COMSAE PHASE 1 FORM 113 EXAM / COMSAE FORM 113 ACTUAL PHASE 1 EXAM
2026/2027 COMPLETE ACCURATE EXAM APPROVED QUESTIONS WITH WELL ELABORATED
ANSWERS AND RATIONALES (100% CORRECT VERIFIED SOLUTIONS) NEWEST UPDATED
VERSION 2026 EDITION |GUARANTEED PASS !!
SECTION 1: OSTEOPATHIC PRINCIPLES AND PRACTICE (Questions 1–10)
Question 1
A 34-year-old male presents with chronic low back pain. Osteopathic structural
examination reveals a lumbar somatic dysfunction. During motion testing, you find that
the vertebra does not move freely in one direction but moves freely in the opposite
direction. According to Fryette's Laws, this dysfunction is best described as:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Type IV dysfunction
CORRECT ANSWER: B
Rationale: Fryette's Laws describe the coupled motions of the vertebral column during flexion
and extension. Type II dysfunction occurs when a single vertebra does not move freely in one
direction but moves freely in the opposite direction. It is associated with non-neutral mechanics
(flexion or extension) and is typically treated with direct techniques. Type I dysfunction (A)
involves a group of vertebrae that are rotated and side-bent in opposite directions and is related
to neutral mechanics. Type III and Type IV dysfunctions (C, D) are not recognized categories
within Fryette's framework.
Question 2
A 45-year-old woman presents with neck pain and restricted cervical motion. The
physician performs a muscle energy technique. Which of the following best describes
the underlying principle of muscle energy?
A) The patient uses maximal voluntary contraction against a counterforce to release a
hypertonic muscle.
B) The physician passively stretches the muscle to its barrier.
C) The patient actively contracts the muscle to inhibit the antagonist.
D) The physician uses high-velocity, low-amplitude thrust to restore motion.
CORRECT ANSWER: A
Rationale: Muscle energy is a direct osteopathic technique in which the patient actively
contracts a specific muscle against a counterforce provided by the physician. This
contraction is followed by relaxation, allowing the physician to take the joint to a new restrictive
,barrier. It is a gentle, patient-controlled technique often used to address somatic dysfunction.
Option B describes a passive stretching technique. Option C describes reciprocal inhibition,
which is a component of muscle energy but not the full principle. Option D describes
high-velocity, low-amplitude (HVLA) thrust, which is a different osteopathic technique.
Question 3
A patient presents with a Chapman reflex point located in the intercostal space at the
level of the 2nd rib, just lateral to the sternum. This reflex point is most commonly
associated with dysfunction of which organ?
A) Heart
B) Lungs
C) Liver
D) Stomach
CORRECT ANSWER: A
Rationale: Chapman reflexes are viscerosomatic reflexes that present as small, tender
nodules in predictable locations. The Chapman reflex for the heart is located in the 2nd
intercostal space, just lateral to the sternum. The reflex point for the lungs is typically found at
the 3rd and 4th intercostal spaces. The liver reflex is located at the 5th and 6th intercostal
spaces on the right side. The stomach reflex is found at the 6th intercostal space on the left
side.
Question 4
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with a
somatic dysfunction at the T3-T5 vertebral levels. The physician suspects a
viscerosomatic reflex. Which of the following best explains this finding?
A) Sympathetic innervation of the lungs originates from T1-T4
B) Parasympathetic innervation of the lungs originates from T3-T5
C) Somatic dysfunction at T3-T5 is unrelated to pulmonary pathology
D) The phrenic nerve innervates the lungs and originates from T3-T5
CORRECT ANSWER: A
Rationale: Viscerosomatic reflexes occur when visceral irritation causes referred somatic
dysfunction at corresponding spinal levels. The sympathetic innervation of the lungs and
bronchi originates from the T1-T4 spinal segments. Therefore, pulmonary pathology can
present with somatic dysfunction at these levels. Option B is incorrect because parasympathetic
innervation of the lungs comes from the vagus nerve (cranial nerve X). Option D is incorrect
because the phrenic nerve (C3-C5) innervates the diaphragm, not the lungs.
Question 5
, A 28-year-old male presents with acute low back pain after lifting a heavy object.
Osteopathic examination reveals a right sacral torsion on a left oblique axis. Which of the
following is the most appropriate osteopathic manipulative treatment for this
dysfunction?
A) Muscle energy for the sacrum
B) Counterstrain for the sacrum
C) HVLA thrust for the sacrum
D) Myofascial release for the lumbar spine
CORRECT ANSWER: A
Rationale: Sacral torsions are commonly treated with muscle energy techniques. A right
sacral torsion on a left oblique axis indicates that the right sacral base is posterior and the left
sacral base is anterior. Muscle energy can effectively correct this dysfunction by engaging the
patient's muscle contractions to restore proper sacral motion. Counterstrain (B) and HVLA (C)
may be used for other sacral dysfunctions but are not the most appropriate first-line treatment
for this specific torsion.
Question 6
Which of the following best describes the cranial rhythmic impulse (CRI)?
A) The palpable movement of the cranial bones during the respiratory cycle
B) The inherent, rhythmic motion of the cranial bones and sacrum
C) The movement of cerebrospinal fluid within the ventricular system
D) The pulsation of the cerebral arteries
CORRECT ANSWER: B
Rationale: The cranial rhythmic impulse (CRI) is the inherent, rhythmic motion of the cranial
bones, the sacrum, and the dural membrane system. It is a fundamental concept in osteopathy
in the cranial field (OCF). The CRI is independent of the respiratory and cardiac cycles and is
typically palpable at a rate of 6-12 cycles per minute.
Question 7
A patient presents with a somatic dysfunction that is described as "flexed, side-bent, and
rotated to the same side." According to Fryette's Laws, this is characteristic of:
A) Type I dysfunction in the neutral position
B) Type II dysfunction in the non-neutral position
C) Type III dysfunction in the neutral position
D) Type IV dysfunction in the non-neutral position
CORRECT ANSWER: B
2026/2027 COMPLETE ACCURATE EXAM APPROVED QUESTIONS WITH WELL ELABORATED
ANSWERS AND RATIONALES (100% CORRECT VERIFIED SOLUTIONS) NEWEST UPDATED
VERSION 2026 EDITION |GUARANTEED PASS !!
SECTION 1: OSTEOPATHIC PRINCIPLES AND PRACTICE (Questions 1–10)
Question 1
A 34-year-old male presents with chronic low back pain. Osteopathic structural
examination reveals a lumbar somatic dysfunction. During motion testing, you find that
the vertebra does not move freely in one direction but moves freely in the opposite
direction. According to Fryette's Laws, this dysfunction is best described as:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Type IV dysfunction
CORRECT ANSWER: B
Rationale: Fryette's Laws describe the coupled motions of the vertebral column during flexion
and extension. Type II dysfunction occurs when a single vertebra does not move freely in one
direction but moves freely in the opposite direction. It is associated with non-neutral mechanics
(flexion or extension) and is typically treated with direct techniques. Type I dysfunction (A)
involves a group of vertebrae that are rotated and side-bent in opposite directions and is related
to neutral mechanics. Type III and Type IV dysfunctions (C, D) are not recognized categories
within Fryette's framework.
Question 2
A 45-year-old woman presents with neck pain and restricted cervical motion. The
physician performs a muscle energy technique. Which of the following best describes
the underlying principle of muscle energy?
A) The patient uses maximal voluntary contraction against a counterforce to release a
hypertonic muscle.
B) The physician passively stretches the muscle to its barrier.
C) The patient actively contracts the muscle to inhibit the antagonist.
D) The physician uses high-velocity, low-amplitude thrust to restore motion.
CORRECT ANSWER: A
Rationale: Muscle energy is a direct osteopathic technique in which the patient actively
contracts a specific muscle against a counterforce provided by the physician. This
contraction is followed by relaxation, allowing the physician to take the joint to a new restrictive
,barrier. It is a gentle, patient-controlled technique often used to address somatic dysfunction.
Option B describes a passive stretching technique. Option C describes reciprocal inhibition,
which is a component of muscle energy but not the full principle. Option D describes
high-velocity, low-amplitude (HVLA) thrust, which is a different osteopathic technique.
Question 3
A patient presents with a Chapman reflex point located in the intercostal space at the
level of the 2nd rib, just lateral to the sternum. This reflex point is most commonly
associated with dysfunction of which organ?
A) Heart
B) Lungs
C) Liver
D) Stomach
CORRECT ANSWER: A
Rationale: Chapman reflexes are viscerosomatic reflexes that present as small, tender
nodules in predictable locations. The Chapman reflex for the heart is located in the 2nd
intercostal space, just lateral to the sternum. The reflex point for the lungs is typically found at
the 3rd and 4th intercostal spaces. The liver reflex is located at the 5th and 6th intercostal
spaces on the right side. The stomach reflex is found at the 6th intercostal space on the left
side.
Question 4
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with a
somatic dysfunction at the T3-T5 vertebral levels. The physician suspects a
viscerosomatic reflex. Which of the following best explains this finding?
A) Sympathetic innervation of the lungs originates from T1-T4
B) Parasympathetic innervation of the lungs originates from T3-T5
C) Somatic dysfunction at T3-T5 is unrelated to pulmonary pathology
D) The phrenic nerve innervates the lungs and originates from T3-T5
CORRECT ANSWER: A
Rationale: Viscerosomatic reflexes occur when visceral irritation causes referred somatic
dysfunction at corresponding spinal levels. The sympathetic innervation of the lungs and
bronchi originates from the T1-T4 spinal segments. Therefore, pulmonary pathology can
present with somatic dysfunction at these levels. Option B is incorrect because parasympathetic
innervation of the lungs comes from the vagus nerve (cranial nerve X). Option D is incorrect
because the phrenic nerve (C3-C5) innervates the diaphragm, not the lungs.
Question 5
, A 28-year-old male presents with acute low back pain after lifting a heavy object.
Osteopathic examination reveals a right sacral torsion on a left oblique axis. Which of the
following is the most appropriate osteopathic manipulative treatment for this
dysfunction?
A) Muscle energy for the sacrum
B) Counterstrain for the sacrum
C) HVLA thrust for the sacrum
D) Myofascial release for the lumbar spine
CORRECT ANSWER: A
Rationale: Sacral torsions are commonly treated with muscle energy techniques. A right
sacral torsion on a left oblique axis indicates that the right sacral base is posterior and the left
sacral base is anterior. Muscle energy can effectively correct this dysfunction by engaging the
patient's muscle contractions to restore proper sacral motion. Counterstrain (B) and HVLA (C)
may be used for other sacral dysfunctions but are not the most appropriate first-line treatment
for this specific torsion.
Question 6
Which of the following best describes the cranial rhythmic impulse (CRI)?
A) The palpable movement of the cranial bones during the respiratory cycle
B) The inherent, rhythmic motion of the cranial bones and sacrum
C) The movement of cerebrospinal fluid within the ventricular system
D) The pulsation of the cerebral arteries
CORRECT ANSWER: B
Rationale: The cranial rhythmic impulse (CRI) is the inherent, rhythmic motion of the cranial
bones, the sacrum, and the dural membrane system. It is a fundamental concept in osteopathy
in the cranial field (OCF). The CRI is independent of the respiratory and cardiac cycles and is
typically palpable at a rate of 6-12 cycles per minute.
Question 7
A patient presents with a somatic dysfunction that is described as "flexed, side-bent, and
rotated to the same side." According to Fryette's Laws, this is characteristic of:
A) Type I dysfunction in the neutral position
B) Type II dysfunction in the non-neutral position
C) Type III dysfunction in the neutral position
D) Type IV dysfunction in the non-neutral position
CORRECT ANSWER: B
