COMSAE Phase 1 Form 113: High-Yield
Questions with Answers & Rationales
Section 1: Osteopathic Principles and Practice (Questions 1-15)
Question 1
,A 34-year-old male presents with chronic low back pain. You identify a somatic dysfunction of the
lumbar spine where the vertebral body is rotated to the left of the midline and sidebent to the right.
According to Type I (neutral) mechanics of Fryette's Laws, this describes which dysfunction?
A) E-N (Extended-Neutral)
B) F-R (Flexed-Rotated)
C) N-R (Neutral-Rotated)
D) Type I dysfunction
Answer: D) Type I dysfunction
Rationale: Fryette's Law I states that in the neutral position (neither flexed nor extended),
sidebending and rotation occur in opposite directions. The description "rotated left, sidebent right"
is the classic definition of a Type I (neutral) somatic dysfunction. Type I mechanics typically
involve groups of vertebrae rather than single segments .
,Question 2
A 45-year-old female with a history of asthma presents for OMT to improve respiratory function.
You wish to increase thoracic inlet diameter and decrease respiratory rate via the parasympathetic
nervous system. Which technique is most specific for this goal?
A) Lumbar paraspinal inhibition
B) Rib raising
C) Cervical ganglion release
D) Sacral rocking
Answer: C) Cervical ganglion release
Rationale: Cervical ganglion release directly targets the vagus nerve (parasympathetic) influence
on the lungs and heart, reducing bronchospasm and anxiety. Rib raising addresses sympathetic
facilitation in the thoracic spine, while cervical ganglion release specifically enhances
parasympathetic tone .
, Question 3
During a structural exam, you ask the patient to touch their left shoulder with their right hand while
you stabilize the left shoulder. You then apply pressure to the right elbow, asking them to resist.
This describes a muscle energy treatment for which muscle?
A) Pectoralis major
B) Rhomboids
C) Upper trapezius
D) Teres major
Answer: C) Upper trapezius
Questions with Answers & Rationales
Section 1: Osteopathic Principles and Practice (Questions 1-15)
Question 1
,A 34-year-old male presents with chronic low back pain. You identify a somatic dysfunction of the
lumbar spine where the vertebral body is rotated to the left of the midline and sidebent to the right.
According to Type I (neutral) mechanics of Fryette's Laws, this describes which dysfunction?
A) E-N (Extended-Neutral)
B) F-R (Flexed-Rotated)
C) N-R (Neutral-Rotated)
D) Type I dysfunction
Answer: D) Type I dysfunction
Rationale: Fryette's Law I states that in the neutral position (neither flexed nor extended),
sidebending and rotation occur in opposite directions. The description "rotated left, sidebent right"
is the classic definition of a Type I (neutral) somatic dysfunction. Type I mechanics typically
involve groups of vertebrae rather than single segments .
,Question 2
A 45-year-old female with a history of asthma presents for OMT to improve respiratory function.
You wish to increase thoracic inlet diameter and decrease respiratory rate via the parasympathetic
nervous system. Which technique is most specific for this goal?
A) Lumbar paraspinal inhibition
B) Rib raising
C) Cervical ganglion release
D) Sacral rocking
Answer: C) Cervical ganglion release
Rationale: Cervical ganglion release directly targets the vagus nerve (parasympathetic) influence
on the lungs and heart, reducing bronchospasm and anxiety. Rib raising addresses sympathetic
facilitation in the thoracic spine, while cervical ganglion release specifically enhances
parasympathetic tone .
, Question 3
During a structural exam, you ask the patient to touch their left shoulder with their right hand while
you stabilize the left shoulder. You then apply pressure to the right elbow, asking them to resist.
This describes a muscle energy treatment for which muscle?
A) Pectoralis major
B) Rhomboids
C) Upper trapezius
D) Teres major
Answer: C) Upper trapezius
