“COMSAE Form 110 – Complete Exam with Answer Key &
Step-by-Step Explanations | Ideal for COMLEX Level 1
Review”
Original COMSAE- Exam — 200 Questions
Questions 1–50: Osteopathic Principles and Practice (OMM)
1. A 45-year-old male presents with low back pain. On physical exam, you note a
somatic dysfunction at T10-T12 with tissue texture changes and restricted motion.
Which osteopathic manipulative technique is most appropriate for acute muscle spasm?
A. HVLA
B. Muscle energy
C. Counterstrain
D. Myofascial release
Correct Answer: C
Rationale: Counterstrain is a gentle, indirect technique used for acute somatic
dysfunction with muscle spasm. HVLA is contraindicated in acute spasm.
2. Which cranial nerve is associated with the occipito-atlantal (OA) joint dysfunction?
A. CN VII
B. CN X
C. CN XII
D. CN V
Correct Answer: C
Rationale: The hypoglossal nerve (CN XII) exits through the hypoglossal canal near the
occipital condyles. OA dysfunction can affect CN XII.
,3. A patient has a positive seated flexion test on the right. This indicates:
A. Right sacral torsion
B. Left sacral torsion
C. Right innominate rotation
D. Left innominate rotation
Correct Answer: A
Rationale: A positive seated flexion test on the right indicates a right sacral torsion
(sacrum rotates right on a left oblique axis).
4. Which of the following is a contraindication to HVLA?
A. Muscle spasm
B. Vertebral fracture
C. Mild osteoarthritis
D. Chronic somatic dysfunction
Correct Answer: B
Rationale: HVLA is absolutely contraindicated in vertebral fracture, severe osteoporosis,
and metastatic disease.
5. The Chapman reflex for the small intestine is located:
A. Anteriorly at the 6th intercostal space
B. Posteriorly between T6-T8
C. Anteriorly at the 10th intercostal space
D. Posteriorly at L1-L2
Correct Answer: B
Rationale: Chapman reflexes for the small intestine are located posteriorly between T6
and T8, and anteriorly at the 10th intercostal space.
6. A patient with pneumonia would most likely have a Chapman reflex at which level?
A. T1-T2
B. T3-T4
,C. T5-T7
D. T10-T12
Correct Answer: B
Rationale: Lung Chapman reflexes are located anteriorly at the 2nd intercostal space
and posteriorly at T3-T4.
7. Which of the following describes a Fryette principle?
A. Type I mechanics: sidebending and rotation in opposite directions
B. Type II mechanics: sidebending and rotation in the same direction
C. Type I mechanics occur at the apex of a curve
D. Type II mechanics are named for the sidebending
Correct Answer: A
Rationale: Fryette Type I: neutral, sidebending and rotation opposite. Type II: flexed or
extended, sidebending and rotation same.
8. A 30-year-old female presents with headache and neck pain. You find C2 rotated
right. Which motion is restricted?
A. Right rotation
B. Left rotation
C. Flexion
D. Extension
Correct Answer: B
Rationale: If C2 is rotated right, left rotation is restricted because the vertebra is stuck in
right rotation.
9. Which of the following is the primary respiratory mechanism (PRM) component?
A. Motility of the CNS
B. Mobility of the sacrum
C. Motion of the cranial bones
D. All of the above
, Correct Answer: D
Rationale: The PRM includes CNS motility, cranial bone motion, sacral motion, and
fluctuation of CSF.
10. A patient has a positive Thomas test. This indicates:
A. Hip flexor tightness
B. Hamstring tightness
C. Iliotibial band tightness
D. Rectus femoris weakness
Correct Answer: A
Rationale: The Thomas test assesses hip flexor tightness (iliopsoas, rectus femoris).
11. Which of the following is a viscerosomatic reflex for the heart?
A. T1-T4
B. T5-T9
C. T10-T12
D. L1-L2
Correct Answer: A
Rationale: Cardiac viscerosomatic reflexes are located at T1-T4.
12. A patient with asthma would most likely have somatic dysfunction at which level?
A. C3-C5
B. T1-T4
C. T5-T9
D. T10-T12
Correct Answer: B
Rationale: Lung viscerosomatic reflexes are T1-T4 (sympathetic) and C3-C5
(parasympathetic).
Step-by-Step Explanations | Ideal for COMLEX Level 1
Review”
Original COMSAE- Exam — 200 Questions
Questions 1–50: Osteopathic Principles and Practice (OMM)
1. A 45-year-old male presents with low back pain. On physical exam, you note a
somatic dysfunction at T10-T12 with tissue texture changes and restricted motion.
Which osteopathic manipulative technique is most appropriate for acute muscle spasm?
A. HVLA
B. Muscle energy
C. Counterstrain
D. Myofascial release
Correct Answer: C
Rationale: Counterstrain is a gentle, indirect technique used for acute somatic
dysfunction with muscle spasm. HVLA is contraindicated in acute spasm.
2. Which cranial nerve is associated with the occipito-atlantal (OA) joint dysfunction?
A. CN VII
B. CN X
C. CN XII
D. CN V
Correct Answer: C
Rationale: The hypoglossal nerve (CN XII) exits through the hypoglossal canal near the
occipital condyles. OA dysfunction can affect CN XII.
,3. A patient has a positive seated flexion test on the right. This indicates:
A. Right sacral torsion
B. Left sacral torsion
C. Right innominate rotation
D. Left innominate rotation
Correct Answer: A
Rationale: A positive seated flexion test on the right indicates a right sacral torsion
(sacrum rotates right on a left oblique axis).
4. Which of the following is a contraindication to HVLA?
A. Muscle spasm
B. Vertebral fracture
C. Mild osteoarthritis
D. Chronic somatic dysfunction
Correct Answer: B
Rationale: HVLA is absolutely contraindicated in vertebral fracture, severe osteoporosis,
and metastatic disease.
5. The Chapman reflex for the small intestine is located:
A. Anteriorly at the 6th intercostal space
B. Posteriorly between T6-T8
C. Anteriorly at the 10th intercostal space
D. Posteriorly at L1-L2
Correct Answer: B
Rationale: Chapman reflexes for the small intestine are located posteriorly between T6
and T8, and anteriorly at the 10th intercostal space.
6. A patient with pneumonia would most likely have a Chapman reflex at which level?
A. T1-T2
B. T3-T4
,C. T5-T7
D. T10-T12
Correct Answer: B
Rationale: Lung Chapman reflexes are located anteriorly at the 2nd intercostal space
and posteriorly at T3-T4.
7. Which of the following describes a Fryette principle?
A. Type I mechanics: sidebending and rotation in opposite directions
B. Type II mechanics: sidebending and rotation in the same direction
C. Type I mechanics occur at the apex of a curve
D. Type II mechanics are named for the sidebending
Correct Answer: A
Rationale: Fryette Type I: neutral, sidebending and rotation opposite. Type II: flexed or
extended, sidebending and rotation same.
8. A 30-year-old female presents with headache and neck pain. You find C2 rotated
right. Which motion is restricted?
A. Right rotation
B. Left rotation
C. Flexion
D. Extension
Correct Answer: B
Rationale: If C2 is rotated right, left rotation is restricted because the vertebra is stuck in
right rotation.
9. Which of the following is the primary respiratory mechanism (PRM) component?
A. Motility of the CNS
B. Mobility of the sacrum
C. Motion of the cranial bones
D. All of the above
, Correct Answer: D
Rationale: The PRM includes CNS motility, cranial bone motion, sacral motion, and
fluctuation of CSF.
10. A patient has a positive Thomas test. This indicates:
A. Hip flexor tightness
B. Hamstring tightness
C. Iliotibial band tightness
D. Rectus femoris weakness
Correct Answer: A
Rationale: The Thomas test assesses hip flexor tightness (iliopsoas, rectus femoris).
11. Which of the following is a viscerosomatic reflex for the heart?
A. T1-T4
B. T5-T9
C. T10-T12
D. L1-L2
Correct Answer: A
Rationale: Cardiac viscerosomatic reflexes are located at T1-T4.
12. A patient with asthma would most likely have somatic dysfunction at which level?
A. C3-C5
B. T1-T4
C. T5-T9
D. T10-T12
Correct Answer: B
Rationale: Lung viscerosomatic reflexes are T1-T4 (sympathetic) and C3-C5
(parasympathetic).
