COMSAE Phase 1 Form 116 — Exam COMPLETE
Questions and Detailed Solutions
Latest Update 2026\2027 actual
Question 1
A 45-year-old male presents with chronic low back pain. On examination, you note tenderness at the
inferior angle of the right scapula. Palpation reveals a small, tender nodule at this location. According to
Chapman's reflex points, this finding is most consistent with dysfunction of which organ?
A) Liver
B) Gallbladder
C) Stomach
D) Kidney
E) Appendix
ANSWER: A) Liver
Rationale:
A) Liver — CORRECT. Chapman's reflex points are neurolymphatic reflexes that correspond to visceral
dysfunction. The point at the inferior angle of the right scapula correlates with liver dysfunction. These
points are tender nodules found in specific locations and are used diagnostically in osteopathic
manipulative medicine.
B) Gallbladder — INCORRECT. The gallbladder reflex point is located between the 7th and 8th ribs on the
right side, not at the inferior angle of the scapula.
,C) Stomach — INCORRECT. The stomach reflex point is located in the mid-thoracic region on the left
side, specifically at the 5th and 6th intercostal spaces.
D) Kidney — INCORRECT. Kidney reflex points are located in the lumbar region, typically at the 12th rib
area bilaterally.
E) Appendix — INCORRECT. The appendix reflex point is located in the right lower quadrant at
McBurney's point area, not at the scapular angle.
Question 2
A 28-year-old female presents with right upper quadrant pain that radiates to her right shoulder. She
reports the pain began after eating a fatty meal. On examination, there is tenderness at the right
costochondral junction. This viscerosomatic reflex is most likely mediated by which spinal cord level?
A) T1-T2
B) T3-T5
C) T6-T8
D) T9-T11
E) T12-L1
ANSWER: C) T6-T8
Rationale:
A) T1-T2 — INCORRECT. T1-T2 corresponds to the heart and upper extremities. Viscerosomatic reflexes
from the gallbladder would not present at this level.
B) T3-T5 — INCORRECT. T3-T5 corresponds primarily to cardiac and pulmonary structures. While there
may be some overlap, gallbladder dysfunction typically reflex at lower thoracic levels.
,C) T6-T8 — CORRECT. The gallbladder receives innervation from T6-T8 spinal segments. Viscerosomatic
reflexes from gallbladder dysfunction typically present at these levels, causing somatic dysfunction in
the corresponding paraspinal muscles and tissues. The referred pain to the right shoulder occurs via
phrenic nerve irritation from diaphragmatic inflammation.
D) T9-T11 — INCORRECT. T9-T11 corresponds to the kidneys, ureters, and small intestine. The
gallbladder is not innervated by these levels.
E) T12-L1 — INCORRECT. T12-L1 corresponds to the pelvic organs and lower extremities. Gallbladder
dysfunction would not present at these spinal levels.
Question 3
A patient presents with a chief complaint of heartburn and epigastric pain. During osteopathic
examination, you find a tender point at the right 5th intercostal space near the sternum. According to
Chapman's reflex system, this finding suggests dysfunction of which structure?
A) Liver
B) Stomach
C) Gallbladder
D) Duodenum
E) Pancreas
ANSWER: D) Duodenum
Rationale:
A) Liver — INCORRECT. The liver reflex point is at the inferior angle of the right scapula, not at the right
5th intercostal space.
B) Stomach — INCORRECT. The stomach reflex points are located at the 5th and 6th intercostal spaces
on the left side, not the right side.
, C) Gallbladder — INCORRECT. The gallbladder reflex point is located between the 7th and 8th ribs on the
right side, not at the 5th intercostal space.
D) Duodenum — CORRECT. The duodenum reflex point is located at the right 5th intercostal space near
the sternum. This is a characteristic Chapman's reflex point that can be used to identify duodenal
dysfunction, which may present with symptoms of peptic ulcer disease or duodenitis.
E) Pancreas — INCORRECT. The pancreas reflex points are located in the upper abdominal region,
typically at the 7th and 8th thoracic levels bilaterally.
Question 4
A 55-year-old male with a history of chronic obstructive pulmonary disease presents with worsening
dyspnea. On osteopathic examination, you note restricted motion of the ribs during inspiration. Which
of the following correctly describes the bucket handle motion of the ribs?
A) Movement occurs primarily in the anteroposterior dimension
B) Movement occurs primarily in the transverse dimension
C) Movement occurs primarily in the vertical dimension
D) Movement is absent in ribs 1-6
E) Movement is mediated by the costovertebral joints only
ANSWER: B) Movement occurs primarily in the transverse dimension
Rationale:
A) Movement occurs primarily in the anteroposterior dimension — INCORRECT. This describes the pump
handle motion, not the bucket handle motion.
B) Movement occurs primarily in the transverse dimension — CORRECT. The bucket handle motion of
the ribs occurs primarily in the transverse (lateral) dimension. During inspiration, the lateral aspects of
Questions and Detailed Solutions
Latest Update 2026\2027 actual
Question 1
A 45-year-old male presents with chronic low back pain. On examination, you note tenderness at the
inferior angle of the right scapula. Palpation reveals a small, tender nodule at this location. According to
Chapman's reflex points, this finding is most consistent with dysfunction of which organ?
A) Liver
B) Gallbladder
C) Stomach
D) Kidney
E) Appendix
ANSWER: A) Liver
Rationale:
A) Liver — CORRECT. Chapman's reflex points are neurolymphatic reflexes that correspond to visceral
dysfunction. The point at the inferior angle of the right scapula correlates with liver dysfunction. These
points are tender nodules found in specific locations and are used diagnostically in osteopathic
manipulative medicine.
B) Gallbladder — INCORRECT. The gallbladder reflex point is located between the 7th and 8th ribs on the
right side, not at the inferior angle of the scapula.
,C) Stomach — INCORRECT. The stomach reflex point is located in the mid-thoracic region on the left
side, specifically at the 5th and 6th intercostal spaces.
D) Kidney — INCORRECT. Kidney reflex points are located in the lumbar region, typically at the 12th rib
area bilaterally.
E) Appendix — INCORRECT. The appendix reflex point is located in the right lower quadrant at
McBurney's point area, not at the scapular angle.
Question 2
A 28-year-old female presents with right upper quadrant pain that radiates to her right shoulder. She
reports the pain began after eating a fatty meal. On examination, there is tenderness at the right
costochondral junction. This viscerosomatic reflex is most likely mediated by which spinal cord level?
A) T1-T2
B) T3-T5
C) T6-T8
D) T9-T11
E) T12-L1
ANSWER: C) T6-T8
Rationale:
A) T1-T2 — INCORRECT. T1-T2 corresponds to the heart and upper extremities. Viscerosomatic reflexes
from the gallbladder would not present at this level.
B) T3-T5 — INCORRECT. T3-T5 corresponds primarily to cardiac and pulmonary structures. While there
may be some overlap, gallbladder dysfunction typically reflex at lower thoracic levels.
,C) T6-T8 — CORRECT. The gallbladder receives innervation from T6-T8 spinal segments. Viscerosomatic
reflexes from gallbladder dysfunction typically present at these levels, causing somatic dysfunction in
the corresponding paraspinal muscles and tissues. The referred pain to the right shoulder occurs via
phrenic nerve irritation from diaphragmatic inflammation.
D) T9-T11 — INCORRECT. T9-T11 corresponds to the kidneys, ureters, and small intestine. The
gallbladder is not innervated by these levels.
E) T12-L1 — INCORRECT. T12-L1 corresponds to the pelvic organs and lower extremities. Gallbladder
dysfunction would not present at these spinal levels.
Question 3
A patient presents with a chief complaint of heartburn and epigastric pain. During osteopathic
examination, you find a tender point at the right 5th intercostal space near the sternum. According to
Chapman's reflex system, this finding suggests dysfunction of which structure?
A) Liver
B) Stomach
C) Gallbladder
D) Duodenum
E) Pancreas
ANSWER: D) Duodenum
Rationale:
A) Liver — INCORRECT. The liver reflex point is at the inferior angle of the right scapula, not at the right
5th intercostal space.
B) Stomach — INCORRECT. The stomach reflex points are located at the 5th and 6th intercostal spaces
on the left side, not the right side.
, C) Gallbladder — INCORRECT. The gallbladder reflex point is located between the 7th and 8th ribs on the
right side, not at the 5th intercostal space.
D) Duodenum — CORRECT. The duodenum reflex point is located at the right 5th intercostal space near
the sternum. This is a characteristic Chapman's reflex point that can be used to identify duodenal
dysfunction, which may present with symptoms of peptic ulcer disease or duodenitis.
E) Pancreas — INCORRECT. The pancreas reflex points are located in the upper abdominal region,
typically at the 7th and 8th thoracic levels bilaterally.
Question 4
A 55-year-old male with a history of chronic obstructive pulmonary disease presents with worsening
dyspnea. On osteopathic examination, you note restricted motion of the ribs during inspiration. Which
of the following correctly describes the bucket handle motion of the ribs?
A) Movement occurs primarily in the anteroposterior dimension
B) Movement occurs primarily in the transverse dimension
C) Movement occurs primarily in the vertical dimension
D) Movement is absent in ribs 1-6
E) Movement is mediated by the costovertebral joints only
ANSWER: B) Movement occurs primarily in the transverse dimension
Rationale:
A) Movement occurs primarily in the anteroposterior dimension — INCORRECT. This describes the pump
handle motion, not the bucket handle motion.
B) Movement occurs primarily in the transverse dimension — CORRECT. The bucket handle motion of
the ribs occurs primarily in the transverse (lateral) dimension. During inspiration, the lateral aspects of
