COMSAE PHASE 1 FORM 114 ACTUAL EXAM Verified Q&A
Study Guide with Detailed Rationales 2026-2027
Section 1: Osteopathic Manipulative Medicine (OMM) &
Principles
Q1: A 45-year-old male presents with complaints of recurrent sore
throats. Physical examination reveals palpable tissue texture changes,
tenderness, and edema over the transverse processes of T2-T5 on the
right. Which viscerosomatic reflex is most likely associated with these
findings?
A) Cardiac
B) Pulmonary
C) Gastric
D) Hepatic
CORRECT ANSWER>: B) Pulmonary.
Rationale: T2-T5 sympathetic innervation correlates with the pulmonary
system (lungs and bronchi). T1-T5 is the classic "thoracic inlet" area for
respiratory and cardiac issues, but T2-T5 specifically maps to the lungs.
Upper cervical (C1-C4) and upper thoracic (T1-T4) reflexes are
commonly associated with head, neck, and upper respiratory infections.
Q2: During an osteopathic structural examination, the physician notes
that the patient’s left transverse process of L5 is more prominent
(posterior) than the right, and the patient’s torso rotates left when
seated. Which somatic dysfunction is present?
,A) L5 Extended, Rotated Right, Sidebent Right (ERRR)
B) L5 Flexed, Rotated Left, Sidebent Left (FRLS)
C) L5 Flexed, Rotated Right, Sidebent Right (FRRS)
D) L5 Extended, Rotated Left, Sidebent Left (ERLS)
CORRECT ANSWER>: B) L5 Flexed, Rotated Left, Sidebent Left (FRLS).
Rationale: In non-neutral (flexed or extended) dysfunctions, the rule of
Fryette (Type II mechanics) applies: the segment rotates and sidebends
to the same side. A prominent left transverse process indicates rotation
to the left. Since the torso is rotated left in the seated (flexed) position,
the segment is flexed. Therefore, it is FRLS.
Q3: Which of the following osteopathic techniques utilizes the
principles of reciprocal inhibition to treat a somatic dysfunction?
A) High-Velocity, Low-Amplitude (HVLA)
B) Muscle Energy
C) Counterstrain
D) Myofascial Release
CORRECT ANSWER>: B) Muscle Energy.
Rationale: Muscle Energy Technique (MET) uses the concept of
reciprocal inhibition. If an agonist muscle is contracting, the antagonist
muscle must relax. By having the patient contract the agonist against a
counterforce, the physician takes advantage of the involuntary
relaxation of the antagonist (the restrictive barrier) to stretch it.
,Q4: A physician is treating a patient with a tender point at the right
anterior 3rd rib. The patient is positioned to minimize the tenderness.
After holding the position for 90 seconds, the physician slowly returns
the patient to a neutral position. Which technique was used?
A) Facilitated Positional Release
B) Counterstrain
C) Balanced Ligamentous Tension
D) Articulatory Technique
CORRECT ANSWER>: B) Counterstrain.
Rationale: Counterstrain involves finding a tender point, positioning the
patient in a position of comfort (exaggerating the position of ease) to
shorten the agonist muscle, holding for 90 seconds, and slowly
returning to neutral. This resets the proprioceptors and breaks the pain
cycle.
Q5: What is the primary physiological effect of the osteopathic
technique known as "Still Technique"?
A) Rhythmic articulation to pump lymphatic fluid
B) Direct myofascial stretching to release fascial restrictions
C) A specific, passive, indirect-to-direct technique that uses a fulcrum to
disengage a restrictive barrier
D) Active resisted contraction to strengthen weakened muscles
, CORRECT ANSWER>: C) A specific, passive, indirect-to-direct technique
that uses a fulcrum to disengage a restrictive barrier.
Rationale: Still Technique is a hybrid indirect-to-direct technique. The
physician finds the position of ease (indirect), applies a fulcrum, and
then actively moves the patient through the restrictive barrier (direct)
in a specific arc to resolve the somatic dysfunction.
Q6: The Chapman’s reflex for the adrenal glands is located:
A) In the upper thoracic region (T1-T4)
B) At the 2nd intercostal space near the sternum
C) In the lumbar region (L1-L2)
D) In the sacral region (S2-S4)
CORRECT ANSWER>: B) At the 2nd intercostal space near the sternum.
Rationale: Chapman’s reflexes are gangliform contractions (tender
points) found on the anterior chest wall. The anterior Chapman’s point
for the adrenals is located in the 2nd intercostal space, close to the
sternum. The posterior point is at the spinous process of T2.
Q7: During the cranial rhythmic impulse (CRI) assessment, the physician
palpates a decreased amplitude and rate. This is most consistent with:
A) Hyperactive sympathetic nervous system
B) Compression of the 4th ventricle (CV4)
C) Parasympathetic dominance
Study Guide with Detailed Rationales 2026-2027
Section 1: Osteopathic Manipulative Medicine (OMM) &
Principles
Q1: A 45-year-old male presents with complaints of recurrent sore
throats. Physical examination reveals palpable tissue texture changes,
tenderness, and edema over the transverse processes of T2-T5 on the
right. Which viscerosomatic reflex is most likely associated with these
findings?
A) Cardiac
B) Pulmonary
C) Gastric
D) Hepatic
CORRECT ANSWER>: B) Pulmonary.
Rationale: T2-T5 sympathetic innervation correlates with the pulmonary
system (lungs and bronchi). T1-T5 is the classic "thoracic inlet" area for
respiratory and cardiac issues, but T2-T5 specifically maps to the lungs.
Upper cervical (C1-C4) and upper thoracic (T1-T4) reflexes are
commonly associated with head, neck, and upper respiratory infections.
Q2: During an osteopathic structural examination, the physician notes
that the patient’s left transverse process of L5 is more prominent
(posterior) than the right, and the patient’s torso rotates left when
seated. Which somatic dysfunction is present?
,A) L5 Extended, Rotated Right, Sidebent Right (ERRR)
B) L5 Flexed, Rotated Left, Sidebent Left (FRLS)
C) L5 Flexed, Rotated Right, Sidebent Right (FRRS)
D) L5 Extended, Rotated Left, Sidebent Left (ERLS)
CORRECT ANSWER>: B) L5 Flexed, Rotated Left, Sidebent Left (FRLS).
Rationale: In non-neutral (flexed or extended) dysfunctions, the rule of
Fryette (Type II mechanics) applies: the segment rotates and sidebends
to the same side. A prominent left transverse process indicates rotation
to the left. Since the torso is rotated left in the seated (flexed) position,
the segment is flexed. Therefore, it is FRLS.
Q3: Which of the following osteopathic techniques utilizes the
principles of reciprocal inhibition to treat a somatic dysfunction?
A) High-Velocity, Low-Amplitude (HVLA)
B) Muscle Energy
C) Counterstrain
D) Myofascial Release
CORRECT ANSWER>: B) Muscle Energy.
Rationale: Muscle Energy Technique (MET) uses the concept of
reciprocal inhibition. If an agonist muscle is contracting, the antagonist
muscle must relax. By having the patient contract the agonist against a
counterforce, the physician takes advantage of the involuntary
relaxation of the antagonist (the restrictive barrier) to stretch it.
,Q4: A physician is treating a patient with a tender point at the right
anterior 3rd rib. The patient is positioned to minimize the tenderness.
After holding the position for 90 seconds, the physician slowly returns
the patient to a neutral position. Which technique was used?
A) Facilitated Positional Release
B) Counterstrain
C) Balanced Ligamentous Tension
D) Articulatory Technique
CORRECT ANSWER>: B) Counterstrain.
Rationale: Counterstrain involves finding a tender point, positioning the
patient in a position of comfort (exaggerating the position of ease) to
shorten the agonist muscle, holding for 90 seconds, and slowly
returning to neutral. This resets the proprioceptors and breaks the pain
cycle.
Q5: What is the primary physiological effect of the osteopathic
technique known as "Still Technique"?
A) Rhythmic articulation to pump lymphatic fluid
B) Direct myofascial stretching to release fascial restrictions
C) A specific, passive, indirect-to-direct technique that uses a fulcrum to
disengage a restrictive barrier
D) Active resisted contraction to strengthen weakened muscles
, CORRECT ANSWER>: C) A specific, passive, indirect-to-direct technique
that uses a fulcrum to disengage a restrictive barrier.
Rationale: Still Technique is a hybrid indirect-to-direct technique. The
physician finds the position of ease (indirect), applies a fulcrum, and
then actively moves the patient through the restrictive barrier (direct)
in a specific arc to resolve the somatic dysfunction.
Q6: The Chapman’s reflex for the adrenal glands is located:
A) In the upper thoracic region (T1-T4)
B) At the 2nd intercostal space near the sternum
C) In the lumbar region (L1-L2)
D) In the sacral region (S2-S4)
CORRECT ANSWER>: B) At the 2nd intercostal space near the sternum.
Rationale: Chapman’s reflexes are gangliform contractions (tender
points) found on the anterior chest wall. The anterior Chapman’s point
for the adrenals is located in the 2nd intercostal space, close to the
sternum. The posterior point is at the spinous process of T2.
Q7: During the cranial rhythmic impulse (CRI) assessment, the physician
palpates a decreased amplitude and rate. This is most consistent with:
A) Hyperactive sympathetic nervous system
B) Compression of the 4th ventricle (CV4)
C) Parasympathetic dominance
