COMSAE Exam 32-Style Practice: High-Yield
Questions with Answers & Rationales
Section 1: Osteopathic Principles & Practice (Questions 1-20)
,Question 1
A 32-year-old female presents with chronic headaches and neck pain. On structural exam, you
find a Type I dysfunction at C3-C5. According to Fryette's principles, which of the following best
describes this dysfunction?
A. Neutral position, rotation and sidebending in opposite directions
B. Flexed position, rotation and sidebending in same direction
C. Extended position, rotation and sidebending in opposite directions
D. Neutral position, rotation and sidebending in same direction
Answer: A
Rationale: Fryette's Type I mechanics occur in the neutral position, where rotation and
sidebending occur in opposite directions. This is the hallmark of a Type I somatic dysfunction,
which typically involves multiple vertebrae in a group curve. Type II mechanics involve flexion or
extension with rotation and sidebending in the same direction.
,Question 2
A patient with chronic low back pain has a somatic dysfunction diagnosed as a rotated innominate
on the left. You perform a muscle energy technique that engages the left gluteus maximus and
hamstrings. Which phase of muscle energy is the activating force applied?
A. Initial resting phase
B. Phase I: agonist contraction against counterforce
C. Phase II: post-isometric relaxation
D. Phase III: repositioning to barrier
Answer: B
Rationale: Muscle energy technique uses an isometric contraction of the patient's muscle against
a precise counterforce from the physician during Phase I. This is followed by relaxation during
Phase II and then movement to a new barrier in Phase III.
, Question 3
A patient presents with right upper quadrant pain. On examination, you identify a Chapman's reflex
point located at the right costochondral junction of the 6th rib. Which organ is most likely affected?
A. Liver
B. Gallbladder
C. Stomach
D. Pancreas
Answer: B
Rationale: Chapman's reflexes are viscerosomatic reflex points that present as small fascial
gangliform contractions. The gallbladder reflex point is located at the right costochondral junction
of the 6th rib. Anterior Chapman's points for the liver are at the 5th-6th intercostal spaces on the
Questions with Answers & Rationales
Section 1: Osteopathic Principles & Practice (Questions 1-20)
,Question 1
A 32-year-old female presents with chronic headaches and neck pain. On structural exam, you
find a Type I dysfunction at C3-C5. According to Fryette's principles, which of the following best
describes this dysfunction?
A. Neutral position, rotation and sidebending in opposite directions
B. Flexed position, rotation and sidebending in same direction
C. Extended position, rotation and sidebending in opposite directions
D. Neutral position, rotation and sidebending in same direction
Answer: A
Rationale: Fryette's Type I mechanics occur in the neutral position, where rotation and
sidebending occur in opposite directions. This is the hallmark of a Type I somatic dysfunction,
which typically involves multiple vertebrae in a group curve. Type II mechanics involve flexion or
extension with rotation and sidebending in the same direction.
,Question 2
A patient with chronic low back pain has a somatic dysfunction diagnosed as a rotated innominate
on the left. You perform a muscle energy technique that engages the left gluteus maximus and
hamstrings. Which phase of muscle energy is the activating force applied?
A. Initial resting phase
B. Phase I: agonist contraction against counterforce
C. Phase II: post-isometric relaxation
D. Phase III: repositioning to barrier
Answer: B
Rationale: Muscle energy technique uses an isometric contraction of the patient's muscle against
a precise counterforce from the physician during Phase I. This is followed by relaxation during
Phase II and then movement to a new barrier in Phase III.
, Question 3
A patient presents with right upper quadrant pain. On examination, you identify a Chapman's reflex
point located at the right costochondral junction of the 6th rib. Which organ is most likely affected?
A. Liver
B. Gallbladder
C. Stomach
D. Pancreas
Answer: B
Rationale: Chapman's reflexes are viscerosomatic reflex points that present as small fascial
gangliform contractions. The gallbladder reflex point is located at the right costochondral junction
of the 6th rib. Anterior Chapman's points for the liver are at the 5th-6th intercostal spaces on the
