COMSAE Phase 1 Form 115:
Complete Question Bank with
Answers & Detailed Explanations
|Graded A+| |Latest Update
2026/2027|
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?
Answer: C) T5 Flexed RR SR
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".
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?
Answer: C) Side-bending and rotation occur to opposite sides
, 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.
3. In Muscle Energy Technique (MET), the patient's
contraction force should be:
Answer: B) Submaximal (approximately 20% of maximal)
isometric contraction
Rationale: MET uses a gentle (submaximal, ~20% effort),
isometric contraction by the patient, followed by relaxation and
repositioning to the new barrier. This avoids muscle fatigue and
injury.
4. A patient presents with a right anterior innominate
rotation. Which of the following muscles is most likely
shortened on the affected side?
Answer: B) Right iliopsoas
Rationale: An anterior innominate rotation results in shortening
of the ipsilateral iliopsoas. The hamstrings are shortened in a
posterior innominate rotation.
5. Which muscle is most likely shortened in a patient with a
right posterior innominate rotation?
Answer: B) Right hamstrings
Rationale: In a posterior innominate rotation, the ipsilateral
hamstrings are shortened. The iliopsoas is typically shortened in
an anterior innominate rotation.
6. What is the primary purpose of the "still point" technique
in cranial osteopathy?
, Answer: C) To induce a therapeutic response and enhance the
body's self-corrective mechanisms
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.
7. Which of the following is a direct osteopathic technique?
Answer: C) High-velocity low-amplitude (HVLA)
Rationale: HVLA is a direct technique that engages the restrictive
barrier and uses a rapid, short-amplitude thrust to restore motion.
Myofascial release, counterstrain, and cranial osteopathy are
indirect techniques.
8. In the diagnosis of a somatic dysfunction, the acronym
TART stands for:
Answer: A) Tenderness, Asymmetry, Restriction, Tissue texture
changes
Rationale: TART is the standard acronym used in osteopathic
diagnosis to identify somatic dysfunction through physical
examination findings.
9. According to the principles of Osteopathic Manipulative
Medicine (OMM), which describes the correct application of
counterstrain technique?
Answer: A) The patient is positioned into the direction of freedom
to normalize aberrant proprioceptive signals
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.
10. Which cranial bone is most commonly associated with
somatic dysfunction in the craniosacral system?
Answer: B) Sphenoid
Rationale: The sphenoid bone, particularly the sphenobasilar
synchondrosis (SBS), is considered the primary motion generator
of the cranium and is a key focus in osteopathic cranial
manipulative medicine.
11. A patient presents with a finding of "flexed, rotated right,
side-bent right" at a single vertebral segment. According to
Fryette's laws, this is consistent with which type of
mechanics?
Answer: B) Type II mechanics
Rationale: Fryette's Second Law (Type II mechanics) describes
single vertebral segments in a non-neutral position (flexion or
extension) where rotation and side-bending occur in the same
direction.
12. Which of the following best describes the difference
between direct and indirect osteopathic techniques?
Answer: A) Direct techniques move toward the barrier; indirect
techniques move away from the barrier
Rationale: Direct techniques engage the restrictive barrier and
move the dysfunctional tissue toward it (e.g., HVLA, muscle
energy). Indirect techniques move away from the barrier into a
position of ease (e.g., counterstrain, myofascial release).
Complete Question Bank with
Answers & Detailed Explanations
|Graded A+| |Latest Update
2026/2027|
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?
Answer: C) T5 Flexed RR SR
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".
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?
Answer: C) Side-bending and rotation occur to opposite sides
, 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.
3. In Muscle Energy Technique (MET), the patient's
contraction force should be:
Answer: B) Submaximal (approximately 20% of maximal)
isometric contraction
Rationale: MET uses a gentle (submaximal, ~20% effort),
isometric contraction by the patient, followed by relaxation and
repositioning to the new barrier. This avoids muscle fatigue and
injury.
4. A patient presents with a right anterior innominate
rotation. Which of the following muscles is most likely
shortened on the affected side?
Answer: B) Right iliopsoas
Rationale: An anterior innominate rotation results in shortening
of the ipsilateral iliopsoas. The hamstrings are shortened in a
posterior innominate rotation.
5. Which muscle is most likely shortened in a patient with a
right posterior innominate rotation?
Answer: B) Right hamstrings
Rationale: In a posterior innominate rotation, the ipsilateral
hamstrings are shortened. The iliopsoas is typically shortened in
an anterior innominate rotation.
6. What is the primary purpose of the "still point" technique
in cranial osteopathy?
, Answer: C) To induce a therapeutic response and enhance the
body's self-corrective mechanisms
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.
7. Which of the following is a direct osteopathic technique?
Answer: C) High-velocity low-amplitude (HVLA)
Rationale: HVLA is a direct technique that engages the restrictive
barrier and uses a rapid, short-amplitude thrust to restore motion.
Myofascial release, counterstrain, and cranial osteopathy are
indirect techniques.
8. In the diagnosis of a somatic dysfunction, the acronym
TART stands for:
Answer: A) Tenderness, Asymmetry, Restriction, Tissue texture
changes
Rationale: TART is the standard acronym used in osteopathic
diagnosis to identify somatic dysfunction through physical
examination findings.
9. According to the principles of Osteopathic Manipulative
Medicine (OMM), which describes the correct application of
counterstrain technique?
Answer: A) The patient is positioned into the direction of freedom
to normalize aberrant proprioceptive signals
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.
10. Which cranial bone is most commonly associated with
somatic dysfunction in the craniosacral system?
Answer: B) Sphenoid
Rationale: The sphenoid bone, particularly the sphenobasilar
synchondrosis (SBS), is considered the primary motion generator
of the cranium and is a key focus in osteopathic cranial
manipulative medicine.
11. A patient presents with a finding of "flexed, rotated right,
side-bent right" at a single vertebral segment. According to
Fryette's laws, this is consistent with which type of
mechanics?
Answer: B) Type II mechanics
Rationale: Fryette's Second Law (Type II mechanics) describes
single vertebral segments in a non-neutral position (flexion or
extension) where rotation and side-bending occur in the same
direction.
12. Which of the following best describes the difference
between direct and indirect osteopathic techniques?
Answer: A) Direct techniques move toward the barrier; indirect
techniques move away from the barrier
Rationale: Direct techniques engage the restrictive barrier and
move the dysfunctional tissue toward it (e.g., HVLA, muscle
energy). Indirect techniques move away from the barrier into a
position of ease (e.g., counterstrain, myofascial release).
