COMSAE Final Form 113 exam
COMPLETE QUESTIONS AND DETAILED
SOLUTIONS LATEST UPDATE THIS YEAR-
JUST RELEASED.pdf
Osteopathic Principles & Practice (OMM)
Question 1
A 45-year-old male presents with chronic low back pain. Physical
examination reveals a short left leg (apparent), a left posterior superior
iliac spine (PSIS) that is superior compared to the right, and a left
anterior inferior iliac spine (AIIS) that is inferior compared to the right.
What is the most likely sacral diagnosis?
A) Right-on-right torsion
B) Left-on-left torsion
C) Left unilateral flexion
D) Right unilateral flexion
Rationale: In a sacral torsion, the side of the oblique axis is named first,
and the side of rotation is named second. The findings of a deep sulcus
on the right, shallow on the left, and an ILA posterior on the left indicate
rotation around a left oblique axis. A "left-on-left" torsion means the
axis is on the left and the base is rotated anteriorly on the left .
,Question 2
A patient with a history of COPD is in respiratory distress. You note
significant rib elevation and restricted motion on the left side during
inspiration. Using a direct technique, you apply a force to the superior
aspect of the left transverse process to correct the restriction. Which rib
dysfunction is being treated?
A) Pump handle
B) Bucket handle
C) Caliper
D) Somatic dysfunction of rib 1
Rationale: The bucket handle component of rib motion involves lateral
movement of the rib shaft. The dysfunctional transverse process (the
pivot point) is treated by applying a force to correct the lateral aspect of
the rib cage. Pump handle involves anterior/posterior movement of the
sternum; caliper refers to ribs 11-12 .
Question 3
During a cranial evaluation, you place your hands on the patient's head
with the hypothenar eminences at the greater wings of the sphenoid and
the fingertips at the occiput. You sense a phase where the occiput is
externally rotating and the sphenoid is internally rotating. Which phase
of the primary respiratory mechanism is this?
A) Flexion phase
B) Extension phase
C) Midline phase
D) Torsion phase
,Rationale: In the cranial rhythmic impulse (CRI), during the flexion
phase, the sphenoid rotates externally (widening) and the occiput rotates
internally. During the extension phase, the opposite occurs: the sphenoid
internally rotates and the occiput externally rotates .
Question 4
A patient presents with acute torticollis. You find the left
sternocleidomastoid (SCM) is tender and in spasm. Which Chapman's
reflex point would be tender if there is a visceral component related to
this somatic dysfunction?
A) 2nd intercostal space, left sternal border
B) 1st intercostal space, right sternal border
C) Umbilicus, right lateral border
D) Tip of the 12th rib
Rationale: Chapman's reflexes are neurolymphatic points. The point for
the upper respiratory tract (including the SCM region and throat) is
located in the 1st intercostal space, right sternal border. The left 2nd
intercostal space corresponds to the stomach .
Question 5
A patient standing with a forward-bending test reveals a right thoracic
rib hump. What is the most likely structural spinal diagnosis?
A) Right thoracic convexity
B) Left thoracic convexity
, C) Lumbarization of S
D) Spondylolisthesis
Rationale: In structural scoliosis, the rib hump appears on the side of
the convexity. A right thoracic rib hump indicates right thoracic
convexity .
Question 6
A 43-year-old construction worker presents with acute, sharp low back
pain after lifting heavy equipment. Physical examination demonstrates a
positive standing flexion test on the right side. Palpation reveals that the
right anterior superior iliac spine (ASIS) is inferior, and the right
posterior superior iliac spine (PSIS) is superior when compared to the
left side. What is the most appropriate diagnostic setup for this patient?
A) Right posterior innominate rotation
B) Left anterior innominate rotation
C) Right anterior innominate rotation
D) Right superior innominate shear
Rationale: A positive standing flexion test lateralizes the somatic
dysfunction to the right side. An inferior ASIS paired with a superior
PSIS on the same side indicates that the right innominate bone has
rotated anteriorly around a transverse axis. A posterior rotation would
feature a superior ASIS and inferior PSIS .
COMPLETE QUESTIONS AND DETAILED
SOLUTIONS LATEST UPDATE THIS YEAR-
JUST RELEASED.pdf
Osteopathic Principles & Practice (OMM)
Question 1
A 45-year-old male presents with chronic low back pain. Physical
examination reveals a short left leg (apparent), a left posterior superior
iliac spine (PSIS) that is superior compared to the right, and a left
anterior inferior iliac spine (AIIS) that is inferior compared to the right.
What is the most likely sacral diagnosis?
A) Right-on-right torsion
B) Left-on-left torsion
C) Left unilateral flexion
D) Right unilateral flexion
Rationale: In a sacral torsion, the side of the oblique axis is named first,
and the side of rotation is named second. The findings of a deep sulcus
on the right, shallow on the left, and an ILA posterior on the left indicate
rotation around a left oblique axis. A "left-on-left" torsion means the
axis is on the left and the base is rotated anteriorly on the left .
,Question 2
A patient with a history of COPD is in respiratory distress. You note
significant rib elevation and restricted motion on the left side during
inspiration. Using a direct technique, you apply a force to the superior
aspect of the left transverse process to correct the restriction. Which rib
dysfunction is being treated?
A) Pump handle
B) Bucket handle
C) Caliper
D) Somatic dysfunction of rib 1
Rationale: The bucket handle component of rib motion involves lateral
movement of the rib shaft. The dysfunctional transverse process (the
pivot point) is treated by applying a force to correct the lateral aspect of
the rib cage. Pump handle involves anterior/posterior movement of the
sternum; caliper refers to ribs 11-12 .
Question 3
During a cranial evaluation, you place your hands on the patient's head
with the hypothenar eminences at the greater wings of the sphenoid and
the fingertips at the occiput. You sense a phase where the occiput is
externally rotating and the sphenoid is internally rotating. Which phase
of the primary respiratory mechanism is this?
A) Flexion phase
B) Extension phase
C) Midline phase
D) Torsion phase
,Rationale: In the cranial rhythmic impulse (CRI), during the flexion
phase, the sphenoid rotates externally (widening) and the occiput rotates
internally. During the extension phase, the opposite occurs: the sphenoid
internally rotates and the occiput externally rotates .
Question 4
A patient presents with acute torticollis. You find the left
sternocleidomastoid (SCM) is tender and in spasm. Which Chapman's
reflex point would be tender if there is a visceral component related to
this somatic dysfunction?
A) 2nd intercostal space, left sternal border
B) 1st intercostal space, right sternal border
C) Umbilicus, right lateral border
D) Tip of the 12th rib
Rationale: Chapman's reflexes are neurolymphatic points. The point for
the upper respiratory tract (including the SCM region and throat) is
located in the 1st intercostal space, right sternal border. The left 2nd
intercostal space corresponds to the stomach .
Question 5
A patient standing with a forward-bending test reveals a right thoracic
rib hump. What is the most likely structural spinal diagnosis?
A) Right thoracic convexity
B) Left thoracic convexity
, C) Lumbarization of S
D) Spondylolisthesis
Rationale: In structural scoliosis, the rib hump appears on the side of
the convexity. A right thoracic rib hump indicates right thoracic
convexity .
Question 6
A 43-year-old construction worker presents with acute, sharp low back
pain after lifting heavy equipment. Physical examination demonstrates a
positive standing flexion test on the right side. Palpation reveals that the
right anterior superior iliac spine (ASIS) is inferior, and the right
posterior superior iliac spine (PSIS) is superior when compared to the
left side. What is the most appropriate diagnostic setup for this patient?
A) Right posterior innominate rotation
B) Left anterior innominate rotation
C) Right anterior innominate rotation
D) Right superior innominate shear
Rationale: A positive standing flexion test lateralizes the somatic
dysfunction to the right side. An inferior ASIS paired with a superior
PSIS on the same side indicates that the right innominate bone has
rotated anteriorly around a transverse axis. A posterior rotation would
feature a superior ASIS and inferior PSIS .
