COMPREHENSIVE OSTEOPATHIC
MEDICAL SELF-ASSESSMENT
EXAMINATION (COMSAE) LEVEL 1
PREP 2026/2027 QUESTIONS AND
VERIFIED ANSWERS
1. A 45-year-old male presents with acute epigastric pain radiating to the back. Lipase is
significantly elevated. Which of the following is the most likely location for a Chapman point
related to this patient’s condition?
A. Right 5th intercostal space
B. Left 7th intercostal space
C. Right 6th intercostal space
D. Left 5th intercostal space
Answer: B
Conceptual Explanation: The patient has pancreatitis. The anterior Chapman reflex point
for the pancreas is located in the left 7th intercostal space.
2. A patient is diagnosed with a L on L sacral torsion. Which of the following physical exam
findings is most consistent with this diagnosis?
A. Positive seated flexion test on the right
,B. Negative lumbosacral spring test
C. A deep right sacral sulcus
D. A posterior left ILA
Answer: B
Conceptual Explanation: In a forward sacral torsion (L on L), the spring test is negative
(good spring) because the sacral base has moved anteriorly.
3. A 24-year-old female presents with frequent headaches. Palpation of the cranium reveals
that the sphenoid and occiput rotate in the same direction about two vertical axes. What is
the diagnosis?
A. Vertical strain
B. Lateral strain
C. Torsion
D. Sidebending rotation
Answer: D
Conceptual Explanation: A sidebending rotation strain occurs around two vertical axes
(rotating in opposite directions) and one AP axis (rotating in the same direction).
4. Which of the following describes the correct setup for muscle energy to treat a Rib 2
exhalation dysfunction?
A. Rotation of the head away from the affected side
, B. Flexion of the neck with resistance against the forehead
C. Adduction of the arm against resistance
D. Pushing the elbow toward the opposite ASIS
Answer: A
Conceptual Explanation: For Ribs 1 and 2 exhalation dysfunction, the post-isometric
relaxation involves the scalene muscles. For Rib 2 specifically, the head is rotated 30
degrees away from the affected side.
5. A 60-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents for a routine visit. Which of the following viscerosomatic reflexes is most likely to be
present?
A. T1-T4
B. T2-T7
C. T5-T9
D. T10-T11
Answer: B
Conceptual Explanation: The lungs receive sympathetic innervation from the T2 to T7
spinal levels. Chronic lung disease like COPD often manifests with somatic dysfunction in
this range.
MEDICAL SELF-ASSESSMENT
EXAMINATION (COMSAE) LEVEL 1
PREP 2026/2027 QUESTIONS AND
VERIFIED ANSWERS
1. A 45-year-old male presents with acute epigastric pain radiating to the back. Lipase is
significantly elevated. Which of the following is the most likely location for a Chapman point
related to this patient’s condition?
A. Right 5th intercostal space
B. Left 7th intercostal space
C. Right 6th intercostal space
D. Left 5th intercostal space
Answer: B
Conceptual Explanation: The patient has pancreatitis. The anterior Chapman reflex point
for the pancreas is located in the left 7th intercostal space.
2. A patient is diagnosed with a L on L sacral torsion. Which of the following physical exam
findings is most consistent with this diagnosis?
A. Positive seated flexion test on the right
,B. Negative lumbosacral spring test
C. A deep right sacral sulcus
D. A posterior left ILA
Answer: B
Conceptual Explanation: In a forward sacral torsion (L on L), the spring test is negative
(good spring) because the sacral base has moved anteriorly.
3. A 24-year-old female presents with frequent headaches. Palpation of the cranium reveals
that the sphenoid and occiput rotate in the same direction about two vertical axes. What is
the diagnosis?
A. Vertical strain
B. Lateral strain
C. Torsion
D. Sidebending rotation
Answer: D
Conceptual Explanation: A sidebending rotation strain occurs around two vertical axes
(rotating in opposite directions) and one AP axis (rotating in the same direction).
4. Which of the following describes the correct setup for muscle energy to treat a Rib 2
exhalation dysfunction?
A. Rotation of the head away from the affected side
, B. Flexion of the neck with resistance against the forehead
C. Adduction of the arm against resistance
D. Pushing the elbow toward the opposite ASIS
Answer: A
Conceptual Explanation: For Ribs 1 and 2 exhalation dysfunction, the post-isometric
relaxation involves the scalene muscles. For Rib 2 specifically, the head is rotated 30
degrees away from the affected side.
5. A 60-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents for a routine visit. Which of the following viscerosomatic reflexes is most likely to be
present?
A. T1-T4
B. T2-T7
C. T5-T9
D. T10-T11
Answer: B
Conceptual Explanation: The lungs receive sympathetic innervation from the T2 to T7
spinal levels. Chronic lung disease like COPD often manifests with somatic dysfunction in
this range.
