COMLEX-USA / COMSAE Level 2 (OMM
Semester 1) Verified Multiple Choice and
Conceptual Actual Emended Exam Questions
With Reviewed 100% Correct Detailed Answers
Guaranteed Pass!!Current Update
Q1. A 28-year-old female presents with unilateral pulsatile headaches,
photophobia, and nausea. OMM exam shows a tenderpoint at the articular pillar
of C2. Which autonomic pathway is most implicated in her symptoms?
A) Increased parasympathetic tone via CN X
B) Increased sympathetic tone from T1–T4
C) Decreased sympathetic tone from T5–T9
D) Increased parasympathetic tone via S2–S4
Answer: B
Rationale: Migraines often involve hypersympathetic tone to cranial vessels (T1–
T4).
Q2. Rib raising at T1–T4 in a migraine patient will:
A) Increase sympathetic tone → vasoconstriction
B) Decrease sympathetic tone → reduce vasoconstriction
C) Increase vagal tone → increase gut motility
D) Have no autonomic effect
Answer: B
Rationale: Rib raising decreases hypersympathetic activity, improving vascular
regulation.
,Q3. A patient with migraine is treated with suboccipital release. Primary goal?
A) Decrease vagal output
B) Reduce occipital nerve irritation and balance parasympathetics
C) Increase cervical lymphatic drainage only
D) Stimulate sympathetic vasoconstriction
Answer: B
Rationale: Suboccipital release normalizes parasympathetic tone (CN X) and
relieves myofascial strain.
Q4. Migraine pain beginning in the occiput and radiating to the temporal region is
most often linked to dysfunction at which level?
A) Upper cervical spine (C1–C3)
B) Lower cervical spine (C5–C7)
C) T5–T9
D) Sacrum
Answer: A
Rationale: Occipito-temporal headache patterns often arise from upper cervical
somatic dysfunction.
Q5. Palpation shows a tenderpoint at the right articular pillar of C2. Which
counterstrain position is correct?
A) Flexion, sidebend right, rotate right
B) Extension, sidebend right, rotate right
C) Flexion, sidebend left, rotate left
D) Extension, sidebend left, rotate right
Answer: B
Rationale: C2 tenderpoint → E, SB right, R right.
,Q6. A patient with migraines has trapezius hypertonicity. Which muscle energy
technique is best?
A) Post-isometric relaxation
B) Reciprocal inhibition
C) Isotonic eccentric contraction
D) High-velocity thrust
Answer: A
Rationale: Post-isometric relaxation decreases hypertonicity in acute tension.
Q7. A patient is treated with cranial OMM. Which phase of the cranial rhythmic
impulse is associated with paired bone external rotation?
A) Flexion
B) Extension
C) SBS compression
D) Torsion strain
Answer: A
Rationale: Flexion → paired bones externally rotate.
Q8. Which cranial strain pattern is most often associated with chronic headaches
after lateral head trauma?
A) Torsion strain
B) Lateral strain
C) Vertical strain
D) SBS compression
Answer: B
Rationale: Blow to the side → lateral strain, often linked to chronic headaches.
9. A 33-year-old female with recurrent migraines is best treated acutely with:
A) Propranolol
B) Sumatriptan
, C) Valproic acid
D) Butalbital
Answer: B
Rationale: Triptans are first-line for acute migraine.
Q10. Propranolol in migraine care is used for:
A) Acute abortive treatment
B) Prophylaxis
C) Cluster headache treatment
D) Tension headache only
Answer: B
Rationale: Beta blockers are migraine prophylaxis, not abortive therapy.
Q11. A patient with migraines is started on valproic acid. Which lab should be
monitored?
A) CBC
B) Liver function tests
C) Creatinine
D) TSH
Answer: B
Rationale: Valproate can cause hepatotoxicity.
Q12. Butalbital is most effective in:
A) Cluster headaches
B) Migraine prophylaxis
C) Tension headaches
D) Chronic daily headache
Semester 1) Verified Multiple Choice and
Conceptual Actual Emended Exam Questions
With Reviewed 100% Correct Detailed Answers
Guaranteed Pass!!Current Update
Q1. A 28-year-old female presents with unilateral pulsatile headaches,
photophobia, and nausea. OMM exam shows a tenderpoint at the articular pillar
of C2. Which autonomic pathway is most implicated in her symptoms?
A) Increased parasympathetic tone via CN X
B) Increased sympathetic tone from T1–T4
C) Decreased sympathetic tone from T5–T9
D) Increased parasympathetic tone via S2–S4
Answer: B
Rationale: Migraines often involve hypersympathetic tone to cranial vessels (T1–
T4).
Q2. Rib raising at T1–T4 in a migraine patient will:
A) Increase sympathetic tone → vasoconstriction
B) Decrease sympathetic tone → reduce vasoconstriction
C) Increase vagal tone → increase gut motility
D) Have no autonomic effect
Answer: B
Rationale: Rib raising decreases hypersympathetic activity, improving vascular
regulation.
,Q3. A patient with migraine is treated with suboccipital release. Primary goal?
A) Decrease vagal output
B) Reduce occipital nerve irritation and balance parasympathetics
C) Increase cervical lymphatic drainage only
D) Stimulate sympathetic vasoconstriction
Answer: B
Rationale: Suboccipital release normalizes parasympathetic tone (CN X) and
relieves myofascial strain.
Q4. Migraine pain beginning in the occiput and radiating to the temporal region is
most often linked to dysfunction at which level?
A) Upper cervical spine (C1–C3)
B) Lower cervical spine (C5–C7)
C) T5–T9
D) Sacrum
Answer: A
Rationale: Occipito-temporal headache patterns often arise from upper cervical
somatic dysfunction.
Q5. Palpation shows a tenderpoint at the right articular pillar of C2. Which
counterstrain position is correct?
A) Flexion, sidebend right, rotate right
B) Extension, sidebend right, rotate right
C) Flexion, sidebend left, rotate left
D) Extension, sidebend left, rotate right
Answer: B
Rationale: C2 tenderpoint → E, SB right, R right.
,Q6. A patient with migraines has trapezius hypertonicity. Which muscle energy
technique is best?
A) Post-isometric relaxation
B) Reciprocal inhibition
C) Isotonic eccentric contraction
D) High-velocity thrust
Answer: A
Rationale: Post-isometric relaxation decreases hypertonicity in acute tension.
Q7. A patient is treated with cranial OMM. Which phase of the cranial rhythmic
impulse is associated with paired bone external rotation?
A) Flexion
B) Extension
C) SBS compression
D) Torsion strain
Answer: A
Rationale: Flexion → paired bones externally rotate.
Q8. Which cranial strain pattern is most often associated with chronic headaches
after lateral head trauma?
A) Torsion strain
B) Lateral strain
C) Vertical strain
D) SBS compression
Answer: B
Rationale: Blow to the side → lateral strain, often linked to chronic headaches.
9. A 33-year-old female with recurrent migraines is best treated acutely with:
A) Propranolol
B) Sumatriptan
, C) Valproic acid
D) Butalbital
Answer: B
Rationale: Triptans are first-line for acute migraine.
Q10. Propranolol in migraine care is used for:
A) Acute abortive treatment
B) Prophylaxis
C) Cluster headache treatment
D) Tension headache only
Answer: B
Rationale: Beta blockers are migraine prophylaxis, not abortive therapy.
Q11. A patient with migraines is started on valproic acid. Which lab should be
monitored?
A) CBC
B) Liver function tests
C) Creatinine
D) TSH
Answer: B
Rationale: Valproate can cause hepatotoxicity.
Q12. Butalbital is most effective in:
A) Cluster headaches
B) Migraine prophylaxis
C) Tension headaches
D) Chronic daily headache
