COMSAE Exam 42 Comprehensive Practice
Questions: High-Yield Q&A with Rationales
,Section 1: Osteopathic Principles & Practice (Questions 1-15)
1. A 45-year-old patient presents with low back pain. On examination, you find a somatic
dysfunction at L5 with rotation to the right and sidebending to the left. According to Fryette's laws,
this is classified as:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Non-neutral dysfunction
Answer: B) Type II dysfunction
Rationale: Fryette's Type II dysfunction occurs in a neutral position where rotation and
sidebending occur in opposite directions (rotation right, sidebending left). Type I involves rotation
and sidebending in the same direction. Type III is not a recognized classification. This
understanding is essential for OMM board preparation as it guides treatment selection and
technique application .
,2. A 32-year-old woman presents with a tension-type headache. On palpation, you note restricted
motion of the occipitoatlantal (OA) joint. Which of the following is the most appropriate osteopathic
manipulative treatment?
A) Muscle energy to the cervical spine
B) High-velocity, low-amplitude (HVLA) to the OA joint
C) Counterstrain to the suboccipital region
D) Myofascial release to the thoracic spine
Answer: C) Counterstrain to the suboccipital region
Rationale: Counterstrain is particularly effective for treating OA joint dysfunctions and tension
headaches. The technique involves positioning the patient to relieve strain on the affected
structures by placing the joint in a position of comfort. Muscle energy and HVLA may be
, appropriate for other dysfunctions but counterstrain is preferred for OA joint restrictions in tension
headaches .
3. During a thoracic spine evaluation, you identify a somatic dysfunction at T4-T6. The patient has
decreased motion in all directions. The most appropriate treatment approach is:
A) Direct HVLA
B) Indirect myofascial release
C) Counterstrain
D) Articulatory technique
Answer: B) Indirect myofascial release
Rationale: When a somatic dysfunction is restricted in all directions, indirect techniques such as
myofascial release are preferred. This allows the dysfunctional tissues to move toward ease and
Questions: High-Yield Q&A with Rationales
,Section 1: Osteopathic Principles & Practice (Questions 1-15)
1. A 45-year-old patient presents with low back pain. On examination, you find a somatic
dysfunction at L5 with rotation to the right and sidebending to the left. According to Fryette's laws,
this is classified as:
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Non-neutral dysfunction
Answer: B) Type II dysfunction
Rationale: Fryette's Type II dysfunction occurs in a neutral position where rotation and
sidebending occur in opposite directions (rotation right, sidebending left). Type I involves rotation
and sidebending in the same direction. Type III is not a recognized classification. This
understanding is essential for OMM board preparation as it guides treatment selection and
technique application .
,2. A 32-year-old woman presents with a tension-type headache. On palpation, you note restricted
motion of the occipitoatlantal (OA) joint. Which of the following is the most appropriate osteopathic
manipulative treatment?
A) Muscle energy to the cervical spine
B) High-velocity, low-amplitude (HVLA) to the OA joint
C) Counterstrain to the suboccipital region
D) Myofascial release to the thoracic spine
Answer: C) Counterstrain to the suboccipital region
Rationale: Counterstrain is particularly effective for treating OA joint dysfunctions and tension
headaches. The technique involves positioning the patient to relieve strain on the affected
structures by placing the joint in a position of comfort. Muscle energy and HVLA may be
, appropriate for other dysfunctions but counterstrain is preferred for OA joint restrictions in tension
headaches .
3. During a thoracic spine evaluation, you identify a somatic dysfunction at T4-T6. The patient has
decreased motion in all directions. The most appropriate treatment approach is:
A) Direct HVLA
B) Indirect myofascial release
C) Counterstrain
D) Articulatory technique
Answer: B) Indirect myofascial release
Rationale: When a somatic dysfunction is restricted in all directions, indirect techniques such as
myofascial release are preferred. This allows the dysfunctional tissues to move toward ease and
