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# COMSAE PHASE 1 FORM 114: COMPLETE
PRACTICE EXAMINATION
## COMPREHENSIVE STUDY GUIDE FOR
OSTEOPATHIC MEDICAL STUDENTS
## Section 1: Osteopathic Principles & Practice (OMM/OPP)
**Question 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 worsens during lumbar flexion and normalizes during
lumbar extension. What is the correct somatic dysfunction diagnosis?
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
**Correct Answer: C) L4 Extended, Rotated Right, Sidebent Right**
**Rationale:** The asymmetry normalizes in extension, indicating an extension
(E) somatic dysfunction (Type II mechanics). Type II mechanics dictate that
rotation and sidebending occur to the same side. Because the right transverse
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process is posterior, the vertebra is rotated right (R_R) and sidebent right (S_R),
giving the diagnosis E RrSr.
---
**Question 2**
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
**Correct 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. Other techniques target specific sutural
restrictions or venous drainage but do not primarily amplify the CRI.
---
**Question 3**
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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
B) Flexion, Adduction, Internal Rotation
C) Extension, Abduction, External Rotation
D) Extension, Adduction, Internal Rotation
E) Pure Abduction without flexion
**Correct Answer: B) Flexion, Adduction, Internal Rotation**
**Rationale:** The medial knee tender point (often associated with the pes
anserinus bursa or medial meniscus) is treated with hip/knee flexion, adduction,
and internal rotation of the tibia. This position shortens the involved tissues,
alleviating the strain. The other choices would stretch rather than shorten the tissue.
---
**Question 4**
A patient presents with a backward sacral torsion. Which of the following is true
regarding the mechanics?
A) L5 is neutral
B) L5 is flexed or extended
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C) The oblique axis is on the same side as the positive seated flexion test
D) The deep sacral sulcus and posterior/inferior ILA are on the same side
E) There is no associated L5 dysfunction
**Correct Answer: B) L5 is flexed or extended**
**Rationale:** In backward sacral torsions (L on R or R on L), L5 is flexed or
extended, rotated and sidebent the same side as the axis. Forward sacral torsions (L
on L or R on R) have neutral L5. The deep sacral sulcus and posterior/inferior ILA
are on the same side for unilateral flexion/extension and opposite for torsions.
---
**Question 5**
A 32-year-old pregnant female at 28 weeks gestation presents with heartburn.
Autonomic reflex pathways would predict somatic manifestations from the
stomach to map to which spinal cord segments?
A) T5-T9
B) T10-T11
C) T12-L2
D) C3-C5
E) T1-T4
**Correct Answer: A) T5-T9**
# COMSAE PHASE 1 FORM 114: COMPLETE
PRACTICE EXAMINATION
## COMPREHENSIVE STUDY GUIDE FOR
OSTEOPATHIC MEDICAL STUDENTS
## Section 1: Osteopathic Principles & Practice (OMM/OPP)
**Question 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 worsens during lumbar flexion and normalizes during
lumbar extension. What is the correct somatic dysfunction diagnosis?
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
**Correct Answer: C) L4 Extended, Rotated Right, Sidebent Right**
**Rationale:** The asymmetry normalizes in extension, indicating an extension
(E) somatic dysfunction (Type II mechanics). Type II mechanics dictate that
rotation and sidebending occur to the same side. Because the right transverse
,2|Page
process is posterior, the vertebra is rotated right (R_R) and sidebent right (S_R),
giving the diagnosis E RrSr.
---
**Question 2**
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
**Correct 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. Other techniques target specific sutural
restrictions or venous drainage but do not primarily amplify the CRI.
---
**Question 3**
,3|Page
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
B) Flexion, Adduction, Internal Rotation
C) Extension, Abduction, External Rotation
D) Extension, Adduction, Internal Rotation
E) Pure Abduction without flexion
**Correct Answer: B) Flexion, Adduction, Internal Rotation**
**Rationale:** The medial knee tender point (often associated with the pes
anserinus bursa or medial meniscus) is treated with hip/knee flexion, adduction,
and internal rotation of the tibia. This position shortens the involved tissues,
alleviating the strain. The other choices would stretch rather than shorten the tissue.
---
**Question 4**
A patient presents with a backward sacral torsion. Which of the following is true
regarding the mechanics?
A) L5 is neutral
B) L5 is flexed or extended
, 4|Page
C) The oblique axis is on the same side as the positive seated flexion test
D) The deep sacral sulcus and posterior/inferior ILA are on the same side
E) There is no associated L5 dysfunction
**Correct Answer: B) L5 is flexed or extended**
**Rationale:** In backward sacral torsions (L on R or R on L), L5 is flexed or
extended, rotated and sidebent the same side as the axis. Forward sacral torsions (L
on L or R on R) have neutral L5. The deep sacral sulcus and posterior/inferior ILA
are on the same side for unilateral flexion/extension and opposite for torsions.
---
**Question 5**
A 32-year-old pregnant female at 28 weeks gestation presents with heartburn.
Autonomic reflex pathways would predict somatic manifestations from the
stomach to map to which spinal cord segments?
A) T5-T9
B) T10-T11
C) T12-L2
D) C3-C5
E) T1-T4
**Correct Answer: A) T5-T9**
