COMSAE PHASE 1 ASA 113
OSTEOPATHIC PRINCIPLES & OMM
PRACTICE EXAMINATION
QUESTIONS WITH CORRECT
ANSWERS PLUS RATIONALES
2026/2027 EDITION WITH INSTANT
PDF DOWNLOAD
Question 1
A 32-year-old patient presents with acute low back pain after
lifting a heavy object. Examination reveals a lumbar segment with
restricted flexion, sidebending right, and rotation right. Which
diagnosis best describes this somatic dysfunction?
A. Neutral dysfunction, rotated left and sidebent right
B. Neutral dysfunction, rotated right and sidebent left
C. Non-neutral dysfunction, flexed, rotated right, and sidebent
right
D. Non-neutral dysfunction, extended, rotated left, and sidebent
left
Correct Answer: C
Rationale: In a non-neutral lumbar dysfunction, rotation and
sidebending occur to the same side. A segment restricted in
flexion is positioned in extension, whereas a segment restricted in
,extension is positioned in flexion. The described findings
correspond to a non-neutral dysfunction involving flexion
restriction and right rotation/right sidebending.
Question 2
Which osteopathic principle states that the body possesses self-
regulatory mechanisms and the inherent capacity to heal?
A. Structure and function are reciprocally interrelated
B. The body is a unit
C. The body is capable of self-regulation, self-healing, and health
maintenance
D. Rational treatment is based on the body's response to disease
Correct Answer: C
Rationale: Osteopathic medicine recognizes that the body has
intrinsic mechanisms for self-regulation and healing. This
principle emphasizes the physician's role in identifying and
supporting these mechanisms rather than focusing exclusively on
treating isolated symptoms.
Question 3
A patient has a tender point in the right upper trapezius. The
physician positions the patient's neck to shorten the involved
muscle and maintains the position for approximately 90 seconds
before returning the patient slowly to neutral. Which technique is
being used?
A. Muscle energy
B. Counterstrain
,C. HVLA
D. Myofascial release
Correct Answer: B
Rationale: Counterstrain is an indirect technique in which the
affected tissue is positioned into a position of maximal comfort,
typically reducing tension and tenderness. The position is
maintained and the patient is then returned slowly to neutral.
Question 4
Which finding is most characteristic of a somatic dysfunction?
A. Fever
B. Tissue texture abnormality
C. Leukocytosis
D. Hyperglycemia
Correct Answer: B
Rationale: Somatic dysfunction is characterized by abnormalities
involving tissue texture, asymmetry, restriction of motion, and
tenderness. These findings are commonly summarized by the
TART mnemonic: Tissue texture abnormality, Asymmetry,
Restriction of motion, and Tenderness.
Question 5
A physician uses a technique in which the patient actively
contracts a muscle against a physician-applied counterforce.
Which osteopathic technique is being described?
, A. Counterstrain
B. Muscle energy
C. Facilitated positional release
D. Balanced ligamentous tension
Correct Answer: B
Rationale: Muscle energy is an active technique in which the
patient voluntarily contracts specific muscles against a precisely
directed counterforce supplied by the physician. It is commonly
used to improve restricted range of motion and normalize somatic
dysfunction.
Question 6
Which structure is most directly responsible for detecting
changes in muscle length?
A. Golgi tendon organ
B. Muscle spindle
C. Pacinian corpuscle
D. Ruffini ending
Correct Answer: B
Rationale: Muscle spindles detect changes in muscle length and
the rate of that change. They contribute to the stretch reflex and
are particularly important in osteopathic techniques involving
muscle tone and neuromuscular reflexes.
Question 7
A patient with a dysfunctional thoracic vertebral segment has
increased paraspinal muscle tone. Which spinal reflex is most
OSTEOPATHIC PRINCIPLES & OMM
PRACTICE EXAMINATION
QUESTIONS WITH CORRECT
ANSWERS PLUS RATIONALES
2026/2027 EDITION WITH INSTANT
PDF DOWNLOAD
Question 1
A 32-year-old patient presents with acute low back pain after
lifting a heavy object. Examination reveals a lumbar segment with
restricted flexion, sidebending right, and rotation right. Which
diagnosis best describes this somatic dysfunction?
A. Neutral dysfunction, rotated left and sidebent right
B. Neutral dysfunction, rotated right and sidebent left
C. Non-neutral dysfunction, flexed, rotated right, and sidebent
right
D. Non-neutral dysfunction, extended, rotated left, and sidebent
left
Correct Answer: C
Rationale: In a non-neutral lumbar dysfunction, rotation and
sidebending occur to the same side. A segment restricted in
flexion is positioned in extension, whereas a segment restricted in
,extension is positioned in flexion. The described findings
correspond to a non-neutral dysfunction involving flexion
restriction and right rotation/right sidebending.
Question 2
Which osteopathic principle states that the body possesses self-
regulatory mechanisms and the inherent capacity to heal?
A. Structure and function are reciprocally interrelated
B. The body is a unit
C. The body is capable of self-regulation, self-healing, and health
maintenance
D. Rational treatment is based on the body's response to disease
Correct Answer: C
Rationale: Osteopathic medicine recognizes that the body has
intrinsic mechanisms for self-regulation and healing. This
principle emphasizes the physician's role in identifying and
supporting these mechanisms rather than focusing exclusively on
treating isolated symptoms.
Question 3
A patient has a tender point in the right upper trapezius. The
physician positions the patient's neck to shorten the involved
muscle and maintains the position for approximately 90 seconds
before returning the patient slowly to neutral. Which technique is
being used?
A. Muscle energy
B. Counterstrain
,C. HVLA
D. Myofascial release
Correct Answer: B
Rationale: Counterstrain is an indirect technique in which the
affected tissue is positioned into a position of maximal comfort,
typically reducing tension and tenderness. The position is
maintained and the patient is then returned slowly to neutral.
Question 4
Which finding is most characteristic of a somatic dysfunction?
A. Fever
B. Tissue texture abnormality
C. Leukocytosis
D. Hyperglycemia
Correct Answer: B
Rationale: Somatic dysfunction is characterized by abnormalities
involving tissue texture, asymmetry, restriction of motion, and
tenderness. These findings are commonly summarized by the
TART mnemonic: Tissue texture abnormality, Asymmetry,
Restriction of motion, and Tenderness.
Question 5
A physician uses a technique in which the patient actively
contracts a muscle against a physician-applied counterforce.
Which osteopathic technique is being described?
, A. Counterstrain
B. Muscle energy
C. Facilitated positional release
D. Balanced ligamentous tension
Correct Answer: B
Rationale: Muscle energy is an active technique in which the
patient voluntarily contracts specific muscles against a precisely
directed counterforce supplied by the physician. It is commonly
used to improve restricted range of motion and normalize somatic
dysfunction.
Question 6
Which structure is most directly responsible for detecting
changes in muscle length?
A. Golgi tendon organ
B. Muscle spindle
C. Pacinian corpuscle
D. Ruffini ending
Correct Answer: B
Rationale: Muscle spindles detect changes in muscle length and
the rate of that change. They contribute to the stretch reflex and
are particularly important in osteopathic techniques involving
muscle tone and neuromuscular reflexes.
Question 7
A patient with a dysfunctional thoracic vertebral segment has
increased paraspinal muscle tone. Which spinal reflex is most
