COMSAE Phase 1 Form 114 Practice
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Section 1: Osteopathic Principles and Practice (OPP) – Questions 1–20
1. A 45-year-old male presents with low back pain after lifting a box. You
diagnose an acute sacroiliac (SI) joint dysfunction. To diagnose somatic
dysfunction of the SI joint using the standing flexion test, a positive test is
indicated by:
• A) Anterior rotation of the ilium on the ipsilateral side
• B) Posterior rotation of the ilium on the ipsilateral side
• C) Superior movement of the PSIS on the ipsilateral side
• D) Inferior movement of the PSIS on the contralateral side
✅ Correct Answer: C
Rationale: In the standing flexion test, the examiner places thumbs under the PSIS.
As the patient bends forward, if the PSIS on one side moves superiorly (upward)
more than the other, it indicates iliosacral dysfunction (often a fixed sacrum or
ilium) on that side.
,2. A 30-year-old female with chronic headaches undergoes OMM. You find
that the right mastoid process is posterior and inferior compared to the left.
Which of the following somatic dysfunctions best describes this finding?
• A) Right rotation, right sidebending (Type I)
• B) Left rotation, right sidebending (Type II)
• C) Right rotation, left sidebending (Type II)
• D) Left rotation, left sidebending (Type I)
✅ Correct Answer: B
Rationale: The mastoid process moving posterior indicates rotation to the opposite
side. The mastoid moving inferior indicates sidebending to the same side (Type II
mechanics: rotation and sidebending occur in opposite directions). Here, right
mastoid is posterior/inferior → Rotation to the left, sidebending to the right.
3. According to Fryette’s first principle (Type I mechanics), when multiple
vertebral segments are in a neutral position, which of the following occurs?
• A) Sidebending and rotation occur to the same side
• B) Sidebending and rotation occur to opposite sides
• C) Rotation occurs without sidebending
• D) Sidebending occurs without rotation
✅ Correct Answer: B
Rationale: Fryette’s first principle describes that when the spine is in neutral
position, sidebending and rotation occur in opposite directions. This applies to
group (multiple vertebrae) dysfunctions. Type II mechanics (non-neutral) have
sidebending and rotation to the same side.
,4. In the seated flexion test, a finding of more than 2 cm of superior iliac crest
movement on the left compared to the right indicates:
• A) A sacral base torsion on the right (R/R)
• B) A sacral base torsion on the left (L/L)
• C) A right unilateral sacral extension
• D) A normal finding
✅ Correct Answer: A
Rationale: In the seated flexion test, the side that moves more cephalad indicates
the side of the deep sacral sulcus (the axis of a sacral torsion). More movement on
the left means the deep sulcus is on the right, which corresponds to an R/R (right
axis, right rotated) torsion.
5. A patient presents with a structural exam revealing a restricted T5
segment. The segment prefers rotation to the right and sidebending to the
right. It improves when the patient slumps forward into spinal flexion. What
is the correct diagnosis?
• A) T5 Neutral SR RL
• B) T5 Extended RR SR
• C) T5 Flexed RR SR
• D) T5 Flexed RL SL
✅ Correct Answer: C
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
sidebending occur in the same direction. Hence, rotation right and sidebending
right yields a diagnosis of “Flexed RR SR.”
, 6. A patient with COPD presents with dyspnea and decreased thoracic
excursion. Which OMT technique is most appropriate to improve lymphatic
drainage and respiratory function?
• A) Cervical traction
• B) Thoracic inlet release and lymphatic pump technique
• C) Lumbar roll
• D) Sacral decompression
✅ Correct Answer: B
Rationale: Lymphatic pump techniques and thoracic inlet release enhance
lymphatic flow and respiratory function, particularly beneficial in COPD patients
with impaired clearance. The thoracic inlet is a key area for lymphatic drainage.
7. 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
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.
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2025|2026 Q&A | Instant Download Pdf
Section 1: Osteopathic Principles and Practice (OPP) – Questions 1–20
1. A 45-year-old male presents with low back pain after lifting a box. You
diagnose an acute sacroiliac (SI) joint dysfunction. To diagnose somatic
dysfunction of the SI joint using the standing flexion test, a positive test is
indicated by:
• A) Anterior rotation of the ilium on the ipsilateral side
• B) Posterior rotation of the ilium on the ipsilateral side
• C) Superior movement of the PSIS on the ipsilateral side
• D) Inferior movement of the PSIS on the contralateral side
✅ Correct Answer: C
Rationale: In the standing flexion test, the examiner places thumbs under the PSIS.
As the patient bends forward, if the PSIS on one side moves superiorly (upward)
more than the other, it indicates iliosacral dysfunction (often a fixed sacrum or
ilium) on that side.
,2. A 30-year-old female with chronic headaches undergoes OMM. You find
that the right mastoid process is posterior and inferior compared to the left.
Which of the following somatic dysfunctions best describes this finding?
• A) Right rotation, right sidebending (Type I)
• B) Left rotation, right sidebending (Type II)
• C) Right rotation, left sidebending (Type II)
• D) Left rotation, left sidebending (Type I)
✅ Correct Answer: B
Rationale: The mastoid process moving posterior indicates rotation to the opposite
side. The mastoid moving inferior indicates sidebending to the same side (Type II
mechanics: rotation and sidebending occur in opposite directions). Here, right
mastoid is posterior/inferior → Rotation to the left, sidebending to the right.
3. According to Fryette’s first principle (Type I mechanics), when multiple
vertebral segments are in a neutral position, which of the following occurs?
• A) Sidebending and rotation occur to the same side
• B) Sidebending and rotation occur to opposite sides
• C) Rotation occurs without sidebending
• D) Sidebending occurs without rotation
✅ Correct Answer: B
Rationale: Fryette’s first principle describes that when the spine is in neutral
position, sidebending and rotation occur in opposite directions. This applies to
group (multiple vertebrae) dysfunctions. Type II mechanics (non-neutral) have
sidebending and rotation to the same side.
,4. In the seated flexion test, a finding of more than 2 cm of superior iliac crest
movement on the left compared to the right indicates:
• A) A sacral base torsion on the right (R/R)
• B) A sacral base torsion on the left (L/L)
• C) A right unilateral sacral extension
• D) A normal finding
✅ Correct Answer: A
Rationale: In the seated flexion test, the side that moves more cephalad indicates
the side of the deep sacral sulcus (the axis of a sacral torsion). More movement on
the left means the deep sulcus is on the right, which corresponds to an R/R (right
axis, right rotated) torsion.
5. A patient presents with a structural exam revealing a restricted T5
segment. The segment prefers rotation to the right and sidebending to the
right. It improves when the patient slumps forward into spinal flexion. What
is the correct diagnosis?
• A) T5 Neutral SR RL
• B) T5 Extended RR SR
• C) T5 Flexed RR SR
• D) T5 Flexed RL SL
✅ Correct Answer: C
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
sidebending occur in the same direction. Hence, rotation right and sidebending
right yields a diagnosis of “Flexed RR SR.”
, 6. A patient with COPD presents with dyspnea and decreased thoracic
excursion. Which OMT technique is most appropriate to improve lymphatic
drainage and respiratory function?
• A) Cervical traction
• B) Thoracic inlet release and lymphatic pump technique
• C) Lumbar roll
• D) Sacral decompression
✅ Correct Answer: B
Rationale: Lymphatic pump techniques and thoracic inlet release enhance
lymphatic flow and respiratory function, particularly beneficial in COPD patients
with impaired clearance. The thoracic inlet is a key area for lymphatic drainage.
7. 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
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.
