COMSAE Phase 1, 2 & 3 – Osteopathic
Principles & Practice (OMM/OMT) High-Yield
Exam Questions with Verified Answers &
Rationales, 2025 | 2026 | 110 Questions – Instant
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Q1. A patient with a respiratory somatic dysfunction (respiratory disease) is
admitted with an "exhaled rib" on the left. This dysfunction is characterized by:
A) The rib is elevated and restricted in depression.
B) The rib is depressed (inferiorly) and restricted in elevation.
C) The rib is rotated externally.
D) The rib is rotated internally.
Correct Answer: B
Rationale: An "exhaled rib" is stuck in the exhalation phase (forced exhalation
position). It is located inferiorly relative to its normal position and is restricted in
the ability to elevate during inhalation. This position is associated with engaging
the rib at the end of exhalation and applying a forced through inhalation.
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in
a neutral position (neither flexed nor extended), which of the following occurs?
A) Sidebending and rotation occur to the same degree.
B) Sidebending occurs without rotation.
C) Sidebending and rotation occur to opposite degrees.
D) Rotation occurs without sidebending.
Correct Answer: C
Rationale: In neutral position, sidebending and rotation occur in opposite
directions (sidebending to the right is accompanied by rotation to the left, and vice
versa). This is Fryette's first principle.
Q3. In the seated flexion test, deeper palpation on the left 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 superiorly (deeper
palpation on the left means left PSIS moves more cephalad) indicates the side of
the sacral base torsion. Left PSIS moving more suggests a right sacral base torsion
(R/R).
Q4. Which Chapman reflex point is correctly matched with its corresponding
organ?
A) Tip of right 12th rib – Cecum/Appendix
B) 2nd intercostal space, right sternal border – Diaphragm
C) Left 5th intercostal space, midclavicular line – Left lung
D) Tip of left 11th rib – Stomach
Correct Answer: A
Rationale: Chapman’s reflexes for the colon are at the tips of the 11th and 12th
ribs. Right 12th rib corresponds to cecum and appendix. Diaphragm reflex is at
5th–6th intercostal space near sternum? Not 2nd. Left lung reflex is anterior at
3rd–4th ICS. Stomach reflex is at left 5th–6th ICS.
Q5. In multiple energy techniques (MET), the patient’s contraction force should
be:
A) Minimal, consistent, a signal of final border
B) Submaximal (approximately 20% of maximal) for 3–5 seconds
C) Moderate, consistent only
D) Moderate, consistent through full range
Correct Answer: B
Rationale: MET uses patient’s submaximal contraction (≈20% of maximal
strength) for 3–5 seconds to activate muscle spindles and allow relaxation,
facilitating joint repositioning.
Q6: A patient has a neutral dysfunction with left sidebending restriction. Which
rotation is also restricted?
A) Left rotation
,B) Right rotation
C) No rotation
D) Bilateral rotation
Correct Answer: B
Rationale: In neutral mechanics (Type I), sidebending and rotation occur to
opposite sides. Therefore left sidebending restriction implies right rotation
restriction.
Q7. Which of the following is a characteristic of a Type II (non-neutral) somatic
dysfunction?
A) Spine is in neutral position
B) Sidebending and rotation occur in opposite directions
C) Sidebending and rotation occur in the same direction
D) Multiple vertebral segments are involved
Correct Answer: C
Rationale: Fryette’s second principle (non-neutral, i.e., spine in flexion or
extension) states that sidebending and rotation occur in the same direction.
Q8. During a cranial rhythm assessment, you detect a decreased amplitude but
normal rate. This is most consistent with:
A) Normal cranial rhythmic impulse
B) Increased intracranial pressure
C) Profound dehydration
D) Severe anxiety
Correct Answer: C
Rationale: Decreased amplitude of the cranial rhythmic impulse (CRI) is often
seen in dehydration, shock, or debilitation. Rate may remain normal. Increased ICP
typically decreases rate.
Q9. A patient with chronic asthma has tender points at the right 5th intercostal
space, midclavicular line anteriorly. This Chapman reflex point corresponds to:
A) Liver
B) Lung (right)
C) Stomach
, D) Appendix
Correct Answer: B
Rationale: Anterior Chapman points for the lungs are located at the 3rd–5th
intercostal spaces, midclavicular line. Right 5th ICS corresponds to the right lung.
Q10. In the supine leg pull test (sacral base torsion assessment), if the left leg
appears shorter when extended, then after applying gentle traction to both legs, the
right leg becomes shorter. This indicates:
A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Left-on-right sacral torsion
D) Normal finding
Correct Answer: C
Rationale: The supine leg pull test: initial short leg indicates the side of the rotated
sacral base. After traction, the opposite leg becomes shorter – that indicates the
axis of torsion. Left short initially, then right short after traction = left-on-right
torsion.
Q11. A patient has a diagnosis of left unilateral sacral extension (L-E). Which of
the following physical exam findings is most consistent?
A) Left ILA is deep and posterior, right ILA is shallow and anterior
B) Left ILA is shallow and anterior, right ILA is deep and posterior
C) Both ILAs are deep
D) Both ILAs are shallow
Correct Answer: A
Rationale: In left unilateral sacral extension (L-E), the left ILA (inferior lateral
angle) is deep (posterior) and the right ILA is shallow (anterior) relative to the
examiner’s palpating finger. The sacral base rotates anteriorly on the left.
Q12. A patient presents with a rib that is "stuck" in inhalation (inhalation
dysfunction). On posterior palpation, you would expect:
A) The rib angle is elevated and restricted in depression
B) The rib angle is depressed and restricted in elevation
C) The rib angle is rotated externally
Principles & Practice (OMM/OMT) High-Yield
Exam Questions with Verified Answers &
Rationales, 2025 | 2026 | 110 Questions – Instant
Download PDF
Q1. A patient with a respiratory somatic dysfunction (respiratory disease) is
admitted with an "exhaled rib" on the left. This dysfunction is characterized by:
A) The rib is elevated and restricted in depression.
B) The rib is depressed (inferiorly) and restricted in elevation.
C) The rib is rotated externally.
D) The rib is rotated internally.
Correct Answer: B
Rationale: An "exhaled rib" is stuck in the exhalation phase (forced exhalation
position). It is located inferiorly relative to its normal position and is restricted in
the ability to elevate during inhalation. This position is associated with engaging
the rib at the end of exhalation and applying a forced through inhalation.
Q2. According to Fryette's first principle (Type I mechanics), when the spine is in
a neutral position (neither flexed nor extended), which of the following occurs?
A) Sidebending and rotation occur to the same degree.
B) Sidebending occurs without rotation.
C) Sidebending and rotation occur to opposite degrees.
D) Rotation occurs without sidebending.
Correct Answer: C
Rationale: In neutral position, sidebending and rotation occur in opposite
directions (sidebending to the right is accompanied by rotation to the left, and vice
versa). This is Fryette's first principle.
Q3. In the seated flexion test, deeper palpation on the left 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 superiorly (deeper
palpation on the left means left PSIS moves more cephalad) indicates the side of
the sacral base torsion. Left PSIS moving more suggests a right sacral base torsion
(R/R).
Q4. Which Chapman reflex point is correctly matched with its corresponding
organ?
A) Tip of right 12th rib – Cecum/Appendix
B) 2nd intercostal space, right sternal border – Diaphragm
C) Left 5th intercostal space, midclavicular line – Left lung
D) Tip of left 11th rib – Stomach
Correct Answer: A
Rationale: Chapman’s reflexes for the colon are at the tips of the 11th and 12th
ribs. Right 12th rib corresponds to cecum and appendix. Diaphragm reflex is at
5th–6th intercostal space near sternum? Not 2nd. Left lung reflex is anterior at
3rd–4th ICS. Stomach reflex is at left 5th–6th ICS.
Q5. In multiple energy techniques (MET), the patient’s contraction force should
be:
A) Minimal, consistent, a signal of final border
B) Submaximal (approximately 20% of maximal) for 3–5 seconds
C) Moderate, consistent only
D) Moderate, consistent through full range
Correct Answer: B
Rationale: MET uses patient’s submaximal contraction (≈20% of maximal
strength) for 3–5 seconds to activate muscle spindles and allow relaxation,
facilitating joint repositioning.
Q6: A patient has a neutral dysfunction with left sidebending restriction. Which
rotation is also restricted?
A) Left rotation
,B) Right rotation
C) No rotation
D) Bilateral rotation
Correct Answer: B
Rationale: In neutral mechanics (Type I), sidebending and rotation occur to
opposite sides. Therefore left sidebending restriction implies right rotation
restriction.
Q7. Which of the following is a characteristic of a Type II (non-neutral) somatic
dysfunction?
A) Spine is in neutral position
B) Sidebending and rotation occur in opposite directions
C) Sidebending and rotation occur in the same direction
D) Multiple vertebral segments are involved
Correct Answer: C
Rationale: Fryette’s second principle (non-neutral, i.e., spine in flexion or
extension) states that sidebending and rotation occur in the same direction.
Q8. During a cranial rhythm assessment, you detect a decreased amplitude but
normal rate. This is most consistent with:
A) Normal cranial rhythmic impulse
B) Increased intracranial pressure
C) Profound dehydration
D) Severe anxiety
Correct Answer: C
Rationale: Decreased amplitude of the cranial rhythmic impulse (CRI) is often
seen in dehydration, shock, or debilitation. Rate may remain normal. Increased ICP
typically decreases rate.
Q9. A patient with chronic asthma has tender points at the right 5th intercostal
space, midclavicular line anteriorly. This Chapman reflex point corresponds to:
A) Liver
B) Lung (right)
C) Stomach
, D) Appendix
Correct Answer: B
Rationale: Anterior Chapman points for the lungs are located at the 3rd–5th
intercostal spaces, midclavicular line. Right 5th ICS corresponds to the right lung.
Q10. In the supine leg pull test (sacral base torsion assessment), if the left leg
appears shorter when extended, then after applying gentle traction to both legs, the
right leg becomes shorter. This indicates:
A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Left-on-right sacral torsion
D) Normal finding
Correct Answer: C
Rationale: The supine leg pull test: initial short leg indicates the side of the rotated
sacral base. After traction, the opposite leg becomes shorter – that indicates the
axis of torsion. Left short initially, then right short after traction = left-on-right
torsion.
Q11. A patient has a diagnosis of left unilateral sacral extension (L-E). Which of
the following physical exam findings is most consistent?
A) Left ILA is deep and posterior, right ILA is shallow and anterior
B) Left ILA is shallow and anterior, right ILA is deep and posterior
C) Both ILAs are deep
D) Both ILAs are shallow
Correct Answer: A
Rationale: In left unilateral sacral extension (L-E), the left ILA (inferior lateral
angle) is deep (posterior) and the right ILA is shallow (anterior) relative to the
examiner’s palpating finger. The sacral base rotates anteriorly on the left.
Q12. A patient presents with a rib that is "stuck" in inhalation (inhalation
dysfunction). On posterior palpation, you would expect:
A) The rib angle is elevated and restricted in depression
B) The rib angle is depressed and restricted in elevation
C) The rib angle is rotated externally
