COMAT Osteopathic Principles & Practice
(OPP/OMM) Exam V2
1. A 28-year-old male presents with persistent neck pain after a minor motor vehicle
accident. Physical examination of the occipitoatlantal (OA) joint reveals that the joint moves
more easily into extension, and the right sulcus is deeper when the head is flexed. What is
the most likely diagnosis?
A. OA F RlRr
B. OA E RrSl
C. OA E RlRr
D. OA F RrSl
Correct Answer: B
Explanation: The OA joint follows modified Fryette’s Law I, meaning sidebending and
rotation occur to opposite sides. In this case, the right sulcus being deeper in flexion
indicates that the right occipital condyle is posterior and resists forward motion, signifying
an extension dysfunction. Consequently, the rotation is to the right and sidebending is to
the left, resulting in the diagnosis of OA E RrSl. A common pitfall is applying Type II
mechanics to the OA joint, which is incorrect for this anatomical region.
,2. A 45-year-old female presents with mid-back pain. Examination of the thoracic spine
reveals that T6 is rotated right and sidebent right. The dysfunction is more pronounced when
the patient is extended. Which of the following describes the most appropriate initial
positioning for Muscle Energy treatment?
A. Flexion, sidebending right, rotation right
B. Extension, sidebending left, rotation left
C. Flexion, sidebending left, rotation left
D. Extension, sidebending right, rotation right
Correct Answer: C
Explanation: The diagnosis for T6 is T6 F RrSr, as the dysfunction is more pronounced in
extension (improving in flexion) and follows Type II Fryette mechanics. Muscle Energy is a
direct technique, requiring the patient to be moved into the restrictive barrier (the
opposite of the diagnosis). Therefore, the setup involves flexion, sidebending left, and
rotation left. Practitioners must carefully differentiate between the diagnosis and the
treatment position to avoid worsening the dysfunction.
3. A 60-year-old male presents with chronic cough and shortness of breath. You suspect a
viscerosomatic reflex related to his pulmonary system. At which spinal level would you most
likely find paraspinal changes associated with the lungs?
A. T1-T4
B. T5-T9
,C. T2-T7
D. T10-T11
Correct Answer: C
Explanation: The viscerosomatic reflex for the lungs is T2 to T7, encompassing the
sympathetic innervation to the pulmonary system. Clinical significance lies in using these
palpatory findings to aid in the diagnosis of underlying visceral pathology or to direct OMT
to improve autonomic balance. A common pitfall is confusing these levels with the
sympathetic levels for the heart (T1-T5) or the upper GI tract (T5-T9).
4. A 35-year-old patient presents with acute low back pain. Examination of L5 reveals it is
neutral, sidebent left, and rotated right. Examination of the sacrum reveals a positive seated
flexion test on the left and a deep sacral sulcus on the right. What is the most likely sacral
diagnosis?
A. Right-on-right forward torsion
B. Right-on-left backward torsion
C. Left-on-right backward torsion
D. Left-on-left forward torsion
Correct Answer: B
Explanation: According to the rules of L5 and sacral torsion, L5 rotation and sacral
rotation occur to opposite sides, and L5 sidebending occurs to the same side as the sacral
oblique axis. In this scenario, L5 is N SlRr, which means the sacrum must rotate to the left
, (opposite of Rr) on a left oblique axis (same as Sl). A left rotation on a left axis is an L on L
torsion; however, the seated flexion test is positive on the left, which suggests a backward
torsion (Right on Left) because the side of the positive test is opposite the rotation in a
backward torsion. This complex relationship is a frequent focus on the COMAT exam and
requires strict adherence to Fryette’s L5 rules.
5. A 52-year-old female presents with pain in the right lower quadrant of her abdomen.
During physical examination, a tender point is noted on the tip of the right 12th rib. Which
visceral organ is associated with this anterior Chapman’s point?
A. Gallbladder
B. Appendix
C. Ovary
D. Kidney
Correct Answer: B
Explanation: The anterior Chapman’s point for the appendix is located at the tip of the
12th rib on the right side. This finding is clinically significant for evaluating a patient with
acute abdominal pain when appendicitis is suspected. Identifying Chapman’s points can
provide adjunctive diagnostic information, but they should never replace standard surgical
or medical evaluation for acute conditions.
(OPP/OMM) Exam V2
1. A 28-year-old male presents with persistent neck pain after a minor motor vehicle
accident. Physical examination of the occipitoatlantal (OA) joint reveals that the joint moves
more easily into extension, and the right sulcus is deeper when the head is flexed. What is
the most likely diagnosis?
A. OA F RlRr
B. OA E RrSl
C. OA E RlRr
D. OA F RrSl
Correct Answer: B
Explanation: The OA joint follows modified Fryette’s Law I, meaning sidebending and
rotation occur to opposite sides. In this case, the right sulcus being deeper in flexion
indicates that the right occipital condyle is posterior and resists forward motion, signifying
an extension dysfunction. Consequently, the rotation is to the right and sidebending is to
the left, resulting in the diagnosis of OA E RrSl. A common pitfall is applying Type II
mechanics to the OA joint, which is incorrect for this anatomical region.
,2. A 45-year-old female presents with mid-back pain. Examination of the thoracic spine
reveals that T6 is rotated right and sidebent right. The dysfunction is more pronounced when
the patient is extended. Which of the following describes the most appropriate initial
positioning for Muscle Energy treatment?
A. Flexion, sidebending right, rotation right
B. Extension, sidebending left, rotation left
C. Flexion, sidebending left, rotation left
D. Extension, sidebending right, rotation right
Correct Answer: C
Explanation: The diagnosis for T6 is T6 F RrSr, as the dysfunction is more pronounced in
extension (improving in flexion) and follows Type II Fryette mechanics. Muscle Energy is a
direct technique, requiring the patient to be moved into the restrictive barrier (the
opposite of the diagnosis). Therefore, the setup involves flexion, sidebending left, and
rotation left. Practitioners must carefully differentiate between the diagnosis and the
treatment position to avoid worsening the dysfunction.
3. A 60-year-old male presents with chronic cough and shortness of breath. You suspect a
viscerosomatic reflex related to his pulmonary system. At which spinal level would you most
likely find paraspinal changes associated with the lungs?
A. T1-T4
B. T5-T9
,C. T2-T7
D. T10-T11
Correct Answer: C
Explanation: The viscerosomatic reflex for the lungs is T2 to T7, encompassing the
sympathetic innervation to the pulmonary system. Clinical significance lies in using these
palpatory findings to aid in the diagnosis of underlying visceral pathology or to direct OMT
to improve autonomic balance. A common pitfall is confusing these levels with the
sympathetic levels for the heart (T1-T5) or the upper GI tract (T5-T9).
4. A 35-year-old patient presents with acute low back pain. Examination of L5 reveals it is
neutral, sidebent left, and rotated right. Examination of the sacrum reveals a positive seated
flexion test on the left and a deep sacral sulcus on the right. What is the most likely sacral
diagnosis?
A. Right-on-right forward torsion
B. Right-on-left backward torsion
C. Left-on-right backward torsion
D. Left-on-left forward torsion
Correct Answer: B
Explanation: According to the rules of L5 and sacral torsion, L5 rotation and sacral
rotation occur to opposite sides, and L5 sidebending occurs to the same side as the sacral
oblique axis. In this scenario, L5 is N SlRr, which means the sacrum must rotate to the left
, (opposite of Rr) on a left oblique axis (same as Sl). A left rotation on a left axis is an L on L
torsion; however, the seated flexion test is positive on the left, which suggests a backward
torsion (Right on Left) because the side of the positive test is opposite the rotation in a
backward torsion. This complex relationship is a frequent focus on the COMAT exam and
requires strict adherence to Fryette’s L5 rules.
5. A 52-year-old female presents with pain in the right lower quadrant of her abdomen.
During physical examination, a tender point is noted on the tip of the right 12th rib. Which
visceral organ is associated with this anterior Chapman’s point?
A. Gallbladder
B. Appendix
C. Ovary
D. Kidney
Correct Answer: B
Explanation: The anterior Chapman’s point for the appendix is located at the tip of the
12th rib on the right side. This finding is clinically significant for evaluating a patient with
acute abdominal pain when appendicitis is suspected. Identifying Chapman’s points can
provide adjunctive diagnostic information, but they should never replace standard surgical
or medical evaluation for acute conditions.
