COMSAE 115 COMPREHENSIVE
OSTEOPATHIC MEDICAL REVIEW
QUESTIONS AND ANSWERS
1. A 24-year-old male presents with acute onset of low back pain. Physical examination
reveals L5 is rotated right and sidebent right. Which of the following findings is most
consistent with this presentation regarding the sacrum?
A. Left on Left forward torsion
B. Left on Right backward torsion
C. Right on Right forward torsion
D. Right on Left backward torsion
Answer: B
Conceptual Explanation: According to Fryette’s laws and sacral mechanics, L5
sidebending induces the sacral oblique axis on the same side, and L5 rotation is opposite to
the sacral rotation. If L5 is sidebent right, the axis is right. If L5 is rotated right, the sacrum
is rotated left. Therefore, the diagnosis is a Left on Right backward torsion.
,2. A 45-year-old patient presents with symptoms of early satiety and weight loss. On physical
exam, a tender nodule is palpated on the right 6th intercostal space at the mid-clavicular line.
This likely represents a Chapman point for which organ?
A. Stomach (Acidity)
B. Pancreas
C. Gallbladder
D. Liver
Answer: D
Conceptual Explanation: The anterior Chapman reflex point for the liver
(peristalsis/acidity) is found in the right 5th and 6th intercostal spaces. Specifically, the 6th
on the right corresponds to the liver/gallbladder area.
3. During a cranial examination, the sphenoid and occiput both rotate in the same direction
about two parallel transverse axes. This describes which type of cranial strain?
A. Torsion
B. Vertical strain
C. Lateral strain
D. Flexion/Extension
Answer: B
, Conceptual Explanation: In a vertical strain, the sphenoid and occiput rotate in the same
direction about two parallel transverse axes. In torsion, they rotate in opposite directions
about an AP axis.
4. A patient with chronic hypertension is started on a new medication. He later develops a
dry cough. Which mechanism of action is responsible for this side effect?
A. Blocking calcium channels
B. Direct vasodilation
C. Antagonizing AT1 receptors
D. Inhibiting angiotensin-converting enzyme
Answer: D
Conceptual Explanation: ACE inhibitors lead to an accumulation of bradykinin in the
lungs, which frequently causes a dry, non-productive cough in patients.
5. A 60-year-old female presents with pain in her right upper extremity. Evaluation reveals
T2-T4 are rotated right and sidebent right. What is the viscerosomatic reflex level for the
heart?
A. T12-L2
B. T5-T9
C. T10-T11
D. T1-T4
OSTEOPATHIC MEDICAL REVIEW
QUESTIONS AND ANSWERS
1. A 24-year-old male presents with acute onset of low back pain. Physical examination
reveals L5 is rotated right and sidebent right. Which of the following findings is most
consistent with this presentation regarding the sacrum?
A. Left on Left forward torsion
B. Left on Right backward torsion
C. Right on Right forward torsion
D. Right on Left backward torsion
Answer: B
Conceptual Explanation: According to Fryette’s laws and sacral mechanics, L5
sidebending induces the sacral oblique axis on the same side, and L5 rotation is opposite to
the sacral rotation. If L5 is sidebent right, the axis is right. If L5 is rotated right, the sacrum
is rotated left. Therefore, the diagnosis is a Left on Right backward torsion.
,2. A 45-year-old patient presents with symptoms of early satiety and weight loss. On physical
exam, a tender nodule is palpated on the right 6th intercostal space at the mid-clavicular line.
This likely represents a Chapman point for which organ?
A. Stomach (Acidity)
B. Pancreas
C. Gallbladder
D. Liver
Answer: D
Conceptual Explanation: The anterior Chapman reflex point for the liver
(peristalsis/acidity) is found in the right 5th and 6th intercostal spaces. Specifically, the 6th
on the right corresponds to the liver/gallbladder area.
3. During a cranial examination, the sphenoid and occiput both rotate in the same direction
about two parallel transverse axes. This describes which type of cranial strain?
A. Torsion
B. Vertical strain
C. Lateral strain
D. Flexion/Extension
Answer: B
, Conceptual Explanation: In a vertical strain, the sphenoid and occiput rotate in the same
direction about two parallel transverse axes. In torsion, they rotate in opposite directions
about an AP axis.
4. A patient with chronic hypertension is started on a new medication. He later develops a
dry cough. Which mechanism of action is responsible for this side effect?
A. Blocking calcium channels
B. Direct vasodilation
C. Antagonizing AT1 receptors
D. Inhibiting angiotensin-converting enzyme
Answer: D
Conceptual Explanation: ACE inhibitors lead to an accumulation of bradykinin in the
lungs, which frequently causes a dry, non-productive cough in patients.
5. A 60-year-old female presents with pain in her right upper extremity. Evaluation reveals
T2-T4 are rotated right and sidebent right. What is the viscerosomatic reflex level for the
heart?
A. T12-L2
B. T5-T9
C. T10-T11
D. T1-T4
