COMSAE PHASE 1 FORM 114 Actual
EXAM – 120 QUESTIONS AND
ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS
RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE | | EXAM PREP
| STUDY GUIDE | PRACTICE TEST
🧑 Domain 1: Osteopathic Principles & Practice (OPP)
1. A patient presents with a somatic dysfunction of the
sacrum. You note that the left sulcus is deeper than the
right, and the left ILA is more posterior than the right.
What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right On Left Torsion
C. Left On Right Torsion
D. Bilateral Sacral Flexion
✅ Correct Answer: C
Rationale: A deep sulcus and posterior ILA on the same side
indicate a forward sacral torsion about an oblique axis. The
naming convention is "side of the deep sulcus" on "side of the
posterior ILA".
2. Which of the following cranial techniques is specifically
designed to enhance the amplitude of the cranial
, rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV4)
C. V-spread technique
D. Frontal lift
✅ Correct Answer: B
Rationale: Compression of the fourth ventricle (CV4) is explicitly
utilized to encourage fluid movement, enhance CRI amplitude,
and assist with autonomic nervous system balancing.
3. A 24-year-old male presents with acute lower back pain
after lifting heavy boxes. Physical examination reveals
that the right L4 transverse process is more posterior
than the left. The asymmetry normalizes in extension.
What is the correct somatic dysfunction?
A. L4 Neutral, Rotated Right, Sidebent Left
B. L4 Flexed, Rotated Left, Sidebent Left
C. L4 Extended, Rotated Right, Sidebent Right
D. L4 Extended, Rotated Left, Sidebent Left
✅ Correct Answer: C
Rationale: The asymmetry normalizes in extension, indicating an
extension (E) somatic dysfunction (Type II mechanics). Type II
mechanics dictate that rotation and sidebending occur to the
same side. Because the right transverse process is posterior, the
vertebra is rotated right and sidebent right.
4. A 45-year-old male presents with chronic low back pain.
During the osteopathic structural exam, you find that the
patient's right iliac crest is superior to the left in the
standing position, and the right ASIS is inferior to the left
, in the supine position. What is the most likely somatic
dysfunction?
A. Right on Left Forward Torsion
B. Left on Right Forward Torsion
C. Right on Left Backward Torsion
D. Left on Right Backward Torsion
✅ Correct Answer: A
Rationale: In a forward torsion, the innominate rotates anteriorly.
The side with the superior PSIS in standing is the side of the
anterior rotation. Here, the right PSIS is superior and the right
ASIS is inferior (anterior rotation). The dysfunction is named for
the side of the anterior innominate relative to the oblique axis.
5. A patient presents with a somatic dysfunction of the
sacrum. You note that the left sulcus is deeper than the
right, and the left ILA is more posterior than the right.
What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right On Left Torsion
C. Left On Right Torsion
D. Bilateral Sacral Flexion
✅ Correct Answer: C
Rationale: A deep sulcus and posterior ILA on the same side
indicate a forward sacral torsion about an oblique axis. The
naming convention is "side of the deep sulcus" on "side of the
posterior ILA".
6. A 45-year-old female presents with pain along the medial
aspect of her right knee. Palpation reveals a tender point
on the medial surface of the tibia, approximately 2 cm
, below the joint line, at the insertion of the pes anserinus.
Which position is used for counterstrain treatment?
A. Flexion, abduction, internal rotation of the hip
B. Extension, abduction, external rotation of the hip
C. Flexion, adduction, internal rotation of the hip
D. Extension, adduction, external rotation of the hip
✅ Correct Answer: A
Rationale: The described tender point is for the pes anserinus. The
counterstrain treatment position for this muscle group involves
flexion, abduction, and internal rotation of the hip to shorten the
involved muscles (sartorius, gracilis, semitendinosus).
7. A 24-year-old male presents with a cough, fever, and
rusty sputum. Physical exam reveals increased tactile
fremitus, dullness to percussion, and bronchial breath
sounds over the right lower lung field. OMM exam shows
tissue texture changes and somatic dysfunction from T2
to T4 on the right. Viscerosomatic reflex signaling from
this pathology travels through which nervous system
pathways?
A. Vagus nerve to the celiac ganglion
B. Greater splanchnic nerve to the superior mesenteric
ganglion
C. Sympathetic postganglionic fibers via the cardiopulmonary
splanchnic nerves
D. Pelvic splanchnic nerves to the inferior mesenteric plexus
✅ Correct Answer: C
Rationale: The patient exhibits classic signs of lobar pneumonia,
which causes a viscerosomatic reflex originating from lung tissue.
Sympathetic innervation to the lungs arises from the T1 to T4
EXAM – 120 QUESTIONS AND
ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS
RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE | | EXAM PREP
| STUDY GUIDE | PRACTICE TEST
🧑 Domain 1: Osteopathic Principles & Practice (OPP)
1. A patient presents with a somatic dysfunction of the
sacrum. You note that the left sulcus is deeper than the
right, and the left ILA is more posterior than the right.
What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right On Left Torsion
C. Left On Right Torsion
D. Bilateral Sacral Flexion
✅ Correct Answer: C
Rationale: A deep sulcus and posterior ILA on the same side
indicate a forward sacral torsion about an oblique axis. The
naming convention is "side of the deep sulcus" on "side of the
posterior ILA".
2. Which of the following cranial techniques is specifically
designed to enhance the amplitude of the cranial
, rhythmic impulse (CRI)?
A. Venous sinus traction
B. Bulb compression (CV4)
C. V-spread technique
D. Frontal lift
✅ Correct Answer: B
Rationale: Compression of the fourth ventricle (CV4) is explicitly
utilized to encourage fluid movement, enhance CRI amplitude,
and assist with autonomic nervous system balancing.
3. A 24-year-old male presents with acute lower back pain
after lifting heavy boxes. Physical examination reveals
that the right L4 transverse process is more posterior
than the left. The asymmetry normalizes in extension.
What is the correct somatic dysfunction?
A. L4 Neutral, Rotated Right, Sidebent Left
B. L4 Flexed, Rotated Left, Sidebent Left
C. L4 Extended, Rotated Right, Sidebent Right
D. L4 Extended, Rotated Left, Sidebent Left
✅ Correct Answer: C
Rationale: The asymmetry normalizes in extension, indicating an
extension (E) somatic dysfunction (Type II mechanics). Type II
mechanics dictate that rotation and sidebending occur to the
same side. Because the right transverse process is posterior, the
vertebra is rotated right and sidebent right.
4. A 45-year-old male presents with chronic low back pain.
During the osteopathic structural exam, you find that the
patient's right iliac crest is superior to the left in the
standing position, and the right ASIS is inferior to the left
, in the supine position. What is the most likely somatic
dysfunction?
A. Right on Left Forward Torsion
B. Left on Right Forward Torsion
C. Right on Left Backward Torsion
D. Left on Right Backward Torsion
✅ Correct Answer: A
Rationale: In a forward torsion, the innominate rotates anteriorly.
The side with the superior PSIS in standing is the side of the
anterior rotation. Here, the right PSIS is superior and the right
ASIS is inferior (anterior rotation). The dysfunction is named for
the side of the anterior innominate relative to the oblique axis.
5. A patient presents with a somatic dysfunction of the
sacrum. You note that the left sulcus is deeper than the
right, and the left ILA is more posterior than the right.
What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right On Left Torsion
C. Left On Right Torsion
D. Bilateral Sacral Flexion
✅ Correct Answer: C
Rationale: A deep sulcus and posterior ILA on the same side
indicate a forward sacral torsion about an oblique axis. The
naming convention is "side of the deep sulcus" on "side of the
posterior ILA".
6. A 45-year-old female presents with pain along the medial
aspect of her right knee. Palpation reveals a tender point
on the medial surface of the tibia, approximately 2 cm
, below the joint line, at the insertion of the pes anserinus.
Which position is used for counterstrain treatment?
A. Flexion, abduction, internal rotation of the hip
B. Extension, abduction, external rotation of the hip
C. Flexion, adduction, internal rotation of the hip
D. Extension, adduction, external rotation of the hip
✅ Correct Answer: A
Rationale: The described tender point is for the pes anserinus. The
counterstrain treatment position for this muscle group involves
flexion, abduction, and internal rotation of the hip to shorten the
involved muscles (sartorius, gracilis, semitendinosus).
7. A 24-year-old male presents with a cough, fever, and
rusty sputum. Physical exam reveals increased tactile
fremitus, dullness to percussion, and bronchial breath
sounds over the right lower lung field. OMM exam shows
tissue texture changes and somatic dysfunction from T2
to T4 on the right. Viscerosomatic reflex signaling from
this pathology travels through which nervous system
pathways?
A. Vagus nerve to the celiac ganglion
B. Greater splanchnic nerve to the superior mesenteric
ganglion
C. Sympathetic postganglionic fibers via the cardiopulmonary
splanchnic nerves
D. Pelvic splanchnic nerves to the inferior mesenteric plexus
✅ Correct Answer: C
Rationale: The patient exhibits classic signs of lobar pneumonia,
which causes a viscerosomatic reflex originating from lung tissue.
Sympathetic innervation to the lungs arises from the T1 to T4
