2026 COMSAE 114 – Latest Questions and Verified
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Exam COMSAE 114 (Comprehensive Osteopathic Medical Self-Assessment
Name Examination)
Level COMLEX Level 1 / Level 2 CE
Content 260 Questions, Verified Answers, Clinical Rationales
Version 2026 – Latest Update
Format Digital Download (PDF)
Use Solo study, group sessions, or review bootcamps
1. A 45-year-old male presents with low back pain after lifting a heavy
box. On examination, you note a right sacral torsion on the oblique axis.
According to Fryette's laws, what type of sacral dysfunction is this?
• A. Type I sacral dysfunction
• B. Type II sacral dysfunction
• C. Type III sacral dysfunction
, • D. Sacral neutral dysfunction
Rationale: Type II sacral dysfunction involves a torsion on an oblique axis,
where the sacrum rotates around an oblique axis. Type I involves a side-
bending rotation in neutral. Type III is a unilateral flexion/extension
dysfunction.
2. A patient presents with a cranial strain pattern characterized by
sphenoid and occiput rotated in opposite directions around a vertical
axis. What is this strain pattern called?
• A. Side-bending rotation
• B. Torsion
• C. Vertical strain
• D. Lateral strain
Rationale: Torsion is a cranial strain pattern where the sphenoid and occiput
rotate in opposite directions around a vertical axis. Side-bending rotation
involves both side-bending and rotation. Vertical strain involves the sphenoid
and occiput moving in opposite directions superiorly/inferiorly.
3. According to Fryette's laws, which of the following describes Type I
somatic dysfunction?
• A. A group of vertebrae that are neutral, side-bent, and rotated to the
same side
• B. A group of vertebrae that are neutral, side-bent, and rotated to
opposite sides
• C. A single vertebra that is flexed or extended and rotated to the same
side
• D. A single vertebra that is flexed or extended and rotated to the
opposite side
Rationale: Fryette's Type I (neutral mechanics) states that when a group of
vertebrae are in neutral, side-bending and rotation occur to opposite sides.
,Type II (non-neutral mechanics) involves a single vertebra that is flexed or
extended and rotated to the same side.
4. A patient with chronic headaches undergoes osteopathic manipulative
treatment. You perform a balancing ligamentosus tension technique.
What is the primary goal of this technique?
• A. To balance the tension of the ligaments supporting the cranial
base
• B. To release muscle spasms in the cervical spine
• C. To correct sacral torsion
• D. To treat a Chapmans reflex
Rationale: Balancing ligamentosus tension is a cranial technique that
balances the tension of the ligaments supporting the cranial base, particularly
the occipitoatlantal and occipitomastoid sutures, to relieve tension and
improve cranial motion.
5. A patient with a history of otitis media presents with a tender point at
the base of the neck, lateral to the spinous processes. This is most likely
which type of reflex?
• A. Chapman's reflex point for the lung
• B. Chapman's reflex point for the tonsils
• C. Chapman's reflex point for the liver
• D. Chapman's reflex point for the kidney
Rationale: Chapman's reflex points are neurolymphatic points that
correspond to viscera. The tonsil reflex point is located at the base of the neck,
lateral to the spinous processes.
6. A 28-year-old female presents with right upper quadrant pain. On
examination, you find a tender point at the right 5th-6th intercostal
space, anteriorly, near the costochondral junction. This is most
consistent with which Chapman's reflex?
, • A. Gallbladder
• B. Liver
• C. Stomach
• D. Kidney
Rationale: The liver Chapman's reflex is located at the right 5th-6th
intercostal space, anteriorly, near the costochondral junction.
7. A patient presents with low back pain. On examination, you note that
the right PSIS is superior and medial compared to the left. The patient
also has a right short leg. What is the most likely diagnosis?
• A. Right sacral torsion on a left oblique axis
• B. Left sacral torsion on a right oblique axis
• C. Right unilateral sacral flexion
• D. Left unilateral sacral extension
Rationale: In a right sacral torsion on a left oblique axis, the right PSIS is
superior and medial, and the patient typically presents with a right short leg.
8. Which of the following cranial nerves exits through the jugular
foramen?
• A. CN V (Trigeminal)
• B. CN IX (Glossopharyngeal)
• C. CN VII (Facial)
• D. CN III (Oculomotor)
Rationale: Cranial nerves IX (Glossopharyngeal), X (Vagus), and XI
(Accessory) exit through the jugular foramen. CN V exits through the foramen
ovale, CN VII through the internal auditory meatus, and CN III through the
superior orbital fissure.
Answers + Detailed Study Guide | Guaranteed Pass
| Fully Updated & Trusted by DO Students
Quick Info
Detail Information
Exam COMSAE 114 (Comprehensive Osteopathic Medical Self-Assessment
Name Examination)
Level COMLEX Level 1 / Level 2 CE
Content 260 Questions, Verified Answers, Clinical Rationales
Version 2026 – Latest Update
Format Digital Download (PDF)
Use Solo study, group sessions, or review bootcamps
1. A 45-year-old male presents with low back pain after lifting a heavy
box. On examination, you note a right sacral torsion on the oblique axis.
According to Fryette's laws, what type of sacral dysfunction is this?
• A. Type I sacral dysfunction
• B. Type II sacral dysfunction
• C. Type III sacral dysfunction
, • D. Sacral neutral dysfunction
Rationale: Type II sacral dysfunction involves a torsion on an oblique axis,
where the sacrum rotates around an oblique axis. Type I involves a side-
bending rotation in neutral. Type III is a unilateral flexion/extension
dysfunction.
2. A patient presents with a cranial strain pattern characterized by
sphenoid and occiput rotated in opposite directions around a vertical
axis. What is this strain pattern called?
• A. Side-bending rotation
• B. Torsion
• C. Vertical strain
• D. Lateral strain
Rationale: Torsion is a cranial strain pattern where the sphenoid and occiput
rotate in opposite directions around a vertical axis. Side-bending rotation
involves both side-bending and rotation. Vertical strain involves the sphenoid
and occiput moving in opposite directions superiorly/inferiorly.
3. According to Fryette's laws, which of the following describes Type I
somatic dysfunction?
• A. A group of vertebrae that are neutral, side-bent, and rotated to the
same side
• B. A group of vertebrae that are neutral, side-bent, and rotated to
opposite sides
• C. A single vertebra that is flexed or extended and rotated to the same
side
• D. A single vertebra that is flexed or extended and rotated to the
opposite side
Rationale: Fryette's Type I (neutral mechanics) states that when a group of
vertebrae are in neutral, side-bending and rotation occur to opposite sides.
,Type II (non-neutral mechanics) involves a single vertebra that is flexed or
extended and rotated to the same side.
4. A patient with chronic headaches undergoes osteopathic manipulative
treatment. You perform a balancing ligamentosus tension technique.
What is the primary goal of this technique?
• A. To balance the tension of the ligaments supporting the cranial
base
• B. To release muscle spasms in the cervical spine
• C. To correct sacral torsion
• D. To treat a Chapmans reflex
Rationale: Balancing ligamentosus tension is a cranial technique that
balances the tension of the ligaments supporting the cranial base, particularly
the occipitoatlantal and occipitomastoid sutures, to relieve tension and
improve cranial motion.
5. A patient with a history of otitis media presents with a tender point at
the base of the neck, lateral to the spinous processes. This is most likely
which type of reflex?
• A. Chapman's reflex point for the lung
• B. Chapman's reflex point for the tonsils
• C. Chapman's reflex point for the liver
• D. Chapman's reflex point for the kidney
Rationale: Chapman's reflex points are neurolymphatic points that
correspond to viscera. The tonsil reflex point is located at the base of the neck,
lateral to the spinous processes.
6. A 28-year-old female presents with right upper quadrant pain. On
examination, you find a tender point at the right 5th-6th intercostal
space, anteriorly, near the costochondral junction. This is most
consistent with which Chapman's reflex?
, • A. Gallbladder
• B. Liver
• C. Stomach
• D. Kidney
Rationale: The liver Chapman's reflex is located at the right 5th-6th
intercostal space, anteriorly, near the costochondral junction.
7. A patient presents with low back pain. On examination, you note that
the right PSIS is superior and medial compared to the left. The patient
also has a right short leg. What is the most likely diagnosis?
• A. Right sacral torsion on a left oblique axis
• B. Left sacral torsion on a right oblique axis
• C. Right unilateral sacral flexion
• D. Left unilateral sacral extension
Rationale: In a right sacral torsion on a left oblique axis, the right PSIS is
superior and medial, and the patient typically presents with a right short leg.
8. Which of the following cranial nerves exits through the jugular
foramen?
• A. CN V (Trigeminal)
• B. CN IX (Glossopharyngeal)
• C. CN VII (Facial)
• D. CN III (Oculomotor)
Rationale: Cranial nerves IX (Glossopharyngeal), X (Vagus), and XI
(Accessory) exit through the jugular foramen. CN V exits through the foramen
ovale, CN VII through the internal auditory meatus, and CN III through the
superior orbital fissure.
