2026 Latest Practice Exam for COMSAE Phase 1
Form 115 with 300 Questions and Correct Answers
with Rationales to Test yourself/ 2026-2027 COMSAE
Phase I Form 115 Correctly Answered Practice Test
1: A structural exam reveals a restricted T5 segment. The segment prefers rotation
to the right and sidebending to the right. It improves when the patient slumps
forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL -ANSWER- C) T5 Flexed RR SR
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed
as Flexed. According to Fryette's Second Law (Type II mechanics), when a single
segment is in a non-neutral position (flexion or extension), rotation and
sidebending occur in the same direction. Thus, rotation right (RR) and sidebending
right (SR) yields a diagnosis of "Flexed RR SR."
2: 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 side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending -ANSWER- C) Sidebending and rotation
occur to opposite sides
Rationale: Fryette's First Principle (Type I mechanics) describes that when
multiple vertebral segments are in a neutral position, sidebending and rotation
occur in opposite directions. This is a key distinction from Type II mechanics
(non-neutral, single segment), where they move together.
3: In the seated flexion test, a finding of more than 2 cm of superior iliac crest
movement on the left compared to the right indicates:
A) A sacral base torsion on the right (R/R)
B) A sacral base torsion on the left (L/L)
1
,C) A right unilateral sacral extension
D) A left unilateral sacral extension -ANSWER- B) A sacral base torsion on the
left (L/L)
Rationale: The seated flexion test is used to screen for iliosacral or sacroiliac
dysfunction. If the left superior iliac crest moves further cephalad than the right, it
suggests a sacral base torsion on the left (L/L). This finding indicates that the ilium
on the side with greater motion is likely sacral-fixated or hypomobile.
4: During muscle energy technique (MET), the patient's contraction force should
be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range -ANSWER- B) Submaximal
(approximately 20% of maximal) isometric contraction
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by
the patient, followed by relaxation and repositioning to the new barrier. Maximal
contraction would be counterproductive and could cause muscle guarding or
injury.
5: A patient with chronic low back pain has a pelvic torsion with a right
innominate rotated posteriorly. Which muscle energy technique is most
appropriate?
A) Direct MET with the patient's right leg in extension
B) Direct MET with the patient's right leg in flexion
C) Indirect MET with the patient's left leg in flexion
D) High-velocity low-amplitude thrust to the left sacroiliac joint -ANSWER- B)
Direct MET with the patient's right leg in flexion
Rationale: A posterior innominate (or posterior rotated ilium) is treated with the
patient supine, flexing the hip and knee on the affected side to stretch the anterior
hip structures and iliofemoral ligament, then using isometric contraction against
resistance to correct the posterior rotation.
6: Which of the following is a contraindication to the use of high-velocity low-
amplitude (HVLA) thrust technique?
A) Acute muscle spasm
B) Osteoporosis
C) Mild joint hypomobility
2
,D) Patient preference for soft tissue treatment -ANSWER- B) Osteoporosis
Rationale: HVLA is absolutely contraindicated in patients with osteoporosis or any
condition that compromises bone integrity, due to the high risk of fracture. Acute
muscle spasm, mild hypomobility, and patient preference are not absolute
contraindications.
7: The "inhibitory" technique in osteopathic manipulative treatment is primarily
used for:
A) Increasing joint mobility
B) Reducing hypertonic muscle tension
C) Correcting vertebral rotation
D) Mobilizing cranial sutures -ANSWER- B) Reducing hypertonic muscle tension
Rationale: Inhibitory techniques involve sustained pressure over muscle bellies,
tendon origins/insertions, or trigger points to decrease hypertonicity, spasm, and
pain through reflex relaxation mechanisms.
8: A patient presents with right-sided tension headache and restricted right cervical
rotation. On osteopathic exam, the occiput is rotated right and sidebent left. What
is the most appropriate cranial manipulation technique?
A) V-spread release
B) Compression of the fourth ventricle (CV4)
C) Galbreath technique
D) Balancing the reciprocal tension membranes -ANSWER- D) Balancing the
reciprocal tension membranes
Rationale: Occipital dysfunction with rotation and sidebending in opposite
directions often reflects a strain pattern in the dural membranes (falx cerebri and
tentorium cerebelli). Balancing the reciprocal tension membranes is the direct
cranial technique used to address these rotational dysfunctions.
9: The primary respiratory mechanism (PRM) in cranial osteopathy includes all of
the following EXCEPT:
A) Inherent motility of the brain and spinal cord
B) Fluctuation of cerebrospinal fluid
C) Mobility of the cranial sutures
D) Voluntary diaphragmatic excursion -ANSWER- D) Voluntary diaphragmatic
excursion
Rationale: The PRM is involuntary and consists of (1) inherent motility of the
brain and spinal cord, (2) fluctuation of CSF, (3) mobility of cranial sutures, and
3
, (4) reciprocal tension membranes. Voluntary diaphragmatic excursion is not part of
the PRM.
10: Which cranial rhythm is assessed in osteopathy as the fluctuation of
cerebrospinal fluid, typically cycling at a rate of 6-12 cycles per minute?
A) Cardiac rhythm
B) Respiratory rhythm
C) Cranial rhythmic impulse (CRI)
D) Gastrointestinal peristaltic rhythm -ANSWER- C) Cranial rhythmic impulse
(CRI)
Rationale: The CRI is a palpable, rhythmic fluctuation of the cranial bones and
sacrum that corresponds to the ebb and flow of cerebrospinal fluid. It is
independent of cardiac and respiratory rhythms and typically cycles at 6-12 cycles
per minute in adults.
11: A patient with chronic obstructive pulmonary disease (COPD) presents with
restrictive rib cage motion. Which osteopathic technique is best to improve rib
excursion?
A) Direct HVLA to the costovertebral joints
B) Rib raising
C) Myofascial release of the pectoralis major
D) Counterstrain of the scalenes -ANSWER- B) Rib raising
Rationale: Rib raising is an osteopathic technique performed with the patient
supine, where the physician contacts the angles of the ribs and gently lifts them
superiorly to improve rib cage mobility, facilitate lymphatic drainage, and enhance
respiratory mechanics.
12: Which of the following is a hallmark finding in a somatic dysfunction of the
pubic symphysis?
A) Asymmetry of the iliac crests
B) Tenderness over the symphysis with unilateral or bilateral shearing
C) Restricted cervical rotation
D) Positive straight leg raise -ANSWER- B) Tenderness over the symphysis with
unilateral or bilateral shearing
Rationale: Pubic symphysis dysfunction presents with tenderness, pain, and
shearing motion (superior/inferior translation) on palpation. Iliac crest asymmetry
is more indicative of pelvic torsion, and cervical rotation restriction points to a
different somatic region.
4
Form 115 with 300 Questions and Correct Answers
with Rationales to Test yourself/ 2026-2027 COMSAE
Phase I Form 115 Correctly Answered Practice Test
1: A structural exam reveals a restricted T5 segment. The segment prefers rotation
to the right and sidebending to the right. It improves when the patient slumps
forward into spinal flexion. What is the correct diagnosis?
A) T5 Neutral SR RL
B) T5 Extended RR SR
C) T5 Flexed RR SR
D) T5 Flexed RL SL -ANSWER- C) T5 Flexed RR SR
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed
as Flexed. According to Fryette's Second Law (Type II mechanics), when a single
segment is in a non-neutral position (flexion or extension), rotation and
sidebending occur in the same direction. Thus, rotation right (RR) and sidebending
right (SR) yields a diagnosis of "Flexed RR SR."
2: 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 side
B) Sidebending occurs without rotation
C) Sidebending and rotation occur to opposite sides
D) Rotation occurs without sidebending -ANSWER- C) Sidebending and rotation
occur to opposite sides
Rationale: Fryette's First Principle (Type I mechanics) describes that when
multiple vertebral segments are in a neutral position, sidebending and rotation
occur in opposite directions. This is a key distinction from Type II mechanics
(non-neutral, single segment), where they move together.
3: In the seated flexion test, a finding of more than 2 cm of superior iliac crest
movement on the left compared to the right indicates:
A) A sacral base torsion on the right (R/R)
B) A sacral base torsion on the left (L/L)
1
,C) A right unilateral sacral extension
D) A left unilateral sacral extension -ANSWER- B) A sacral base torsion on the
left (L/L)
Rationale: The seated flexion test is used to screen for iliosacral or sacroiliac
dysfunction. If the left superior iliac crest moves further cephalad than the right, it
suggests a sacral base torsion on the left (L/L). This finding indicates that the ilium
on the side with greater motion is likely sacral-fixated or hypomobile.
4: During muscle energy technique (MET), the patient's contraction force should
be:
A) Maximal contraction against a fixed barrier
B) Submaximal (approximately 20% of maximal) isometric contraction
C) Eccentric contraction only
D) Isotonic contraction through full range -ANSWER- B) Submaximal
(approximately 20% of maximal) isometric contraction
Rationale: MET uses a gentle (submaximal, ~20% effort), isometric contraction by
the patient, followed by relaxation and repositioning to the new barrier. Maximal
contraction would be counterproductive and could cause muscle guarding or
injury.
5: A patient with chronic low back pain has a pelvic torsion with a right
innominate rotated posteriorly. Which muscle energy technique is most
appropriate?
A) Direct MET with the patient's right leg in extension
B) Direct MET with the patient's right leg in flexion
C) Indirect MET with the patient's left leg in flexion
D) High-velocity low-amplitude thrust to the left sacroiliac joint -ANSWER- B)
Direct MET with the patient's right leg in flexion
Rationale: A posterior innominate (or posterior rotated ilium) is treated with the
patient supine, flexing the hip and knee on the affected side to stretch the anterior
hip structures and iliofemoral ligament, then using isometric contraction against
resistance to correct the posterior rotation.
6: Which of the following is a contraindication to the use of high-velocity low-
amplitude (HVLA) thrust technique?
A) Acute muscle spasm
B) Osteoporosis
C) Mild joint hypomobility
2
,D) Patient preference for soft tissue treatment -ANSWER- B) Osteoporosis
Rationale: HVLA is absolutely contraindicated in patients with osteoporosis or any
condition that compromises bone integrity, due to the high risk of fracture. Acute
muscle spasm, mild hypomobility, and patient preference are not absolute
contraindications.
7: The "inhibitory" technique in osteopathic manipulative treatment is primarily
used for:
A) Increasing joint mobility
B) Reducing hypertonic muscle tension
C) Correcting vertebral rotation
D) Mobilizing cranial sutures -ANSWER- B) Reducing hypertonic muscle tension
Rationale: Inhibitory techniques involve sustained pressure over muscle bellies,
tendon origins/insertions, or trigger points to decrease hypertonicity, spasm, and
pain through reflex relaxation mechanisms.
8: A patient presents with right-sided tension headache and restricted right cervical
rotation. On osteopathic exam, the occiput is rotated right and sidebent left. What
is the most appropriate cranial manipulation technique?
A) V-spread release
B) Compression of the fourth ventricle (CV4)
C) Galbreath technique
D) Balancing the reciprocal tension membranes -ANSWER- D) Balancing the
reciprocal tension membranes
Rationale: Occipital dysfunction with rotation and sidebending in opposite
directions often reflects a strain pattern in the dural membranes (falx cerebri and
tentorium cerebelli). Balancing the reciprocal tension membranes is the direct
cranial technique used to address these rotational dysfunctions.
9: The primary respiratory mechanism (PRM) in cranial osteopathy includes all of
the following EXCEPT:
A) Inherent motility of the brain and spinal cord
B) Fluctuation of cerebrospinal fluid
C) Mobility of the cranial sutures
D) Voluntary diaphragmatic excursion -ANSWER- D) Voluntary diaphragmatic
excursion
Rationale: The PRM is involuntary and consists of (1) inherent motility of the
brain and spinal cord, (2) fluctuation of CSF, (3) mobility of cranial sutures, and
3
, (4) reciprocal tension membranes. Voluntary diaphragmatic excursion is not part of
the PRM.
10: Which cranial rhythm is assessed in osteopathy as the fluctuation of
cerebrospinal fluid, typically cycling at a rate of 6-12 cycles per minute?
A) Cardiac rhythm
B) Respiratory rhythm
C) Cranial rhythmic impulse (CRI)
D) Gastrointestinal peristaltic rhythm -ANSWER- C) Cranial rhythmic impulse
(CRI)
Rationale: The CRI is a palpable, rhythmic fluctuation of the cranial bones and
sacrum that corresponds to the ebb and flow of cerebrospinal fluid. It is
independent of cardiac and respiratory rhythms and typically cycles at 6-12 cycles
per minute in adults.
11: A patient with chronic obstructive pulmonary disease (COPD) presents with
restrictive rib cage motion. Which osteopathic technique is best to improve rib
excursion?
A) Direct HVLA to the costovertebral joints
B) Rib raising
C) Myofascial release of the pectoralis major
D) Counterstrain of the scalenes -ANSWER- B) Rib raising
Rationale: Rib raising is an osteopathic technique performed with the patient
supine, where the physician contacts the angles of the ribs and gently lifts them
superiorly to improve rib cage mobility, facilitate lymphatic drainage, and enhance
respiratory mechanics.
12: Which of the following is a hallmark finding in a somatic dysfunction of the
pubic symphysis?
A) Asymmetry of the iliac crests
B) Tenderness over the symphysis with unilateral or bilateral shearing
C) Restricted cervical rotation
D) Positive straight leg raise -ANSWER- B) Tenderness over the symphysis with
unilateral or bilateral shearing
Rationale: Pubic symphysis dysfunction presents with tenderness, pain, and
shearing motion (superior/inferior translation) on palpation. Iliac crest asymmetry
is more indicative of pelvic torsion, and cervical rotation restriction points to a
different somatic region.
4
