2026 COMSAE 114 LATEST EXAM VERSION |
QUESTIONS AND CORRECT ANSWERS AND STUDY
GUIDE FOR GUARANTEED PASS
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1–25)
Q1. A 24-year-old male presents with acute lower back pain after lifting heavy boxes.
Physical examination reveals a right-on-right forward sacral torsion. Which of the
following is the correct positioning for treating this patient using Muscle Energy
Technique (MET)?
• A) Left lateral recumbent, torso rotated left, hips flexed
• B) Right lateral recumbent, torso rotated right, hips flexed
• C) Left lateral recumbent, torso rotated right, hips extended
• D) Right lateral recumbent, torso rotated left, hips extended
Correct Answer: A
Rationale: For a forward sacral torsion (e.g., right-on-right), the patient is placed in the
lateral recumbent position on the side of the oblique axis (left side). The torso is rotated
face down (left rotation) to engage the axis, and the hips are flexed until motion is felt at
the lumbosacral junction to isolate the sacrum.
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur:
• A) To the same side
• B) To opposite sides
• C) Without rotation
, • D) Only in the lumbar spine
Correct Answer: B
Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. For example, sidebending
right is accompanied by rotation left.
Q3. A 45-year-old male presents with low back pain after lifting. The standing flexion
test shows superior movement of the right PSIS. Which somatic dysfunction is most
likely?
• A) Right anterior innominate
• B) Left posterior innominate
• C) Right sacral torsion on a left oblique axis
• D) Bilateral innominate rotation
Correct Answer: A
Rationale: A positive standing flexion test on the right suggests iliosacral dysfunction.
The superior movement of the PSIS often correlates with a right anterior innominate,
where the ASIS is positioned anteriorly and inferiorly, creating a functional short leg.
Q4. A patient has a somatic dysfunction described as "left fibular head, posterior." What
motion is restricted?
• A) Anterior glide
• B) Posterior glide
, • C) Lateral glide
• D) Medial glide
Correct Answer: A
Rationale: A "left fibular head, posterior" indicates the fibular head has moved
posteriorly. The restricted motion is the opposite direction—anterior glide.
Q5. During an osteopathic structural exam, you note a flexed, adducted, and internally
rotated thigh. Which joint is likely dislocated?
• A) Hip joint
• B) Knee joint
• C) Sacroiliac joint
• D) Pubic symphysis
Correct Answer: A
Rationale: Posterior hip dislocation classically presents with the lower extremity flexed,
adducted, and internally rotated. Anterior dislocation causes external rotation.
Q6. A physician identifies a viscerosomatic reflex at the T10–L2 spinal levels. Which
organ system is most likely associated with this finding?
• A) Cardiac system
• B) Gastrointestinal system
• C) Pulmonary system
• D) Renal system
, Correct Answer: D
Rationale: The T10–L2 spinal levels correspond to viscerosomatic reflexes for the
kidneys and urinary tract. Cardiac reflexes are at T1–T4, pulmonary at T2–T7, and
gastrointestinal varies by region.
Q7. A patient with chronic low back pain has a right anterior innominate dysfunction.
Which of the following is the most appropriate osteopathic manipulative treatment
(OMT)?
• A) Muscle energy to treat the right innominate in the posterior rotation direction
• B) High-velocity low-amplitude (HVLA) thrust to the left innominate
• C) Counterstrain for the right anterior innominate tender point
• D) Myofascial release of the lumbar paraspinals only
Correct Answer: A
Rationale: A right anterior innominate requires treatment to rotate the innominate
posteriorly. Muscle energy is an effective direct technique for this dysfunction. HVLA to
the contralateral side would be incorrect.
Q8. During cranial osteopathic examination, you note a strain pattern where the
sphenobasilar synchondrosis (SBS) is rotated around an anteroposterior axis. This is
most consistent with:
• A) Flexion
• B) Extension
• C) Torsion
QUESTIONS AND CORRECT ANSWERS AND STUDY
GUIDE FOR GUARANTEED PASS
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE
(Questions 1–25)
Q1. A 24-year-old male presents with acute lower back pain after lifting heavy boxes.
Physical examination reveals a right-on-right forward sacral torsion. Which of the
following is the correct positioning for treating this patient using Muscle Energy
Technique (MET)?
• A) Left lateral recumbent, torso rotated left, hips flexed
• B) Right lateral recumbent, torso rotated right, hips flexed
• C) Left lateral recumbent, torso rotated right, hips extended
• D) Right lateral recumbent, torso rotated left, hips extended
Correct Answer: A
Rationale: For a forward sacral torsion (e.g., right-on-right), the patient is placed in the
lateral recumbent position on the side of the oblique axis (left side). The torso is rotated
face down (left rotation) to engage the axis, and the hips are flexed until motion is felt at
the lumbosacral junction to isolate the sacrum.
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position, sidebending and rotation occur:
• A) To the same side
• B) To opposite sides
• C) Without rotation
, • D) Only in the lumbar spine
Correct Answer: B
Rationale: Fryette's first principle states that in a neutral spine (neither flexed nor
extended), sidebending and rotation occur to opposite sides. For example, sidebending
right is accompanied by rotation left.
Q3. A 45-year-old male presents with low back pain after lifting. The standing flexion
test shows superior movement of the right PSIS. Which somatic dysfunction is most
likely?
• A) Right anterior innominate
• B) Left posterior innominate
• C) Right sacral torsion on a left oblique axis
• D) Bilateral innominate rotation
Correct Answer: A
Rationale: A positive standing flexion test on the right suggests iliosacral dysfunction.
The superior movement of the PSIS often correlates with a right anterior innominate,
where the ASIS is positioned anteriorly and inferiorly, creating a functional short leg.
Q4. A patient has a somatic dysfunction described as "left fibular head, posterior." What
motion is restricted?
• A) Anterior glide
• B) Posterior glide
, • C) Lateral glide
• D) Medial glide
Correct Answer: A
Rationale: A "left fibular head, posterior" indicates the fibular head has moved
posteriorly. The restricted motion is the opposite direction—anterior glide.
Q5. During an osteopathic structural exam, you note a flexed, adducted, and internally
rotated thigh. Which joint is likely dislocated?
• A) Hip joint
• B) Knee joint
• C) Sacroiliac joint
• D) Pubic symphysis
Correct Answer: A
Rationale: Posterior hip dislocation classically presents with the lower extremity flexed,
adducted, and internally rotated. Anterior dislocation causes external rotation.
Q6. A physician identifies a viscerosomatic reflex at the T10–L2 spinal levels. Which
organ system is most likely associated with this finding?
• A) Cardiac system
• B) Gastrointestinal system
• C) Pulmonary system
• D) Renal system
, Correct Answer: D
Rationale: The T10–L2 spinal levels correspond to viscerosomatic reflexes for the
kidneys and urinary tract. Cardiac reflexes are at T1–T4, pulmonary at T2–T7, and
gastrointestinal varies by region.
Q7. A patient with chronic low back pain has a right anterior innominate dysfunction.
Which of the following is the most appropriate osteopathic manipulative treatment
(OMT)?
• A) Muscle energy to treat the right innominate in the posterior rotation direction
• B) High-velocity low-amplitude (HVLA) thrust to the left innominate
• C) Counterstrain for the right anterior innominate tender point
• D) Myofascial release of the lumbar paraspinals only
Correct Answer: A
Rationale: A right anterior innominate requires treatment to rotate the innominate
posteriorly. Muscle energy is an effective direct technique for this dysfunction. HVLA to
the contralateral side would be incorrect.
Q8. During cranial osteopathic examination, you note a strain pattern where the
sphenobasilar synchondrosis (SBS) is rotated around an anteroposterior axis. This is
most consistent with:
• A) Flexion
• B) Extension
• C) Torsion
