COMSAE PHASE 1 FORM 115 PRACTICE EXAM
LATEST UPDATED EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS A NEW UPDATED VERSION
LATEST 2026-2027 (VERIFIED ANSWERS) ALREADY
GRADED A+
Question 1
A patient presents with a structural exam revealing a restricted T5 segment. The segment
prefers rotation to the right and side-bending to the right. It improves when the patient slumps
forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed as Flexed.
According to Fryette's Second Law (Type II mechanics), when a single segment is in a non-
neutral position (flexion or extension), rotation and side-bending occur in the same direction.
Hence, rotation right and side-bending right yields a diagnosis of "Flexed RR SR."
Question 2
According to Fryette's first principle (Type I mechanics), when the spine is in a neutral position
(neither flexed nor extended), which of the following occurs?
,A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Rationale: Fryette's first principle (Type I mechanics) describes that when multiple vertebral
segments are in neutral position, side-bending and rotation occur in opposite directions. This is
a key distinction from Type II mechanics (non-neutral, single segment), where they move
together.
Question 3
A patient with a left anterior innominate dysfunction has an increase in standing flexion test on
the left. What is the most appropriate osteopathic treatment?
A) Isolate the left PSIS with the patient in a right sidelying position
B) Apply muscle energy to the right ilium with the patient's left leg extended
C) Use an HVLA thrust on the left anterior innominate in the direction of extension
D) Perform a direct thrust on the left innominate in the direction of flexion
Rationale: Anterior innominate dysfunction is treated by directing the force toward extension
(i.e., moving the ilium posteriorly). The patient may be positioned in left sidelying or supine with
the left leg extended.
Question 4
In muscle energy technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by the patient,
followed by relaxation and repositioning to the new barrier. This avoids muscle fatigue and
injury while effectively treating somatic dysfunction.
Question 5
During an osteopathic structural exam, you find a T4 spinous process deviated left, with right
rotation restriction. Fryette's Type II mechanics apply. Which of the following is true?
,A) The segment is in neutral position
B) Side-bending and rotation occur to opposite sides
C) The segment is in a non-neutral position (flexion or extension)
D) Multiple segments are involved
Rationale: Fryette's Type II mechanics apply to single segments in non-neutral positions (flexion
or extension), where rotation and side-bending occur to the same side.
Question 6
A patient with chronic low back pain has a right posterior innominate rotation. Which muscle is
likely shortened?
A) Left quadratus lumborum
B) Right hamstrings
C) Right iliopsoas
D) Left gluteus maximus
Rationale: A posterior innominate rotation is a shear of the ilium in which the ilium moves
posteriorly on the sacrum. In this dysfunction, the ipsilateral hamstrings are shortened, whereas
the iliopsoas is typically shortened in an anterior innominate.
Question 7
What is the primary goal of counterstrain technique?
A) To engage the restrictive barrier
B) To position the patient into a position of ease
C) To use high-velocity thrust
D) To stretch the muscle to its maximal length
Rationale: Counterstrain involves positioning the patient into a position of ease (away from the
restrictive barrier) to reduce tender point sensitivity. This indirect technique uses passive
positioning rather than active patient engagement.
Question 8
Which of the following best describes TART criteria?
A) Tenderness, Asymmetry, Range of motion, Texture
B) Tenderness, Asymmetry, Restriction, Tissue texture changes
, C) Tension, Asymmetry, Restriction, Tone
D) Temperature, Alignment, Restriction, Tenderness
Rationale: TART criteria is the foundation of the osteopathic structural exam: Tenderness (pain
on palpation), Asymmetry (structural imbalance), Restriction (limited motion), and Tissue
texture changes (abnormal tissue quality).
Question 9
A patient with asthma has tenderness at the 2nd intercostal space, right parasternal region. This
is a Chapman's reflex for which organ?
A) Kidney
B) Lung
C) Liver
D) Stomach
Rationale: The Chapman's reflex point for the lung is located in the second intercostal space on
the parasternal border. Viscerosomatic reflexes in this area are a key component of the
osteopathic structural exam in patients with pulmonary conditions.
Question 10
A patient presents with a structural exam revealing a restricted T4 segment. The segment
prefers rotation to the right and side-bending to the right. It improves when the patient extends
into spinal extension. What is the correct diagnosis?
A) T4 Neutral SR RL
B) T4 Extended RR SR
C) T4 Flexed RR SR
D) T4 Flexed RL SL
Rationale: Because the dysfunction improves in extension, the segment is diagnosed as
Extended. According to Fryette's Second Law (Type II mechanics), when a single segment is in a
non-neutral position (flexion or extension), rotation and side-bending occur in the same
direction. Hence, rotation right (RR) and side-bending right (SR) yields a diagnosis of "Extended
RR SR."
Question 11
Which muscle is tested by asking a patient to shrug their shoulders against resistance?
LATEST UPDATED EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS A NEW UPDATED VERSION
LATEST 2026-2027 (VERIFIED ANSWERS) ALREADY
GRADED A+
Question 1
A patient presents with a structural exam revealing a restricted T5 segment. The segment
prefers rotation to the right and side-bending to the right. It improves when the patient slumps
forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed as Flexed.
According to Fryette's Second Law (Type II mechanics), when a single segment is in a non-
neutral position (flexion or extension), rotation and side-bending occur in the same direction.
Hence, rotation right and side-bending right yields a diagnosis of "Flexed RR SR."
Question 2
According to Fryette's first principle (Type I mechanics), when the spine is in a neutral position
(neither flexed nor extended), which of the following occurs?
,A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Rationale: Fryette's first principle (Type I mechanics) describes that when multiple vertebral
segments are in neutral position, side-bending and rotation occur in opposite directions. This is
a key distinction from Type II mechanics (non-neutral, single segment), where they move
together.
Question 3
A patient with a left anterior innominate dysfunction has an increase in standing flexion test on
the left. What is the most appropriate osteopathic treatment?
A) Isolate the left PSIS with the patient in a right sidelying position
B) Apply muscle energy to the right ilium with the patient's left leg extended
C) Use an HVLA thrust on the left anterior innominate in the direction of extension
D) Perform a direct thrust on the left innominate in the direction of flexion
Rationale: Anterior innominate dysfunction is treated by directing the force toward extension
(i.e., moving the ilium posteriorly). The patient may be positioned in left sidelying or supine with
the left leg extended.
Question 4
In muscle energy technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by the patient,
followed by relaxation and repositioning to the new barrier. This avoids muscle fatigue and
injury while effectively treating somatic dysfunction.
Question 5
During an osteopathic structural exam, you find a T4 spinous process deviated left, with right
rotation restriction. Fryette's Type II mechanics apply. Which of the following is true?
,A) The segment is in neutral position
B) Side-bending and rotation occur to opposite sides
C) The segment is in a non-neutral position (flexion or extension)
D) Multiple segments are involved
Rationale: Fryette's Type II mechanics apply to single segments in non-neutral positions (flexion
or extension), where rotation and side-bending occur to the same side.
Question 6
A patient with chronic low back pain has a right posterior innominate rotation. Which muscle is
likely shortened?
A) Left quadratus lumborum
B) Right hamstrings
C) Right iliopsoas
D) Left gluteus maximus
Rationale: A posterior innominate rotation is a shear of the ilium in which the ilium moves
posteriorly on the sacrum. In this dysfunction, the ipsilateral hamstrings are shortened, whereas
the iliopsoas is typically shortened in an anterior innominate.
Question 7
What is the primary goal of counterstrain technique?
A) To engage the restrictive barrier
B) To position the patient into a position of ease
C) To use high-velocity thrust
D) To stretch the muscle to its maximal length
Rationale: Counterstrain involves positioning the patient into a position of ease (away from the
restrictive barrier) to reduce tender point sensitivity. This indirect technique uses passive
positioning rather than active patient engagement.
Question 8
Which of the following best describes TART criteria?
A) Tenderness, Asymmetry, Range of motion, Texture
B) Tenderness, Asymmetry, Restriction, Tissue texture changes
, C) Tension, Asymmetry, Restriction, Tone
D) Temperature, Alignment, Restriction, Tenderness
Rationale: TART criteria is the foundation of the osteopathic structural exam: Tenderness (pain
on palpation), Asymmetry (structural imbalance), Restriction (limited motion), and Tissue
texture changes (abnormal tissue quality).
Question 9
A patient with asthma has tenderness at the 2nd intercostal space, right parasternal region. This
is a Chapman's reflex for which organ?
A) Kidney
B) Lung
C) Liver
D) Stomach
Rationale: The Chapman's reflex point for the lung is located in the second intercostal space on
the parasternal border. Viscerosomatic reflexes in this area are a key component of the
osteopathic structural exam in patients with pulmonary conditions.
Question 10
A patient presents with a structural exam revealing a restricted T4 segment. The segment
prefers rotation to the right and side-bending to the right. It improves when the patient extends
into spinal extension. What is the correct diagnosis?
A) T4 Neutral SR RL
B) T4 Extended RR SR
C) T4 Flexed RR SR
D) T4 Flexed RL SL
Rationale: Because the dysfunction improves in extension, the segment is diagnosed as
Extended. According to Fryette's Second Law (Type II mechanics), when a single segment is in a
non-neutral position (flexion or extension), rotation and side-bending occur in the same
direction. Hence, rotation right (RR) and side-bending right (SR) yields a diagnosis of "Extended
RR SR."
Question 11
Which muscle is tested by asking a patient to shrug their shoulders against resistance?
