COMSAE Phase 1, 2 & 3 – Osteopathic
Principles & Practice (OMM/OMT) Exam
Questions with Verified Answers & Rationales |
110 Questions | 2025–2026
Q1. A 45-year-old patient presents with acute low back pain after lifting a heavy
box. On examination, you note tissue texture changes, asymmetry, restriction of
motion, and tenderness at the L5 segment. Which mnemonic summarizes these
findings?
A) SOAP
B) TART
C) PQRST
D) OLD CARTS
Answer: B — TART
Rationale: TART stands for Tissue texture abnormality, Asymmetry, Restriction
of motion, and Tenderness—the four diagnostic criteria for somatic dysfunction.
SOAP is a note-taking format (Subjective, Objective, Assessment, Plan), PQRST
is for pain assessment (Provocation, Quality, Region/Radiation, Severity, Timing),
and OLD CARTS is a history-taking mnemonic (Onset, Location, Duration,
Character, Aggravating/Alleviating factors, Radiation, Timing, Severity).
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in
a neutral position (neither flexed nor extended), which of the following occurs?
A) Sidebending and rotation occur to the same degree
B) Sidebending occurs without rotation
C) Sidebending and rotation occur in opposite directions
D) Rotation occurs without sidebending
Answer: C — Sidebending and rotation occur in opposite directions
Rationale: In neutral position, sidebending and rotation occur in opposite
directions (sidebending to the right is accompanied by rotation to the left, and vice
versa). This is Fryette's first principle (Type I mechanics).
,Q3. A patient is diagnosed with a somatic dysfunction of the 5th thoracic vertebra.
Palpation reveals that the T5 spinous process is rotated right. The rotation
abnormality worsens during lumbar and thoracic extension but symmetry improves
during flexion. How should this dysfunction be named?
A) T5 F R(R) S(R)
B) T5 E R(L) S(L)
C) T5 F R(L) S(L)
D) T5 E R(R) S(R)
Answer: A — T5 F R(R) S(R)
Rationale: Somatic dysfunctions are named for their position of comfort (what
they "like" to do). Because symmetry improves in flexion, the vertebra is flexed
(F) . The spinous process rotates to the right (R) . In Type II mechanics,
sidebending and rotation occur in the same direction. Therefore, the naming is F
R(R) S(R).
Q4. Which of the following is an indirect osteopathic manipulative technique?
A) High-velocity low-amplitude (HVLA) thrust
B) Muscle energy (MET)
C) Counterstrain
D) Articulatory technique
Answer: C — Counterstrain
Rationale: Counterstrain is an indirect technique that positions the patient into a
position of ease away from the restrictive barrier. HVLA, muscle energy, and
articulatory techniques are generally considered direct techniques that engage and
move through the restrictive barrier.
Q5. A patient with a respiratory somatic dysfunction is found to have an "exhaled
rib" on the left. This dysfunction is characterized by:
A) The rib is elevated and restricted in depression
B) The rib is depressed (inferiorly) and restricted in elevation
,C) The rib is rotated externally
D) The rib is rotated internally
Answer: B — The rib is depressed (inferiorly) and restricted in elevation
Rationale: An "exhaled rib" is stuck in the exhalation phase (forced exhalation
position). It is located inferiorly relative to its normal position and is restricted in
the ability to elevate during inhalation.
Q6. What is the recommended treatment time for holding a counterstrain tender
point position?
A) 30 seconds
B) 60 seconds
C) 90 seconds
D) 120 seconds
Answer: C — 90 seconds
Rationale: In counterstrain, the position of ease is held for approximately 90
seconds to allow the tender point to resolve, followed by slow return to neutral.
Q7. A 28-year-old female presents with right-sided neck pain after a motor vehicle
collision. On examination, you find a tender point in the right trapezius muscle.
Which OMM technique is most appropriate as an initial treatment?
A) HVLA thrust to C5
B) Counterstrain targeted to the trapezius tender point
C) High-velocity rotation of the skull
D) Prolonged static stretching only
Answer: B — Counterstrain targeted to the trapezius tender point
Rationale: Acute tender points following trauma often respond well
to counterstrain, an indirect technique that relieves pain by positioning the patient
into a position of ease.
Q8. In the seated flexion test, deeper palpation on the left indicates:
, A) A sacral base torsion on the right (R/R)
B) A sacral base torsion on the left (L/L)
C) A right unilateral sacral extension
D) A normal finding
Answer: A — A sacral base torsion on the right (R/R)
Rationale: In the seated flexion test, the side that moves superiorly (deeper
palpation on the left means left PSIS moves more cephalad) indicates the side of
the sacral base torsion. Left PSIS moving more suggests a right sacral base
torsion (R/R) .
Q9. Which Chapman reflex point is correctly matched with its corresponding
organ?
A) Tip of right 12th rib – Cecum/Appendix
B) 2nd intercostal space, right sternal border – Diaphragm
C) Left 5th intercostal space, midclavicular line – Left lung
D) Tip of left 11th rib – Stomach
Answer: A — Tip of right 12th rib – Cecum/Appendix
Rationale: Chapman's reflexes for the colon are at the tips of the 11th and 12th
ribs. The right 12th rib corresponds to the cecum/appendix region. The
diaphragm corresponds to the 3rd-4th intercostal spaces, the lungs to the 3rd-5th
intercostal spaces, and the stomach to the 5th-6th intercostal spaces on the left.
Q10. A patient presents with a deep sacral sulcus on the left and a
posterior/inferior left ILA. This finding is consistent with which sacral
dysfunction?
A) Right unilateral sacral flexion
B) Left unilateral sacral flexion
C) Bilateral sacral extension
D) Sacral base torsion
Answer: B — Left unilateral sacral flexion
Principles & Practice (OMM/OMT) Exam
Questions with Verified Answers & Rationales |
110 Questions | 2025–2026
Q1. A 45-year-old patient presents with acute low back pain after lifting a heavy
box. On examination, you note tissue texture changes, asymmetry, restriction of
motion, and tenderness at the L5 segment. Which mnemonic summarizes these
findings?
A) SOAP
B) TART
C) PQRST
D) OLD CARTS
Answer: B — TART
Rationale: TART stands for Tissue texture abnormality, Asymmetry, Restriction
of motion, and Tenderness—the four diagnostic criteria for somatic dysfunction.
SOAP is a note-taking format (Subjective, Objective, Assessment, Plan), PQRST
is for pain assessment (Provocation, Quality, Region/Radiation, Severity, Timing),
and OLD CARTS is a history-taking mnemonic (Onset, Location, Duration,
Character, Aggravating/Alleviating factors, Radiation, Timing, Severity).
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in
a neutral position (neither flexed nor extended), which of the following occurs?
A) Sidebending and rotation occur to the same degree
B) Sidebending occurs without rotation
C) Sidebending and rotation occur in opposite directions
D) Rotation occurs without sidebending
Answer: C — Sidebending and rotation occur in opposite directions
Rationale: In neutral position, sidebending and rotation occur in opposite
directions (sidebending to the right is accompanied by rotation to the left, and vice
versa). This is Fryette's first principle (Type I mechanics).
,Q3. A patient is diagnosed with a somatic dysfunction of the 5th thoracic vertebra.
Palpation reveals that the T5 spinous process is rotated right. The rotation
abnormality worsens during lumbar and thoracic extension but symmetry improves
during flexion. How should this dysfunction be named?
A) T5 F R(R) S(R)
B) T5 E R(L) S(L)
C) T5 F R(L) S(L)
D) T5 E R(R) S(R)
Answer: A — T5 F R(R) S(R)
Rationale: Somatic dysfunctions are named for their position of comfort (what
they "like" to do). Because symmetry improves in flexion, the vertebra is flexed
(F) . The spinous process rotates to the right (R) . In Type II mechanics,
sidebending and rotation occur in the same direction. Therefore, the naming is F
R(R) S(R).
Q4. Which of the following is an indirect osteopathic manipulative technique?
A) High-velocity low-amplitude (HVLA) thrust
B) Muscle energy (MET)
C) Counterstrain
D) Articulatory technique
Answer: C — Counterstrain
Rationale: Counterstrain is an indirect technique that positions the patient into a
position of ease away from the restrictive barrier. HVLA, muscle energy, and
articulatory techniques are generally considered direct techniques that engage and
move through the restrictive barrier.
Q5. A patient with a respiratory somatic dysfunction is found to have an "exhaled
rib" on the left. This dysfunction is characterized by:
A) The rib is elevated and restricted in depression
B) The rib is depressed (inferiorly) and restricted in elevation
,C) The rib is rotated externally
D) The rib is rotated internally
Answer: B — The rib is depressed (inferiorly) and restricted in elevation
Rationale: An "exhaled rib" is stuck in the exhalation phase (forced exhalation
position). It is located inferiorly relative to its normal position and is restricted in
the ability to elevate during inhalation.
Q6. What is the recommended treatment time for holding a counterstrain tender
point position?
A) 30 seconds
B) 60 seconds
C) 90 seconds
D) 120 seconds
Answer: C — 90 seconds
Rationale: In counterstrain, the position of ease is held for approximately 90
seconds to allow the tender point to resolve, followed by slow return to neutral.
Q7. A 28-year-old female presents with right-sided neck pain after a motor vehicle
collision. On examination, you find a tender point in the right trapezius muscle.
Which OMM technique is most appropriate as an initial treatment?
A) HVLA thrust to C5
B) Counterstrain targeted to the trapezius tender point
C) High-velocity rotation of the skull
D) Prolonged static stretching only
Answer: B — Counterstrain targeted to the trapezius tender point
Rationale: Acute tender points following trauma often respond well
to counterstrain, an indirect technique that relieves pain by positioning the patient
into a position of ease.
Q8. In the seated flexion test, deeper palpation on the left indicates:
, A) A sacral base torsion on the right (R/R)
B) A sacral base torsion on the left (L/L)
C) A right unilateral sacral extension
D) A normal finding
Answer: A — A sacral base torsion on the right (R/R)
Rationale: In the seated flexion test, the side that moves superiorly (deeper
palpation on the left means left PSIS moves more cephalad) indicates the side of
the sacral base torsion. Left PSIS moving more suggests a right sacral base
torsion (R/R) .
Q9. Which Chapman reflex point is correctly matched with its corresponding
organ?
A) Tip of right 12th rib – Cecum/Appendix
B) 2nd intercostal space, right sternal border – Diaphragm
C) Left 5th intercostal space, midclavicular line – Left lung
D) Tip of left 11th rib – Stomach
Answer: A — Tip of right 12th rib – Cecum/Appendix
Rationale: Chapman's reflexes for the colon are at the tips of the 11th and 12th
ribs. The right 12th rib corresponds to the cecum/appendix region. The
diaphragm corresponds to the 3rd-4th intercostal spaces, the lungs to the 3rd-5th
intercostal spaces, and the stomach to the 5th-6th intercostal spaces on the left.
Q10. A patient presents with a deep sacral sulcus on the left and a
posterior/inferior left ILA. This finding is consistent with which sacral
dysfunction?
A) Right unilateral sacral flexion
B) Left unilateral sacral flexion
C) Bilateral sacral extension
D) Sacral base torsion
Answer: B — Left unilateral sacral flexion
