August 2026 COMSAE 114
Comprehensive Osteopathic Medical Self
Assessment Examination Latest Version
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A
Instant Download Pdf
1. A 45-year-old male presents with low back pain that worsens with extension
and improves with flexion. Physical exam reveals a left-on-left sacral torsion.
Which muscle energy treatment position is most appropriate?
A) Patient in right lateral recumbent position, physician induces right rotation and
left sidebending
B) Patient in left lateral recumbent position, physician induces left rotation and right
sidebending
C) Patient supine, bilateral hip flexion
D) Patient prone, extension thrust
Answer: A) Patient in right lateral recumbent position, physician induces right
rotation and left sidebending
,rational,: For a left-on-left sacral torsion (left axis, left rotation), the physician
positions the patient in the lateral recumbent position opposite the axis (right
lateral) and introduces motion opposite the rotation (right rotation and left
sidebending) to engage the restrictive barrier for muscle energy.
,2. Which cranial bone is responsible for the “cranial rhythmic impulse” as
described by Sutherland?
A) Temporal
B) Sphenoid
C) Occiput
D) Ethmoid
Answer: B) Sphenoid
,rational,: The sphenoid is considered the prime mover of the cranial rhythmic
impulse; its articulation with the occiput at the sphenobasilar synchondrosis is a
primary fulcrum for cranial motion.
3. A patient with pneumonia presents with tender nodules in the intercostal
spaces at the midclavicular line. These represent which type of reflex?
A) Chapman reflexes
B) Viscerosomatic reflexes
C) Somatovisceral reflexes
D) Counterstrain tender points
Answer: A) Chapman reflexes
,rational,: Chapman reflexes are small, palpable nodules in specific locations
associated with visceral dysfunction; the lung Chapman points are in the
intercostal spaces near the sternum and midclavicular lines.
4. Which spinal cord level is associated with the sympathetic innervation of the
appendix?
A) T8
,B) T10
C) T12
D) L2
Answer: C) T12
,rational,: The appendix is innervated by sympathetic fibers from T10–T12; the
classic viscerosomatic reflex for appendicitis is around T12, often with right lower
quadrant pain referring to the periumbilical area early.
5. A 30-year-old female presents with dysmenorrhea and a history of
endometriosis. Which Chapman point is most likely associated?
A) Anterior tip of the 12th rib
B) Upper border of the pubic bone
C) Superior aspect of the iliotibial band
D) Fifth intercostal space at the sternal border
Answer: B) Upper border of the pubic bone
,rational,: The anterior Chapman point for the uterus is located on the upper border
of the pubic bone; for the ovaries, it's near the greater trochanter.
6. In osteopathic cranial manipulative medicine, a flexion strain of the
sphenobasilar synchondrosis is characterized by:
A) The sphenoid and occiput rotating in opposite directions, increasing the
superior-inferior angle
B) The sphenoid and occiput rotating in the same direction, decreasing the
superior-inferior angle
, C) The sphenoid rotating anteriorly and the occiput posteriorly
D) Sidebending and rotation in opposite directions
Answer: A) The sphenoid and occiput rotating in opposite directions, increasing
the superior-inferior angle
,rational,: In a flexion strain, the sphenoid and occiput rotate about parallel
transverse axes in opposite directions (sphenoid flexes, occiput extends),
increasing the superior-inferior angle of the SBS.
7. A 55-year-old male with chronic pancreatitis is likely to have viscerosomatic
changes at which spinal level?
A) T2–T4
B) T5–T9
C) T10–T11
D) L1–L2
Answer: B) T5–T9
,rational,: The pancreas is innervated by sympathetic fibers from T5–T9, with the
head at T5–T6 and the tail at T7–T9. Viscerosomatic reflexes from pancreatic
pathology are often found in these levels.
8. Which of the following best describes the mechanism of action of
corticosteroid medications in reducing inflammation?
A) Inhibition of cyclooxygenase
B) Inhibition of phospholipase A2
C) Blockade of histamine H1 receptors
D) Inhibition of leukotriene synthesis directly
Comprehensive Osteopathic Medical Self
Assessment Examination Latest Version
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A
Instant Download Pdf
1. A 45-year-old male presents with low back pain that worsens with extension
and improves with flexion. Physical exam reveals a left-on-left sacral torsion.
Which muscle energy treatment position is most appropriate?
A) Patient in right lateral recumbent position, physician induces right rotation and
left sidebending
B) Patient in left lateral recumbent position, physician induces left rotation and right
sidebending
C) Patient supine, bilateral hip flexion
D) Patient prone, extension thrust
Answer: A) Patient in right lateral recumbent position, physician induces right
rotation and left sidebending
,rational,: For a left-on-left sacral torsion (left axis, left rotation), the physician
positions the patient in the lateral recumbent position opposite the axis (right
lateral) and introduces motion opposite the rotation (right rotation and left
sidebending) to engage the restrictive barrier for muscle energy.
,2. Which cranial bone is responsible for the “cranial rhythmic impulse” as
described by Sutherland?
A) Temporal
B) Sphenoid
C) Occiput
D) Ethmoid
Answer: B) Sphenoid
,rational,: The sphenoid is considered the prime mover of the cranial rhythmic
impulse; its articulation with the occiput at the sphenobasilar synchondrosis is a
primary fulcrum for cranial motion.
3. A patient with pneumonia presents with tender nodules in the intercostal
spaces at the midclavicular line. These represent which type of reflex?
A) Chapman reflexes
B) Viscerosomatic reflexes
C) Somatovisceral reflexes
D) Counterstrain tender points
Answer: A) Chapman reflexes
,rational,: Chapman reflexes are small, palpable nodules in specific locations
associated with visceral dysfunction; the lung Chapman points are in the
intercostal spaces near the sternum and midclavicular lines.
4. Which spinal cord level is associated with the sympathetic innervation of the
appendix?
A) T8
,B) T10
C) T12
D) L2
Answer: C) T12
,rational,: The appendix is innervated by sympathetic fibers from T10–T12; the
classic viscerosomatic reflex for appendicitis is around T12, often with right lower
quadrant pain referring to the periumbilical area early.
5. A 30-year-old female presents with dysmenorrhea and a history of
endometriosis. Which Chapman point is most likely associated?
A) Anterior tip of the 12th rib
B) Upper border of the pubic bone
C) Superior aspect of the iliotibial band
D) Fifth intercostal space at the sternal border
Answer: B) Upper border of the pubic bone
,rational,: The anterior Chapman point for the uterus is located on the upper border
of the pubic bone; for the ovaries, it's near the greater trochanter.
6. In osteopathic cranial manipulative medicine, a flexion strain of the
sphenobasilar synchondrosis is characterized by:
A) The sphenoid and occiput rotating in opposite directions, increasing the
superior-inferior angle
B) The sphenoid and occiput rotating in the same direction, decreasing the
superior-inferior angle
, C) The sphenoid rotating anteriorly and the occiput posteriorly
D) Sidebending and rotation in opposite directions
Answer: A) The sphenoid and occiput rotating in opposite directions, increasing
the superior-inferior angle
,rational,: In a flexion strain, the sphenoid and occiput rotate about parallel
transverse axes in opposite directions (sphenoid flexes, occiput extends),
increasing the superior-inferior angle of the SBS.
7. A 55-year-old male with chronic pancreatitis is likely to have viscerosomatic
changes at which spinal level?
A) T2–T4
B) T5–T9
C) T10–T11
D) L1–L2
Answer: B) T5–T9
,rational,: The pancreas is innervated by sympathetic fibers from T5–T9, with the
head at T5–T6 and the tail at T7–T9. Viscerosomatic reflexes from pancreatic
pathology are often found in these levels.
8. Which of the following best describes the mechanism of action of
corticosteroid medications in reducing inflammation?
A) Inhibition of cyclooxygenase
B) Inhibition of phospholipase A2
C) Blockade of histamine H1 receptors
D) Inhibition of leukotriene synthesis directly
