COMSAE Phase 1 Form 113 Practice Exam
Questions And Correct Verified Detailed Answers
(GUARANTEED PASS)
Section 1: Osteopathic Principles & Practice (OPP)
Question 1
A 35-year-old female presents with chronic low back pain. During osteopathic
evaluation, you find that the patient's left iliac crest is superior to the right in the
standing position, and the left ASIS is inferior to the right in the supine position.
What is the most likely somatic dysfunction?
A. Left on Right Forward Torsion
B. Right on Left Forward Torsion
C. Left on Right Backward Torsion
D. Right on Left 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 left
PSIS is superior and the left ASIS is inferior, indicating a left anterior innominate.
This is a Left on Right Forward Torsion (left anterior on a right oblique axis).
Question 2
A patient presents with a sacral dysfunction. On examination, the right sulcus is
deeper than the left, and the right ILA is more posterior than the left. What is the
diagnosis?
A. Right on Left Torsion
,B. Left on Right Torsion
C. Right unilateral flexion
D. Left unilateral extension
Verified Answer: A
Rationale: The criteria for a sacral torsion include a deep sulcus and a posterior
ILA on the same side. Here, the right sulcus is deep and the right ILA is posterior,
indicating the right side is the "posterior" side. This is a Right on Left Torsion
(right posterior on a left oblique axis).
Question 3
During a Chapman's reflex evaluation, you palpate a small, tender nodule in the left
5th intercostal space, parasternal region. This finding is most commonly
associated with dysfunction of which organ?
A. Liver
B. Spleen
C. Stomach
D. Heart
Verified Answer: C
Rationale: Anterior Chapman's reflexes for the stomach are located in the left
5th-6th intercostal space, parasternal region. The spleen is associated with the
left 7th-8th ICS, the heart with left 2nd-5th ICS, and the liver with right 5th-6th
ICS.
Question 4
A 40-year-old male presents with neck pain. You find that the patient is unable to
sidebend her head to the left. Restricted sidebending to the left with a Type II
(non-neutral) somatic dysfunction indicates restriction of which spinal motion
segment component?
A. Sidebending to the left, rotation to the left
,B. Sidebending to the left, rotation to the right
C. Sidebending to the right, rotation to the left
D. Sidebending to the right, rotation to the right
Verified Answer: A
Rationale: Type II (non-neutral) mechanics follow Fryette's Second Law: when the
spine is in flexion or extension, sidebending and rotation occur in the same
direction. If sidebending is restricted to the left, rotation is also restricted to the
left.
Question 5
A patient with a history of chronic sinusitis presents for OMT. You decide to
perform a venous sinus drainage technique, specifically the sphenopalatine
ganglion release. What is the primary anatomic target of this technique?
A. The sphenoid bone
B. The pterygopalatine fossa
C. The ethmoid sinus
D. The frontal sinus
Verified Answer: B
Rationale: The sphenopalatine ganglion (pterygopalatine ganglion) is located in the
pterygopalatine fossa. Release of this ganglion helps improve venous and
lymphatic drainage from the sinuses and is used for sinusitis and headaches.
Question 6
A 50-year-old male presents with chronic constipation. On examination, you find a
tender nodule at the tip of the left 12th rib. This Chapman's point is associated with
which structure? A. Cecum
B. Sigmoid colon
C. Descending colon
D. Transverse colon
, Verified Answer: B
Rationale: The anterior Chapman's point for the sigmoid colon is located at the tip
of the left 12th rib. The cecum is associated with the right 12th rib tip.
Question 7
During the supine-to-sit transition, a patient's sacral base moves into extension
(counternutation) rather than the expected flexion (nutation). This finding
suggests which of the following?
A. Normal sacroiliac motion
B. Bilateral sacral extension dysfunction
C. Unilateral sacral flexion dysfunction
D. L5 somatic dysfunction
Verified Answer: B
Rationale: During the transition from supine to sitting, the sacrum normally
nutates (base moves anteriorly and inferiorly). If the sacral base moves into
extension (counternutation), this indicates a bilateral sacral extension dysfunction
where the sacrum is "locked" in extension.
Question 8
A patient presents with a right unilateral sacral flexion (forward torsion)
dysfunction. Which of the following physical exam findings would you expect?
A. Deep right sulcus, posterior right ILA
B. Deep right sulcus, anterior right ILA
C. Shallow right sulcus, posterior right ILA
D. Shallow right sulcus, anterior right ILA
Verified Answer: A
Rationale: In a sacral flexion (forward torsion) dysfunction, the sacrum is rotated
anteriorly on the side of the dysfunction. This results in a deep sulcus and a
Questions And Correct Verified Detailed Answers
(GUARANTEED PASS)
Section 1: Osteopathic Principles & Practice (OPP)
Question 1
A 35-year-old female presents with chronic low back pain. During osteopathic
evaluation, you find that the patient's left iliac crest is superior to the right in the
standing position, and the left ASIS is inferior to the right in the supine position.
What is the most likely somatic dysfunction?
A. Left on Right Forward Torsion
B. Right on Left Forward Torsion
C. Left on Right Backward Torsion
D. Right on Left 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 left
PSIS is superior and the left ASIS is inferior, indicating a left anterior innominate.
This is a Left on Right Forward Torsion (left anterior on a right oblique axis).
Question 2
A patient presents with a sacral dysfunction. On examination, the right sulcus is
deeper than the left, and the right ILA is more posterior than the left. What is the
diagnosis?
A. Right on Left Torsion
,B. Left on Right Torsion
C. Right unilateral flexion
D. Left unilateral extension
Verified Answer: A
Rationale: The criteria for a sacral torsion include a deep sulcus and a posterior
ILA on the same side. Here, the right sulcus is deep and the right ILA is posterior,
indicating the right side is the "posterior" side. This is a Right on Left Torsion
(right posterior on a left oblique axis).
Question 3
During a Chapman's reflex evaluation, you palpate a small, tender nodule in the left
5th intercostal space, parasternal region. This finding is most commonly
associated with dysfunction of which organ?
A. Liver
B. Spleen
C. Stomach
D. Heart
Verified Answer: C
Rationale: Anterior Chapman's reflexes for the stomach are located in the left
5th-6th intercostal space, parasternal region. The spleen is associated with the
left 7th-8th ICS, the heart with left 2nd-5th ICS, and the liver with right 5th-6th
ICS.
Question 4
A 40-year-old male presents with neck pain. You find that the patient is unable to
sidebend her head to the left. Restricted sidebending to the left with a Type II
(non-neutral) somatic dysfunction indicates restriction of which spinal motion
segment component?
A. Sidebending to the left, rotation to the left
,B. Sidebending to the left, rotation to the right
C. Sidebending to the right, rotation to the left
D. Sidebending to the right, rotation to the right
Verified Answer: A
Rationale: Type II (non-neutral) mechanics follow Fryette's Second Law: when the
spine is in flexion or extension, sidebending and rotation occur in the same
direction. If sidebending is restricted to the left, rotation is also restricted to the
left.
Question 5
A patient with a history of chronic sinusitis presents for OMT. You decide to
perform a venous sinus drainage technique, specifically the sphenopalatine
ganglion release. What is the primary anatomic target of this technique?
A. The sphenoid bone
B. The pterygopalatine fossa
C. The ethmoid sinus
D. The frontal sinus
Verified Answer: B
Rationale: The sphenopalatine ganglion (pterygopalatine ganglion) is located in the
pterygopalatine fossa. Release of this ganglion helps improve venous and
lymphatic drainage from the sinuses and is used for sinusitis and headaches.
Question 6
A 50-year-old male presents with chronic constipation. On examination, you find a
tender nodule at the tip of the left 12th rib. This Chapman's point is associated with
which structure? A. Cecum
B. Sigmoid colon
C. Descending colon
D. Transverse colon
, Verified Answer: B
Rationale: The anterior Chapman's point for the sigmoid colon is located at the tip
of the left 12th rib. The cecum is associated with the right 12th rib tip.
Question 7
During the supine-to-sit transition, a patient's sacral base moves into extension
(counternutation) rather than the expected flexion (nutation). This finding
suggests which of the following?
A. Normal sacroiliac motion
B. Bilateral sacral extension dysfunction
C. Unilateral sacral flexion dysfunction
D. L5 somatic dysfunction
Verified Answer: B
Rationale: During the transition from supine to sitting, the sacrum normally
nutates (base moves anteriorly and inferiorly). If the sacral base moves into
extension (counternutation), this indicates a bilateral sacral extension dysfunction
where the sacrum is "locked" in extension.
Question 8
A patient presents with a right unilateral sacral flexion (forward torsion)
dysfunction. Which of the following physical exam findings would you expect?
A. Deep right sulcus, posterior right ILA
B. Deep right sulcus, anterior right ILA
C. Shallow right sulcus, posterior right ILA
D. Shallow right sulcus, anterior right ILA
Verified Answer: A
Rationale: In a sacral flexion (forward torsion) dysfunction, the sacrum is rotated
anteriorly on the side of the dysfunction. This results in a deep sulcus and a
