COMSAE COMPREHENSIVE STUDY
GUIDE QUESTIONS AND VERIFIED
ANSWERS
1. A 45-year-old male presents with acute onset of right upper quadrant pain that radiates to
his right scapula. On physical examination, there is tenderness over the 10th intercostal space
on the right side. Which viscerosomatic reflex level is most likely associated with this
patient’s condition?
A. T2-T8
B. T5-T9
C. T10-T11
D. T12-L2
Answer: B
Conceptual Explanation: The patient’s symptoms are suggestive of gallbladder disease
(cholecystitis). The viscerosomatic reflex for the gallbladder and liver is T5-T9 on the right
side. T10-T11 corresponds to the kidneys and upper ureters, while T12-L2 corresponds to
the lower ureters and bladder.
,2. In a patient with a suspected diagnosis of appendicitis, where would you expect to find the
anterior Chapman reflex point?
A. Tip of the 12th rib
B. Superior border of the 2nd rib
C. Periumbilical region
D. Lateral aspect of the IT band
Answer: A
Conceptual Explanation: The anterior Chapman reflex point for the appendix is located at
the tip of the 12th rib on the right. The posterior point is at the transverse process of T11.
3. A 28-year-old female in her third trimester of pregnancy presents with low back pain.
Examination reveals a positive seated flexion test on the right, a deep sacral sulcus on the
left, and a posterior inferior ILA on the right. The spring test is negative. What is the
diagnosis?
A. Left-on-Left Forward Sacral Torsion
B. Right-on-Left Backward Sacral Torsion
C. Left-on-Right Backward Sacral Torsion
D. Right-on-Right Forward Sacral Torsion
Answer: D
, Conceptual Explanation: A positive seated flexion test on the right indicates the side of
the dysfunction. A negative spring test suggests a forward torsion. A deep sulcus on the left
and posterior ILA on the right indicate right rotation. Therefore, it is a Right-on-Right
torsion.
4. During the cranial rhythmic impulse (CRI), what occurs during the flexion phase of the
sphenobasilar synchondrosis (SBS)?
A. The midline bones undergo internal rotation
B. The sacral base moves anteriorly (nutation)
C. The AP diameter of the cranium increases
D. The paired bones undergo external rotation
Answer: D
Conceptual Explanation: During SBS flexion, the midline bones (sphenoid, occiput,
ethmoid, vomer) flex, and the paired bones (temporals, parietals) externally rotate. The AP
diameter decreases, and the sacral base moves posteriorly (counternutation).
5. A patient presents with a thoracic spine segment where the transverse processes are more
posterior on the right. This asymmetry improves when the patient flexes their spine but
worsens during extension. What is the correct Fryette diagnosis?
A. T-spine Neutral, Sidebent Left, Rotated Right
B. T-spine Flexed, Sidebent Left, Rotated Right
C. T-spine Extended, Sidebent Right, Rotated Right
GUIDE QUESTIONS AND VERIFIED
ANSWERS
1. A 45-year-old male presents with acute onset of right upper quadrant pain that radiates to
his right scapula. On physical examination, there is tenderness over the 10th intercostal space
on the right side. Which viscerosomatic reflex level is most likely associated with this
patient’s condition?
A. T2-T8
B. T5-T9
C. T10-T11
D. T12-L2
Answer: B
Conceptual Explanation: The patient’s symptoms are suggestive of gallbladder disease
(cholecystitis). The viscerosomatic reflex for the gallbladder and liver is T5-T9 on the right
side. T10-T11 corresponds to the kidneys and upper ureters, while T12-L2 corresponds to
the lower ureters and bladder.
,2. In a patient with a suspected diagnosis of appendicitis, where would you expect to find the
anterior Chapman reflex point?
A. Tip of the 12th rib
B. Superior border of the 2nd rib
C. Periumbilical region
D. Lateral aspect of the IT band
Answer: A
Conceptual Explanation: The anterior Chapman reflex point for the appendix is located at
the tip of the 12th rib on the right. The posterior point is at the transverse process of T11.
3. A 28-year-old female in her third trimester of pregnancy presents with low back pain.
Examination reveals a positive seated flexion test on the right, a deep sacral sulcus on the
left, and a posterior inferior ILA on the right. The spring test is negative. What is the
diagnosis?
A. Left-on-Left Forward Sacral Torsion
B. Right-on-Left Backward Sacral Torsion
C. Left-on-Right Backward Sacral Torsion
D. Right-on-Right Forward Sacral Torsion
Answer: D
, Conceptual Explanation: A positive seated flexion test on the right indicates the side of
the dysfunction. A negative spring test suggests a forward torsion. A deep sulcus on the left
and posterior ILA on the right indicate right rotation. Therefore, it is a Right-on-Right
torsion.
4. During the cranial rhythmic impulse (CRI), what occurs during the flexion phase of the
sphenobasilar synchondrosis (SBS)?
A. The midline bones undergo internal rotation
B. The sacral base moves anteriorly (nutation)
C. The AP diameter of the cranium increases
D. The paired bones undergo external rotation
Answer: D
Conceptual Explanation: During SBS flexion, the midline bones (sphenoid, occiput,
ethmoid, vomer) flex, and the paired bones (temporals, parietals) externally rotate. The AP
diameter decreases, and the sacral base moves posteriorly (counternutation).
5. A patient presents with a thoracic spine segment where the transverse processes are more
posterior on the right. This asymmetry improves when the patient flexes their spine but
worsens during extension. What is the correct Fryette diagnosis?
A. T-spine Neutral, Sidebent Left, Rotated Right
B. T-spine Flexed, Sidebent Left, Rotated Right
C. T-spine Extended, Sidebent Right, Rotated Right
