COMSAE 2026/2027 COMPREHENSIVE
OSTEOPATHIC MEDICAL EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with acute onset epigastric pain that radiates to the back.
Physical examination reveals a viscerosomatic reflex at the level of T5-T9 on the right. Which
of the following organs is the most likely source of this reflex?
A. Stomach
B. Gallbladder
C. Appendix
D. Descending colon
Answer: B
Conceptual Explanation: The gallbladder and liver viscerosomatic reflexes are typically
found at T5-T9 on the right side. The stomach is T5-T9 on the left.
,2. A 24-year-old female presents with a diagnosis of L5 rotated right and sidebent right.
According to Fryette’s laws and the relationship between L5 and the sacrum, what is the most
likely sacral diagnosis?
A. Left on left forward torsion
B. Right on right forward torsion
C. Left on right backward torsion
D. Right on left backward torsion
Answer: D
Conceptual Explanation: According to the rules of L5 and the sacrum, the sacral torsion
occurs on the same side as the L5 sidebending and rotates in the opposite direction of L5. If
L5 is sidebent right, the torsion is on the right axis. If L5 is rotated right, the sacrum rotates
left. Thus, a Right on Left backward torsion.
3. A patient presents with a Chapman’s point located on the lateral aspect of the middle to
lower thigh (along the IT band). This reflex point is most commonly associated with which of
the following conditions?
A. Appendicitis
B. Colon congestion
C. Ovarian cyst
D. Prostatitis
, Answer: B
Conceptual Explanation: The Chapman reflex point for the colon (specifically the iliotibial
band) indicates colon dysfunction or congestion.
4. A 30-year-old male presents with a complaint of lower back pain. Osteopathic examination
reveals a positive seated flexion test on the right. Deep sulcus is noted on the left, and a
posterior inferior ILA is noted on the right. The spring test is negative. What is the diagnosis?
A. Right on left sacral torsion
B. Right on right sacral torsion
C. Left on right sacral torsion
D. Left on left sacral torsion
Answer: D
Conceptual Explanation: A positive seated flexion test on the right with a deep left sulcus
and posterior right ILA suggests a torsion. A negative spring test indicates a forward
torsion. The axis is determined by the side opposite the positive seated flexion test in
forward torsions, so a Left on Left torsion.
5. Which of the following muscle energy setups is correct for a rib 2 inhalation dysfunction?
A. Patient pushes head anteriorly against resistance
B. Patient pushes elbow against resistance toward the opposite hip
C. Patient pushes wrist against resistance toward the same hip
OSTEOPATHIC MEDICAL EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with acute onset epigastric pain that radiates to the back.
Physical examination reveals a viscerosomatic reflex at the level of T5-T9 on the right. Which
of the following organs is the most likely source of this reflex?
A. Stomach
B. Gallbladder
C. Appendix
D. Descending colon
Answer: B
Conceptual Explanation: The gallbladder and liver viscerosomatic reflexes are typically
found at T5-T9 on the right side. The stomach is T5-T9 on the left.
,2. A 24-year-old female presents with a diagnosis of L5 rotated right and sidebent right.
According to Fryette’s laws and the relationship between L5 and the sacrum, what is the most
likely sacral diagnosis?
A. Left on left forward torsion
B. Right on right forward torsion
C. Left on right backward torsion
D. Right on left backward torsion
Answer: D
Conceptual Explanation: According to the rules of L5 and the sacrum, the sacral torsion
occurs on the same side as the L5 sidebending and rotates in the opposite direction of L5. If
L5 is sidebent right, the torsion is on the right axis. If L5 is rotated right, the sacrum rotates
left. Thus, a Right on Left backward torsion.
3. A patient presents with a Chapman’s point located on the lateral aspect of the middle to
lower thigh (along the IT band). This reflex point is most commonly associated with which of
the following conditions?
A. Appendicitis
B. Colon congestion
C. Ovarian cyst
D. Prostatitis
, Answer: B
Conceptual Explanation: The Chapman reflex point for the colon (specifically the iliotibial
band) indicates colon dysfunction or congestion.
4. A 30-year-old male presents with a complaint of lower back pain. Osteopathic examination
reveals a positive seated flexion test on the right. Deep sulcus is noted on the left, and a
posterior inferior ILA is noted on the right. The spring test is negative. What is the diagnosis?
A. Right on left sacral torsion
B. Right on right sacral torsion
C. Left on right sacral torsion
D. Left on left sacral torsion
Answer: D
Conceptual Explanation: A positive seated flexion test on the right with a deep left sulcus
and posterior right ILA suggests a torsion. A negative spring test indicates a forward
torsion. The axis is determined by the side opposite the positive seated flexion test in
forward torsions, so a Left on Left torsion.
5. Which of the following muscle energy setups is correct for a rib 2 inhalation dysfunction?
A. Patient pushes head anteriorly against resistance
B. Patient pushes elbow against resistance toward the opposite hip
C. Patient pushes wrist against resistance toward the same hip
