COMSAE PHASE 1 FORM 114 Actual
EXAM – 176 QUESTIONS AND ANSWERS
VERIFIED AND WELL DETAILED
ANSWERS PLUS RATIONALES
GUARANTEED PASS LATEST EXAM
UPDATE
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Questions 1–30
Question 1
A patient presents with low back pain that worsens with lumbar extension and improves
with flexion. On examination, there is a prominent right PSIS and a short right leg in the
supine position, with the leg length equalizing when seated. This is most consistent with:
A) Sacral torsion about an oblique axis
B) Iliosacral shear dysfunction
C) Unilateral anterior innominate
D) Bilateral innominate rotation
Answer: C
Rationale: An anterior innominate (ASIS moves anterior/inferior) produces a functional
short leg on the same side in supine, which corrects when sitting (pelvis fixed). Extension
worsens pain (anterior rotation increases lumbar lordosis), flexion improves it. A posterior
innominate would cause a long leg.
Question 2
A 35-year-old female has chronic headaches, cervical spine tenderness, and a history of
whiplash. The OA joint is restricted in flexion and sidebending to the right. The most
appropriate osteopathic manipulative treatment (OMT) is:
1
,A) Indirect balanced ligamentous tension for OA extension
B) Direct HVLA with the patient supine, OA joint flexed, rotated left, sidebent right
C) Muscle energy for the suboccipitals (agonist pattern)
D) Myofascial release of the scalenes
Answer: B
Rationale: The OA joint is a modified synovial joint. If restricted in flexion and sidebending to
the right, the restrictive barrier is in flexion and right sidebending. HVLA positioning: flex,
rotate left (away), sidebent right (toward barrier). Type II somatic dysfunction: flexed,
sidebent, rotated (same side = right).
Question 3
During a Chapman reflex examination, a patient has a small, tender nodule at the tip of the
12th rib posteriorly. This is most likely associated with:
A) Colon dysfunction
B) Kidney dysfunction
C) Adrenal dysfunction
D) Liver dysfunction
Answer: B
Rationale: Chapman reflexes are viscerosomatic points. The kidney reflex is found at the tip
of the 12th rib posteriorly. The colon reflex is at the 11th rib tip or McBurney's point, and the
adrenal reflex is at the 11th rib near the costovertebral angle.
Question 4
A patient has a posterior fibular head restriction with ankle dorsiflexion and eversion
limitations. The most appropriate OMT is:
A) Articulatory technique of the talocrural joint
B) Muscle energy – direct for the fibular head
C) HVLA of the proximal tibiofibular joint
D) Counterstrain for the peroneals
2
,Answer: B
Rationale: A posterior fibular head is a Type I dysfunction (grouped with the talus). Muscle
energy using the peroneals to draw the fibula anteriorly (agonist contraction) is appropriate.
HVLA is possible but more aggressive.
Question 5
Which of the following best describes the concept of "somatic dysfunction" in osteopathic
medicine?
A) A psychological condition that manifests with physical symptoms
B) Impaired or altered function of the musculoskeletal system and related neural,
lymphatic, and vascular elements
C) A permanent structural deformity of the spine
D) An autoimmune disorder affecting the connective tissue
Answer: B
Rationale: The osteopathic definition of somatic dysfunction is impaired or altered function
of the somatic (body framework) system, including skeletal, arthrodial, myofascial, and
vascular/lymphatic/neural elements.
Question 6
A patient with chronic asthma receives OMT. The Chapman reflex for the lung is located:
A) Midclavicular line, 1st intercostal space
B) Intercostal spaces 2-3, 2-3 cm from sternum
C) Intercostal spaces 4-5, midclavicular line
D) Posterior scapular spine
Answer: B
Rationale: Lung Chapman reflexes: anterior – 2nd-3rd intercostal spaces, 2-3 cm from
sternum; posterior – between T3-T5, 2 cm from midline.
Question 7
A patient has a decreased right patellar reflex. The nerve root most likely involved is:
3
, A) L2
B) L3
C) L4
D) S1
Answer: C
Rationale: The patellar reflex (knee jerk) tests the L4 nerve root (femoral nerve). L3 also
contributes, but L4 is the primary reflex tested. L2 is more hip flexor, S1 is Achilles reflex.
Question 8
During a cranial OMT evaluation, the physician notes that the right sphenoid bone is
restricted in flexion while the left sphenoid moves freely. This is termed:
A) Sphenobasilar symphysis compression
B) SBS torsion
C) SBS sidebending rotation
D) Vertical strain pattern
Answer: B
Rationale: SBS torsion: sphenoid and occiput rotate in opposite directions around an AP
axis. The greater wing of the sphenoid moves anterior on the side of the torsion (right
sphenoid flexion restriction here).
Question 9
A patient with chronic sinusitis undergoes OMT. Which technique is most appropriate for
maxillary sinus drainage?
A) Galbreath technique
B) Mastoid pump and frontal lift
C) Temporal lift
D) Suboccipital decompression
Answer: B
4
EXAM – 176 QUESTIONS AND ANSWERS
VERIFIED AND WELL DETAILED
ANSWERS PLUS RATIONALES
GUARANTEED PASS LATEST EXAM
UPDATE
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OPP)
Questions 1–30
Question 1
A patient presents with low back pain that worsens with lumbar extension and improves
with flexion. On examination, there is a prominent right PSIS and a short right leg in the
supine position, with the leg length equalizing when seated. This is most consistent with:
A) Sacral torsion about an oblique axis
B) Iliosacral shear dysfunction
C) Unilateral anterior innominate
D) Bilateral innominate rotation
Answer: C
Rationale: An anterior innominate (ASIS moves anterior/inferior) produces a functional
short leg on the same side in supine, which corrects when sitting (pelvis fixed). Extension
worsens pain (anterior rotation increases lumbar lordosis), flexion improves it. A posterior
innominate would cause a long leg.
Question 2
A 35-year-old female has chronic headaches, cervical spine tenderness, and a history of
whiplash. The OA joint is restricted in flexion and sidebending to the right. The most
appropriate osteopathic manipulative treatment (OMT) is:
1
,A) Indirect balanced ligamentous tension for OA extension
B) Direct HVLA with the patient supine, OA joint flexed, rotated left, sidebent right
C) Muscle energy for the suboccipitals (agonist pattern)
D) Myofascial release of the scalenes
Answer: B
Rationale: The OA joint is a modified synovial joint. If restricted in flexion and sidebending to
the right, the restrictive barrier is in flexion and right sidebending. HVLA positioning: flex,
rotate left (away), sidebent right (toward barrier). Type II somatic dysfunction: flexed,
sidebent, rotated (same side = right).
Question 3
During a Chapman reflex examination, a patient has a small, tender nodule at the tip of the
12th rib posteriorly. This is most likely associated with:
A) Colon dysfunction
B) Kidney dysfunction
C) Adrenal dysfunction
D) Liver dysfunction
Answer: B
Rationale: Chapman reflexes are viscerosomatic points. The kidney reflex is found at the tip
of the 12th rib posteriorly. The colon reflex is at the 11th rib tip or McBurney's point, and the
adrenal reflex is at the 11th rib near the costovertebral angle.
Question 4
A patient has a posterior fibular head restriction with ankle dorsiflexion and eversion
limitations. The most appropriate OMT is:
A) Articulatory technique of the talocrural joint
B) Muscle energy – direct for the fibular head
C) HVLA of the proximal tibiofibular joint
D) Counterstrain for the peroneals
2
,Answer: B
Rationale: A posterior fibular head is a Type I dysfunction (grouped with the talus). Muscle
energy using the peroneals to draw the fibula anteriorly (agonist contraction) is appropriate.
HVLA is possible but more aggressive.
Question 5
Which of the following best describes the concept of "somatic dysfunction" in osteopathic
medicine?
A) A psychological condition that manifests with physical symptoms
B) Impaired or altered function of the musculoskeletal system and related neural,
lymphatic, and vascular elements
C) A permanent structural deformity of the spine
D) An autoimmune disorder affecting the connective tissue
Answer: B
Rationale: The osteopathic definition of somatic dysfunction is impaired or altered function
of the somatic (body framework) system, including skeletal, arthrodial, myofascial, and
vascular/lymphatic/neural elements.
Question 6
A patient with chronic asthma receives OMT. The Chapman reflex for the lung is located:
A) Midclavicular line, 1st intercostal space
B) Intercostal spaces 2-3, 2-3 cm from sternum
C) Intercostal spaces 4-5, midclavicular line
D) Posterior scapular spine
Answer: B
Rationale: Lung Chapman reflexes: anterior – 2nd-3rd intercostal spaces, 2-3 cm from
sternum; posterior – between T3-T5, 2 cm from midline.
Question 7
A patient has a decreased right patellar reflex. The nerve root most likely involved is:
3
, A) L2
B) L3
C) L4
D) S1
Answer: C
Rationale: The patellar reflex (knee jerk) tests the L4 nerve root (femoral nerve). L3 also
contributes, but L4 is the primary reflex tested. L2 is more hip flexor, S1 is Achilles reflex.
Question 8
During a cranial OMT evaluation, the physician notes that the right sphenoid bone is
restricted in flexion while the left sphenoid moves freely. This is termed:
A) Sphenobasilar symphysis compression
B) SBS torsion
C) SBS sidebending rotation
D) Vertical strain pattern
Answer: B
Rationale: SBS torsion: sphenoid and occiput rotate in opposite directions around an AP
axis. The greater wing of the sphenoid moves anterior on the side of the torsion (right
sphenoid flexion restriction here).
Question 9
A patient with chronic sinusitis undergoes OMT. Which technique is most appropriate for
maxillary sinus drainage?
A) Galbreath technique
B) Mastoid pump and frontal lift
C) Temporal lift
D) Suboccipital decompression
Answer: B
4
