COMSAE Phase 1 Form 115 Comprehensive Practice
Exam | Complete Actual Exam Questions with
Verified Answers & Detailed Rationales - Updated for
2026/2027 | COMLEX-USA Level 1 Readiness
Section 1: Osteopathic Principles & Practice (OPP/OMT)
Question 1
A patient presents with a structural exam revealing a restricted T5 segment. The
segment prefers rotation to the right and side-bending to the right. It improves
when the patient slumps forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answer: C
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed
as Flexed. According to Fryette's Second Law (Type II mechanics), when a single
segment is in a non-neutral position (flexion or extension), rotation and side-
bending occur in the same direction . Hence, rotation right (RR) and side-bending
right (SR) yields a diagnosis of "Flexed RR SR." Neutral mechanics would apply if
the segment were in neutral position, and opposite directions would violate
Fryette's laws .
Question 2
According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position (neither flexed nor extended), which of the following occurs?
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Answer: C
pg. 1
,Rationale: Fryette's first principle (Type I mechanics) describes that when
multiple vertebral segments are in neutral position, side-bending and rotation occur
in opposite directions . This typically occurs in group curves and involves multiple
vertebral segments. Type II mechanics describes single segments in non-neutral
positions where rotation and side-bending occur in the same direction .
Question 3
In Muscle Energy Technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
Answer: B
Rationale: MET uses a gentle, submaximal (~20% of maximal) isometric
contraction by the patient, followed by relaxation and repositioning to the new
barrier . This avoids muscle fatigue, patient injury, and excessive guarding.
Maximal contraction is not used as it can cause muscle strain and is not necessary
for the technique .
Question 4
A 35-year-old with chronic low back pain has a right posterior innominate rotation.
Which muscle is likely shortened?
A) Left quadratus lumborum
B) Right hamstrings
C) Right iliopsoas
D) Left gluteus maximus
Answer: B
Rationale: A posterior innominate rotation is a shear of the ilium in which the
ilium moves posteriorly on the sacrum . In this dysfunction, the ipsilateral
hamstrings are shortened. The iliopsoas is typically shortened in an anterior
innominate rotation .
Question 5
A patient presents with a right anterior innominate rotation. Which muscle is most
likely shortened on the affected side?
pg. 2
,A) Right hamstrings
B) Right iliopsoas
C) Right gluteus maximus
D) Right quadratus lumborum
Answer: B
Rationale: Anterior innominate rotation results in shortening of the ipsilateral
iliopsoas . The hamstrings are shortened in a posterior innominate rotation. This
pattern is essential for diagnosing sacroiliac dysfunctions and selecting the
appropriate muscle-energy treatment .
Question 6
A patient with sacral dysfunction presents with a diagnosis of Left-on-Left (L-on-
L) sacral torsion. Which of the following best describes the mechanics of this
dysfunction?
A) The sacrum is rotated around a vertical axis with the left base deeper and more
posterior
B) The sacrum is rotated around an oblique axis with the left base anterior and the
right base posterior
C) The sacrum is rotated around an oblique axis with the left base posterior and the
right base anterior
D) The sacrum is flexed on the ilia bilaterally
Answer: B
Rationale: In an L-on-L sacral torsion, the sacrum rotates around a left oblique
axis . The left base moves anteriorly and inferiorly, while the right base moves
posteriorly and superiorly . The "L-on-L" nomenclature indicates the side of the
axis (left) and the side of the rotated sacral base (left) .
Question 7
According to the principles of Osteopathic Manipulative Medicine (OMM), which
of the following describes the correct application of counterstrain technique?
A) The patient is positioned into the direction of freedom to normalize aberrant
proprioceptive signals
B) The patient is positioned away from the dysfunction to stretch the affected
muscle
C) The patient is positioned into the restrictive barrier and held for 30 seconds
pg. 3
, D) The patient is positioned into the restrictive barrier with maximal contraction
Answer: A
Rationale: Counterstrain technique involves passively positioning the patient into
the direction of ease (freedom) away from the restrictive barrier to reduce aberrant
proprioceptive signals from dysfunctional muscle spindles . This is an indirect
technique that does not engage the restrictive barrier .
Question 8
Which cranial bone is most commonly associated with somatic dysfunction in the
craniosacral system and is a key focus in osteopathic cranial manipulative
medicine?
A) Occiput
B) Sphenoid
C) Temporal
D) Frontal
Answer: B
Rationale: The sphenoid bone articulates with all other cranial bones and is a key
driver of cranial motion patterns . Sphenoid dysfunction is a primary focus in
cranial osteopathy. The sphenobasilar synchondrosis (SBS) is central to cranial
rhythm assessment .
Question 9
What is the primary purpose of the "still point" technique in cranial osteopathy?
A) To increase cranial motion
B) To release restrictive barriers
C) To induce a therapeutic response and enhance the body's self-corrective
mechanisms
D) To diagnose cranial bone motion
Answer: C
Rationale: The still point technique is used to induce a therapeutic response by
temporarily halting the cranial rhythmic impulse, allowing the body's inherent self-
corrective mechanisms to restore normal motion . The CV4 compression is used
for general cranial rhythm regulation .
Question 10
pg. 4
Exam | Complete Actual Exam Questions with
Verified Answers & Detailed Rationales - Updated for
2026/2027 | COMLEX-USA Level 1 Readiness
Section 1: Osteopathic Principles & Practice (OPP/OMT)
Question 1
A patient presents with a structural exam revealing a restricted T5 segment. The
segment prefers rotation to the right and side-bending to the right. It improves
when the patient slumps forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL
Answer: C
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed
as Flexed. According to Fryette's Second Law (Type II mechanics), when a single
segment is in a non-neutral position (flexion or extension), rotation and side-
bending occur in the same direction . Hence, rotation right (RR) and side-bending
right (SR) yields a diagnosis of "Flexed RR SR." Neutral mechanics would apply if
the segment were in neutral position, and opposite directions would violate
Fryette's laws .
Question 2
According to Fryette's first principle (Type I mechanics), when the spine is in a
neutral position (neither flexed nor extended), which of the following occurs?
A) Side-bending and rotation occur to the same side
B) Side-bending occurs without rotation
C) Side-bending and rotation occur to opposite sides
D) Rotation occurs without side-bending
Answer: C
pg. 1
,Rationale: Fryette's first principle (Type I mechanics) describes that when
multiple vertebral segments are in neutral position, side-bending and rotation occur
in opposite directions . This typically occurs in group curves and involves multiple
vertebral segments. Type II mechanics describes single segments in non-neutral
positions where rotation and side-bending occur in the same direction .
Question 3
In Muscle Energy Technique (MET), the patient's contraction force should be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range
Answer: B
Rationale: MET uses a gentle, submaximal (~20% of maximal) isometric
contraction by the patient, followed by relaxation and repositioning to the new
barrier . This avoids muscle fatigue, patient injury, and excessive guarding.
Maximal contraction is not used as it can cause muscle strain and is not necessary
for the technique .
Question 4
A 35-year-old with chronic low back pain has a right posterior innominate rotation.
Which muscle is likely shortened?
A) Left quadratus lumborum
B) Right hamstrings
C) Right iliopsoas
D) Left gluteus maximus
Answer: B
Rationale: A posterior innominate rotation is a shear of the ilium in which the
ilium moves posteriorly on the sacrum . In this dysfunction, the ipsilateral
hamstrings are shortened. The iliopsoas is typically shortened in an anterior
innominate rotation .
Question 5
A patient presents with a right anterior innominate rotation. Which muscle is most
likely shortened on the affected side?
pg. 2
,A) Right hamstrings
B) Right iliopsoas
C) Right gluteus maximus
D) Right quadratus lumborum
Answer: B
Rationale: Anterior innominate rotation results in shortening of the ipsilateral
iliopsoas . The hamstrings are shortened in a posterior innominate rotation. This
pattern is essential for diagnosing sacroiliac dysfunctions and selecting the
appropriate muscle-energy treatment .
Question 6
A patient with sacral dysfunction presents with a diagnosis of Left-on-Left (L-on-
L) sacral torsion. Which of the following best describes the mechanics of this
dysfunction?
A) The sacrum is rotated around a vertical axis with the left base deeper and more
posterior
B) The sacrum is rotated around an oblique axis with the left base anterior and the
right base posterior
C) The sacrum is rotated around an oblique axis with the left base posterior and the
right base anterior
D) The sacrum is flexed on the ilia bilaterally
Answer: B
Rationale: In an L-on-L sacral torsion, the sacrum rotates around a left oblique
axis . The left base moves anteriorly and inferiorly, while the right base moves
posteriorly and superiorly . The "L-on-L" nomenclature indicates the side of the
axis (left) and the side of the rotated sacral base (left) .
Question 7
According to the principles of Osteopathic Manipulative Medicine (OMM), which
of the following describes the correct application of counterstrain technique?
A) The patient is positioned into the direction of freedom to normalize aberrant
proprioceptive signals
B) The patient is positioned away from the dysfunction to stretch the affected
muscle
C) The patient is positioned into the restrictive barrier and held for 30 seconds
pg. 3
, D) The patient is positioned into the restrictive barrier with maximal contraction
Answer: A
Rationale: Counterstrain technique involves passively positioning the patient into
the direction of ease (freedom) away from the restrictive barrier to reduce aberrant
proprioceptive signals from dysfunctional muscle spindles . This is an indirect
technique that does not engage the restrictive barrier .
Question 8
Which cranial bone is most commonly associated with somatic dysfunction in the
craniosacral system and is a key focus in osteopathic cranial manipulative
medicine?
A) Occiput
B) Sphenoid
C) Temporal
D) Frontal
Answer: B
Rationale: The sphenoid bone articulates with all other cranial bones and is a key
driver of cranial motion patterns . Sphenoid dysfunction is a primary focus in
cranial osteopathy. The sphenobasilar synchondrosis (SBS) is central to cranial
rhythm assessment .
Question 9
What is the primary purpose of the "still point" technique in cranial osteopathy?
A) To increase cranial motion
B) To release restrictive barriers
C) To induce a therapeutic response and enhance the body's self-corrective
mechanisms
D) To diagnose cranial bone motion
Answer: C
Rationale: The still point technique is used to induce a therapeutic response by
temporarily halting the cranial rhythmic impulse, allowing the body's inherent self-
corrective mechanisms to restore normal motion . The CV4 compression is used
for general cranial rhythm regulation .
Question 10
pg. 4
