COMSAE Phase 1 Form 113 Question Bank | 150+ Complete MCQs with Verified Correct Answers & Detailed Rationales | Latest Update 2026/2027 Edition

COMSAE Phase 1 Form 113 Question Bank |
150+ Complete MCQs with Verified Correct
Answers & Detailed Rationales | Latest
Update 2026/2027 Edition

SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP/OMM)


Question 1
A 24-year-old male presents with acute lower back pain after lifting heavy boxes.
Physical examination reveals a positive standing flexion test on the right. In the prone
position, the right ASIS is superior, and the right PSIS is inferior. What is the most likely
diagnosis?
A. Right anterior innominate rotation
B. Right posterior innominate rotation
C. Left superior innominate shear
D. Right superior innominate shear
Answer: B
Rationale: A positive standing flexion test localizes the side of somatic dysfunction to
the right. A posterior innominate rotation is characterized by an ASIS that is superior
and a PSIS that is inferior on the affected side.


Question 2
A patient presents with a structural exam revealing a restricted T5 segment. The
segment prefers rotation to the right and side-bending to the right. It improves when the
patient slumps forward into spinal flexion. What is the correct diagnosis?
A. T5 Neutral SR RL
B. T5 Extended RR SR
C. T5 Flexed RL SL
D. T5 Flexed RR SR
Answer: D
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed as
Flexed. According to Fryette's Second Law (Type II mechanics), when a single segment

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,is in a non-neutral position (flexion or extension), rotation and side-bending occur in
the same direction.


Question 3
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. Side-bending and rotation occur to the same side
B. Side-bending occurs without rotation
C. Side-bending and rotation occur to opposite sides
D. Rotation occurs without side-bending
Answer: C
Rationale: Fryette's first principle (Type I mechanics) describes that when multiple
vertebral segments are in neutral position, side-bending and rotation occur in opposite
directions.


Question 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: B
Rationale: The dysfunction worsens with extension (E) and improves with flexion.
Since the spinous process is rotated right, the rule of the spinous process dictates that
the body is rotated left. Therefore, the diagnosis is T5 E R(L) S(L).


Question 5
A 45-year-old male presents with chronic low back pain. Physical examination reveals
an apparent short left leg, a left posterior superior iliac spine (PSIS) that is superior
compared to the right, and a left anterior inferior iliac spine (AIIS) that is inferior. What
is the most likely sacral diagnosis?
A. Right-on-right torsion
B. Left unilateral flexion
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,C. Left-on-left torsion
D. Right unilateral flexion
E. Left-on-right torsion
Answer: C
Rationale: In a sacral torsion, the side of the oblique axis is named first, and the side of
the rotation is named second. The findings (deep sulcus on the right, shallow on the left;
ILA posterior on the left) indicate rotation around a left oblique axis. A "Left-on-left"
torsion means the axis is on the left and the base is rotating anteriorly on the left.


Question 6
In Muscle Energy Technique (MET), the patient's contraction force should be:
A. Maximum effort for 10 seconds
B. Submaximal (about 20% of maximum) for 3-5 seconds
C. Isometric contraction held for 30 seconds
D. Rhythmic contraction and relaxation
Answer: B
Rationale: In MET, the patient uses a submaximal contraction (approximately 20% of
available strength) held for 3-5 seconds against a counterforce provided by the
physician.


Question 7
A patient presents with a right unilateral sacral flexion. Which of the following findings
would you expect on examination?
A. Deep right sulcus, prominent right ILA
B. Shallow right sulcus, prominent right ILA
C. Deep right sulcus, posterior right ILA
D. Shallow right sulcus, posterior left ILA
Answer: B
Rationale: In unilateral sacral flexion, the sulcus on the affected side is shallow, and
the ILA on the affected side is prominent (more posterior). The base of the sacrum is
flexed anteriorly on the affected side.


Question 8
What is the most appropriate treatment for a patient with an acute torticollis (wry neck)
with the head rotated to the right and side-bent to the left?
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, A. HVLA thrust to the left
B. Muscle energy to the right
C. Counterstrain for the right sternocleidomastoid
D. Myofascial release of the left trapezius
Answer: A
Rationale: Acute torticollis typically involves a Type II dysfunction. According to
Fryette's laws, rotation and side-bending occur to the same side in Type II mechanics.
The head rotated right and side-bent left represents a neutral dysfunction requiring
treatment.


Question 9
The primary respiratory motion of the sacrum during inhalation is:
A. Sacral extension (base posterior, apex anterior)
B. Sacral flexion (base anterior, apex posterior)
C. Sacral rotation to the right
D. Sacral side-bending to the left
Answer: B
Rationale: During inhalation, the sacrum undergoes primary respiratory motion with
the base moving anteriorly and the apex moving posteriorly (sacral flexion). This is
associated with the reciprocal tension membrane motion in cranial osteopathy.


Question 10
Which cranial bone is considered the "keystone" of the cranium and is a primary driver
of cranial motion?
A. Frontal bone
B. Sphenoid bone
C. Occipital bone
D. Temporal bone
Answer: B
Rationale: The sphenoid bone articulates with all other cranial bones and is a key
driver of cranial motion patterns. Sphenoid dysfunction is a primary focus in cranial
osteopathy.




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