COMSAE ALL EXAMS BUNDLED TOGETHER (LATEST 2024/
2025 UPDATE) QUESTIONS AND VERIFIED ANSWERS| 100%
CORRECT| GRADE A
## SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OMM)
*(Questions 1-10)*
### Question 1
A 45-year-old male presents with chronic low back pain. Physical examination
reveals an apparent short left leg, a left posterior superior iliac spine (PSIS) that
is superior compared to the right, and a left anterior inferior iliac spine (AIIS)
that is inferior. What is the most likely sacral diagnosis?
A) Right-on-right torsion
B) Left unilateral flexion
C) Left-on-left torsion
D) Right unilateral flexion
E) Left-on-right torsion
**Answer: C) Left-on-left torsion**
**Rationale:** In a sacral torsion, the side of the oblique axis is named first,
and the side of the rotation is named second. The findings (deep sulcus on the
right, shallow on the left; ILA posterior on the left) indicate rotation around a
left oblique axis. A "Left-on-left" torsion means the axis is on the left and the
base is rotating anteriorly on the left .
,---
### Question 2
A patient with COPD is in respiratory distress. You note significant rib elevation
and restricted motion on the left side. Using a direct technique, you apply force
to the superior aspect of the left transverse process. Which rib dysfunction is
being treated?
A) Pump handle
B) Bucket handle
C) Caliper motion
D) Rib rotation
**Answer: B) Bucket handle**
**Rationale:** The bucket handle motion of the ribs occurs primarily in the
lower ribs (7-10) and involves lateral movement. Applying force to the superior
aspect of the transverse process addresses the bucket handle component of rib
elevation dysfunction. Pump handle affects the upper ribs (1-6) via anterior-
posterior motion .
---
### Question 3
A patient presents with acute torticollis after sleeping in an awkward position.
Cervical examination shows the head rotated to the left and side-bent to the
right. The most likely diagnosis is:
,A) Right rotated, right side-bent somatic dysfunction
B) Left rotated, left side-bent somatic dysfunction
C) Left rotated, right side-bent somatic dysfunction
D) Right rotated, left side-bent somatic dysfunction
**Answer: D) Right rotated, left side-bent somatic dysfunction**
**Rationale:** In acute torticollis, the patient presents with rotation toward
the side of pain and side-bending away from the side of pain (rotation R, side-
bending L). This follows Fryette's Type II mechanics, where side-bending and
rotation occur in opposite directions .
---
### Question 4
A patient with asthma is found to have increased tension in the paraspinal
muscles from T2-T5 with restricted rib elevation on inspiration. Which Chapman
reflex point would be most likely tender?
A) Posterior interosseous membrane of the forearm
B) Tip of the 12th rib (posterior)
C) 2nd intercostal space, near the sternal border (anterior)
D) Lateral epicondyle of the humerus
**Answer: C) 2nd intercostal space, near the sternal border (anterior)**
, **Rationale:** Anterior Chapman reflexes for bronchial/lung pathology are
located in the 2nd intercostal space near the sternum. These neuro-lymphatic
reflexes correlate with visceral dysfunction of the respiratory system .
---
### Question 5
A patient with chronic migraines presents for OMT. The physician finds
tenderness at the suboccipital triangle. Restriction of cervical flexion is noted.
Which technique is most appropriate?
A) High-velocity, low-amplitude thrust to C1
B) Muscle energy for the suboccipitals
C) Lymphatic pump
D) Rib raising
E) Sacral rocking
**Answer: B) Muscle energy for the suboccipitals**
**Rationale:** Suboccipital muscle tenderness and restricted cervical
flexion indicate somatic dysfunction of the suboccipital muscles. Muscle energy
technique (MET) is appropriate for treating these short, deep cervical extensors.
MET uses the patient's voluntary muscle contraction to achieve relaxation and
increased range of motion .
---
2025 UPDATE) QUESTIONS AND VERIFIED ANSWERS| 100%
CORRECT| GRADE A
## SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OMM)
*(Questions 1-10)*
### Question 1
A 45-year-old male presents with chronic low back pain. Physical examination
reveals an apparent short left leg, a left posterior superior iliac spine (PSIS) that
is superior compared to the right, and a left anterior inferior iliac spine (AIIS)
that is inferior. What is the most likely sacral diagnosis?
A) Right-on-right torsion
B) Left unilateral flexion
C) Left-on-left torsion
D) Right unilateral flexion
E) Left-on-right torsion
**Answer: C) Left-on-left torsion**
**Rationale:** In a sacral torsion, the side of the oblique axis is named first,
and the side of the rotation is named second. The findings (deep sulcus on the
right, shallow on the left; ILA posterior on the left) indicate rotation around a
left oblique axis. A "Left-on-left" torsion means the axis is on the left and the
base is rotating anteriorly on the left .
,---
### Question 2
A patient with COPD is in respiratory distress. You note significant rib elevation
and restricted motion on the left side. Using a direct technique, you apply force
to the superior aspect of the left transverse process. Which rib dysfunction is
being treated?
A) Pump handle
B) Bucket handle
C) Caliper motion
D) Rib rotation
**Answer: B) Bucket handle**
**Rationale:** The bucket handle motion of the ribs occurs primarily in the
lower ribs (7-10) and involves lateral movement. Applying force to the superior
aspect of the transverse process addresses the bucket handle component of rib
elevation dysfunction. Pump handle affects the upper ribs (1-6) via anterior-
posterior motion .
---
### Question 3
A patient presents with acute torticollis after sleeping in an awkward position.
Cervical examination shows the head rotated to the left and side-bent to the
right. The most likely diagnosis is:
,A) Right rotated, right side-bent somatic dysfunction
B) Left rotated, left side-bent somatic dysfunction
C) Left rotated, right side-bent somatic dysfunction
D) Right rotated, left side-bent somatic dysfunction
**Answer: D) Right rotated, left side-bent somatic dysfunction**
**Rationale:** In acute torticollis, the patient presents with rotation toward
the side of pain and side-bending away from the side of pain (rotation R, side-
bending L). This follows Fryette's Type II mechanics, where side-bending and
rotation occur in opposite directions .
---
### Question 4
A patient with asthma is found to have increased tension in the paraspinal
muscles from T2-T5 with restricted rib elevation on inspiration. Which Chapman
reflex point would be most likely tender?
A) Posterior interosseous membrane of the forearm
B) Tip of the 12th rib (posterior)
C) 2nd intercostal space, near the sternal border (anterior)
D) Lateral epicondyle of the humerus
**Answer: C) 2nd intercostal space, near the sternal border (anterior)**
, **Rationale:** Anterior Chapman reflexes for bronchial/lung pathology are
located in the 2nd intercostal space near the sternum. These neuro-lymphatic
reflexes correlate with visceral dysfunction of the respiratory system .
---
### Question 5
A patient with chronic migraines presents for OMT. The physician finds
tenderness at the suboccipital triangle. Restriction of cervical flexion is noted.
Which technique is most appropriate?
A) High-velocity, low-amplitude thrust to C1
B) Muscle energy for the suboccipitals
C) Lymphatic pump
D) Rib raising
E) Sacral rocking
**Answer: B) Muscle energy for the suboccipitals**
**Rationale:** Suboccipital muscle tenderness and restricted cervical
flexion indicate somatic dysfunction of the suboccipital muscles. Muscle energy
technique (MET) is appropriate for treating these short, deep cervical extensors.
MET uses the patient's voluntary muscle contraction to achieve relaxation and
increased range of motion .
---
