COMSAE 115 COMPREHENSIVE
OSTEOPATHIC MEDICAL EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with acute low back pain after lifting a heavy box. Physical
examination reveals a positive seated flexion test on the right, a deep sacral sulcus on the
left, and a posterior inferior lateral angle (ILA) on the right. Spring test is negative. What is
the most likely sacral diagnosis?
A. Right-on-right forward torsion
B. Left-on-left forward torsion
C. Left-on-right backward torsion
D. Right-on-left backward torsion
Answer: B
Conceptual Explanation: A positive seated flexion test on the right indicates the side of
the dysfunction. A deep sulcus on the left and posterior ILA on the right suggest a left
rotation. A negative spring test indicates a forward torsion. Therefore, it is a left-on-left
forward torsion.
,2. A 62-year-old male with a history of hypertension and smoking presents with sudden onset
tearing chest pain radiating to his back. His blood pressure is 180/100 mmHg in the right arm
and 140/80 mmHg in the left arm. What is the most appropriate next step in management?
A. Administer IV thrombolytics
B. Perform an immediate chest X-ray
C. Transthoracic echocardiogram
D. CT angiography of the chest
Answer: D
Conceptual Explanation: The clinical presentation is highly suggestive of aortic dissection
(tearing pain, BP discrepancy). CT angiography is the gold standard for rapid and accurate
diagnosis in hemodynamically stable patients.
3. A 24-year-old female presents for a routine checkup. During the osteopathic exam, the
physician finds that T5 is rotated right and sidebent right. When the patient flexes her spine,
the asymmetry improves. What is the correct diagnosis?
A. T5 Neutral RRSL
B. T5 Flexed RRSR
C. T5 Extended RLSL
D. T5 Flexed RLSL
Answer: B
, Conceptual Explanation: Because the asymmetry (RRSR) improves in flexion, the
diagnosis is flexed. Fryette’s Type II mechanics state that in flexion or extension, rotation
and sidebending occur to the same side.
4. Which of the following Chapman points is correctly matched with its associated organ?
A. Appendix - Tip of the 12th rib
B. Bladder - Periumbilical region
C. Liver - 5th intercostal space on the left
D. Colon - Lateral aspect of the femur
Answer: A
Conceptual Explanation: The anterior Chapman point for the appendix is the tip of the
12th rib on the right. The posterior point is the transverse process of T11.
5. A 30-year-old female at 34 weeks gestation presents with epigastric pain and blurred
vision. Her BP is 165/110 mmHg. Lab results show elevated liver enzymes and low platelets.
What is the most definitive treatment?
A. Hydralazine
B. Delivery of the fetus
C. Magnesium sulfate
D. Betamethasone
Answer: B
OSTEOPATHIC MEDICAL EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with acute low back pain after lifting a heavy box. Physical
examination reveals a positive seated flexion test on the right, a deep sacral sulcus on the
left, and a posterior inferior lateral angle (ILA) on the right. Spring test is negative. What is
the most likely sacral diagnosis?
A. Right-on-right forward torsion
B. Left-on-left forward torsion
C. Left-on-right backward torsion
D. Right-on-left backward torsion
Answer: B
Conceptual Explanation: A positive seated flexion test on the right indicates the side of
the dysfunction. A deep sulcus on the left and posterior ILA on the right suggest a left
rotation. A negative spring test indicates a forward torsion. Therefore, it is a left-on-left
forward torsion.
,2. A 62-year-old male with a history of hypertension and smoking presents with sudden onset
tearing chest pain radiating to his back. His blood pressure is 180/100 mmHg in the right arm
and 140/80 mmHg in the left arm. What is the most appropriate next step in management?
A. Administer IV thrombolytics
B. Perform an immediate chest X-ray
C. Transthoracic echocardiogram
D. CT angiography of the chest
Answer: D
Conceptual Explanation: The clinical presentation is highly suggestive of aortic dissection
(tearing pain, BP discrepancy). CT angiography is the gold standard for rapid and accurate
diagnosis in hemodynamically stable patients.
3. A 24-year-old female presents for a routine checkup. During the osteopathic exam, the
physician finds that T5 is rotated right and sidebent right. When the patient flexes her spine,
the asymmetry improves. What is the correct diagnosis?
A. T5 Neutral RRSL
B. T5 Flexed RRSR
C. T5 Extended RLSL
D. T5 Flexed RLSL
Answer: B
, Conceptual Explanation: Because the asymmetry (RRSR) improves in flexion, the
diagnosis is flexed. Fryette’s Type II mechanics state that in flexion or extension, rotation
and sidebending occur to the same side.
4. Which of the following Chapman points is correctly matched with its associated organ?
A. Appendix - Tip of the 12th rib
B. Bladder - Periumbilical region
C. Liver - 5th intercostal space on the left
D. Colon - Lateral aspect of the femur
Answer: A
Conceptual Explanation: The anterior Chapman point for the appendix is the tip of the
12th rib on the right. The posterior point is the transverse process of T11.
5. A 30-year-old female at 34 weeks gestation presents with epigastric pain and blurred
vision. Her BP is 165/110 mmHg. Lab results show elevated liver enzymes and low platelets.
What is the most definitive treatment?
A. Hydralazine
B. Delivery of the fetus
C. Magnesium sulfate
D. Betamethasone
Answer: B
