COMSAE COMPREHENSIVE MEDICAL
AND OSTEOPATHIC ASSESSMENT
2026/2027 QUESTIONS AND ANSWERS
1. A 62-year-old male presents to the emergency department with acute onset crushing
substernal chest pain. His EKG shows ST-segment elevation in leads II, III, and aVF. Which of
the following coronary arteries is most likely occluded?
A. Left anterior descending artery
B. Posterior descending artery
C. Left circumflex artery
D. Right coronary artery
Answer: D
Conceptual Explanation: ST elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction. In approximately 80 percent of individuals, the right coronary artery
(RCA) supplies the inferior wall of the heart via the posterior descending artery.
,2. A 45-year-old female presents with acute right upper quadrant pain that radiates to her
right shoulder. Physical examination reveals a positive Murphy sign. Which of the following
viscerosomatic reflex levels is most consistent with this patient’s condition?
A. T2-T8 on the left
B. T10-T11 on the right
C. T5-T9 on the right
D. T12-L2 on the left
Answer: C
Conceptual Explanation: Acute cholecystitis typically presents with right upper quadrant
pain. The viscerosomatic reflex for the gallbladder and liver is T5-T9 on the right side.
3. A 24-year-old female athlete presents with a dull ache in her low back. Examination reveals
a positive standing flexion test on the right. Her right sacral base is deep, and the right
inferior lateral angle is posterior. What is the most likely diagnosis?
A. Right unilateral sacral flexion
B. Left unilateral sacral extension
C. Left-on-left sacral torsion
D. Right-on-right sacral torsion
Answer: A
, Conceptual Explanation: A positive standing flexion test on the right indicates right-sided
sacral dysfunction. A deep sacral base and a posterior ILA on the same side (right) indicate
a unilateral sacral flexion.
4. A 50-year-old male with a history of chronic hypertension presents for a routine checkup.
During his osteopathic exam, the physician finds T5 rotated right and sidebent right. Which
Fryette law does this finding violate?
A. Fryette Law II
B. Fryette Law I
C. Fryette Law III
D. It does not violate any laws
Answer: B
Conceptual Explanation: Fryette Law I states that in neutral, rotation and sidebending
occur to opposite sides. Since T5 is sidebent and rotated to the same side (right), it
describes a Type II dysfunction, which typically occurs in a non-neutral (flexed or
extended) state.
5. A patient presents with sharp pain at the tip of the 12th rib on the right. This Chapman
point is most indicative of dysfunction in which of the following organs?
A. Kidney
B. Bladder
C. Ovary
AND OSTEOPATHIC ASSESSMENT
2026/2027 QUESTIONS AND ANSWERS
1. A 62-year-old male presents to the emergency department with acute onset crushing
substernal chest pain. His EKG shows ST-segment elevation in leads II, III, and aVF. Which of
the following coronary arteries is most likely occluded?
A. Left anterior descending artery
B. Posterior descending artery
C. Left circumflex artery
D. Right coronary artery
Answer: D
Conceptual Explanation: ST elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction. In approximately 80 percent of individuals, the right coronary artery
(RCA) supplies the inferior wall of the heart via the posterior descending artery.
,2. A 45-year-old female presents with acute right upper quadrant pain that radiates to her
right shoulder. Physical examination reveals a positive Murphy sign. Which of the following
viscerosomatic reflex levels is most consistent with this patient’s condition?
A. T2-T8 on the left
B. T10-T11 on the right
C. T5-T9 on the right
D. T12-L2 on the left
Answer: C
Conceptual Explanation: Acute cholecystitis typically presents with right upper quadrant
pain. The viscerosomatic reflex for the gallbladder and liver is T5-T9 on the right side.
3. A 24-year-old female athlete presents with a dull ache in her low back. Examination reveals
a positive standing flexion test on the right. Her right sacral base is deep, and the right
inferior lateral angle is posterior. What is the most likely diagnosis?
A. Right unilateral sacral flexion
B. Left unilateral sacral extension
C. Left-on-left sacral torsion
D. Right-on-right sacral torsion
Answer: A
, Conceptual Explanation: A positive standing flexion test on the right indicates right-sided
sacral dysfunction. A deep sacral base and a posterior ILA on the same side (right) indicate
a unilateral sacral flexion.
4. A 50-year-old male with a history of chronic hypertension presents for a routine checkup.
During his osteopathic exam, the physician finds T5 rotated right and sidebent right. Which
Fryette law does this finding violate?
A. Fryette Law II
B. Fryette Law I
C. Fryette Law III
D. It does not violate any laws
Answer: B
Conceptual Explanation: Fryette Law I states that in neutral, rotation and sidebending
occur to opposite sides. Since T5 is sidebent and rotated to the same side (right), it
describes a Type II dysfunction, which typically occurs in a non-neutral (flexed or
extended) state.
5. A patient presents with sharp pain at the tip of the 12th rib on the right. This Chapman
point is most indicative of dysfunction in which of the following organs?
A. Kidney
B. Bladder
C. Ovary
