COMLEX-USA Level 1 / COMSAE Phase 1
High-Yield Content Practice 2026 Exam 200
Questions with Bold Italic Answers &
Rationales
Section 1: Osteopathic Principles & OMM (Questions 1–30)
1. A 35-year-old with chronic low back pain has a somatic dysfunction of the lumbar spine
characterized by ease of side-bending to the right and restriction of side-bending to the
left. According to the Fryette laws, this most likely represents:
A) Type I dysfunction (neutral mechanics)
B) Type II dysfunction (non-neutral mechanics)
C) Type III dysfunction (somatic dysfunction)
D) A normal functional spinal unit
Answer: B (Type II dysfunction (non-neutral mechanics))
Rationale: Fryette’s 2nd law states that when the spine is in a non-neutral position (flexed
or extended), side-bending and rotation occur in opposite directions. Restriction of
side-bending to one side indicates a Type II dysfunction.
2. A 28-year-old presents with acute torticollis after sleeping in an awkward position.
Cervical examination shows the head rotated to the left and side-bent to the right. The
most likely diagnosis is:
A) Right rotated, right side-bent somatic dysfunction
B) Left rotated, left side-bent somatic dysfunction
C) Left rotated, right side-bent somatic dysfunction
D) Right rotated, left side-bent somatic dysfunction
*Answer: D (Right rotated, left side-bent somatic dysfunction) *
Rationale: In acute torticollis, the patient presents with rotation toward the side of pain
and side-bending away from the side of pain (rotation R, side-bending L). This follows
Fryette’s Type II mechanics.
3. A patient with asthma is found to have increased tension in the paraspinal muscles
from T2–T5 with restricted rib elevation on inspiration. Which Chapman reflex point
would be most likely tender?
A) Posterior interosseous membrane of the forearm
,B) Tip of the 12th rib (posterior)
C) Intercostal space, 2nd rib, near the sternal border (anterior)
D) Lateral epicondyle of the humerus
*Answer: C (Intercostal space, 2nd rib, near the sternal border – anterior) *
Rationale: Anterior Chapman reflexes for bronchial/lung pathology are located in the 2nd
intercostal space near the sternum. These neuro-lymphatic reflexes correlate with visceral
dysfunction.
4. A patient with chronic sinusitis has tender points in the nasal mucosa and along the
sphenoid region. Which osteopathic technique is specifically designed to address
sphenobasilar dysfunction?
A) Counterstrain
B) Still technique
C) Balanced ligamentous tension (BLT) of the cranial base
D) High-velocity low-amplitude (HVLA)
*Answer: C (Balanced ligamentous tension (BLT) of the cranial base) *
Rationale: Cranial osteopathy uses BLT to normalize the sphenobasilar synchondrosis and
cranial rhythmic impulse, often addressing sinus and other head/neck complaints.
5. A 45-year-old with chronic tension headaches has restricted occipitoatlantal extension
and side-bending to the right. According to the Sutherland fulcrum, the most appropriate
treatment direction is:
A) Compress the occiput into extension
B) Induce a flexion and left side-bending strain
C) Perform a right rotation HVLA
D) Apply direct pressure to the mastoid process
*Answer: B (Induce a flexion and left side-bending strain) *
Rationale: The Sutherland fulcrum concept suggests balancing the occipitoatlantal joint
by treating into the directions of restriction. If extension and right side-bending are
restricted, induce flexion and left side-bending.
6. A 30-year-old with mechanical low back pain is found to have a deep tender point in
the gluteus medius. The most appropriate counterstrain treatment position is:
A) Externally rotate and abduct the hip
B) Internally rotate and adduct the hip
C) Flex and internally rotate the hip
D) Extend and abduct the hip
,*Answer: B (Internally rotate and adduct the hip) *
Rationale: For a tender point in the gluteus medius, counterstrain position typically
shortens the muscle: internal rotation and adduction of the hip.
7. A patient with gastroesophageal reflux disease (GERD) has a tender point near the
xiphoid process. This Chapman reflex is associated with:
A) Stomach dysfunction (anterior, 5th–6th intercostal space)
B) Liver dysfunction (anterior, right 6th rib)
C) Kidney dysfunction (posterior, 12th rib tip)
D) Spleen dysfunction (anterior, left 8th rib)
*Answer: A (Stomach dysfunction – anterior, 5th–6th intercostal space) *
Rationale: Anterior Chapman reflex for stomach pathology is located in the 5th–6th
intercostal space near the sternum, often tender in GERD or gastritis.
8. A 22-year-old with acute ankle inversion injury has pain and edema over the lateral
malleolus. According to osteopathic principles, the FIRST step in management should be:
A) Immediate HVLA of the talus
B) Rest, ice, compression, elevation (RICE)
C) Lateral ankle counterstrain
D) Cranial sacral therapy
*Answer: B (Rest, ice, compression, elevation – RICE) *
Rationale: Osteopathic principles emphasize the body’s self-healing mechanism. Acute
inflammation must be managed first; manipulative treatment is best applied after the
acute inflammatory phase.
9. A patient with chronic constipation has a tender, boggy Chapman reflex in the left
lower quadrant. This is associated with dysfunction of:
A) Small intestine
B) Descending colon
C) Liver
D) Kidney
*Answer: B (Descending colon) *
Rationale: The Chapman reflex for the descending colon is located in the left lower
quadrant near McBurney’s point (or slightly inferior). Viscerosomatic reflexes often
accompany colonic dysfunction.
10. A 50-year-old with chronic low back pain has a positive standing flexion test on the
right. The most likely somatic dysfunction is:
A) Right anterior innominate rotation
, B) Left anterior innominate rotation
C) Right sacroiliac joint dysfunction with restricted motion
D) Bilateral sacroiliac dysfunction
*Answer: A (Right anterior innominate rotation) *
Rationale: A standing flexion test that is positive on the right indicates that the right
innominate fails to move posteriorly relative to the sacrum, consistent with a right
anterior innominate rotation.
11. A patient with right-sided sciatica has a seated flexion test that is positive on the right.
The most likely finding is:
A) Right anterior innominate rotation
B) Left posterior innominate rotation
C) Sacral torsion about an oblique axis
D) Bilateral sacroiliac joint dysfunction
*Answer: C (Sacral torsion about an oblique axis) *
Rationale: A seated flexion test removes innominate contribution; a positive test indicates
a sacral base dysfunction, often a torsion about an oblique axis (L on L, R on R, etc.).
12. A 34-year-old with acute lumbar strain has a tender point in the quadratus lumborum.
The most appropriate counterstrain position is:
A) Side-bend the patient toward the tender point while slightly flexing the trunk
B) Side-bend the patient away from the tender point and extend the trunk
C) Rotate the trunk toward the tender point and flex the hip
D) Extend and rotate the trunk away
*Answer: A (Side-bend toward the tender point while slightly flexing the trunk) *
Rationale: Counterstrain for the quadratus lumborum involves side-bending toward the
tender point to shorten the muscle and relieve the strain.
13. A patient with chronic migraines has decreased cranial rhythmic impulse amplitude.
Which osteopathic technique is most appropriate to normalize this finding?
A) Myofascial release of the cervical paraspinals
B) Balanced membranous tension (BMT) at the occipitomastoid suture
C) HVLA of the atlanto-occipital joint
D) Muscle energy to the sternocleidomastoid
*Answer: B (Balanced membranous tension (BMT) at the occipitomastoid suture) *
Rationale: BMT is a cranial technique used to normalize the dural membranes and restore
cranial rhythmic impulse.
High-Yield Content Practice 2026 Exam 200
Questions with Bold Italic Answers &
Rationales
Section 1: Osteopathic Principles & OMM (Questions 1–30)
1. A 35-year-old with chronic low back pain has a somatic dysfunction of the lumbar spine
characterized by ease of side-bending to the right and restriction of side-bending to the
left. According to the Fryette laws, this most likely represents:
A) Type I dysfunction (neutral mechanics)
B) Type II dysfunction (non-neutral mechanics)
C) Type III dysfunction (somatic dysfunction)
D) A normal functional spinal unit
Answer: B (Type II dysfunction (non-neutral mechanics))
Rationale: Fryette’s 2nd law states that when the spine is in a non-neutral position (flexed
or extended), side-bending and rotation occur in opposite directions. Restriction of
side-bending to one side indicates a Type II dysfunction.
2. A 28-year-old presents with acute torticollis after sleeping in an awkward position.
Cervical examination shows the head rotated to the left and side-bent to the right. The
most likely diagnosis is:
A) Right rotated, right side-bent somatic dysfunction
B) Left rotated, left side-bent somatic dysfunction
C) Left rotated, right side-bent somatic dysfunction
D) Right rotated, left side-bent somatic dysfunction
*Answer: D (Right rotated, left side-bent somatic dysfunction) *
Rationale: In acute torticollis, the patient presents with rotation toward the side of pain
and side-bending away from the side of pain (rotation R, side-bending L). This follows
Fryette’s Type II mechanics.
3. A patient with asthma is found to have increased tension in the paraspinal muscles
from T2–T5 with restricted rib elevation on inspiration. Which Chapman reflex point
would be most likely tender?
A) Posterior interosseous membrane of the forearm
,B) Tip of the 12th rib (posterior)
C) Intercostal space, 2nd rib, near the sternal border (anterior)
D) Lateral epicondyle of the humerus
*Answer: C (Intercostal space, 2nd rib, near the sternal border – anterior) *
Rationale: Anterior Chapman reflexes for bronchial/lung pathology are located in the 2nd
intercostal space near the sternum. These neuro-lymphatic reflexes correlate with visceral
dysfunction.
4. A patient with chronic sinusitis has tender points in the nasal mucosa and along the
sphenoid region. Which osteopathic technique is specifically designed to address
sphenobasilar dysfunction?
A) Counterstrain
B) Still technique
C) Balanced ligamentous tension (BLT) of the cranial base
D) High-velocity low-amplitude (HVLA)
*Answer: C (Balanced ligamentous tension (BLT) of the cranial base) *
Rationale: Cranial osteopathy uses BLT to normalize the sphenobasilar synchondrosis and
cranial rhythmic impulse, often addressing sinus and other head/neck complaints.
5. A 45-year-old with chronic tension headaches has restricted occipitoatlantal extension
and side-bending to the right. According to the Sutherland fulcrum, the most appropriate
treatment direction is:
A) Compress the occiput into extension
B) Induce a flexion and left side-bending strain
C) Perform a right rotation HVLA
D) Apply direct pressure to the mastoid process
*Answer: B (Induce a flexion and left side-bending strain) *
Rationale: The Sutherland fulcrum concept suggests balancing the occipitoatlantal joint
by treating into the directions of restriction. If extension and right side-bending are
restricted, induce flexion and left side-bending.
6. A 30-year-old with mechanical low back pain is found to have a deep tender point in
the gluteus medius. The most appropriate counterstrain treatment position is:
A) Externally rotate and abduct the hip
B) Internally rotate and adduct the hip
C) Flex and internally rotate the hip
D) Extend and abduct the hip
,*Answer: B (Internally rotate and adduct the hip) *
Rationale: For a tender point in the gluteus medius, counterstrain position typically
shortens the muscle: internal rotation and adduction of the hip.
7. A patient with gastroesophageal reflux disease (GERD) has a tender point near the
xiphoid process. This Chapman reflex is associated with:
A) Stomach dysfunction (anterior, 5th–6th intercostal space)
B) Liver dysfunction (anterior, right 6th rib)
C) Kidney dysfunction (posterior, 12th rib tip)
D) Spleen dysfunction (anterior, left 8th rib)
*Answer: A (Stomach dysfunction – anterior, 5th–6th intercostal space) *
Rationale: Anterior Chapman reflex for stomach pathology is located in the 5th–6th
intercostal space near the sternum, often tender in GERD or gastritis.
8. A 22-year-old with acute ankle inversion injury has pain and edema over the lateral
malleolus. According to osteopathic principles, the FIRST step in management should be:
A) Immediate HVLA of the talus
B) Rest, ice, compression, elevation (RICE)
C) Lateral ankle counterstrain
D) Cranial sacral therapy
*Answer: B (Rest, ice, compression, elevation – RICE) *
Rationale: Osteopathic principles emphasize the body’s self-healing mechanism. Acute
inflammation must be managed first; manipulative treatment is best applied after the
acute inflammatory phase.
9. A patient with chronic constipation has a tender, boggy Chapman reflex in the left
lower quadrant. This is associated with dysfunction of:
A) Small intestine
B) Descending colon
C) Liver
D) Kidney
*Answer: B (Descending colon) *
Rationale: The Chapman reflex for the descending colon is located in the left lower
quadrant near McBurney’s point (or slightly inferior). Viscerosomatic reflexes often
accompany colonic dysfunction.
10. A 50-year-old with chronic low back pain has a positive standing flexion test on the
right. The most likely somatic dysfunction is:
A) Right anterior innominate rotation
, B) Left anterior innominate rotation
C) Right sacroiliac joint dysfunction with restricted motion
D) Bilateral sacroiliac dysfunction
*Answer: A (Right anterior innominate rotation) *
Rationale: A standing flexion test that is positive on the right indicates that the right
innominate fails to move posteriorly relative to the sacrum, consistent with a right
anterior innominate rotation.
11. A patient with right-sided sciatica has a seated flexion test that is positive on the right.
The most likely finding is:
A) Right anterior innominate rotation
B) Left posterior innominate rotation
C) Sacral torsion about an oblique axis
D) Bilateral sacroiliac joint dysfunction
*Answer: C (Sacral torsion about an oblique axis) *
Rationale: A seated flexion test removes innominate contribution; a positive test indicates
a sacral base dysfunction, often a torsion about an oblique axis (L on L, R on R, etc.).
12. A 34-year-old with acute lumbar strain has a tender point in the quadratus lumborum.
The most appropriate counterstrain position is:
A) Side-bend the patient toward the tender point while slightly flexing the trunk
B) Side-bend the patient away from the tender point and extend the trunk
C) Rotate the trunk toward the tender point and flex the hip
D) Extend and rotate the trunk away
*Answer: A (Side-bend toward the tender point while slightly flexing the trunk) *
Rationale: Counterstrain for the quadratus lumborum involves side-bending toward the
tender point to shorten the muscle and relieve the strain.
13. A patient with chronic migraines has decreased cranial rhythmic impulse amplitude.
Which osteopathic technique is most appropriate to normalize this finding?
A) Myofascial release of the cervical paraspinals
B) Balanced membranous tension (BMT) at the occipitomastoid suture
C) HVLA of the atlanto-occipital joint
D) Muscle energy to the sternocleidomastoid
*Answer: B (Balanced membranous tension (BMT) at the occipitomastoid suture) *
Rationale: BMT is a cranial technique used to normalize the dural membranes and restore
cranial rhythmic impulse.
