COMSAE LEVEL 1 PRACTICE EXAM
QUESTIONS AND VERIFIED ANSWERS
1. A 24-year-old male presents with acute onset of right lower quadrant pain. On physical
examination, you identify a tender point located at the tip of the right 12th rib. This Chapman
reflex point is most commonly associated with which of the following visceral pathologies?
A. Gallbladder
B. Bladder
C. Appendix
D. Kidney
Answer: C
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.
2. When evaluating a patient’s lumbar spine, you find that L3 is restricted in right rotation
and right sidebending. The somatic dysfunction is most likely to be neutral. According to
Fryette’s Law I, what is the expected sidebending and rotation relationship?
A. Sidebending and rotation to the same side
B. Sidebending only without rotation
C. Rotation only without sidebending
,D. Sidebending and rotation to the opposite side
Answer: D
Conceptual Explanation: Fryette’s Law I applies to neutral (type I) mechanics in the
thoracic and lumbar spine, where sidebending and rotation occur to opposite sides.
3. In a patient diagnosed with a right-on-right sacral torsion, which of the following findings
would be expected when evaluating the L5 vertebra?
A. L5 rotated right, sidebent right
B. L5 rotated left, sidebent left
C. L5 rotated left, sidebent right
D. L5 rotated right, sidebent left
Answer: C
Conceptual Explanation: In sacral torsions, L5 follows Fryette mechanics: L5 rotates
opposite to the sacral rotation and sidebends toward the side of the sacral oblique axis. For
a R-on-R torsion, the axis is right, so L5 sidebends right and rotates left.
4. A patient presents with a psoas syndrome. Which of the following osteopathic findings is
most characteristic of this condition?
A. A non-neutral somatic dysfunction of L1 or L2
B. A backward sacral torsion
C. External rotation of the ipsilateral hip
, D. Somatic dysfunction at L5
Answer: A
Conceptual Explanation: Psoas syndrome is often associated with a non-neutral (Type II)
somatic dysfunction at L1 or L2, which is rotated and sidebent toward the side of the
shortened psoas muscle.
5. During the cranial rhythmic impulse (CRI), what motion is the sphenobasilar synchondrosis
(SBS) performing during the extension phase?
A. The SBS moves superiorly
B. The SBS rotates to the right
C. The SBS moves inferiorly
D. The sphenoid and occiput rotate in the same direction
Answer: C
Conceptual Explanation: During the extension phase of the CRI, the sphenobasilar
synchondrosis (SBS) moves inferiorly (caudad), and the paired bones internally rotate.
6. A 55-year-old male with a history of hypertension presents for a routine check-up. You find
T1-T5 paraspinal fullness and hypertonicity on the left. This viscerosomatic reflex is most
likely associated with which organ?
A. Stomach
B. Lungs
QUESTIONS AND VERIFIED ANSWERS
1. A 24-year-old male presents with acute onset of right lower quadrant pain. On physical
examination, you identify a tender point located at the tip of the right 12th rib. This Chapman
reflex point is most commonly associated with which of the following visceral pathologies?
A. Gallbladder
B. Bladder
C. Appendix
D. Kidney
Answer: C
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.
2. When evaluating a patient’s lumbar spine, you find that L3 is restricted in right rotation
and right sidebending. The somatic dysfunction is most likely to be neutral. According to
Fryette’s Law I, what is the expected sidebending and rotation relationship?
A. Sidebending and rotation to the same side
B. Sidebending only without rotation
C. Rotation only without sidebending
,D. Sidebending and rotation to the opposite side
Answer: D
Conceptual Explanation: Fryette’s Law I applies to neutral (type I) mechanics in the
thoracic and lumbar spine, where sidebending and rotation occur to opposite sides.
3. In a patient diagnosed with a right-on-right sacral torsion, which of the following findings
would be expected when evaluating the L5 vertebra?
A. L5 rotated right, sidebent right
B. L5 rotated left, sidebent left
C. L5 rotated left, sidebent right
D. L5 rotated right, sidebent left
Answer: C
Conceptual Explanation: In sacral torsions, L5 follows Fryette mechanics: L5 rotates
opposite to the sacral rotation and sidebends toward the side of the sacral oblique axis. For
a R-on-R torsion, the axis is right, so L5 sidebends right and rotates left.
4. A patient presents with a psoas syndrome. Which of the following osteopathic findings is
most characteristic of this condition?
A. A non-neutral somatic dysfunction of L1 or L2
B. A backward sacral torsion
C. External rotation of the ipsilateral hip
, D. Somatic dysfunction at L5
Answer: A
Conceptual Explanation: Psoas syndrome is often associated with a non-neutral (Type II)
somatic dysfunction at L1 or L2, which is rotated and sidebent toward the side of the
shortened psoas muscle.
5. During the cranial rhythmic impulse (CRI), what motion is the sphenobasilar synchondrosis
(SBS) performing during the extension phase?
A. The SBS moves superiorly
B. The SBS rotates to the right
C. The SBS moves inferiorly
D. The sphenoid and occiput rotate in the same direction
Answer: C
Conceptual Explanation: During the extension phase of the CRI, the sphenobasilar
synchondrosis (SBS) moves inferiorly (caudad), and the paired bones internally rotate.
6. A 55-year-old male with a history of hypertension presents for a routine check-up. You find
T1-T5 paraspinal fullness and hypertonicity on the left. This viscerosomatic reflex is most
likely associated with which organ?
A. Stomach
B. Lungs
