COMSAE COMPREHENSIVE STUDY
GUIDE 2026/2027 QUESTIONS AND
ANSWERS
1. A 45-year-old male presents with acute chest pain. Osteopathic examination reveals tissue
texture changes and exquisite tenderness at the level of T1-T4 on the left. Which of the
following viscerosomatic reflexes is most likely involved?
A. Stomach
B. Lungs
C. Heart
D. Liver
Answer: C
Conceptual Explanation: The viscerosomatic reflex for the heart is located at T1-T4,
typically on the left side, representing sympathetic innervation to the myocardium.
,2. A patient presents with sharp pain in the right lower quadrant. During the physical exam, a
Chapman reflex point is noted at the tip of the right 12th rib. This point is diagnostic for
which condition?
A. Gallbladder disease
B. Urolithiasis
C. Ovarian cyst
D. Appendicitis
Answer: D
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib; the posterior point is at the transverse process of T11.
3. When evaluating a patient with a L on L sacral torsion, what would be the expected
findings for L5 mechanics?
A. L5 Flexed, Sidebent Left, Rotated Left
B. L5 Neutral, Sidebent Right, Rotated Left
C. L5 Neutral, Sidebent Left, Rotated Right
D. L5 Extended, Sidebent Right, Rotated Right
Answer: C
Conceptual Explanation: In a neutral (forward) sacral torsion, L5 follows Fryette Type I
mechanics where sidebending is to the same side as the axis and rotation is opposite.
, 4. Which muscle is utilized during muscle energy to treat an inhalation dysfunction of rib 7?
A. Pectoralis minor
B. Latissimus dorsi
C. Scalene anterior
D. Serratus anterior
Answer: D
Conceptual Explanation: Muscle energy for ribs 6-8 in inhalation dysfunction (where the
goal is to move the rib down) involves the serratus anterior; however, for inhalation
dysfunction, the patient uses primary muscles of exhalation to pull the rib down. For ribs 6-
10, the serratus anterior is specifically targeted for exhalation dysfunction.
5. A patient is diagnosed with an OA dysfunction that is restricted in right rotation and
flexion. What is the correct diagnosis?
A. OA F SR RL
B. OA F SL RR
C. OA E SR RL
D. OA E SL RR
Answer: D
GUIDE 2026/2027 QUESTIONS AND
ANSWERS
1. A 45-year-old male presents with acute chest pain. Osteopathic examination reveals tissue
texture changes and exquisite tenderness at the level of T1-T4 on the left. Which of the
following viscerosomatic reflexes is most likely involved?
A. Stomach
B. Lungs
C. Heart
D. Liver
Answer: C
Conceptual Explanation: The viscerosomatic reflex for the heart is located at T1-T4,
typically on the left side, representing sympathetic innervation to the myocardium.
,2. A patient presents with sharp pain in the right lower quadrant. During the physical exam, a
Chapman reflex point is noted at the tip of the right 12th rib. This point is diagnostic for
which condition?
A. Gallbladder disease
B. Urolithiasis
C. Ovarian cyst
D. Appendicitis
Answer: D
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib; the posterior point is at the transverse process of T11.
3. When evaluating a patient with a L on L sacral torsion, what would be the expected
findings for L5 mechanics?
A. L5 Flexed, Sidebent Left, Rotated Left
B. L5 Neutral, Sidebent Right, Rotated Left
C. L5 Neutral, Sidebent Left, Rotated Right
D. L5 Extended, Sidebent Right, Rotated Right
Answer: C
Conceptual Explanation: In a neutral (forward) sacral torsion, L5 follows Fryette Type I
mechanics where sidebending is to the same side as the axis and rotation is opposite.
, 4. Which muscle is utilized during muscle energy to treat an inhalation dysfunction of rib 7?
A. Pectoralis minor
B. Latissimus dorsi
C. Scalene anterior
D. Serratus anterior
Answer: D
Conceptual Explanation: Muscle energy for ribs 6-8 in inhalation dysfunction (where the
goal is to move the rib down) involves the serratus anterior; however, for inhalation
dysfunction, the patient uses primary muscles of exhalation to pull the rib down. For ribs 6-
10, the serratus anterior is specifically targeted for exhalation dysfunction.
5. A patient is diagnosed with an OA dysfunction that is restricted in right rotation and
flexion. What is the correct diagnosis?
A. OA F SR RL
B. OA F SL RR
C. OA E SR RL
D. OA E SL RR
Answer: D
