COMSAE Phase 1 Form 114: Complete -
Question Practice Exam with Answers &
Rationales
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (Questions 1-25)
,Question 1
A 24-year-old male presents with acute lower back pain after lifting heavy boxes. Physical
examination reveals that the right L4 transverse process is more posterior than the left. The
asymmetry worsens during lumbar flexion and normalizes during lumbar extension. What is the
correct somatic dysfunction diagnosis?
A) L4 Neutral, Rotated Right, Sidebent Left
B) L4 Flexed, Rotated Left, Sidebent Left
C) L4 Extended, Rotated Right, Sidebent Right
D) L4 Extended, Rotated Left, Sidebent Left
E) L4 Neutral, Rotated Left, Sidebent Right
Answer: C) L4 Extended, Rotated Right, Sidebent Right
,Rationale: The asymmetry normalizes in extension, indicating an extension (E) somatic
dysfunction (Type II mechanics). Type II mechanics dictate that rotation and sidebending occur to
the same side. Because the right transverse process is posterior, the vertebra is rotated right (Rr)
and sidebent right (Sr), giving the diagnosis E RrSr .
Question 2
Which of the following cranial techniques is specifically designed to enhance the amplitude of the
cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Bulb compression (CV4)
C) V-spread technique
D) Frontal lift
E) Parietal lift
, Answer: B) Bulb compression (CV4)
Rationale: Compression of the fourth ventricle (CV4) is explicitly utilized to encourage fluid
movement, enhance the amplitude of the CRI, and assist with autonomic nervous system
balancing. Other techniques target specific sutural restrictions or venous drainage but do not
primarily amplify the CRI .
Question 3
A patient has restricted left rotation of the lumbar spine, with pain and muscle spasm. The seated
flexion test is negative. Which Fryette principle describes the expected coupling pattern?
A) Type I: sidebending and rotation occur to opposite sides
B) Type I: sidebending and rotation occur to the same side
C) Type II: sidebending and rotation occur to opposite sides
D) Type II: sidebending and rotation occur to the same side
Question Practice Exam with Answers &
Rationales
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (Questions 1-25)
,Question 1
A 24-year-old male presents with acute lower back pain after lifting heavy boxes. Physical
examination reveals that the right L4 transverse process is more posterior than the left. The
asymmetry worsens during lumbar flexion and normalizes during lumbar extension. What is the
correct somatic dysfunction diagnosis?
A) L4 Neutral, Rotated Right, Sidebent Left
B) L4 Flexed, Rotated Left, Sidebent Left
C) L4 Extended, Rotated Right, Sidebent Right
D) L4 Extended, Rotated Left, Sidebent Left
E) L4 Neutral, Rotated Left, Sidebent Right
Answer: C) L4 Extended, Rotated Right, Sidebent Right
,Rationale: The asymmetry normalizes in extension, indicating an extension (E) somatic
dysfunction (Type II mechanics). Type II mechanics dictate that rotation and sidebending occur to
the same side. Because the right transverse process is posterior, the vertebra is rotated right (Rr)
and sidebent right (Sr), giving the diagnosis E RrSr .
Question 2
Which of the following cranial techniques is specifically designed to enhance the amplitude of the
cranial rhythmic impulse (CRI)?
A) Venous sinus traction
B) Bulb compression (CV4)
C) V-spread technique
D) Frontal lift
E) Parietal lift
, Answer: B) Bulb compression (CV4)
Rationale: Compression of the fourth ventricle (CV4) is explicitly utilized to encourage fluid
movement, enhance the amplitude of the CRI, and assist with autonomic nervous system
balancing. Other techniques target specific sutural restrictions or venous drainage but do not
primarily amplify the CRI .
Question 3
A patient has restricted left rotation of the lumbar spine, with pain and muscle spasm. The seated
flexion test is negative. Which Fryette principle describes the expected coupling pattern?
A) Type I: sidebending and rotation occur to opposite sides
B) Type I: sidebending and rotation occur to the same side
C) Type II: sidebending and rotation occur to opposite sides
D) Type II: sidebending and rotation occur to the same side
