COMSAE PHASE 1 FORM 114
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with low back pain. Physical examination reveals L5 is rotated
right and sidebent right. What is the most likely diagnosis for his sacrum?
A. Left-on-right backward torsion
B. Left-on-left forward torsion
C. Right-on-right forward torsion
D. Right-on-left backward torsion
Answer: A
Conceptual Explanation: According to Fryette’s laws applied to the sacrum, L5 rotates in
the opposite direction of the sacral rotation, and L5 sidebends to the side of the sacral
oblique axis. In a left-on-right torsion, the axis is right, and the rotation is left. Thus, L5
would be sidebent right and rotated right.
2. Which of the following muscles is used as the activating force during muscle energy for an
exhalation dysfunction of the second rib?
A. Posterior scalene
,B. Anterior scalene
C. Pectoralis minor
D. Serratus anterior
Answer: A
Conceptual Explanation: For rib 2 exhalation dysfunction, the activating muscle is the
posterior scalene. Rib 1 uses the anterior and middle scalenes, ribs 3-5 use the pectoralis
minor, and ribs 6-10 use the serratus anterior.
3. A patient presents with mid-thoracic pain. Examination reveals T4 is flexed, rotated right,
and sidebent right. Which of the following describes the most likely viscerosomatic reflex
associated with the heart?
A. T5-T9
B. T1-T5
C. T10-T11
D. T12-L2
Answer: B
Conceptual Explanation: The heart’s sympathetic viscerosomatic reflex levels are
typically T1-T5. T5-T9 is generally associated with the upper GI tract (stomach, liver,
gallbladder).
, 4. A 22-year-old female presents with frequent episodes of dizziness and fainting. Physical
exam reveals a systolic murmur that increases with Valsalva maneuver. What is the most
likely diagnosis?
A. Hypertrophic obstructive cardiomyopathy
B. Mitral valve prolapse
C. Aortic stenosis
D. Atrial septal defect
Answer: A
Conceptual Explanation: Hypertrophic obstructive cardiomyopathy (HOCM) presents
with a systolic murmur that increases with Valsalva or standing (decreased preload) and
decreases with squatting (increased preload).
5. In a patient with cranial dysfunction, the sphenobasilar synchondrosis (SBS) moves
superiorly, and the greater wings of the sphenoid move inferiorly. What is this strain pattern?
A. Superior vertical strain
B. Inferior vertical strain
C. Lateral strain
D. Torsion
Answer: B
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with low back pain. Physical examination reveals L5 is rotated
right and sidebent right. What is the most likely diagnosis for his sacrum?
A. Left-on-right backward torsion
B. Left-on-left forward torsion
C. Right-on-right forward torsion
D. Right-on-left backward torsion
Answer: A
Conceptual Explanation: According to Fryette’s laws applied to the sacrum, L5 rotates in
the opposite direction of the sacral rotation, and L5 sidebends to the side of the sacral
oblique axis. In a left-on-right torsion, the axis is right, and the rotation is left. Thus, L5
would be sidebent right and rotated right.
2. Which of the following muscles is used as the activating force during muscle energy for an
exhalation dysfunction of the second rib?
A. Posterior scalene
,B. Anterior scalene
C. Pectoralis minor
D. Serratus anterior
Answer: A
Conceptual Explanation: For rib 2 exhalation dysfunction, the activating muscle is the
posterior scalene. Rib 1 uses the anterior and middle scalenes, ribs 3-5 use the pectoralis
minor, and ribs 6-10 use the serratus anterior.
3. A patient presents with mid-thoracic pain. Examination reveals T4 is flexed, rotated right,
and sidebent right. Which of the following describes the most likely viscerosomatic reflex
associated with the heart?
A. T5-T9
B. T1-T5
C. T10-T11
D. T12-L2
Answer: B
Conceptual Explanation: The heart’s sympathetic viscerosomatic reflex levels are
typically T1-T5. T5-T9 is generally associated with the upper GI tract (stomach, liver,
gallbladder).
, 4. A 22-year-old female presents with frequent episodes of dizziness and fainting. Physical
exam reveals a systolic murmur that increases with Valsalva maneuver. What is the most
likely diagnosis?
A. Hypertrophic obstructive cardiomyopathy
B. Mitral valve prolapse
C. Aortic stenosis
D. Atrial septal defect
Answer: A
Conceptual Explanation: Hypertrophic obstructive cardiomyopathy (HOCM) presents
with a systolic murmur that increases with Valsalva or standing (decreased preload) and
decreases with squatting (increased preload).
5. In a patient with cranial dysfunction, the sphenobasilar synchondrosis (SBS) moves
superiorly, and the greater wings of the sphenoid move inferiorly. What is this strain pattern?
A. Superior vertical strain
B. Inferior vertical strain
C. Lateral strain
D. Torsion
Answer: B
