COMAT Osteopathic Principles & Practice
(OPP/OMM) Exam V3 | COMAT Osteopathic
Principles & Practice (OPP/OMM) Exam V3
1. A 45-year-old male presents with mid-back pain. Physical examination reveals that T6 is
rotated right and sidebent right, and the findings worsen when the patient is asked to slump
forward. Which of the following is the most likely diagnosis?
A. T6 Flexed, Rotated Right, Sidebent Right
B. T6 Extended, Rotated Right, Sidebent Right
C. T6 Neutral, Sidebent Right, Rotated Left
D. T6 Neutral, Sidebent Left, Rotated Right
Correct Answer: B
Explanation: According to Fryette’s Law II, in a non-neutral (flexed or extended) state,
rotation and sidebending occur to the same side. Since the somatic dysfunction worsens in
flexion (slumping forward), it must be an extension dysfunction, meaning it improves in
extension. Therefore, the diagnosis is T6 Extended, Rotated Right, and Sidebent Right (T6 E
RRSR).
,2. A 22-year-old female presents with lower back pain after a fall. Examination shows a deep
sacral sulcus on the left and a posterior inferior lateral angle (ILA) on the right. The Spring test
is negative, and L5 is neutral, sidebent left, and rotated right. What is the most likely sacral
diagnosis?
A. Left-on-Left Forward Torsion
B. Right-on-Right Forward Torsion
C. Right-on-Left Backward Torsion
D. Left-on-Right Backward Torsion
Correct Answer: A
Explanation: A negative Spring test indicates a forward torsion (neutral). In a Left-on-Left
torsion, the sacrum rotates left on a left oblique axis, which creates a deep left sulcus and a
posterior right ILA. This diagnosis is consistent with L5 following Fryette’s Law III/Torsion
rules where L5 is neutral and rotated opposite to the sacral rotation.
3. A 34-year-old patient presents with neck stiffness. Upon examination, you find the Atlas
(C1) is rotated left. What is the correct setup for Muscle Energy to treat this dysfunction?
A. Rotate the head to the right into the restrictive barrier
B. Rotate the head to the left into the restrictive barrier
C. Sidebend the head to the right
D. Flex the head to engage the barrier
,Correct Answer: A
Explanation: The Atlanto-Axial (AA) joint is primarily responsible for rotation. If the AA is
rotated left, its restrictive barrier is to the right. Muscle energy is a direct technique, so the
physician should rotate the head to the right until the barrier is felt before the patient is
asked to rotate back toward the left against resistance.
4. A 55-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents for a routine check-up. You find a tender point on the lateral aspect of the 6th
intercostal space on the right. Which organ is most likely associated with this finding?
A. Stomach (acidity)
B. Appendix
C. Gallbladder
D. Liver
Correct Answer: C
Explanation: The anterior Chapman point for the gallbladder is located in the right 6th
intercostal space between the mid-clavicular and mid-axillary lines. This point is often
associated with cholecystitis or biliary stasis. Knowing the specific locations of Chapman
reflex points is crucial for identifying visceral pathology manifesting as somatic tender
points.
, 5. A patient fell forward on an outstretched hand. Radiographs are negative for fracture.
Examination of the elbow reveals that the radial head does not move anteriorly with ease but
moves posteriorly very well. What is the diagnosis?
A. Anterior Radial Head
B. Medial Radial Head
C. Lateral Radial Head
D. Posterior Radial Head
Correct Answer: D
Explanation: A posterior radial head dysfunction is characterized by ease of posterior
motion and a restriction in anterior motion. This injury commonly occurs when falling
forward on an outstretched hand (pronation of the forearm). In OMM, dysfunctions are
named for their position of ease.
6. Which of the following describes the correct sequence of treatment when performing
lymphatic techniques?
A. Pedal pump, Thoracic pump, Thoracic inlet
B. Thoracic inlet, Thoracic pump, Pedal pump
C. Thoracic pump, Thoracic inlet, Pedal pump
D. Pedal pump, Pelvic diaphragm, Thoracic inlet
Correct Answer: B
(OPP/OMM) Exam V3 | COMAT Osteopathic
Principles & Practice (OPP/OMM) Exam V3
1. A 45-year-old male presents with mid-back pain. Physical examination reveals that T6 is
rotated right and sidebent right, and the findings worsen when the patient is asked to slump
forward. Which of the following is the most likely diagnosis?
A. T6 Flexed, Rotated Right, Sidebent Right
B. T6 Extended, Rotated Right, Sidebent Right
C. T6 Neutral, Sidebent Right, Rotated Left
D. T6 Neutral, Sidebent Left, Rotated Right
Correct Answer: B
Explanation: According to Fryette’s Law II, in a non-neutral (flexed or extended) state,
rotation and sidebending occur to the same side. Since the somatic dysfunction worsens in
flexion (slumping forward), it must be an extension dysfunction, meaning it improves in
extension. Therefore, the diagnosis is T6 Extended, Rotated Right, and Sidebent Right (T6 E
RRSR).
,2. A 22-year-old female presents with lower back pain after a fall. Examination shows a deep
sacral sulcus on the left and a posterior inferior lateral angle (ILA) on the right. The Spring test
is negative, and L5 is neutral, sidebent left, and rotated right. What is the most likely sacral
diagnosis?
A. Left-on-Left Forward Torsion
B. Right-on-Right Forward Torsion
C. Right-on-Left Backward Torsion
D. Left-on-Right Backward Torsion
Correct Answer: A
Explanation: A negative Spring test indicates a forward torsion (neutral). In a Left-on-Left
torsion, the sacrum rotates left on a left oblique axis, which creates a deep left sulcus and a
posterior right ILA. This diagnosis is consistent with L5 following Fryette’s Law III/Torsion
rules where L5 is neutral and rotated opposite to the sacral rotation.
3. A 34-year-old patient presents with neck stiffness. Upon examination, you find the Atlas
(C1) is rotated left. What is the correct setup for Muscle Energy to treat this dysfunction?
A. Rotate the head to the right into the restrictive barrier
B. Rotate the head to the left into the restrictive barrier
C. Sidebend the head to the right
D. Flex the head to engage the barrier
,Correct Answer: A
Explanation: The Atlanto-Axial (AA) joint is primarily responsible for rotation. If the AA is
rotated left, its restrictive barrier is to the right. Muscle energy is a direct technique, so the
physician should rotate the head to the right until the barrier is felt before the patient is
asked to rotate back toward the left against resistance.
4. A 55-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents for a routine check-up. You find a tender point on the lateral aspect of the 6th
intercostal space on the right. Which organ is most likely associated with this finding?
A. Stomach (acidity)
B. Appendix
C. Gallbladder
D. Liver
Correct Answer: C
Explanation: The anterior Chapman point for the gallbladder is located in the right 6th
intercostal space between the mid-clavicular and mid-axillary lines. This point is often
associated with cholecystitis or biliary stasis. Knowing the specific locations of Chapman
reflex points is crucial for identifying visceral pathology manifesting as somatic tender
points.
, 5. A patient fell forward on an outstretched hand. Radiographs are negative for fracture.
Examination of the elbow reveals that the radial head does not move anteriorly with ease but
moves posteriorly very well. What is the diagnosis?
A. Anterior Radial Head
B. Medial Radial Head
C. Lateral Radial Head
D. Posterior Radial Head
Correct Answer: D
Explanation: A posterior radial head dysfunction is characterized by ease of posterior
motion and a restriction in anterior motion. This injury commonly occurs when falling
forward on an outstretched hand (pronation of the forearm). In OMM, dysfunctions are
named for their position of ease.
6. Which of the following describes the correct sequence of treatment when performing
lymphatic techniques?
A. Pedal pump, Thoracic pump, Thoracic inlet
B. Thoracic inlet, Thoracic pump, Pedal pump
C. Thoracic pump, Thoracic inlet, Pedal pump
D. Pedal pump, Pelvic diaphragm, Thoracic inlet
Correct Answer: B
