COMSAE Phase 1 Form 114 Practice Exam
Questions And Correct Verified Detailed Answers
(GUARANTEED PASS)
Section 1: Osteopathic Principles & Practice (OPP)
Question 1
A 45-year-old male presents with chronic low back pain. During the
osteopathic structural exam, you find that the patient's right iliac crest is
superior to the left in the standing position, and the right ASIS is inferior
to the left in the supine position. What is the most likely somatic
dysfunction?
A. Right on Left Forward Torsion
B. Left on Right Forward Torsion
C. Right on Left Backward Torsion
D. Left on Right Backward Torsion
Verified Answer: A
Rationale: In a forward torsion, the innominate rotates anteriorly. The
side with the superior PSIS in standing is the side of the anterior rotation.
Here, the right PSIS is superior and the right ASIS is inferior (anterior
rotation). The dysfunction is named for the side of the anterior innominate
relative to the oblique axis. A right anterior innominate on a left oblique
axis is a Right on Left Forward Torsion.
,Question 2
A patient presents with a somatic dysfunction of the sacrum. You note
that the left sulcus is deeper than the right, and the left ILA is more
posterior than the right. What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right On Left Torsion
C. Left On Right Torsion
D. Bilateral Sacral Flexion
Verified Answer: B
Rationale: The criteria for a sacral torsion include a deep sulcus and a
posterior ILA on the same side. Here, the left sulcus is deep and the left
ILA is posterior, indicating the left side is the "posterior" side. The torsion
is named for the side of the posterior ILA relative to the axis
(contralateral oblique axis). A left posterior ILA with a right oblique axis is
a Right on Left Torsion.
Question 3
During a Chapman's reflex evaluation, you palpate an exquisite, small,
nodular tender point in the second intercostal space, parasternal region
on the right. This finding is most commonly associated with dysfunction of
which organ?
A. Stomach
B. Appendix
C. Heart
D. Gallbladder
Verified Answer: B
,Rationale: Anterior Chapman's reflexes for the appendix are located in
the right 2nd intercostal space, parasternal region. The stomach is
typically left 5th-6th ICS, the heart is left 2nd-5th ICS, and the gallbladder
is right 5th-6th ICS.
Question 4
A 30-year-old female presents with right-sided neck pain after sleeping in
an awkward position. You find the patient is unable to rotate her head to
the left. Restricted rotation to the left with a Type I (neutral) somatic
dysfunction indicates restriction of which spinal motion segment
component?
A. Rotation to the left, sidebending to the left
B. Rotation to the left, sidebending to the right
C. Rotation to the right, sidebending to the left
D. Rotation to the right, sidebending to the right
Verified Answer: B
Rationale: Type I (neutral) mechanics follow Fryette's First Law: when the
spine is in neutral, sidebending and rotation occur in opposite directions.
If rotation is restricted to the left, the dysfunction is rotation left,
sidebending right (R l Sr).
Question 5
A patient with a history of chronic obstructive pulmonary disease (COPD)
presents with shortness of breath. You decide to utilize rib raising to
facilitate lymphatic drainage and sympathetic inhibition. What is the
primary anatomic target of the rib raising technique?
, A. The costovertebral joints
B. The sympathetic chain ganglia
C. The phrenic nerve
D. The intercostal muscles
Verified Answer: B
Rationale: Rib raising is performed with the patient supine. The physician
places their fingers under the patient's ribs bilaterally at the
costovertebral angle and applies gentle anterior pressure. This inhibits
the sympathetic chain ganglia, reducing sympathetic outflow and
promoting parasympathetic tone and lymphatic flow.
Question 6
A 55-year-old male presents with chronic constipation. On examination,
you find a tender nodule at the tip of the right 12th rib. This Chapman's
point is associated with which structure?
A. Cecum
B. Liver
C. Kidney
D. Sigmoid colon
Verified Answer: A
Rationale: The anterior Chapman's point for the cecum is located at the
tip of the right 12th rib. The sigmoid colon is associated with the left 12th
rib tip.
Question 7
Which of the following best describes the "automatic shift" phenomenon
Questions And Correct Verified Detailed Answers
(GUARANTEED PASS)
Section 1: Osteopathic Principles & Practice (OPP)
Question 1
A 45-year-old male presents with chronic low back pain. During the
osteopathic structural exam, you find that the patient's right iliac crest is
superior to the left in the standing position, and the right ASIS is inferior
to the left in the supine position. What is the most likely somatic
dysfunction?
A. Right on Left Forward Torsion
B. Left on Right Forward Torsion
C. Right on Left Backward Torsion
D. Left on Right Backward Torsion
Verified Answer: A
Rationale: In a forward torsion, the innominate rotates anteriorly. The
side with the superior PSIS in standing is the side of the anterior rotation.
Here, the right PSIS is superior and the right ASIS is inferior (anterior
rotation). The dysfunction is named for the side of the anterior innominate
relative to the oblique axis. A right anterior innominate on a left oblique
axis is a Right on Left Forward Torsion.
,Question 2
A patient presents with a somatic dysfunction of the sacrum. You note
that the left sulcus is deeper than the right, and the left ILA is more
posterior than the right. What is the diagnosis?
A. Left-on-Left L5 dysfunction
B. Right On Left Torsion
C. Left On Right Torsion
D. Bilateral Sacral Flexion
Verified Answer: B
Rationale: The criteria for a sacral torsion include a deep sulcus and a
posterior ILA on the same side. Here, the left sulcus is deep and the left
ILA is posterior, indicating the left side is the "posterior" side. The torsion
is named for the side of the posterior ILA relative to the axis
(contralateral oblique axis). A left posterior ILA with a right oblique axis is
a Right on Left Torsion.
Question 3
During a Chapman's reflex evaluation, you palpate an exquisite, small,
nodular tender point in the second intercostal space, parasternal region
on the right. This finding is most commonly associated with dysfunction of
which organ?
A. Stomach
B. Appendix
C. Heart
D. Gallbladder
Verified Answer: B
,Rationale: Anterior Chapman's reflexes for the appendix are located in
the right 2nd intercostal space, parasternal region. The stomach is
typically left 5th-6th ICS, the heart is left 2nd-5th ICS, and the gallbladder
is right 5th-6th ICS.
Question 4
A 30-year-old female presents with right-sided neck pain after sleeping in
an awkward position. You find the patient is unable to rotate her head to
the left. Restricted rotation to the left with a Type I (neutral) somatic
dysfunction indicates restriction of which spinal motion segment
component?
A. Rotation to the left, sidebending to the left
B. Rotation to the left, sidebending to the right
C. Rotation to the right, sidebending to the left
D. Rotation to the right, sidebending to the right
Verified Answer: B
Rationale: Type I (neutral) mechanics follow Fryette's First Law: when the
spine is in neutral, sidebending and rotation occur in opposite directions.
If rotation is restricted to the left, the dysfunction is rotation left,
sidebending right (R l Sr).
Question 5
A patient with a history of chronic obstructive pulmonary disease (COPD)
presents with shortness of breath. You decide to utilize rib raising to
facilitate lymphatic drainage and sympathetic inhibition. What is the
primary anatomic target of the rib raising technique?
, A. The costovertebral joints
B. The sympathetic chain ganglia
C. The phrenic nerve
D. The intercostal muscles
Verified Answer: B
Rationale: Rib raising is performed with the patient supine. The physician
places their fingers under the patient's ribs bilaterally at the
costovertebral angle and applies gentle anterior pressure. This inhibits
the sympathetic chain ganglia, reducing sympathetic outflow and
promoting parasympathetic tone and lymphatic flow.
Question 6
A 55-year-old male presents with chronic constipation. On examination,
you find a tender nodule at the tip of the right 12th rib. This Chapman's
point is associated with which structure?
A. Cecum
B. Liver
C. Kidney
D. Sigmoid colon
Verified Answer: A
Rationale: The anterior Chapman's point for the cecum is located at the
tip of the right 12th rib. The sigmoid colon is associated with the left 12th
rib tip.
Question 7
Which of the following best describes the "automatic shift" phenomenon
