COMSAE 115 FINAL EXAM PREP
2026/2027 QUESTIONS AND ANSWERS
1. A 45-year-old male presents with low back pain. Physical examination reveals a deep sacral
sulcus on the right, a posterior inferior lateral angle (ILA) on the left, and a negative
lumbosacral spring test. What is the most likely diagnosis?
A. Right-on-right forward sacral torsion
B. Left-on-left forward sacral torsion
C. Left-on-right backward sacral torsion
D. Right-on-left backward sacral torsion
Answer: B
Conceptual Explanation: A negative spring test indicates a forward torsion. In a forward
torsion, the deep sulcus and the posterior ILA are on opposite sides. A deep right sulcus
and a posterior left ILA define a left-on-left torsion.
,2. A 24-year-old female presents with a headache. Palpation of the cranium reveals that the
base of the sphenoid moves superiorly while the base of the occiput moves inferiorly. Which
cranial strain pattern is present?
A. Superior vertical strain
B. Inferior vertical strain
C. Right torsion
D. Left lateral strain
Answer: B
Conceptual Explanation: In an inferior vertical strain, the base of the sphenoid moves
inferiorly relative to the occiput. Conversely, if the sphenoid base moves superiorly, it is a
superior vertical strain. In this case, the sphenoid base is moving superiorly relative to the
occiput, which describes a superior vertical strain.
3. An 8-year-old boy is brought to the clinic for a follow-up on his asthma. During the
osteopathic structural exam, the physician finds a Chapman point. Where is the anterior
Chapman point for the bronchus located?
A. 4th intercostal space near the sternum
B. 3rd intercostal space near the sternum
C. 2nd intercostal space near the sternum
D. 5th intercostal space near the sternum
, Answer: C
Conceptual Explanation: The anterior Chapman point for the bronchus is located in the
2nd intercostal space, while the 3rd is for the upper lung and the 4th is for the lower lung.
4. A 60-year-old patient with chronic cholecystitis is likely to exhibit viscerosomatic reflexes
at which spinal level?
A. T5-T9 on the right
B. T5-T9 on the left
C. T10-T11 on the right
D. T12-L2 on the left
Answer: A
Conceptual Explanation: The gallbladder and liver receive sympathetic innervation from
T5-T9, and symptoms are typically found on the right side.
5. When treating a patient with muscle energy for a T4 shifted right (T4 RRSR), which way
should the patient be directed to move their torso against the physician’s resistance?
A. To the right
B. To the left
C. Into extension
D. Into further rotation
Answer: B
2026/2027 QUESTIONS AND ANSWERS
1. A 45-year-old male presents with low back pain. Physical examination reveals a deep sacral
sulcus on the right, a posterior inferior lateral angle (ILA) on the left, and a negative
lumbosacral spring test. What is the most likely diagnosis?
A. Right-on-right forward sacral torsion
B. Left-on-left forward sacral torsion
C. Left-on-right backward sacral torsion
D. Right-on-left backward sacral torsion
Answer: B
Conceptual Explanation: A negative spring test indicates a forward torsion. In a forward
torsion, the deep sulcus and the posterior ILA are on opposite sides. A deep right sulcus
and a posterior left ILA define a left-on-left torsion.
,2. A 24-year-old female presents with a headache. Palpation of the cranium reveals that the
base of the sphenoid moves superiorly while the base of the occiput moves inferiorly. Which
cranial strain pattern is present?
A. Superior vertical strain
B. Inferior vertical strain
C. Right torsion
D. Left lateral strain
Answer: B
Conceptual Explanation: In an inferior vertical strain, the base of the sphenoid moves
inferiorly relative to the occiput. Conversely, if the sphenoid base moves superiorly, it is a
superior vertical strain. In this case, the sphenoid base is moving superiorly relative to the
occiput, which describes a superior vertical strain.
3. An 8-year-old boy is brought to the clinic for a follow-up on his asthma. During the
osteopathic structural exam, the physician finds a Chapman point. Where is the anterior
Chapman point for the bronchus located?
A. 4th intercostal space near the sternum
B. 3rd intercostal space near the sternum
C. 2nd intercostal space near the sternum
D. 5th intercostal space near the sternum
, Answer: C
Conceptual Explanation: The anterior Chapman point for the bronchus is located in the
2nd intercostal space, while the 3rd is for the upper lung and the 4th is for the lower lung.
4. A 60-year-old patient with chronic cholecystitis is likely to exhibit viscerosomatic reflexes
at which spinal level?
A. T5-T9 on the right
B. T5-T9 on the left
C. T10-T11 on the right
D. T12-L2 on the left
Answer: A
Conceptual Explanation: The gallbladder and liver receive sympathetic innervation from
T5-T9, and symptoms are typically found on the right side.
5. When treating a patient with muscle energy for a T4 shifted right (T4 RRSR), which way
should the patient be directed to move their torso against the physician’s resistance?
A. To the right
B. To the left
C. Into extension
D. Into further rotation
Answer: B
