COMSAE Form 113 Practice Exam Version
3 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Section 1: Osteopathic Principles & Practice (Questions 1-10)
1. A patient presents with low back pain and a diagnosis of a right on right
(R/R) sacral torsion. Which of the following is true regarding the seated
flexion test?
• A) The right inferior lateral angle (ILA) is posterior
• B) The left ILA is anterior
• C) The left ilium moves more cephalad than the right
• D) The right ilium moves more cephalad than the left
Correct Answer: C. The left ilium moves more cephalad than the right
Rationale: In an R/R sacral torsion (axis on right, sacral base rotated right), the
deep sulcus is on the right. The seated flexion test shows greater cephalad motion
of the ilium opposite the deep sulcus, so the left ilium moves more. The ILA
opposite the axis (left) is posterior.
2. According to Fryette’s second principle (Type II mechanics), when the spine
is in a non-neutral position (flexion or extension), which of the following
occurs?
• A) Rotation and sidebending are to opposite sides
• B) Rotation and sidebending are to the same side
• C) Rotation occurs without sidebending
, • D) Sidebending occurs without rotation
Correct Answer: B. Rotation and sidebending are to the same side
Rationale: Fryette’s second principle describes a single vertebral segment in a
non-neutral (flexion or extension) position. In this case, sidebending and rotation
occur in the same direction. This is high-yield for COMLEX OMM questions.
3. A patient with chronic asthma is found to have restricted rib elevation on
the right. Which of the following OMT techniques is most appropriate to
improve rib motion?
• A) Inhibitory pressure to the suboccipital muscles
• B) Still technique to the thoracic spine
• C) Direct HVLA thrust to the right rib (exhaled rib)
• D) Counterstrain for the right scalenes
Correct Answer: C. Direct HVLA thrust to the right rib (exhaled rib)
Rationale: An exhaled rib (stuck inferiorly) is treated with a direct HVLA thrust
during exhalation to engage the restrictive barrier. This restores rib elevation
during inhalation, improving respiratory mechanics in asthma.
4. A Chapman reflex point at the right 12th rib tip is associated with
dysfunction of which organ?
• A) Stomach
• B) Liver
• C) Appendix
• D) Cecum
Correct Answer: D. Cecum
Rationale: Chapman’s reflexes for the colon are at the tips of the 11th and 12th
,ribs: the right 12th rib corresponds to the cecum/appendix region; the right 11th rib
is the ascending colon; left 11th and 12th are descending and sigmoid colon.
5. Which of the following is an absolute contraindication to high-velocity,
low-amplitude (HVLA) manipulation of the cervical spine?
• A) Cervical muscle spasm
• B) Rheumatoid arthritis with cervical instability
• C) Occipital headache
• D) History of whiplash
Correct Answer: B. Rheumatoid arthritis with cervical instability
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to risk of spinal cord
injury. Muscle spasm and whiplash are relative contraindications, not absolute.
6. A patient with a somatic dysfunction of the left fibular head that is
“posterior” will demonstrate a restriction in which direction?
• A) Anterior glide
• B) Posterior glide
• C) Lateral glide
• D) Medial glide
Correct Answer: A. Anterior glide
Rationale: A “posterior fibular head” means the fibula is fixed in a posterior
position relative to the tibia, therefore its motion toward the anterior direction is
restricted. Treatment aims to restore anterior glide.
, 7. During a cranial examination, a physician notes that the sphenobasilar
synchondrosis (SBS) is “flexed.” What does this mean in cranial osteopathic
terms?
• A) The sphenoid rotates anteriorly and the occiput rotates posteriorly
• B) The sphenoid rotates posteriorly and the occiput rotates anteriorly
• C) The lateral angles of the sphenoid move superiorly and the occipital
squama moves inferiorly
• D) The SBS is locked in a neutral position
Correct Answer: B. The sphenoid rotates posteriorly and the occiput
rotates anteriorly
Rationale: In cranial flexion, the sphenoid rotates posteriorly and the occiput
rotates anteriorly (relative to the SBS), narrowing the SBS angle. In extension, the
opposite occurs. This is pure cranial osteopathic theory.
8. A patient with a Type I (neutral) group dysfunction of the lumbar spine at
L1-L3 has a sidebending restriction to the right. Which of the following is the
correct diagnosis?
• A) L1-L3 rotated right, sidebent right (Type II)
• B) L1-L3 rotated left, sidebent right (Type I)
• C) L1-L3 rotated right, sidebent left (Type I)
• D) L1-L3 neutral rotation only
Correct Answer: B. L1-L3 rotated left, sidebent right (Type I)
Rationale: Type I mechanics (neutral spine, multiple segments) dictate that
sidebending and rotation are opposite. Therefore, sidebending right is coupled with
rotation left.
9. Which of the following conditions is most likely to benefit from lymphatic
pump techniques?
3 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Section 1: Osteopathic Principles & Practice (Questions 1-10)
1. A patient presents with low back pain and a diagnosis of a right on right
(R/R) sacral torsion. Which of the following is true regarding the seated
flexion test?
• A) The right inferior lateral angle (ILA) is posterior
• B) The left ILA is anterior
• C) The left ilium moves more cephalad than the right
• D) The right ilium moves more cephalad than the left
Correct Answer: C. The left ilium moves more cephalad than the right
Rationale: In an R/R sacral torsion (axis on right, sacral base rotated right), the
deep sulcus is on the right. The seated flexion test shows greater cephalad motion
of the ilium opposite the deep sulcus, so the left ilium moves more. The ILA
opposite the axis (left) is posterior.
2. According to Fryette’s second principle (Type II mechanics), when the spine
is in a non-neutral position (flexion or extension), which of the following
occurs?
• A) Rotation and sidebending are to opposite sides
• B) Rotation and sidebending are to the same side
• C) Rotation occurs without sidebending
, • D) Sidebending occurs without rotation
Correct Answer: B. Rotation and sidebending are to the same side
Rationale: Fryette’s second principle describes a single vertebral segment in a
non-neutral (flexion or extension) position. In this case, sidebending and rotation
occur in the same direction. This is high-yield for COMLEX OMM questions.
3. A patient with chronic asthma is found to have restricted rib elevation on
the right. Which of the following OMT techniques is most appropriate to
improve rib motion?
• A) Inhibitory pressure to the suboccipital muscles
• B) Still technique to the thoracic spine
• C) Direct HVLA thrust to the right rib (exhaled rib)
• D) Counterstrain for the right scalenes
Correct Answer: C. Direct HVLA thrust to the right rib (exhaled rib)
Rationale: An exhaled rib (stuck inferiorly) is treated with a direct HVLA thrust
during exhalation to engage the restrictive barrier. This restores rib elevation
during inhalation, improving respiratory mechanics in asthma.
4. A Chapman reflex point at the right 12th rib tip is associated with
dysfunction of which organ?
• A) Stomach
• B) Liver
• C) Appendix
• D) Cecum
Correct Answer: D. Cecum
Rationale: Chapman’s reflexes for the colon are at the tips of the 11th and 12th
,ribs: the right 12th rib corresponds to the cecum/appendix region; the right 11th rib
is the ascending colon; left 11th and 12th are descending and sigmoid colon.
5. Which of the following is an absolute contraindication to high-velocity,
low-amplitude (HVLA) manipulation of the cervical spine?
• A) Cervical muscle spasm
• B) Rheumatoid arthritis with cervical instability
• C) Occipital headache
• D) History of whiplash
Correct Answer: B. Rheumatoid arthritis with cervical instability
Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial
instability) is an absolute contraindication to HVLA due to risk of spinal cord
injury. Muscle spasm and whiplash are relative contraindications, not absolute.
6. A patient with a somatic dysfunction of the left fibular head that is
“posterior” will demonstrate a restriction in which direction?
• A) Anterior glide
• B) Posterior glide
• C) Lateral glide
• D) Medial glide
Correct Answer: A. Anterior glide
Rationale: A “posterior fibular head” means the fibula is fixed in a posterior
position relative to the tibia, therefore its motion toward the anterior direction is
restricted. Treatment aims to restore anterior glide.
, 7. During a cranial examination, a physician notes that the sphenobasilar
synchondrosis (SBS) is “flexed.” What does this mean in cranial osteopathic
terms?
• A) The sphenoid rotates anteriorly and the occiput rotates posteriorly
• B) The sphenoid rotates posteriorly and the occiput rotates anteriorly
• C) The lateral angles of the sphenoid move superiorly and the occipital
squama moves inferiorly
• D) The SBS is locked in a neutral position
Correct Answer: B. The sphenoid rotates posteriorly and the occiput
rotates anteriorly
Rationale: In cranial flexion, the sphenoid rotates posteriorly and the occiput
rotates anteriorly (relative to the SBS), narrowing the SBS angle. In extension, the
opposite occurs. This is pure cranial osteopathic theory.
8. A patient with a Type I (neutral) group dysfunction of the lumbar spine at
L1-L3 has a sidebending restriction to the right. Which of the following is the
correct diagnosis?
• A) L1-L3 rotated right, sidebent right (Type II)
• B) L1-L3 rotated left, sidebent right (Type I)
• C) L1-L3 rotated right, sidebent left (Type I)
• D) L1-L3 neutral rotation only
Correct Answer: B. L1-L3 rotated left, sidebent right (Type I)
Rationale: Type I mechanics (neutral spine, multiple segments) dictate that
sidebending and rotation are opposite. Therefore, sidebending right is coupled with
rotation left.
9. Which of the following conditions is most likely to benefit from lymphatic
pump techniques?
