COMSAE PHASE 1 FORM 116 EXAMINATION QUESTIONS AND
CORRECT ANSWER WITH DETAILED EXPLANATION STUDY GUIDE FOR
OSTEOPATHIC MEDICAL STUDENT
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM
1. A 45-year-old woman presents with epigastric burning and
bloating after meals for several months. On osteopathic structural
exam, you find tenderness and increased tissue texture at the right
T6-T8 paraspinal region. Which viscerosomatic reflex best explains
this finding?
A. Gallbladder
B. Pancreas
C. Stomach
D. Liver
Answer: A
Rationale: Viscerosomatic reflexes occur when visceral disease causes
somatic dysfunction in corresponding spinal segments. The gallbladder reflex
corresponds to T6-T9 on the right side. The stomach reflex is left-sided at T6-
T9, while the pancreas reflex is left-sided at T7-T9. The combination of
epigastric symptoms with right T6-T8 tenderness is classic for gallbladder
pathology .
2. A patient with chronic low back pain has a seated flexion test
positive on the left. In the prone position, the left ILA is more
posterior than the right. What is the most likely diagnosis?
A. Left on left sacral torsion
B. Right on right sacral torsion
C. Left unilateral sacral flexion
D. Bilateral sacral extension
Answer: A
Rationale: The seated flexion test points to the side of dysfunction (left). A
posterior ILA indicates the axis. In a left on left torsion, the axis is on the left
,and the left ILA is posterior. The naming convention for sacral torsion is "axis
on the side of the deep sulcus" .
3. Which of the following is an absolute contraindication to cervical
HVLA technique?
A. Acute muscle spasm
B. Joint hypomobility
C. Vertebral artery insufficiency
D. Somatic dysfunction
Answer: C
Rationale: Vertebral artery insufficiency is an absolute contraindication to
cervical HVLA techniques due to the risk of vertebrobasilar stroke. Other
contraindications include fracture, dislocation, malignancy, infection, and
severe osteoporosis. Acute muscle spasm and joint hypomobility are actually
indications for HVLA .
4. 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
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 and sidebends to the
right, so the naming is T5 F R(R) S(R) .
, 5. A patient with chronic neck pain has a restriction at C3-C4 that is
more prominent in flexion than extension. According to Fryette's
principles, this represents:
A. Type I dysfunction
B. Type II dysfunction
C. Neutral dysfunction
D. Group dysfunction
Answer: B
Rationale: Type II (non-neutral) dysfunctions occur in flexion or extension
with rotation and sidebending in the same direction. The fact that the
restriction is more prominent in flexion than extension indicates a non-
neutral dysfunction. Type I mechanics involve neutral position with rotation
and sidebending in opposite directions .
6. A patient with chronic sinusitis and restricted motion of the
maxilla is being evaluated. Which cranial bone is most likely
involved?
A. Frontal
B. Sphenoid
C. Maxilla
D. Temporal
Answer: C
Rationale: Chronic sinusitis can cause restricted motion of the maxilla,
which forms the floor of the maxillary sinuses. The maxilla is a cranial bone
that can develop somatic dysfunction affecting sinus drainage .
7. Use of which OMM technique has been shown to result in
increased sIgA levels?
CORRECT ANSWER WITH DETAILED EXPLANATION STUDY GUIDE FOR
OSTEOPATHIC MEDICAL STUDENT
SECTION 1: OSTEOPATHIC PRINCIPLES & OMM
1. A 45-year-old woman presents with epigastric burning and
bloating after meals for several months. On osteopathic structural
exam, you find tenderness and increased tissue texture at the right
T6-T8 paraspinal region. Which viscerosomatic reflex best explains
this finding?
A. Gallbladder
B. Pancreas
C. Stomach
D. Liver
Answer: A
Rationale: Viscerosomatic reflexes occur when visceral disease causes
somatic dysfunction in corresponding spinal segments. The gallbladder reflex
corresponds to T6-T9 on the right side. The stomach reflex is left-sided at T6-
T9, while the pancreas reflex is left-sided at T7-T9. The combination of
epigastric symptoms with right T6-T8 tenderness is classic for gallbladder
pathology .
2. A patient with chronic low back pain has a seated flexion test
positive on the left. In the prone position, the left ILA is more
posterior than the right. What is the most likely diagnosis?
A. Left on left sacral torsion
B. Right on right sacral torsion
C. Left unilateral sacral flexion
D. Bilateral sacral extension
Answer: A
Rationale: The seated flexion test points to the side of dysfunction (left). A
posterior ILA indicates the axis. In a left on left torsion, the axis is on the left
,and the left ILA is posterior. The naming convention for sacral torsion is "axis
on the side of the deep sulcus" .
3. Which of the following is an absolute contraindication to cervical
HVLA technique?
A. Acute muscle spasm
B. Joint hypomobility
C. Vertebral artery insufficiency
D. Somatic dysfunction
Answer: C
Rationale: Vertebral artery insufficiency is an absolute contraindication to
cervical HVLA techniques due to the risk of vertebrobasilar stroke. Other
contraindications include fracture, dislocation, malignancy, infection, and
severe osteoporosis. Acute muscle spasm and joint hypomobility are actually
indications for HVLA .
4. 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
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 and sidebends to the
right, so the naming is T5 F R(R) S(R) .
, 5. A patient with chronic neck pain has a restriction at C3-C4 that is
more prominent in flexion than extension. According to Fryette's
principles, this represents:
A. Type I dysfunction
B. Type II dysfunction
C. Neutral dysfunction
D. Group dysfunction
Answer: B
Rationale: Type II (non-neutral) dysfunctions occur in flexion or extension
with rotation and sidebending in the same direction. The fact that the
restriction is more prominent in flexion than extension indicates a non-
neutral dysfunction. Type I mechanics involve neutral position with rotation
and sidebending in opposite directions .
6. A patient with chronic sinusitis and restricted motion of the
maxilla is being evaluated. Which cranial bone is most likely
involved?
A. Frontal
B. Sphenoid
C. Maxilla
D. Temporal
Answer: C
Rationale: Chronic sinusitis can cause restricted motion of the maxilla,
which forms the floor of the maxillary sinuses. The maxilla is a cranial bone
that can develop somatic dysfunction affecting sinus drainage .
7. Use of which OMM technique has been shown to result in
increased sIgA levels?
