COMSAE 115 COMPREHENSIVE HIGH-
DIFFICULTY PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with sharp right lower quadrant pain. Physical examination
reveals tenderness at McBurney’s point and a positive psoas sign. If an osteopathic physician
were to palpate for a Chapman point associated with this condition, where would the
anterior point most likely be located?
A. The lateral aspect of the right thigh at the level of the trochanter
B. 2 inches superior and 1 inch lateral to the umbilicus
C. The tip of the right 12th rib
D. The right 5th intercostal space
Answer: C
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib. The posterior point is located at the transverse process of T11.
,2. A 28-year-old female presents with a chronic cough and wheezing. Physical exam reveals a
T3-T5 segment that is neutral, sidebent right, and rotated left. Which of Fryette’s Laws best
explains this finding?
A. Law III
B. Law II
C. Law I
D. Law IV
Answer: C
Conceptual Explanation: Fryette Law I states that in a neutral range, sidebending and
rotation occur to opposite sides. A neutral, sidebent right, rotated left segment follows this
law, typically occurring in groups.
3. An 8-year-old boy is brought to the clinic for a routine check-up. The physician notes a
scoliotic curve. Measurement of the Cobb angle reveals a curve of 55 degrees. What is the
most appropriate next step in management?
A. Observation with serial X-rays every 6 months
B. Physical therapy and OMM
C. Surgical consultation
D. Bracing
Answer: C
, Conceptual Explanation: A Cobb angle greater than 50 degrees is an indication for
surgical evaluation because the curve is likely to progress even after skeletal maturity.
4. A patient presents with restricted motion of the sacrum. Testing reveals a positive seated
flexion test on the right, a deep sacral sulcus on the left, and a posterior ILA on the right. The
Spring test is negative. What is the 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
Answer: D
Conceptual Explanation: A negative spring test indicates a forward torsion. The positive
seated flexion test on the right indicates the side opposite the axis (Left axis). Deep left
sulcus and posterior right ILA confirm a Left on Left torsion.
5. Which of the following describes the correct positioning for treating a T5 E RL SL
dysfunction using muscle energy?
A. Flexed, rotated right, sidebent right to the barrier
B. Flexed, rotated left, sidebent left to the barrier
C. Extended, rotated right, sidebent right to the barrier
D. Extended, rotated left, sidebent left to the barrier
DIFFICULTY PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with sharp right lower quadrant pain. Physical examination
reveals tenderness at McBurney’s point and a positive psoas sign. If an osteopathic physician
were to palpate for a Chapman point associated with this condition, where would the
anterior point most likely be located?
A. The lateral aspect of the right thigh at the level of the trochanter
B. 2 inches superior and 1 inch lateral to the umbilicus
C. The tip of the right 12th rib
D. The right 5th intercostal space
Answer: C
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib. The posterior point is located at the transverse process of T11.
,2. A 28-year-old female presents with a chronic cough and wheezing. Physical exam reveals a
T3-T5 segment that is neutral, sidebent right, and rotated left. Which of Fryette’s Laws best
explains this finding?
A. Law III
B. Law II
C. Law I
D. Law IV
Answer: C
Conceptual Explanation: Fryette Law I states that in a neutral range, sidebending and
rotation occur to opposite sides. A neutral, sidebent right, rotated left segment follows this
law, typically occurring in groups.
3. An 8-year-old boy is brought to the clinic for a routine check-up. The physician notes a
scoliotic curve. Measurement of the Cobb angle reveals a curve of 55 degrees. What is the
most appropriate next step in management?
A. Observation with serial X-rays every 6 months
B. Physical therapy and OMM
C. Surgical consultation
D. Bracing
Answer: C
, Conceptual Explanation: A Cobb angle greater than 50 degrees is an indication for
surgical evaluation because the curve is likely to progress even after skeletal maturity.
4. A patient presents with restricted motion of the sacrum. Testing reveals a positive seated
flexion test on the right, a deep sacral sulcus on the left, and a posterior ILA on the right. The
Spring test is negative. What is the 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
Answer: D
Conceptual Explanation: A negative spring test indicates a forward torsion. The positive
seated flexion test on the right indicates the side opposite the axis (Left axis). Deep left
sulcus and posterior right ILA confirm a Left on Left torsion.
5. Which of the following describes the correct positioning for treating a T5 E RL SL
dysfunction using muscle energy?
A. Flexed, rotated right, sidebent right to the barrier
B. Flexed, rotated left, sidebent left to the barrier
C. Extended, rotated right, sidebent right to the barrier
D. Extended, rotated left, sidebent left to the barrier
