COMSAE PHASE 1 FORM 113 EXAM 2026 | ACTUAL AND
CURRENTLY TESTING QUESTIONS WITH VERIFIED ANSWERS
AND RATIONALES | EXPERT VERIFIED FOR GUARANTEED PASS
| LATEST UPDATE
COVERAGE AREAS (30 TOPICS):
1. Osteopathic Principles, OMM, & Somatic Dysfunction (TART, viscerosomatic)
2. Sympathetic (T1-L2) & Parasympathetic (CN III,VII,IX,X; S2-S4) Levels
3. Chapman Reflex Points
4. Counterstrain Technique
5. Muscle Energy Technique (MET)
6. HVLA Technique
7. Myofascial Release
8. Rib Dysfunctions
9. Fryette Laws (Type I & II)
10. Lumbar & Thoracic Dysfunctions
11. Sacral Dysfunctions
12. Innominate Dysfunctions
13. Cranial OMM
14. Lymphatic Techniques
15. Cardiovascular Physiology & Pathology
16. ECG Interpretation
17. Respiratory System
18. Renal Physiology & Pathology
19. Acid-Base Disorders
20. Endocrine Disorders
21. Gastrointestinal System
22. Hematology
23. Neurology
24. Psychiatry
25. Infectious Disease
26. Immunology
27. Pharmacology
28. Biochemistry
29. Genetics
30. Integrated Clinical Reasoning
1
,SECTION 1: OSTEOPATHIC PRINCIPLES, OMM, & SOMATIC DYSFUNCTION
(Questions 1-10)
Question 1:
A patient presents with tissue texture changes, asymmetry, restriction of motion,
and tenderness at T5-T7. These findings are collectively known as which
osteopathic concept?
A) Fryette mechanics
B) TART findings
C) Chapman reflexes
D) Facilitation syndrome
Answer: B
Rationale: TART = Tissue texture changes, Asymmetry, Restriction of motion,
Tenderness — the four diagnostic criteria for somatic dysfunction.
Question 2:
A 24-year-old male has acute low back pain after lifting. Prone exam shows right
ASIS superior and right PSIS inferior. Standing flexion test positive on right.
What is the diagnosis?
A) Right anterior innominate rotation
B) Right posterior innominate rotation
C) Left superior innominate shear
D) Right superior innominate shear
Answer: B
Rationale: Positive standing flexion test localizes to right. Posterior rotation
has ASIS superior and PSIS inferior on the affected side.
Question 3:
A patient with chronic headache has a tender occipital region. Palpation reveals
increased tissue tension and decreased mobility at the occipito-atlantal joint.
This is an example of:
A) Viscerosomatic reflex
B) Somatic dysfunction
C) Chapman reflex
2
,D) Facilitated segment
Answer: B
Rationale: Somatic dysfunction is defined as impaired or altered function of
somatic structures. TART findings confirm it.
Question 4:
Which of the following best describes a viscerosomatic reflex?
A) Somatic pain referred from a visceral organ
B) Visceral pain referred from somatic structures
C) Somatic dysfunction causing visceral disease
D) Joint dysfunction causing muscle spasm
Answer: A
Rationale: Viscerosomatic reflexes occur when visceral organ pathology causes
somatic changes (tenderness, hypertonicity) in corresponding spinal segments.
Question 5:
A patient with chronic gallstones has a palpable tender point at the right
scapular region. This is an example of:
A) Somaticovisceral reflex
B) Viscerosomatic reflex
C) Chapman reflex
D) Counterstrain tender point
Answer: B
Rationale: Gallbladder pathology (visceral) refers tenderness to the right
scapular area (somatic). This is a classic viscerosomatic reflex.
Question 6:
A patient presents with a somatic dysfunction at L4. Which of the following is
the most appropriate osteopathic manipulative treatment (OMT) principle?
A) Treat the most restrictive barrier first
B) Treat the most painful area first
C) Always start with HVLA
D) Treat the spine before the extremities
3
, Answer: A
Rationale: The fundamental OMM principle is to identify and treat the
restrictive barrier(s) in the order of clinical significance.
Question 7:
A patient with a somatic dysfunction at T10 has localized muscle hypertonicity.
This hypertonicity is most likely due to:
A) Central nervous system lesion
B) Facilitated segment at the spinal cord level
C) Peripheral nerve injury
D) Direct muscle trauma
Answer: B
Rationale: Facilitation occurs when prolonged noxious input causes increased
excitability of spinal cord neurons, leading to muscle hypertonicity and
tenderness.
Question 8:
Which of the following findings is NOT part of TART criteria?
A) Asymmetry
B) Tenderness
C) Temperature change
D) Restriction
Answer: C
Rationale: TART stands for Tissue texture changes, Asymmetry, Restriction, and
Tenderness. Temperature change is a tissue texture change, but not a separate
criterion.
Question 9:
A patient has a somatic dysfunction at C5. The practitioner notes that the
dysfunction is accompanied by increased sympathetic tone. Which level of the
spinal cord is facilitating this response?
A) C5
B) T1-L2
4
CURRENTLY TESTING QUESTIONS WITH VERIFIED ANSWERS
AND RATIONALES | EXPERT VERIFIED FOR GUARANTEED PASS
| LATEST UPDATE
COVERAGE AREAS (30 TOPICS):
1. Osteopathic Principles, OMM, & Somatic Dysfunction (TART, viscerosomatic)
2. Sympathetic (T1-L2) & Parasympathetic (CN III,VII,IX,X; S2-S4) Levels
3. Chapman Reflex Points
4. Counterstrain Technique
5. Muscle Energy Technique (MET)
6. HVLA Technique
7. Myofascial Release
8. Rib Dysfunctions
9. Fryette Laws (Type I & II)
10. Lumbar & Thoracic Dysfunctions
11. Sacral Dysfunctions
12. Innominate Dysfunctions
13. Cranial OMM
14. Lymphatic Techniques
15. Cardiovascular Physiology & Pathology
16. ECG Interpretation
17. Respiratory System
18. Renal Physiology & Pathology
19. Acid-Base Disorders
20. Endocrine Disorders
21. Gastrointestinal System
22. Hematology
23. Neurology
24. Psychiatry
25. Infectious Disease
26. Immunology
27. Pharmacology
28. Biochemistry
29. Genetics
30. Integrated Clinical Reasoning
1
,SECTION 1: OSTEOPATHIC PRINCIPLES, OMM, & SOMATIC DYSFUNCTION
(Questions 1-10)
Question 1:
A patient presents with tissue texture changes, asymmetry, restriction of motion,
and tenderness at T5-T7. These findings are collectively known as which
osteopathic concept?
A) Fryette mechanics
B) TART findings
C) Chapman reflexes
D) Facilitation syndrome
Answer: B
Rationale: TART = Tissue texture changes, Asymmetry, Restriction of motion,
Tenderness — the four diagnostic criteria for somatic dysfunction.
Question 2:
A 24-year-old male has acute low back pain after lifting. Prone exam shows right
ASIS superior and right PSIS inferior. Standing flexion test positive on right.
What is the diagnosis?
A) Right anterior innominate rotation
B) Right posterior innominate rotation
C) Left superior innominate shear
D) Right superior innominate shear
Answer: B
Rationale: Positive standing flexion test localizes to right. Posterior rotation
has ASIS superior and PSIS inferior on the affected side.
Question 3:
A patient with chronic headache has a tender occipital region. Palpation reveals
increased tissue tension and decreased mobility at the occipito-atlantal joint.
This is an example of:
A) Viscerosomatic reflex
B) Somatic dysfunction
C) Chapman reflex
2
,D) Facilitated segment
Answer: B
Rationale: Somatic dysfunction is defined as impaired or altered function of
somatic structures. TART findings confirm it.
Question 4:
Which of the following best describes a viscerosomatic reflex?
A) Somatic pain referred from a visceral organ
B) Visceral pain referred from somatic structures
C) Somatic dysfunction causing visceral disease
D) Joint dysfunction causing muscle spasm
Answer: A
Rationale: Viscerosomatic reflexes occur when visceral organ pathology causes
somatic changes (tenderness, hypertonicity) in corresponding spinal segments.
Question 5:
A patient with chronic gallstones has a palpable tender point at the right
scapular region. This is an example of:
A) Somaticovisceral reflex
B) Viscerosomatic reflex
C) Chapman reflex
D) Counterstrain tender point
Answer: B
Rationale: Gallbladder pathology (visceral) refers tenderness to the right
scapular area (somatic). This is a classic viscerosomatic reflex.
Question 6:
A patient presents with a somatic dysfunction at L4. Which of the following is
the most appropriate osteopathic manipulative treatment (OMT) principle?
A) Treat the most restrictive barrier first
B) Treat the most painful area first
C) Always start with HVLA
D) Treat the spine before the extremities
3
, Answer: A
Rationale: The fundamental OMM principle is to identify and treat the
restrictive barrier(s) in the order of clinical significance.
Question 7:
A patient with a somatic dysfunction at T10 has localized muscle hypertonicity.
This hypertonicity is most likely due to:
A) Central nervous system lesion
B) Facilitated segment at the spinal cord level
C) Peripheral nerve injury
D) Direct muscle trauma
Answer: B
Rationale: Facilitation occurs when prolonged noxious input causes increased
excitability of spinal cord neurons, leading to muscle hypertonicity and
tenderness.
Question 8:
Which of the following findings is NOT part of TART criteria?
A) Asymmetry
B) Tenderness
C) Temperature change
D) Restriction
Answer: C
Rationale: TART stands for Tissue texture changes, Asymmetry, Restriction, and
Tenderness. Temperature change is a tissue texture change, but not a separate
criterion.
Question 9:
A patient has a somatic dysfunction at C5. The practitioner notes that the
dysfunction is accompanied by increased sympathetic tone. Which level of the
spinal cord is facilitating this response?
A) C5
B) T1-L2
4
