OMSAE ALL EXAMS
C
BUNDLED 2024-2025 | Latest
Update | Questions & Verified
Answers | 100% Correct | Grade
A | Pass Guaranteed
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PART I – COMSAE LEVEL 1 (200 QUESTIONS)
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SECTION A: OSTEOPATHIC PRINCIPLES & OMM (Questions 1-40)
Q1 (OMM – Lumbar Somatic Dysfunction): A 45-year-old male presents with low back pain after
lifting heavy boxes. On osteopathic structural examination, the L3 vertebra is found to be rotated
right and sidebent left. Which somatic dysfunction diagnosis is most consistent with these
findings?
A. L3 NSRRL (neutral, sidebent right, rotated right)
B. L3 NSLRR (neutral, sidebent left, rotated right)
C. L3 ESRRR (extended, sidebent right, rotated right)
D. L3 ESLRL (extended, sidebent left, rotated left)
E. L3 FSLRR (flexed, sidebent left, rotated right)
[CORRECT] B
Rationale: Per NBOME OPP blueprint, lumbar vertebrae follow Fryette's Type I mechanics in
neutral (NSLRR = neutral, sidebent left, rotated right), where sidebending and rotation occur in
opposite directions. The L3 finding of rotation right and sidebent left fits NSLRR. Option A
incorrectly pairs sidebending and rotation to the same side, which violates Type I mechanics.
Option C describes extended mechanics with same-side coupling (Type II), which does not
apply in neutral positioning.
Q2 (OMM – Counterstrain Technique): A 28-year-old female with chronic neck pain has
tenderness at the anterior C5 tender point. Which counterstrain position is appropriate for
treatment?
A. Extension, sidebending toward, rotation toward
B. Flexion, sidebending away, rotation away
C. Extension, sidebending away, rotation away
, . Flexion, sidebending toward, rotation toward
D
E. Neutral, sidebending toward, rotation away
[CORRECT] D
Rationale: NBOME OPP specifications state that anterior cervical tender points are treated with
flexion, sidebending toward, and rotation toward the tender point. This position shortens the
anterior musculature and allows spontaneous release of the tender point. Option B represents
the treatment for posterior cervical tender points. Option A would lengthen rather than shorten
the dysfunctional tissue, preventing counterstrain effectiveness.
Q3 (OMM – HVLA Contraindications): A 62-year-old male with osteoporosis (T-score -3.2) and
cervical spondylosis presents with neck stiffness. Which OMT technique is absolutely
contraindicated in the cervical spine?
A. Muscle energy technique
B. Myofascial release
C. High-velocity low-amplitude (HVLA) thrust
D. Counterstrain
E. Cranial osteopathy
[CORRECT] C
Rationale: Per NBOME safety guidelines and OPP blueprint, HVLA thrust techniques are
contraindicated in the cervical spine of patients with severe osteoporosis (T-score <-2.5) due to
risk of fracture and vertebral artery injury. Muscle energy (A) and myofascial release (B) are safe
indirect/low-force alternatives. Counterstrain (D) and cranial osteopathy (E) involve no forceful
manipulation and are appropriate for this patient.
Q4 (OMM – Sacral Torsion): During pelvic examination, the sacral sulcus is deep on the right
and shallow on the left, with the inferior lateral angle (ILA) posterior on the left and anterior on
the right. The lumbar spine is neutral. Which sacral torsion is present?
A. Left-on-left sacral torsion
B. Left-on-right sacral torsion
C. Right-on-right sacral torsion
D. Right-on-left sacral torsion
E. Sacral extension dysfunction
[CORRECT] C
Rationale: NBOME OPP blueprint identifies this pattern as right-on-right sacral torsion: deep
right sulcus indicates right rotation of the sacral base, posterior left ILA indicates left rotation of
the inferior sacrum, and neutral lumbar spine confirms torsion (not unilateral sacral
flexion/extension). The naming convention is "axis of rotation-on-side of rotation of the superior
sacral surface"—here the axis is the right oblique axis and the base rotates right. Option A
would show a deep left sulcus and posterior right ILA.
Q5 (OMM – Chapman Reflexes): A patient with chronic sinusitis has palpable tender nodules in
the intercostal spaces at the anterior aspect of ribs 2-3 on the right. These represent Chapman
reflexes associated with which organ system?
A. Liver
B. Gallbladder
C. Lung
D. Sinuses
, . Heart
E
[CORRECT] D
Rationale: Per NBOME OPP content specifications, Chapman reflexes for the sinuses are
located at the anterior aspect of ribs 2-3 on the right side. This viscerosomatic reflex pattern was
mapped by Frank Chapman, DO, and represents gangliform contractions in the deep fascia
associated with visceral dysfunction. The liver (A) reflexes are at ribs 5-6 right anterior,
gallbladder (B) at ribs 6-7 right, lung (C) at ribs 2-3 bilateral, and heart (E) at ribs 2-5 left
anterior.
Q6 (OMM – Cranial Strain Patterns): During cranial osteopathic examination, the sphenobasilar
synchondrosis (SBS) is found to be sidebent right and rotated left. Which cranial strain pattern is
present?
A. Sidebending-rotation (SBR) right
B. Sidebending-rotation (SBR) left
C. Torsion right
D. Torsion left
E. Vertical strain
[CORRECT] A
Rationale: NBOME cranial OMM specifications define sidebending-rotation (SBR) as occurring
when sidebending and rotation occur to opposite sides; the pattern is named for the side of
sidebending. Here, sidebending right with rotation left constitutes SBR right. Option B would be
sidebending left with rotation right. Torsion patterns (C, D) involve rotation around an
anteroposterior axis with no sidebending component. Vertical strain (E) involves superior or
inferior shear of the SBS.
Q7 (OMM – Muscle Energy – Pelvis): A 30-year-old runner has an anteriorly rotated right
innominate. Which muscle energy procedure is appropriate?
A. Resisted hip extension with the leg off the table edge
B. Resisted hip flexion with the leg off the table edge
C. Resisted hip abduction in supine
D. Resisted hip adduction in supine
E. Resisted internal rotation in prone
[CORRECT] A
Rationale: Per NBOME OPP blueprint, an anteriorly rotated innominate is treated by engaging
the hamstrings (hip extensors) to pull the innominate posteriorly. The patient lies supine with the
right leg off the table edge; the patient pushes down (hip extension) against resistance for 3-5
seconds, then relaxes as the physician moves the leg further into extension to take up the slack.
Option B would engage the hip flexors (iliopsoas), worsening anterior rotation. Options C, D,
and E address coronal or transverse plane dysfunctions, not sagittal plane rotation.
Q8 (OMM – Visceral Manipulation): A patient with gastroesophageal reflux disease (GERD) has
restricted motion of the gastroesophageal junction. Which ligamentous attachment is most
commonly restricted in this condition?
A. Hepatogastric ligament
B. Gastrophrenic ligament
C. Gastrocolic ligament
D. Gastrosplenic ligament
, . Phrenicocolic ligament
E
[CORRECT] B
Rationale: NBOME visceral manipulation content specifies that the gastrophrenic ligament
anchors the superior stomach to the diaphragm and is commonly restricted in GERD,
contributing to decreased mobility of the gastroesophageal junction and impaired lower
esophageal sphincter function. The hepatogastric ligament (A) connects the liver to lesser
curvature. The gastrocolic (C) and gastrosplenic (D) ligaments attach to the greater curvature
and are less relevant to GE junction mobility. The phrenicocolic ligament (E) supports the
splenic flexure.
Q9 (OMM – TART Findings): During thoracic spine examination, a segment is found to have
tissue texture changes (warmth, edema), asymmetry of position, restricted range of motion, and
tenderness (TART). These findings are characteristic of:
A. Acute somatic dysfunction
B. Chronic somatic dysfunction
C. Viscerosomatic reflex
D. Somatovisceral reflex
E. Myofascial trigger point
[CORRECT] A
Rationale: NBOME OPP blueprint distinguishes acute somatic dysfunction by the full TART
constellation including tissue texture changes (warmth, edema, sweating) and significant
tenderness. Chronic somatic dysfunction (B) shows decreased tissue texture changes, fibrotic
changes, and less tenderness. Viscerosomatic reflex (C) may produce TART findings but is
secondary to visceral pathology. Somatovisceral reflex (D) refers to somatic dysfunction causing
visceral symptoms. Myofascial trigger points (E) are hyperirritable nodules without the complete
TART profile.
Q10 (OMM – Still Technique): Which OMT technique involves disengagement, exaggeration of
the somatic dysfunction, and final balancing without a thrust?
A. HVLA
B. Muscle energy
C. Still technique
D. Myofascial release
E. Counterstrain
[CORRECT] C
Rationale: Per NBOME OPP specifications, Still technique is defined by three phases:
disengagement (taking the joint to neutral), exaggeration (moving into the direction of
ease/barrier), and balance (holding until release occurs) without a high-velocity thrust. HVLA (A)
requires a thrust. Muscle energy (B) uses isometric contraction. Myofascial release (D) uses
sustained pressure/traction. Counterstrain (E) uses passive positioning on tender points.
Q11 (OMM – Rib Dysfunction): A patient has an inhalation dysfunction of rib 5 on the right.
Which finding is expected on palpation?
A. Rib 5 right is restricted in inhalation; exhalation is freer; rib angle is posterior
B. Rib 5 right is restricted in exhalation; inhalation is freer; rib angle is anterior
C. Rib 5 right is restricted in both inhalation and exhalation equally
D. Rib 5 right has increased bucket handle motion bilaterally
C
BUNDLED 2024-2025 | Latest
Update | Questions & Verified
Answers | 100% Correct | Grade
A | Pass Guaranteed
=======================================================================
=
========
PART I – COMSAE LEVEL 1 (200 QUESTIONS)
========================================================================
========
SECTION A: OSTEOPATHIC PRINCIPLES & OMM (Questions 1-40)
Q1 (OMM – Lumbar Somatic Dysfunction): A 45-year-old male presents with low back pain after
lifting heavy boxes. On osteopathic structural examination, the L3 vertebra is found to be rotated
right and sidebent left. Which somatic dysfunction diagnosis is most consistent with these
findings?
A. L3 NSRRL (neutral, sidebent right, rotated right)
B. L3 NSLRR (neutral, sidebent left, rotated right)
C. L3 ESRRR (extended, sidebent right, rotated right)
D. L3 ESLRL (extended, sidebent left, rotated left)
E. L3 FSLRR (flexed, sidebent left, rotated right)
[CORRECT] B
Rationale: Per NBOME OPP blueprint, lumbar vertebrae follow Fryette's Type I mechanics in
neutral (NSLRR = neutral, sidebent left, rotated right), where sidebending and rotation occur in
opposite directions. The L3 finding of rotation right and sidebent left fits NSLRR. Option A
incorrectly pairs sidebending and rotation to the same side, which violates Type I mechanics.
Option C describes extended mechanics with same-side coupling (Type II), which does not
apply in neutral positioning.
Q2 (OMM – Counterstrain Technique): A 28-year-old female with chronic neck pain has
tenderness at the anterior C5 tender point. Which counterstrain position is appropriate for
treatment?
A. Extension, sidebending toward, rotation toward
B. Flexion, sidebending away, rotation away
C. Extension, sidebending away, rotation away
, . Flexion, sidebending toward, rotation toward
D
E. Neutral, sidebending toward, rotation away
[CORRECT] D
Rationale: NBOME OPP specifications state that anterior cervical tender points are treated with
flexion, sidebending toward, and rotation toward the tender point. This position shortens the
anterior musculature and allows spontaneous release of the tender point. Option B represents
the treatment for posterior cervical tender points. Option A would lengthen rather than shorten
the dysfunctional tissue, preventing counterstrain effectiveness.
Q3 (OMM – HVLA Contraindications): A 62-year-old male with osteoporosis (T-score -3.2) and
cervical spondylosis presents with neck stiffness. Which OMT technique is absolutely
contraindicated in the cervical spine?
A. Muscle energy technique
B. Myofascial release
C. High-velocity low-amplitude (HVLA) thrust
D. Counterstrain
E. Cranial osteopathy
[CORRECT] C
Rationale: Per NBOME safety guidelines and OPP blueprint, HVLA thrust techniques are
contraindicated in the cervical spine of patients with severe osteoporosis (T-score <-2.5) due to
risk of fracture and vertebral artery injury. Muscle energy (A) and myofascial release (B) are safe
indirect/low-force alternatives. Counterstrain (D) and cranial osteopathy (E) involve no forceful
manipulation and are appropriate for this patient.
Q4 (OMM – Sacral Torsion): During pelvic examination, the sacral sulcus is deep on the right
and shallow on the left, with the inferior lateral angle (ILA) posterior on the left and anterior on
the right. The lumbar spine is neutral. Which sacral torsion is present?
A. Left-on-left sacral torsion
B. Left-on-right sacral torsion
C. Right-on-right sacral torsion
D. Right-on-left sacral torsion
E. Sacral extension dysfunction
[CORRECT] C
Rationale: NBOME OPP blueprint identifies this pattern as right-on-right sacral torsion: deep
right sulcus indicates right rotation of the sacral base, posterior left ILA indicates left rotation of
the inferior sacrum, and neutral lumbar spine confirms torsion (not unilateral sacral
flexion/extension). The naming convention is "axis of rotation-on-side of rotation of the superior
sacral surface"—here the axis is the right oblique axis and the base rotates right. Option A
would show a deep left sulcus and posterior right ILA.
Q5 (OMM – Chapman Reflexes): A patient with chronic sinusitis has palpable tender nodules in
the intercostal spaces at the anterior aspect of ribs 2-3 on the right. These represent Chapman
reflexes associated with which organ system?
A. Liver
B. Gallbladder
C. Lung
D. Sinuses
, . Heart
E
[CORRECT] D
Rationale: Per NBOME OPP content specifications, Chapman reflexes for the sinuses are
located at the anterior aspect of ribs 2-3 on the right side. This viscerosomatic reflex pattern was
mapped by Frank Chapman, DO, and represents gangliform contractions in the deep fascia
associated with visceral dysfunction. The liver (A) reflexes are at ribs 5-6 right anterior,
gallbladder (B) at ribs 6-7 right, lung (C) at ribs 2-3 bilateral, and heart (E) at ribs 2-5 left
anterior.
Q6 (OMM – Cranial Strain Patterns): During cranial osteopathic examination, the sphenobasilar
synchondrosis (SBS) is found to be sidebent right and rotated left. Which cranial strain pattern is
present?
A. Sidebending-rotation (SBR) right
B. Sidebending-rotation (SBR) left
C. Torsion right
D. Torsion left
E. Vertical strain
[CORRECT] A
Rationale: NBOME cranial OMM specifications define sidebending-rotation (SBR) as occurring
when sidebending and rotation occur to opposite sides; the pattern is named for the side of
sidebending. Here, sidebending right with rotation left constitutes SBR right. Option B would be
sidebending left with rotation right. Torsion patterns (C, D) involve rotation around an
anteroposterior axis with no sidebending component. Vertical strain (E) involves superior or
inferior shear of the SBS.
Q7 (OMM – Muscle Energy – Pelvis): A 30-year-old runner has an anteriorly rotated right
innominate. Which muscle energy procedure is appropriate?
A. Resisted hip extension with the leg off the table edge
B. Resisted hip flexion with the leg off the table edge
C. Resisted hip abduction in supine
D. Resisted hip adduction in supine
E. Resisted internal rotation in prone
[CORRECT] A
Rationale: Per NBOME OPP blueprint, an anteriorly rotated innominate is treated by engaging
the hamstrings (hip extensors) to pull the innominate posteriorly. The patient lies supine with the
right leg off the table edge; the patient pushes down (hip extension) against resistance for 3-5
seconds, then relaxes as the physician moves the leg further into extension to take up the slack.
Option B would engage the hip flexors (iliopsoas), worsening anterior rotation. Options C, D,
and E address coronal or transverse plane dysfunctions, not sagittal plane rotation.
Q8 (OMM – Visceral Manipulation): A patient with gastroesophageal reflux disease (GERD) has
restricted motion of the gastroesophageal junction. Which ligamentous attachment is most
commonly restricted in this condition?
A. Hepatogastric ligament
B. Gastrophrenic ligament
C. Gastrocolic ligament
D. Gastrosplenic ligament
, . Phrenicocolic ligament
E
[CORRECT] B
Rationale: NBOME visceral manipulation content specifies that the gastrophrenic ligament
anchors the superior stomach to the diaphragm and is commonly restricted in GERD,
contributing to decreased mobility of the gastroesophageal junction and impaired lower
esophageal sphincter function. The hepatogastric ligament (A) connects the liver to lesser
curvature. The gastrocolic (C) and gastrosplenic (D) ligaments attach to the greater curvature
and are less relevant to GE junction mobility. The phrenicocolic ligament (E) supports the
splenic flexure.
Q9 (OMM – TART Findings): During thoracic spine examination, a segment is found to have
tissue texture changes (warmth, edema), asymmetry of position, restricted range of motion, and
tenderness (TART). These findings are characteristic of:
A. Acute somatic dysfunction
B. Chronic somatic dysfunction
C. Viscerosomatic reflex
D. Somatovisceral reflex
E. Myofascial trigger point
[CORRECT] A
Rationale: NBOME OPP blueprint distinguishes acute somatic dysfunction by the full TART
constellation including tissue texture changes (warmth, edema, sweating) and significant
tenderness. Chronic somatic dysfunction (B) shows decreased tissue texture changes, fibrotic
changes, and less tenderness. Viscerosomatic reflex (C) may produce TART findings but is
secondary to visceral pathology. Somatovisceral reflex (D) refers to somatic dysfunction causing
visceral symptoms. Myofascial trigger points (E) are hyperirritable nodules without the complete
TART profile.
Q10 (OMM – Still Technique): Which OMT technique involves disengagement, exaggeration of
the somatic dysfunction, and final balancing without a thrust?
A. HVLA
B. Muscle energy
C. Still technique
D. Myofascial release
E. Counterstrain
[CORRECT] C
Rationale: Per NBOME OPP specifications, Still technique is defined by three phases:
disengagement (taking the joint to neutral), exaggeration (moving into the direction of
ease/barrier), and balance (holding until release occurs) without a high-velocity thrust. HVLA (A)
requires a thrust. Muscle energy (B) uses isometric contraction. Myofascial release (D) uses
sustained pressure/traction. Counterstrain (E) uses passive positioning on tender points.
Q11 (OMM – Rib Dysfunction): A patient has an inhalation dysfunction of rib 5 on the right.
Which finding is expected on palpation?
A. Rib 5 right is restricted in inhalation; exhalation is freer; rib angle is posterior
B. Rib 5 right is restricted in exhalation; inhalation is freer; rib angle is anterior
C. Rib 5 right is restricted in both inhalation and exhalation equally
D. Rib 5 right has increased bucket handle motion bilaterally
