COMPREHENSIVE OSTEOPATHIC
MEDICAL SELF-ASSESSMENT
EXAMINATION (COMSAE) STUDY
GUIDE QUESTIONS AND VERIFIED
ANSWERS
1. A 45-year-old male presents with epigastric pain. Physical exam reveals tissue texture
changes at the level of T5-T9 on the left. Which of the following Chapman points is most likely
to be found in this patient?
A. Right 5th intercostal space
B. Left 5th intercostal space
C. Left 6th intercostal space
D. Right 6th intercostal space
Answer: C
Conceptual Explanation: The Chapman point for the stomach (acidity) is located in the
left 5th intercostal space, while the point for stomach (peristalsis) is in the left 6th
intercostal space. Given epigastric pain and T5-T9 left viscerosomatics, the 6th space is a
common high-yield clinical finding for gastric dysfunction.
,2. During a cranial examination, the physician notes that the sphenoid base moves superiorly
relative to the occiput. Which strain pattern is present?
A. Inferior vertical strain
B. Superior vertical strain
C. Torsion
D. Lateral strain
Answer: B
Conceptual Explanation: In a vertical strain, the naming is based on the movement of the
base of the sphenoid. If the base moves superiorly, it is a superior vertical strain.
3. A patient is diagnosed with a L on L forward sacral torsion. Which of the following is most
likely to be found during the structural exam?
A. Deep left sulcus
B. Decreased lumbosacral spring
C. Positive seated flexion test on the right
D. Posterior right ILA
Answer: A
Conceptual Explanation: In an L on L torsion, the axis is the left oblique axis. The seated
flexion test is positive on the right (opposite the axis). The sacrum rotates left, resulting in a
, deep left sulcus and a posterior right ILA. Forward torsions have a negative (normal)
spring test.
4. Regarding Fryette’s Laws, if L2 is found to be Flexed, Rotated Right, and Sidebent Right,
which of the following is true?
A. It follows Type I mechanics
B. It involves a group of vertebrae
C. It occurs in a neutral position
D. Sidebending and rotation occur to the same side
Answer: D
Conceptual Explanation: This describes Type II mechanics (Flexed or Extended). In Type
II mechanics, sidebending and rotation occur to the same side at a single vertebral segment.
5. A 30-year-old female presents with primary dysmenorrhea. Which spinal level is most
likely to show viscerosomatic changes?
A. T10-T11
B. L3-L5
C. T5-T9
D. T12-L2
Answer: D
MEDICAL SELF-ASSESSMENT
EXAMINATION (COMSAE) STUDY
GUIDE QUESTIONS AND VERIFIED
ANSWERS
1. A 45-year-old male presents with epigastric pain. Physical exam reveals tissue texture
changes at the level of T5-T9 on the left. Which of the following Chapman points is most likely
to be found in this patient?
A. Right 5th intercostal space
B. Left 5th intercostal space
C. Left 6th intercostal space
D. Right 6th intercostal space
Answer: C
Conceptual Explanation: The Chapman point for the stomach (acidity) is located in the
left 5th intercostal space, while the point for stomach (peristalsis) is in the left 6th
intercostal space. Given epigastric pain and T5-T9 left viscerosomatics, the 6th space is a
common high-yield clinical finding for gastric dysfunction.
,2. During a cranial examination, the physician notes that the sphenoid base moves superiorly
relative to the occiput. Which strain pattern is present?
A. Inferior vertical strain
B. Superior vertical strain
C. Torsion
D. Lateral strain
Answer: B
Conceptual Explanation: In a vertical strain, the naming is based on the movement of the
base of the sphenoid. If the base moves superiorly, it is a superior vertical strain.
3. A patient is diagnosed with a L on L forward sacral torsion. Which of the following is most
likely to be found during the structural exam?
A. Deep left sulcus
B. Decreased lumbosacral spring
C. Positive seated flexion test on the right
D. Posterior right ILA
Answer: A
Conceptual Explanation: In an L on L torsion, the axis is the left oblique axis. The seated
flexion test is positive on the right (opposite the axis). The sacrum rotates left, resulting in a
, deep left sulcus and a posterior right ILA. Forward torsions have a negative (normal)
spring test.
4. Regarding Fryette’s Laws, if L2 is found to be Flexed, Rotated Right, and Sidebent Right,
which of the following is true?
A. It follows Type I mechanics
B. It involves a group of vertebrae
C. It occurs in a neutral position
D. Sidebending and rotation occur to the same side
Answer: D
Conceptual Explanation: This describes Type II mechanics (Flexed or Extended). In Type
II mechanics, sidebending and rotation occur to the same side at a single vertebral segment.
5. A 30-year-old female presents with primary dysmenorrhea. Which spinal level is most
likely to show viscerosomatic changes?
A. T10-T11
B. L3-L5
C. T5-T9
D. T12-L2
Answer: D
