominate anterior rotation
Rationale: In a right anterior innominate rotation, the right iliac crest is
superior and the right ASIS is inferior to the left. This creates a "down
and back" position of the innominate. The right innominate rotates
anteriorly, causing the ASIS to move inferiorly and the iliac crest to
move superiorly. The hamstrings are typically shortened in this
dysfunction .
3. Which of the following cranial techniques is specifically designed
to enhance the amplitude of the cranial rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV4)
C. V-spread technique
D. Frontal lift
E. Parietal lift
,,,answer,,,: B. Bulb compression (CV4)
Rationale: Compression of the fourth ventricle (CV4) is explicitly
utilized to encourage fluid movement, enhance the amplitude of the CRI,
and assist with autonomic nervous system balancing. CV4 involves
flexing the occiput to reduce the volume of the fourth ventricle, which
facilitates cerebrospinal fluid movement. Venous sinus traction, V-
spread, and frontal/parietal lifts target specific sutural restrictions or
venous drainage but do not primarily amplify the CRI .
, 4. A patient presents with somatic dysfunction of the sacrum. You
note that the left sulcus is deeper than the right, and the left ILA is
more posterior than the right. What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right-on-Left torsion
C. Left-on-Right torsion
D. Bilateral sacral flexion
E. Unilateral sacral extension
,,,answer,,,: C. Left-on-Right torsion
Rationale: A deep sulcus and posterior ILA on the same side indicate a
forward sacral torsion about an oblique axis. The naming convention is
"side of the deep sulcus" on "side of the posterior ILA." Here, the left
sulcus is deeper and the left ILA is posterior, so this is a Left-on-Right
torsion (forward torsion about a right oblique axis). The sacrum rotates
forward on the right side, causing the left base to be more posterior .
5. A 45-year-old female presents with pain along the medial aspect
of her right knee. Palpation reveals a tender point on the medial
surface of the tibia, approximately 2 cm below the joint line, at the
insertion of the pes anserinus. Which position is used for
counterstrain treatment?
A. Flexion, abduction, external rotation of the hip
B. Flexion, adduction, internal rotation of the hip
C. Extension, abduction, external rotation of the hip
D. Extension, adduction, internal rotation of the hip
E. Pure abduction without flexion
,,,answer,,,: B. Flexion, adduction, internal rotation of the hip
questions with correct verified answers & detailed rationales verified
based on current NBOME standards and COMLEX-USA Level 1
blueprint for the 2026 examination cycle
,DOMAIN 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Questions 1-30: Somatic Dysfunction & Spinal Mechanics
1. A 24-year-old male presents with acute lower back pain after
lifting heavy boxes. Physical examination reveals that the right L4
transverse process is more posterior than the left. The asymmetry
normalizes in extension. What is the correct somatic dysfunction?
A. L4 Neutral, Rotated Right, Sidebent Left
B. L4 Flexed, Rotated Left, Sidebent Left
C. L4 Extended, Rotated Right, Sidebent Right
D. L4 Extended, Rotated Left, Sidebent Left
E. L4 Neutral, Rotated Left, Sidebent Right
,,,answer,,,: C. L4 Extended, Rotated Right, Sidebent Right
Rationale: The asymmetry normalizes in extension, indicating an
extension (E) somatic dysfunction. This is a Type II somatic dysfunction
(non-neutral mechanics), meaning rotation and sidebending occur to the
same side. Since the right transverse process is posterior, the vertebra is
rotated right and sidebent right. Type I mechanics (neutral) involve
rotation opposite sidebending. Flexion dysfunctions would worsen in
extension. The "E" dysfunction follows the rule: "E = R and S to the
same side" .
2. A 45-year-old male presents with chronic low back pain. During
the osteopathic structural exam, you find that the patient's right
iliac crest is superior to the left in the standing position, and the
right ASIS is inferior to the left. What is the correct diagnosis?
A. Right innominate posterior rotation
B. Left innominate anterior rotation
,C. Right innominate anterior rotation
D. Left innominate posterior rotation
E. Bilateral iliac crest dysfunction
,,,answer,,,: C. Right innominate anterior rotation
Rationale: In a right anterior innominate rotation, the right iliac crest is
superior and the right ASIS is inferior to the left. This creates a "down
and back" position of the innominate. The right innominate rotates
anteriorly, causing the ASIS to move inferiorly and the iliac crest to
move superiorly. The hamstrings are typically shortened in this
dysfunction .
3. Which of the following cranial techniques is specifically designed
to enhance the amplitude of the cranial rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV4)
C. V-spread technique
D. Frontal lift
E. Parietal lift
,,,answer,,,: B. Bulb compression (CV4)
Rationale: Compression of the fourth ventricle (CV4) is explicitly
utilized to encourage fluid movement, enhance the amplitude of the CRI,
and assist with autonomic nervous system balancing. CV4 involves
flexing the occiput to reduce the volume of the fourth ventricle, which
facilitates cerebrospinal fluid movement. Venous sinus traction, V-
spread, and frontal/parietal lifts target specific sutural restrictions or
venous drainage but do not primarily amplify the CRI .
, 4. A patient presents with somatic dysfunction of the sacrum. You
note that the left sulcus is deeper than the right, and the left ILA is
more posterior than the right. What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right-on-Left torsion
C. Left-on-Right torsion
D. Bilateral sacral flexion
E. Unilateral sacral extension
,,,answer,,,: C. Left-on-Right torsion
Rationale: A deep sulcus and posterior ILA on the same side indicate a
forward sacral torsion about an oblique axis. The naming convention is
"side of the deep sulcus" on "side of the posterior ILA." Here, the left
sulcus is deeper and the left ILA is posterior, so this is a Left-on-Right
torsion (forward torsion about a right oblique axis). The sacrum rotates
forward on the right side, causing the left base to be more posterior .
5. A 45-year-old female presents with pain along the medial aspect
of her right knee. Palpation reveals a tender point on the medial
surface of the tibia, approximately 2 cm below the joint line, at the
insertion of the pes anserinus. Which position is used for
counterstrain treatment?
A. Flexion, abduction, external rotation of the hip
B. Flexion, adduction, internal rotation of the hip
C. Extension, abduction, external rotation of the hip
D. Extension, adduction, internal rotation of the hip
E. Pure abduction without flexion
,,,answer,,,: B. Flexion, adduction, internal rotation of the hip
