1
COMSAE Phase 2 Form 115 Practice
Exam 176 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2025|2026 Q&A | Instant
Download Pdf
Question 1
A 45-year-old male presents with chronic low back pain. During osteopathic
evaluation, you note a right anterior innominate rotation. Which of the following
findings is consistent with this diagnosis?
A) Right ASIS superior and posterior, right ischial tuberosity inferior
B) Right ASIS inferior and anterior, right ischial tuberosity superior
C) Left ASIS inferior and posterior, left ischial tuberosity inferior
D) Symmetric PSIS levels with the patient in a seated position
,,,answer,,,: B
Rationale: In a right anterior innominate rotation, the ilium rotates anteriorly
relative to the sacrum. The ASIS (anterior superior iliac spine) moves inferior and
anterior, while the ischial tuberosity moves superior. This dysfunction is often
associated with a shortened ipsilateral hip flexor (iliopsoas) .
High-Yield Concept: Anterior innominate → shortened iliopsoas; Posterior
innominate → shortened hamstrings.
,2
Question 2
A patient presents with acute onset shortness of breath and decreased breath
sounds on the right. You suspect a rib dysfunction. Which rib group is most likely
associated with sympathetic innervation affecting bronchial smooth muscle?
A) Ribs 1–2
B) Ribs 3–5
C) Ribs 6–10
D) Ribs 11–12
,,,answer,,,: B
Rationale: Ribs 3–5 correspond to the sympathetics from T2–T6, which innervate
the lungs and bronchi. Rib raising in this area is used to treat increased sympathetic
tone in conditions such as asthma or bronchitis. The sympathetic chain ganglia lie
along the heads of the ribs, and somatic dysfunction in this region can contribute to
bronchospasm .
High-Yield Concept: Viscerosomatic reflexes: Lung pathology → T2–T6 somatic
dysfunction.
Question 3
A 30-year-old female with a history of migraines undergoes OMM. You perform a
CV4 (compression of the fourth ventricle) technique. What is the intended
physiologic effect?
,3
A) Increase sympathetic outflow
B) Decrease parasympathetic tone
C) Enhance the primary respiratory mechanism and sedate the patient
D) Increase lymphatic drainage of the thoracic duct
,,,answer,,,: C
Rationale: CV4 (Compression of the Fourth Ventricle) is a direct osteopathic
cranial technique that compresses the occiput to balance the cranial rhythmic
impulse. It is primarily used for its sedative effect and to enhance the primary
respiratory mechanism. The technique involves gentle compression of the
occiput to increase intracranial pressure momentarily, followed by a release that
facilitates the inherent cranial motion .
High-Yield Concept: CV4 = sedation; V-spread = parasympathetic stimulation.
Question 4
According to Fryette's Laws, which of the following describes Type I (Neutral)
mechanics?
A) A group of vertebrae are rotated opposite to side bending in a neutral
position
B) A single vertebra is rotated to the same side as side bending
C) Only occurs in non-neutral positions
D) The facets are locked in flexion
,,,answer,,,: A
Rationale: Fryette's Type I mechanics describe motion in the neutral position (no
flexion or extension). When a group of vertebrae sidebends, they rotate to
, 4
the opposite side. This pattern typically involves multiple vertebral segments and
is often seen in scoliosis. Type II mechanics (non-neutral) involve a single vertebra
rotating to the same side as side bending .
High-Yield Concept: Type I (Neutral): Sidebending and rotation
→ opposite directions; Type II (Non-neutral): Same direction.
Question 5
A patient presents with chronic constipation. You diagnose a somatic dysfunction
at the L5–S1 segment. Which parasympathetic innervation is likely affected?
A) Vagus nerve (CN X)
B) Pelvic splanchnic nerves (S2–S4)
C) Thoracolumbar outflow (T5–T9)
D) Superior mesenteric ganglion
,,,answer,,,: B
Rationale: The descending colon, sigmoid colon, and rectum receive
parasympathetic innervation from the pelvic splanchnic nerves (S2–S4). Somatic
dysfunction in the lumbar or sacral region can impair this reflex arc, leading to
constipation. The vagus nerve supplies parasympathetic fibers to the proximal
colon only .
High-Yield Concept: "Vagus to the splenic flexure; pelvic splanchnics the rest."
Question 6
COMSAE Phase 2 Form 115 Practice
Exam 176 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2025|2026 Q&A | Instant
Download Pdf
Question 1
A 45-year-old male presents with chronic low back pain. During osteopathic
evaluation, you note a right anterior innominate rotation. Which of the following
findings is consistent with this diagnosis?
A) Right ASIS superior and posterior, right ischial tuberosity inferior
B) Right ASIS inferior and anterior, right ischial tuberosity superior
C) Left ASIS inferior and posterior, left ischial tuberosity inferior
D) Symmetric PSIS levels with the patient in a seated position
,,,answer,,,: B
Rationale: In a right anterior innominate rotation, the ilium rotates anteriorly
relative to the sacrum. The ASIS (anterior superior iliac spine) moves inferior and
anterior, while the ischial tuberosity moves superior. This dysfunction is often
associated with a shortened ipsilateral hip flexor (iliopsoas) .
High-Yield Concept: Anterior innominate → shortened iliopsoas; Posterior
innominate → shortened hamstrings.
,2
Question 2
A patient presents with acute onset shortness of breath and decreased breath
sounds on the right. You suspect a rib dysfunction. Which rib group is most likely
associated with sympathetic innervation affecting bronchial smooth muscle?
A) Ribs 1–2
B) Ribs 3–5
C) Ribs 6–10
D) Ribs 11–12
,,,answer,,,: B
Rationale: Ribs 3–5 correspond to the sympathetics from T2–T6, which innervate
the lungs and bronchi. Rib raising in this area is used to treat increased sympathetic
tone in conditions such as asthma or bronchitis. The sympathetic chain ganglia lie
along the heads of the ribs, and somatic dysfunction in this region can contribute to
bronchospasm .
High-Yield Concept: Viscerosomatic reflexes: Lung pathology → T2–T6 somatic
dysfunction.
Question 3
A 30-year-old female with a history of migraines undergoes OMM. You perform a
CV4 (compression of the fourth ventricle) technique. What is the intended
physiologic effect?
,3
A) Increase sympathetic outflow
B) Decrease parasympathetic tone
C) Enhance the primary respiratory mechanism and sedate the patient
D) Increase lymphatic drainage of the thoracic duct
,,,answer,,,: C
Rationale: CV4 (Compression of the Fourth Ventricle) is a direct osteopathic
cranial technique that compresses the occiput to balance the cranial rhythmic
impulse. It is primarily used for its sedative effect and to enhance the primary
respiratory mechanism. The technique involves gentle compression of the
occiput to increase intracranial pressure momentarily, followed by a release that
facilitates the inherent cranial motion .
High-Yield Concept: CV4 = sedation; V-spread = parasympathetic stimulation.
Question 4
According to Fryette's Laws, which of the following describes Type I (Neutral)
mechanics?
A) A group of vertebrae are rotated opposite to side bending in a neutral
position
B) A single vertebra is rotated to the same side as side bending
C) Only occurs in non-neutral positions
D) The facets are locked in flexion
,,,answer,,,: A
Rationale: Fryette's Type I mechanics describe motion in the neutral position (no
flexion or extension). When a group of vertebrae sidebends, they rotate to
, 4
the opposite side. This pattern typically involves multiple vertebral segments and
is often seen in scoliosis. Type II mechanics (non-neutral) involve a single vertebra
rotating to the same side as side bending .
High-Yield Concept: Type I (Neutral): Sidebending and rotation
→ opposite directions; Type II (Non-neutral): Same direction.
Question 5
A patient presents with chronic constipation. You diagnose a somatic dysfunction
at the L5–S1 segment. Which parasympathetic innervation is likely affected?
A) Vagus nerve (CN X)
B) Pelvic splanchnic nerves (S2–S4)
C) Thoracolumbar outflow (T5–T9)
D) Superior mesenteric ganglion
,,,answer,,,: B
Rationale: The descending colon, sigmoid colon, and rectum receive
parasympathetic innervation from the pelvic splanchnic nerves (S2–S4). Somatic
dysfunction in the lumbar or sacral region can impair this reflex arc, leading to
constipation. The vagus nerve supplies parasympathetic fibers to the proximal
colon only .
High-Yield Concept: "Vagus to the splenic flexure; pelvic splanchnics the rest."
Question 6
