1
COMSAE Phase 1 ASA 113– The Complete 176 Question
TestBank All questions with correct verified answers &
detailedrationales – graded A+ for the newest 2026
actual exam (please dont do this: Multiple questions are
repeated. Some of these questions are from a
completely different test )
COMSAE Phase 1 (ASA 113) – The Complete 176 Question TestBank
SECTION 1: Osteopathic Principles & Practice (OPP) – Questions 1–22
1. During a routine structural examination, a physician palpates the T2–T5
vertebral segment and notes that the transverse processes are more prominent
and closer together on the right side. The tissues feel firm and resistant to
movement. Which Fryette principle best explains the position of these vertebrae?
A. Type I mechanics—sidebending and rotation occur to opposite sides in a
neutral plane
B. Type II mechanics—sidebending and rotation occur to the same side in a non-
neutral plane
C. Type III mechanics—rotation precedes sidebending in all planes
D. Type IV mechanics—sidebending is coupled with flexion and extension only
Correct : Answer : B
Rationale: Type II (non-neutral) mechanics govern motion in a single vertebral
segment when the spine is flexed or extended (non-neutral position). In this state,
sidebending and rotation are coupled to the same side. The palpatory finding of
transverse processes more prominent and closer together on one side indicates
segmental rotation to that side, and the tissue texture change (firm, resistant)
suggests a non-neutral dysfunction. Type I mechanics describe group curves
pg. 1
,2
where sidebending and rotation occur to opposite sides in the neutral plane.
Types III and IV are not standard Fryette principles.
2. A 45-year-old woman presents with palpitations, anxiety, and a sense of
fullness in her chest that is unrelated to exertion. Cardiac workup, including ECG,
echocardiogram, and Holter monitoring, is normal. Structural examination reveals
tissue texture changes, tenderness, and a ropy, string-like texture over the left
third intercostal space near the sternum. Which of the following is the most likely
palpable finding?
A. Cranial rhythmic impulse restriction
B. Chapman reflex point
C. Trigger point in the pectoralis major
D. Joint restriction at the costosternal junction
Correct : Answer : B
Rationale: The presentation—palpitations with a normal cardiac workup and a
palpable, ropy, tender nodule in the left third intercostal space—is classic for an
anterior Chapman reflex point for the heart. Chapman reflexes are small, discrete,
palpable tissue texture changes associated with visceral dysfunction. The anterior
point for the heart is located in the left third intercostal space near the sternum.
Trigger points are found within muscle bellies and refer pain. Joint restrictions
produce a hard end-feel with motion testing, not the small nodular texture
change described.
3. A 32-year-old pregnant patient at 34 weeks gestation presents with low back
pain that worsens with standing and walking. The physician diagnoses an
anteriorly rotated right innominate (ilium). Which of the following findings would
be most consistent with this diagnosis in a standing flexion test?
A. Right PSIS moves cephalad compared to the left
B. Right ASIS is inferior compared to the left
C. Right PSIS moves caudad compared to the left
D. Right ASIS is superior compared to the left
pg. 2
,3
Correct : Answer : D
Rationale: An anterior rotation of the innominate bone causes the anterior
superior iliac spine (ASIS) on the affected side to be more inferior (caudad)
relative to the contralateral side, and the posterior superior iliac spine (PSIS) to be
more superior (cephalad). In a standing flexion test, the PSIS on the side of
dysfunction moves cephalad during forward bending. A positive standing flexion
test confirms iliosacral (innominate) dysfunction on the side of the superior PSIS
excursion. The finding that the right ASIS is superior compared to the left is the
classic finding for an anteriorly rotated innominate.
4. A patient presents with chronic sinusitis and headaches. The physician wishes
to facilitate lymphatic drainage from the head and neck using osteopathic
manipulative treatment. Which technique is most specifically designed to
enhance thoracic inlet and respiratory diaphragm function to improve overall
lymphatic return?
A. Thoracic pump (pedal pump)
B. Suboccipital decompression
C. Venous sinus drainage technique
D. Mesenteric release
Correct : Answer : A
Rationale: The thoracic (pedal) pump is an active technique that utilizes the
respiratory diaphragm and thoracic cage to create pressure gradients, thereby
enhancing lymphatic and venous return from the entire body, including the head
and neck. Suboccipital decompression reduces tension at the cervicocranial
junction, which can improve cranial motion and venous outflow from the brain.
Venous sinus drainage techniques target the dural sinuses directly. Mesenteric
release addresses abdominal fascial tensions. For generalized improvement of
lymphatic return via the thoracic inlet, the thoracic pump is the most specific and
effective technique listed.
5. A 50-year-old man with a history of chronic gastroesophageal reflux disease
(GERD) is found to have a Chapman reflex point. Where would the physician
expect to palpate this viscerosomatic reflex?
pg. 3
, 4
A. 2nd intercostal space at the sternal border, bilaterally
B. Tip of the 12th rib on the right
C. Lateral to the umbilicus on the left
D. Interspace between the T4 and T5 spinous processes
Correct : Answer : A
Rationale: The anterior Chapman reflex point for the esophagus, including the
distal esophagus affected by GERD, is located at the 2nd intercostal space near
the sternal border, bilaterally. GERD can also refer to the T5–T6 area posteriorly.
The tip of the 12th rib is associated with the appendix (right) or sigmoid colon
(left). The area lateral to the umbilicus corresponds to the small intestine and
colon. Interspace T4–T5 is a posterior Chapman point area for other structures,
but the classic anterior esophageal point is the bilateral 2nd ICS.
6. A physician performs a seated flexion test on a patient with low back pain. The
right PSIS is found to move more cephalad than the left during the test. What is
the most appropriate diagnosis?
A. Right sacroiliac joint restriction
B. Right anterior innominate rotation
C. Left posterior innominate rotation
D. Left sacroiliac hypermobility
Correct : Answer : B
Rationale: A positive seated flexion test indicates an iliosacral (innominate)
dysfunction on the side of the superior PSIS excursion. The finding that the right
PSIS moves more cephalad suggests that the right innominate is restricted in its
normal posterior/inferior glide during forward bending. This is consistent with an
anterior rotation of the right innominate, where the PSIS is already positioned
superiorly and fails to move caudad appropriately. The test identifies the side of
dysfunction, and the motion finding helps define the specific somatic dysfunction.
7. An OMT practitioner is treating a patient with a primary cranial restriction
identified at the sphenobasilar synchondrosis (SBS). The cranial vault hold reveals
that the sphenoid and occiput are moving in opposite directions around two
pg. 4
COMSAE Phase 1 ASA 113– The Complete 176 Question
TestBank All questions with correct verified answers &
detailedrationales – graded A+ for the newest 2026
actual exam (please dont do this: Multiple questions are
repeated. Some of these questions are from a
completely different test )
COMSAE Phase 1 (ASA 113) – The Complete 176 Question TestBank
SECTION 1: Osteopathic Principles & Practice (OPP) – Questions 1–22
1. During a routine structural examination, a physician palpates the T2–T5
vertebral segment and notes that the transverse processes are more prominent
and closer together on the right side. The tissues feel firm and resistant to
movement. Which Fryette principle best explains the position of these vertebrae?
A. Type I mechanics—sidebending and rotation occur to opposite sides in a
neutral plane
B. Type II mechanics—sidebending and rotation occur to the same side in a non-
neutral plane
C. Type III mechanics—rotation precedes sidebending in all planes
D. Type IV mechanics—sidebending is coupled with flexion and extension only
Correct : Answer : B
Rationale: Type II (non-neutral) mechanics govern motion in a single vertebral
segment when the spine is flexed or extended (non-neutral position). In this state,
sidebending and rotation are coupled to the same side. The palpatory finding of
transverse processes more prominent and closer together on one side indicates
segmental rotation to that side, and the tissue texture change (firm, resistant)
suggests a non-neutral dysfunction. Type I mechanics describe group curves
pg. 1
,2
where sidebending and rotation occur to opposite sides in the neutral plane.
Types III and IV are not standard Fryette principles.
2. A 45-year-old woman presents with palpitations, anxiety, and a sense of
fullness in her chest that is unrelated to exertion. Cardiac workup, including ECG,
echocardiogram, and Holter monitoring, is normal. Structural examination reveals
tissue texture changes, tenderness, and a ropy, string-like texture over the left
third intercostal space near the sternum. Which of the following is the most likely
palpable finding?
A. Cranial rhythmic impulse restriction
B. Chapman reflex point
C. Trigger point in the pectoralis major
D. Joint restriction at the costosternal junction
Correct : Answer : B
Rationale: The presentation—palpitations with a normal cardiac workup and a
palpable, ropy, tender nodule in the left third intercostal space—is classic for an
anterior Chapman reflex point for the heart. Chapman reflexes are small, discrete,
palpable tissue texture changes associated with visceral dysfunction. The anterior
point for the heart is located in the left third intercostal space near the sternum.
Trigger points are found within muscle bellies and refer pain. Joint restrictions
produce a hard end-feel with motion testing, not the small nodular texture
change described.
3. A 32-year-old pregnant patient at 34 weeks gestation presents with low back
pain that worsens with standing and walking. The physician diagnoses an
anteriorly rotated right innominate (ilium). Which of the following findings would
be most consistent with this diagnosis in a standing flexion test?
A. Right PSIS moves cephalad compared to the left
B. Right ASIS is inferior compared to the left
C. Right PSIS moves caudad compared to the left
D. Right ASIS is superior compared to the left
pg. 2
,3
Correct : Answer : D
Rationale: An anterior rotation of the innominate bone causes the anterior
superior iliac spine (ASIS) on the affected side to be more inferior (caudad)
relative to the contralateral side, and the posterior superior iliac spine (PSIS) to be
more superior (cephalad). In a standing flexion test, the PSIS on the side of
dysfunction moves cephalad during forward bending. A positive standing flexion
test confirms iliosacral (innominate) dysfunction on the side of the superior PSIS
excursion. The finding that the right ASIS is superior compared to the left is the
classic finding for an anteriorly rotated innominate.
4. A patient presents with chronic sinusitis and headaches. The physician wishes
to facilitate lymphatic drainage from the head and neck using osteopathic
manipulative treatment. Which technique is most specifically designed to
enhance thoracic inlet and respiratory diaphragm function to improve overall
lymphatic return?
A. Thoracic pump (pedal pump)
B. Suboccipital decompression
C. Venous sinus drainage technique
D. Mesenteric release
Correct : Answer : A
Rationale: The thoracic (pedal) pump is an active technique that utilizes the
respiratory diaphragm and thoracic cage to create pressure gradients, thereby
enhancing lymphatic and venous return from the entire body, including the head
and neck. Suboccipital decompression reduces tension at the cervicocranial
junction, which can improve cranial motion and venous outflow from the brain.
Venous sinus drainage techniques target the dural sinuses directly. Mesenteric
release addresses abdominal fascial tensions. For generalized improvement of
lymphatic return via the thoracic inlet, the thoracic pump is the most specific and
effective technique listed.
5. A 50-year-old man with a history of chronic gastroesophageal reflux disease
(GERD) is found to have a Chapman reflex point. Where would the physician
expect to palpate this viscerosomatic reflex?
pg. 3
, 4
A. 2nd intercostal space at the sternal border, bilaterally
B. Tip of the 12th rib on the right
C. Lateral to the umbilicus on the left
D. Interspace between the T4 and T5 spinous processes
Correct : Answer : A
Rationale: The anterior Chapman reflex point for the esophagus, including the
distal esophagus affected by GERD, is located at the 2nd intercostal space near
the sternal border, bilaterally. GERD can also refer to the T5–T6 area posteriorly.
The tip of the 12th rib is associated with the appendix (right) or sigmoid colon
(left). The area lateral to the umbilicus corresponds to the small intestine and
colon. Interspace T4–T5 is a posterior Chapman point area for other structures,
but the classic anterior esophageal point is the bilateral 2nd ICS.
6. A physician performs a seated flexion test on a patient with low back pain. The
right PSIS is found to move more cephalad than the left during the test. What is
the most appropriate diagnosis?
A. Right sacroiliac joint restriction
B. Right anterior innominate rotation
C. Left posterior innominate rotation
D. Left sacroiliac hypermobility
Correct : Answer : B
Rationale: A positive seated flexion test indicates an iliosacral (innominate)
dysfunction on the side of the superior PSIS excursion. The finding that the right
PSIS moves more cephalad suggests that the right innominate is restricted in its
normal posterior/inferior glide during forward bending. This is consistent with an
anterior rotation of the right innominate, where the PSIS is already positioned
superiorly and fails to move caudad appropriately. The test identifies the side of
dysfunction, and the motion finding helps define the specific somatic dysfunction.
7. An OMT practitioner is treating a patient with a primary cranial restriction
identified at the sphenobasilar synchondrosis (SBS). The cranial vault hold reveals
that the sphenoid and occiput are moving in opposite directions around two
pg. 4
