COMSAE 113 HIGH-YIELD EXAM PREP
COMSAE 113 HIGH-YIELD EXAM PREP NEWEST 2026/2027 ACTUAL
EXAM COMPLETE 176 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH DETAILED RATIONALES |ALREADY GRADED
A+||BRAND NEW VERSION!!
This form is heavily tailored toward high-yield clinical presentations,
pathopharmacology, microbiology, and complex OMM mechanics (sacral torsions,
innominate dysfunctions, and cranial strains).
Structure: 4 sections of 44 questions each
Contents
Section 1 ................................................................................................................ 2
Section 2 .............................................................................................................. 32
Section 3 .............................................................................................................. 64
Section 4 .............................................................................................................. 95
1|Page
, COMSAE 113 HIGH-YIELD EXAM PREP
Section 1
1. A 45-year-old female presents to the emergency department with severe,
epigastric pain that radiates directly to her back, accompanied by nausea and
intractable vomiting. She admits to a history of alcohol abuse. Laboratory
evaluation is remarkable for a serum lipase level greater than three times the
upper limit of normal. Which of the following acute local complications is most
likely to develop 4 to 6 weeks after this initial insult, presenting as a fluid
collection walled off by granulation and fibrous tissue lacking an epithelial lining?
A. Pancreatic Adenocarcinoma
B. Pancreatic Pseudocyst
C. Pancreatic Abscess
D. Serous Cystadenoma
E. Meckel's Diverticulum
Correct Answer: B. Pancreatic Pseudocyst
Rationale: The patient has acute pancreatitis, confirmed by classic epigastric
pain radiating to the back and a lipase level >3 times normal. A pancreatic
pseudocyst is a common local complication that typically forms 4 to 6 weeks
after the onset of acute pancreatitis. It is characterized as a "pseudo" cyst
because, unlike true cysts, its walls are formed by granulation and fibrous
tissue rather than an epithelial lining. It contains high concentrations of
pancreatic enzymes and can present with persistent pain or palpable mass.
2. A patient presents with a sacral somatic dysfunction. Structural evaluation
reveals a positive seated flexion test on the left. In the prone position, the left
sacral base is deep (anterior) and the right inferior lateral angle (ILA) is prominent
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, COMSAE 113 HIGH-YIELD EXAM PREP
posterior and inferior. The lumbosacral spring test is negative (there is good
spring). What is the correct sacral diagnosis?
A. Left-on-Left sacral torsion
B. Right-on-Right sacral torsion
C. Left-on-Right sacral torsion
D. Right-on-Left sacral torsion
E. Left unilateral sacral flexion
Correct Answer: A. Left-on-Left sacral torsion
Rationale: A negative spring test indicates that the sacrum can spring forward
normally, meaning it is a forward (neutral) sacral torsion (L-on-L or R-on-R). In
forward torsions, the rotation and the oblique axis occur on the same side. A
deep left sacral base indicates that the sacrum is rotated Left. Therefore, the
axis must also be Left, establishing a Left-on-Left (L-on-L) sacral torsion. The
seated flexion test is positive on the left, which correctly correlates with the side
opposite the oblique axis in a neutral torsion.
3. A 58-year-old male with a history of severe chronic obstructive pulmonary
disease (COPD) is admitted to the intensive care unit with an acute exacerbation.
Arterial blood gas (ABG) analysis on room air reveals the following values: pH =
7.24, pCO2 = 70mmHg, HCO3- = 29mEq/L. Which of the following choices best
describes his acid-base status?
A. Acute respiratory acidosis with complete metabolic compensation
B. Chronic respiratory acidosis with no metabolic compensation
C. Acute respiratory acidosis superimposed on a chronic respiratory acidosis
D. Metabolic acidosis with respiratory compensation
E. Pure acute respiratory acidosis
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, COMSAE 113 HIGH-YIELD EXAM PREP
Correct Answer: C. Acute respiratory acidosis superimposed on a chronic
respiratory acidosis
Rationale: The patient has an acidemia (pH = 7.24) driven by a primary
respiratory retention of carbon dioxide (pCO2 = 70mmHg). In a pure acute
respiratory acidosis, the bicarbonate (HCO3-) increases by roughly 1mEq/L for
every 10mmHg rise in pCO2 above normal (40mmHg). For a pCO2 of 70 (a
30mmHg increase), the acute bicarbonate should be around 24 + 3 = 27mEq/L.
In a chronic respiratory acidosis, the kidneys retain more bicarbonate
(3.5mEq/L per 10mmHg rise), yielding a predicted bicarbonate of 24 + 10.5 =
34.5mEq/L. The patient's actual bicarbonate (29mEq/L) falls squarely between
the acute and chronic expectations, confirming an acute-on-chronic respiratory
condition typical of an acute COPD exacerbation.
4. A patient presents with a cranial somatic dysfunction. Structural assessment
using the vault hold reveals that the clinician's index fingers move superiorly while
the fifth digits move inferiorly. The sphenobasilar synchondrosis (SBS) is noted to
move cephalad during the inhalation phase of the primary respiratory mechanism.
What type of cranial motion or strain pattern does this represent?
A. Extension
B. Flexion
C. Superior Vertical Strain
D. Inferior Vertical Strain
E. Torsion
Correct Answer: B. Flexion
Rationale: During the flexion phase of the Cranial Rhythmic Impulse (CRI), the
sphenobasilar synchondrosis (SBS) moves superiorly (cephalad). This motion
causes the great wings of the sphenoid to rotate anteriorly and inferiorly, which
pushes the clinician's index fingers superiorly/cephalad (toward the ceiling
4|Page
COMSAE 113 HIGH-YIELD EXAM PREP NEWEST 2026/2027 ACTUAL
EXAM COMPLETE 176 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH DETAILED RATIONALES |ALREADY GRADED
A+||BRAND NEW VERSION!!
This form is heavily tailored toward high-yield clinical presentations,
pathopharmacology, microbiology, and complex OMM mechanics (sacral torsions,
innominate dysfunctions, and cranial strains).
Structure: 4 sections of 44 questions each
Contents
Section 1 ................................................................................................................ 2
Section 2 .............................................................................................................. 32
Section 3 .............................................................................................................. 64
Section 4 .............................................................................................................. 95
1|Page
, COMSAE 113 HIGH-YIELD EXAM PREP
Section 1
1. A 45-year-old female presents to the emergency department with severe,
epigastric pain that radiates directly to her back, accompanied by nausea and
intractable vomiting. She admits to a history of alcohol abuse. Laboratory
evaluation is remarkable for a serum lipase level greater than three times the
upper limit of normal. Which of the following acute local complications is most
likely to develop 4 to 6 weeks after this initial insult, presenting as a fluid
collection walled off by granulation and fibrous tissue lacking an epithelial lining?
A. Pancreatic Adenocarcinoma
B. Pancreatic Pseudocyst
C. Pancreatic Abscess
D. Serous Cystadenoma
E. Meckel's Diverticulum
Correct Answer: B. Pancreatic Pseudocyst
Rationale: The patient has acute pancreatitis, confirmed by classic epigastric
pain radiating to the back and a lipase level >3 times normal. A pancreatic
pseudocyst is a common local complication that typically forms 4 to 6 weeks
after the onset of acute pancreatitis. It is characterized as a "pseudo" cyst
because, unlike true cysts, its walls are formed by granulation and fibrous
tissue rather than an epithelial lining. It contains high concentrations of
pancreatic enzymes and can present with persistent pain or palpable mass.
2. A patient presents with a sacral somatic dysfunction. Structural evaluation
reveals a positive seated flexion test on the left. In the prone position, the left
sacral base is deep (anterior) and the right inferior lateral angle (ILA) is prominent
2|Page
, COMSAE 113 HIGH-YIELD EXAM PREP
posterior and inferior. The lumbosacral spring test is negative (there is good
spring). What is the correct sacral diagnosis?
A. Left-on-Left sacral torsion
B. Right-on-Right sacral torsion
C. Left-on-Right sacral torsion
D. Right-on-Left sacral torsion
E. Left unilateral sacral flexion
Correct Answer: A. Left-on-Left sacral torsion
Rationale: A negative spring test indicates that the sacrum can spring forward
normally, meaning it is a forward (neutral) sacral torsion (L-on-L or R-on-R). In
forward torsions, the rotation and the oblique axis occur on the same side. A
deep left sacral base indicates that the sacrum is rotated Left. Therefore, the
axis must also be Left, establishing a Left-on-Left (L-on-L) sacral torsion. The
seated flexion test is positive on the left, which correctly correlates with the side
opposite the oblique axis in a neutral torsion.
3. A 58-year-old male with a history of severe chronic obstructive pulmonary
disease (COPD) is admitted to the intensive care unit with an acute exacerbation.
Arterial blood gas (ABG) analysis on room air reveals the following values: pH =
7.24, pCO2 = 70mmHg, HCO3- = 29mEq/L. Which of the following choices best
describes his acid-base status?
A. Acute respiratory acidosis with complete metabolic compensation
B. Chronic respiratory acidosis with no metabolic compensation
C. Acute respiratory acidosis superimposed on a chronic respiratory acidosis
D. Metabolic acidosis with respiratory compensation
E. Pure acute respiratory acidosis
3|Page
, COMSAE 113 HIGH-YIELD EXAM PREP
Correct Answer: C. Acute respiratory acidosis superimposed on a chronic
respiratory acidosis
Rationale: The patient has an acidemia (pH = 7.24) driven by a primary
respiratory retention of carbon dioxide (pCO2 = 70mmHg). In a pure acute
respiratory acidosis, the bicarbonate (HCO3-) increases by roughly 1mEq/L for
every 10mmHg rise in pCO2 above normal (40mmHg). For a pCO2 of 70 (a
30mmHg increase), the acute bicarbonate should be around 24 + 3 = 27mEq/L.
In a chronic respiratory acidosis, the kidneys retain more bicarbonate
(3.5mEq/L per 10mmHg rise), yielding a predicted bicarbonate of 24 + 10.5 =
34.5mEq/L. The patient's actual bicarbonate (29mEq/L) falls squarely between
the acute and chronic expectations, confirming an acute-on-chronic respiratory
condition typical of an acute COPD exacerbation.
4. A patient presents with a cranial somatic dysfunction. Structural assessment
using the vault hold reveals that the clinician's index fingers move superiorly while
the fifth digits move inferiorly. The sphenobasilar synchondrosis (SBS) is noted to
move cephalad during the inhalation phase of the primary respiratory mechanism.
What type of cranial motion or strain pattern does this represent?
A. Extension
B. Flexion
C. Superior Vertical Strain
D. Inferior Vertical Strain
E. Torsion
Correct Answer: B. Flexion
Rationale: During the flexion phase of the Cranial Rhythmic Impulse (CRI), the
sphenobasilar synchondrosis (SBS) moves superiorly (cephalad). This motion
causes the great wings of the sphenoid to rotate anteriorly and inferiorly, which
pushes the clinician's index fingers superiorly/cephalad (toward the ceiling
4|Page
