COMSAE PHASE 1 COMPREHENSIVE
REVIEW (FORM 118 STYLE)
QUESTIONS AND VERIFIED ANSWERS
1. A 45-year-old male presents with acute onset of severe low back pain after lifting a heavy
box. Physical examination reveals a positive seated flexion test on the right. The right sacral
base is deep, and the left ILA is posterior. L5 is found to be rotated left and sidebent left.
What is the most likely sacral diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Left-on-right backward torsion
D. Right-on-left backward torsion
Answer: D
Conceptual Explanation: A positive seated flexion test indicates the side of the restricted
axis. In sacral torsions, L5 rotates opposite to the sacrum. Given L5 is rotated left, the
sacrum must be rotated right. A right-on-left torsion involves a right rotation on a left
oblique axis, which matches a positive seated flexion test on the right and L5 rotation.
,2. A 62-year-old female with a history of hypertension presents for a routine checkup.
Osteopathic examination reveals a tissue texture change at the level of T5-T9 on the left side.
Which of the following visceral organs is most likely associated with this viscerosomatic
reflex?
A. Bladder
B. Appendix
C. Descending Colon
D. Stomach
Answer: D
Conceptual Explanation: T5-T9 represents the greater splanchnic nerve distribution,
primarily associated with upper GI structures like the stomach, liver, gallbladder, and
duodenum.
3. A 24-year-old African American male is treated with primaquine for malaria prophylaxis.
Several days later, he develops dark urine and fatigue. Laboratory studies show Heinz bodies
on peripheral smear. Which enzyme is most likely deficient?
A. Pyruvate kinase
B. Glucose-6-phosphate dehydrogenase
C. Glutathione reductase
D. Hexokinase
, Answer: B
Conceptual Explanation: G6PD deficiency leads to oxidative stress in RBCs when exposed
to certain drugs (like primaquine), resulting in hemoglobin precipitation (Heinz bodies)
and hemolytic anemia.
4. During a cranial examination, the physician notes that the sphenoid base moves superiorly
while the occiput moves inferiorly during the inhalation phase. What is the correct diagnosis
for this cranial strain?
A. Superior vertical strain
B. Sidebending rotation
C. Torsion
D. Inferior vertical strain
Answer: D
Conceptual Explanation: A vertical strain is named for the direction of the sphenoid base.
In an inferior vertical strain, the sphenoid base moves inferiorly (meaning the greater
wings move superiorly) relative to the occiput.
5. A 68-year-old male with a history of atrial fibrillation is taking warfarin. He is started on a
new medication for a respiratory infection and subsequently presents with a significantly
elevated INR and bleeding gums. Which of the following drugs was likely added?
A. Erythromycin
B. Rifampin
REVIEW (FORM 118 STYLE)
QUESTIONS AND VERIFIED ANSWERS
1. A 45-year-old male presents with acute onset of severe low back pain after lifting a heavy
box. Physical examination reveals a positive seated flexion test on the right. The right sacral
base is deep, and the left ILA is posterior. L5 is found to be rotated left and sidebent left.
What is the most likely sacral diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Left-on-right backward torsion
D. Right-on-left backward torsion
Answer: D
Conceptual Explanation: A positive seated flexion test indicates the side of the restricted
axis. In sacral torsions, L5 rotates opposite to the sacrum. Given L5 is rotated left, the
sacrum must be rotated right. A right-on-left torsion involves a right rotation on a left
oblique axis, which matches a positive seated flexion test on the right and L5 rotation.
,2. A 62-year-old female with a history of hypertension presents for a routine checkup.
Osteopathic examination reveals a tissue texture change at the level of T5-T9 on the left side.
Which of the following visceral organs is most likely associated with this viscerosomatic
reflex?
A. Bladder
B. Appendix
C. Descending Colon
D. Stomach
Answer: D
Conceptual Explanation: T5-T9 represents the greater splanchnic nerve distribution,
primarily associated with upper GI structures like the stomach, liver, gallbladder, and
duodenum.
3. A 24-year-old African American male is treated with primaquine for malaria prophylaxis.
Several days later, he develops dark urine and fatigue. Laboratory studies show Heinz bodies
on peripheral smear. Which enzyme is most likely deficient?
A. Pyruvate kinase
B. Glucose-6-phosphate dehydrogenase
C. Glutathione reductase
D. Hexokinase
, Answer: B
Conceptual Explanation: G6PD deficiency leads to oxidative stress in RBCs when exposed
to certain drugs (like primaquine), resulting in hemoglobin precipitation (Heinz bodies)
and hemolytic anemia.
4. During a cranial examination, the physician notes that the sphenoid base moves superiorly
while the occiput moves inferiorly during the inhalation phase. What is the correct diagnosis
for this cranial strain?
A. Superior vertical strain
B. Sidebending rotation
C. Torsion
D. Inferior vertical strain
Answer: D
Conceptual Explanation: A vertical strain is named for the direction of the sphenoid base.
In an inferior vertical strain, the sphenoid base moves inferiorly (meaning the greater
wings move superiorly) relative to the occiput.
5. A 68-year-old male with a history of atrial fibrillation is taking warfarin. He is started on a
new medication for a respiratory infection and subsequently presents with a significantly
elevated INR and bleeding gums. Which of the following drugs was likely added?
A. Erythromycin
B. Rifampin
