COMSAE PHASE 1 FORM 114 ACTUAL EXAM – 176
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE | STUVIA VERIFIED | EXAM
PREP
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM
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 process is posterior, the vertebra is rotated right (Rr) and
sidebent right (Sr), 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
A patient has restricted left rotation of the lumbar spine, with pain and
muscle spasm. The seated flexion test is negative. Which Fryette principle
describes the expected coupling pattern?
A) Type I: sidebending and rotation occur to opposite sides
B) Type I: sidebending and rotation occur to the same side
C) Type II: sidebending and rotation occur to opposite sides
D) Type II: sidebending and rotation occur to the same side
Correct Answer: A) Type I: sidebending and rotation occur to
opposite sides
Rationale: Fryette Type I (neutral mechanics) applies to groups of
vertebrae; sidebending and rotation occur to opposite sides .
Question 4
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
Rationale: The stomach receives its sympathetic innervation from the
greater splanchnic nerve, which originates from the T5-T9 segments of the
spinal cord. This viscerosomatic reflex can manifest as segmental somatic
dysfunction in the lower thoracic spine .
Question 5
During a newborn examination, the physician notes that the infant's occiput
is compressed anteriorly against the atlas. This condition can compress
which cranial nerve passing through the jugular foramen?
A) CN VII (Facial)
B) CN IX (Glossopharyngeal)
C) CN X (Vagus)
,D) CN XI (Accessory)
E) CN XII (Hypoglossal)
Correct Answer: C) CN X (Vagus)
Rationale: Compression of the occiput against the atlas can affect
structures passing through the jugular foramen, which transmits CN IX, X,
and XI. Vagus nerve dysfunction may present with hoarseness, dysphagia, or
autonomic disturbances .
Question 6
A patient presents with an anterior innominate rotation. Which muscle is
most likely shortened?
A) Right iliopsoas
B) Right hamstrings
C) Left quadratus lumborum
D) Left gluteus maximus
Correct Answer: A) Right iliopsoas
Rationale: In an anterior innominate rotation, the ipsilateral iliopsoas is
shortened, causing the ilium to rotate anteriorly. Posterior innominate
rotation is associated with shortened hamstrings .
Question 7
An osteopathic physician performs a structural exam and finds a left-on-left
sacral torsion. Which finding is most consistent with this diagnosis?
A) A shallow right sacral sulcus
B) A posterior/prominent left ILA
C) A positive right spring test
D) A positive left seated flexion test
Correct Answer: D) A positive left seated flexion test
Rationale: For a left-on-left (L-on-L) sacral torsion, the sacrum rotates left
on a left oblique axis. The seated flexion test is positive on the side opposite
the axis, which is the left side. In an L-on-L forward torsion, the right sacral
sulcus is deep (not shallow), and the right inferior lateral angle (ILA) is
posterior and inferior. Forward torsions yield a negative spring test .
Question 8
A patient with C3 translates easier to the left and more symmetrically in
extension. What is the somatic dysfunction diagnosis?
A) C3 E RrSr
B) C3 F RrSr
, C) C3 E RlSl
D) C3 F RlSl
E) C3 neutral
Correct Answer: A) C3 E RrSr
Rationale: The diagnosis follows the convention: E = Extension, Rr =
Rotated right, Sr = Sidebent right. C3 translates easier to the left and more
symmetrically in extension, indicating the dysfunction is in extension, with
rotation and sidebending to the right .
Question 9
What are Chapman's reflexes?
A) Pain out of proportion to amount of pressure used
B) Associated with remote segmental somatic dysfunctions
C) Microscopic analysis yields identifiable tissue pathology
D) Radiate pain (like a trigger point)
E) Both A and B
Correct Answer: E) Both A and B
Rationale: Chapman's reflexes are neurolymphatic reflex points located in
the fascia, associated with specific visceral dysfunction. They are tender to
palpation (pain out of proportion to pressure) and linked to remote
segmental somatic dysfunctions. They differ from trigger points, which
radiate pain .
Question 10
A patient presents with a flexed, sidebent, rotated somatic dysfunction at L3.
According to Fryette Type II mechanics, the sidebending and rotation occur
to which sides?
A) Opposite sides
B) Same side
C) Rotation only without sidebending
D) Sidebending with no rotation
Correct Answer: B) Same side
Rationale: Type II mechanics (non-neutral) affect single vertebrae.
Sidebending and rotation occur to the same side. The patient is also flexed .
Question 11
A 45-year-old male has a somatic dysfunction of the T5 thoracic vertebra.
Palpation reveals that the T5 spinous process rotates preferentially to the
right and sidebends preferentially to the right. When the patient flexes his
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE | STUVIA VERIFIED | EXAM
PREP
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM
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 process is posterior, the vertebra is rotated right (Rr) and
sidebent right (Sr), 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
A patient has restricted left rotation of the lumbar spine, with pain and
muscle spasm. The seated flexion test is negative. Which Fryette principle
describes the expected coupling pattern?
A) Type I: sidebending and rotation occur to opposite sides
B) Type I: sidebending and rotation occur to the same side
C) Type II: sidebending and rotation occur to opposite sides
D) Type II: sidebending and rotation occur to the same side
Correct Answer: A) Type I: sidebending and rotation occur to
opposite sides
Rationale: Fryette Type I (neutral mechanics) applies to groups of
vertebrae; sidebending and rotation occur to opposite sides .
Question 4
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
Rationale: The stomach receives its sympathetic innervation from the
greater splanchnic nerve, which originates from the T5-T9 segments of the
spinal cord. This viscerosomatic reflex can manifest as segmental somatic
dysfunction in the lower thoracic spine .
Question 5
During a newborn examination, the physician notes that the infant's occiput
is compressed anteriorly against the atlas. This condition can compress
which cranial nerve passing through the jugular foramen?
A) CN VII (Facial)
B) CN IX (Glossopharyngeal)
C) CN X (Vagus)
,D) CN XI (Accessory)
E) CN XII (Hypoglossal)
Correct Answer: C) CN X (Vagus)
Rationale: Compression of the occiput against the atlas can affect
structures passing through the jugular foramen, which transmits CN IX, X,
and XI. Vagus nerve dysfunction may present with hoarseness, dysphagia, or
autonomic disturbances .
Question 6
A patient presents with an anterior innominate rotation. Which muscle is
most likely shortened?
A) Right iliopsoas
B) Right hamstrings
C) Left quadratus lumborum
D) Left gluteus maximus
Correct Answer: A) Right iliopsoas
Rationale: In an anterior innominate rotation, the ipsilateral iliopsoas is
shortened, causing the ilium to rotate anteriorly. Posterior innominate
rotation is associated with shortened hamstrings .
Question 7
An osteopathic physician performs a structural exam and finds a left-on-left
sacral torsion. Which finding is most consistent with this diagnosis?
A) A shallow right sacral sulcus
B) A posterior/prominent left ILA
C) A positive right spring test
D) A positive left seated flexion test
Correct Answer: D) A positive left seated flexion test
Rationale: For a left-on-left (L-on-L) sacral torsion, the sacrum rotates left
on a left oblique axis. The seated flexion test is positive on the side opposite
the axis, which is the left side. In an L-on-L forward torsion, the right sacral
sulcus is deep (not shallow), and the right inferior lateral angle (ILA) is
posterior and inferior. Forward torsions yield a negative spring test .
Question 8
A patient with C3 translates easier to the left and more symmetrically in
extension. What is the somatic dysfunction diagnosis?
A) C3 E RrSr
B) C3 F RrSr
, C) C3 E RlSl
D) C3 F RlSl
E) C3 neutral
Correct Answer: A) C3 E RrSr
Rationale: The diagnosis follows the convention: E = Extension, Rr =
Rotated right, Sr = Sidebent right. C3 translates easier to the left and more
symmetrically in extension, indicating the dysfunction is in extension, with
rotation and sidebending to the right .
Question 9
What are Chapman's reflexes?
A) Pain out of proportion to amount of pressure used
B) Associated with remote segmental somatic dysfunctions
C) Microscopic analysis yields identifiable tissue pathology
D) Radiate pain (like a trigger point)
E) Both A and B
Correct Answer: E) Both A and B
Rationale: Chapman's reflexes are neurolymphatic reflex points located in
the fascia, associated with specific visceral dysfunction. They are tender to
palpation (pain out of proportion to pressure) and linked to remote
segmental somatic dysfunctions. They differ from trigger points, which
radiate pain .
Question 10
A patient presents with a flexed, sidebent, rotated somatic dysfunction at L3.
According to Fryette Type II mechanics, the sidebending and rotation occur
to which sides?
A) Opposite sides
B) Same side
C) Rotation only without sidebending
D) Sidebending with no rotation
Correct Answer: B) Same side
Rationale: Type II mechanics (non-neutral) affect single vertebrae.
Sidebending and rotation occur to the same side. The patient is also flexed .
Question 11
A 45-year-old male has a somatic dysfunction of the T5 thoracic vertebra.
Palpation reveals that the T5 spinous process rotates preferentially to the
right and sidebends preferentially to the right. When the patient flexes his
