COMSAE Section 1 OPP/OMM Practice Exam 2026 | Questions 1–30 | 150-Question Comprehensive Review

COMSAE COMPREHENSIVE EXAMINATION — 150 PRACTICE QUESTIONS


SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP/OMM) —
Questions 1–30 2026




Question 1
A 35-year-old patient presents with chronic low back pain. Physical examination reveals a
right posterior innominate rotation. Which muscle is most likely shortened?

• A) Left quadratus lumborum
• B) Right hamstrings
• C) Right iliopsoas
• D) Left gluteus maximus

Question 2
A patient with acute lumbar strain and paraspinal muscle spasm is being evaluated for
osteopathic manipulative treatment. Which technique is most appropriate as the initial
intervention?

• A) High-velocity, low-amplitude (HVLA) thrust
• B) Muscle energy technique
• C) Myofascial release
• D) Lymphatic pump technique

, Question 3
During the standing flexion test, a patient demonstrates superior movement of the right
PSIS. Which somatic dysfunction is most likely?

• A) Right sacral base anterior
• B) Right sacral base posterior
• C) Left sacral base anterior
• D) Bilateral sacral flexion

Question 4
A 45-year-old male presents with low back pain that is worse with extension and relieved
with flexion. Examination reveals a step-off deformity at the lumbosacral junction and tight
hamstrings. Which OMT technique is most appropriate?

• A) HVLA thrust to the sacrum
• B) Counterstrain to the psoas muscle
• C) Muscle energy technique to the iliopsoas and lumbar spine
• D) Myofascial release of the thoracolumbar fascia

Question 5
Which of the following best describes Fryette's first principle of spinal motion?

• A) In the neutral position, side-bending and rotation occur in opposite directions
• B) In the neutral position, side-bending and rotation occur in the same direction
• C) In the non-neutral position, side-bending and rotation occur in the same direction
• D) In the non-neutral position, only rotation occurs

, Question 6
A patient presents with TART findings at the T4 level. Viscerosomatic reflexes from which
organ are most likely responsible?

• A) Heart
• B) Stomach
• C) Gallbladder
• D) Kidney

Question 7
Which Chapman point is correctly matched with its corresponding organ?

• A) Anterior T5–T6 — Liver
• B) Anterior T3–T5 — Heart
• C) Anterior T7–T9 — Pancreas
• D) Anterior T10–T11 — Spleen

Question 8
A patient with a diagnosis of somatic dysfunction of the sacrum has a restricted sacral
sulcus on the left. What is the most likely diagnosis?

• A) Left unilateral sacral extension
• B) Left unilateral sacral flexion
• C) Right unilateral sacral flexion
• D) Bilateral sacral extension

Question 9
Which cranial bone exhibits a "torsion" strain pattern according to Sutherland's cranial
concept?

, • A) Occiput
• B) Frontal
• C) Sphenoid
• D) Temporal

Question 10
A 28-year-old female presents with chronic headaches and a history of neck trauma. Cranial
examination reveals a restricted sphenobasilar synchondrosis. Which of the following is the
most appropriate indirect technique?

• A) HVLA
• B) Muscle energy
• C) Counterstrain
• D) Myofascial release

Question 11
During a lymphatic pump technique, what is the primary physiologic effect?

• A) Increased arterial perfusion
• B) Enhanced lymphatic return and immune surveillance
• C) Decreased sympathetic tone
• D) Increased venous stasis

Question 12
A patient with asthma presents with increased work of breathing. Which rib dysfunction is
most commonly associated with this condition?

• A) Rib 1
• B) Ribs 3–5