COMSAE 115 HIGH-YIELD EXAM PREP
COMPLETE QUESTIONS WITH
VERIFIED ANSWERS & RATIONALES
Q1. A 28-year-old female presents with a headache. Physical exam reveals a
restricted cranial rhythmic impulse. Palpation of the sphenobasilar synchondrosis
(SBS) reveals that the base of the sphenoid moves superiorly while the base of the
occiput moves inferiorly. Which of the following is the most likely diagnosis?
• A) Flexion dysfunction
• B) Extension dysfunction
• C) Superior vertical shear
• D) Inferior vertical shear
• E) Torsion
Correct Answer: C) Superior vertical shear
Rationale: In a vertical shear dysfunction of the SBS, the sphenoid and occiput
move in opposite directions along two parallel transverse axes. In superior vertical
shear, the sphenoid base moves superiorly relative to the occipital base. This
differs from flexion (sphenoid anterior/inferior, occiput posterior/superior) and
extension (opposite). Torsion involves rotation around an AP axis.
Q2. An osteopathic structural exam on a 30-year-old female reveals a restricted T5
segment. The segment prefers rotation right and sidebending right. It improves
when the patient slumps forward into spinal flexion. What is the correct diagnosis?
• A) T5 Neutral SR RL
• B) T5 Extended RR SR
• C) T5 Flexed RR SR
• D) T5 Flexed RL SL
,Correct Answer: C) T5 Flexed RR SR
Rationale: The segment improves in flexion → it is a flexion (non-neutral)
dysfunction. According to Fryette's Second Law (Type II mechanics), rotation and
sidebending occur to the same side in a non-neutral (flexed or extended) position.
Rotation right and sidebending right = RR SR. Type II involves a single vertebral
segment.
Q3. A 45-year-old male with chronic gout is started on a new medication. Two
weeks later, he develops a severe skin rash with epidermal detachment involving
35% of his body surface area. Which medication was most likely started?
• A) Colchicine
• B) Probenecid
• C) Allopurinol
• D) Febuxostat
• E) Sulfinpyrazone
Correct Answer: C) Allopurinol
Rationale: Allopurinol is a known cause of Stevens-Johnson syndrome (SJS) and
toxic epidermal necrolysis (TEN), typically occurring within the first 4 weeks of
therapy. Risk is higher in patients with the HLA-B*5801 allele, more common in
Han Chinese, Thai, and Korean populations. Colchicine causes GI toxicity;
probenecid causes rash but rarely SJS/TEN.
Q4. A patient with chronic low back pain has a right short leg in supine. In prone,
the right iliac crest is superior to the left. What is the most likely innominate
dysfunction?
• A) Right anterior innominate
• B) Right posterior innominate
• C) Left anterior innominate
• D) Left posterior innominate
, • E) Bilateral anterior innominate
Correct Answer: B) Right posterior innominate
Rationale: A short leg in supine suggests a posterior innominate on that side (the
posterior rotation shortens the apparent leg length). In prone, a posterior
innominate presents with a superior iliac crest because the posterior rotation
elevates the crest. Anterior innominate would show an inferior iliac crest in prone.
Q5. Chapman's point at the right second intercostal space, just lateral to the
sternum, indicates pathology in which organ?
• A) Liver
• B) Gallbladder
• C) Stomach
• D) Appendix
• E) Lung
Correct Answer: C) Stomach
Rationale: Anterior Chapman's point for the stomach is at the right 2nd intercostal
space, near the sternum. The posterior gastric Chapman's point is at T5-T7
paravertebral. Liver is right 5th-6th ICS; gallbladder is right 6th-7th ICS; appendix
is right 8th-9th ICS.
Q6. During a cranial osteopathic exam, the examiner's index fingers are placed on
the greater wings of the sphenoid. During the flexion phase of the cranial rhythmic
impulse, what direction do the greater wings move?
• A) Laterally and superiorly
• B) Medially and inferiorly
• C) Laterally and inferiorly
• D) Medially and superiorly
• E) No movement
, Correct Answer: B) Medially and inferiorly
Rationale: In cranial flexion, the SBS opens superiorly and posteriorly. The
sphenoid greater wings move medially and inferiorly, while the occiput moves
posteriorly and superiorly. In extension, the greater wings move laterally and
superiorly.
Q7. A 55-year-old female with a history of asthma presents with increased
wheezing and shortness of breath. Osteopathic exam reveals restricted rib motion
on the left, with increased muscle tone in the left scalene muscles. Which of the
following is the most appropriate osteopathic treatment approach?
• A) HVLA to the left first rib
• B) Rib raising technique on the left
• C) Cervical traction
• D) Lumbar spine HVLA
• E) Sacral decompression
Correct Answer: B) Rib raising technique on the left
Rationale: Rib raising technique is used to treat rib somatic dysfunction associated
with pulmonary conditions like asthma. It addresses hypertonic intercostals and
scalenes, improves rib excursion, and can reduce sympathetic tone via inhibition of
paravertebral ganglia. HVLA to the first rib is more specific for first rib
dysfunction.
Q8. Fryette's First Law (Type I mechanics) applies to which of the following
spinal regions?
• A) Occiput to C2
• B) C3 to C7
• C) T1 to T12
• D) L1 to L5
• E) Entire vertebral column
COMPLETE QUESTIONS WITH
VERIFIED ANSWERS & RATIONALES
Q1. A 28-year-old female presents with a headache. Physical exam reveals a
restricted cranial rhythmic impulse. Palpation of the sphenobasilar synchondrosis
(SBS) reveals that the base of the sphenoid moves superiorly while the base of the
occiput moves inferiorly. Which of the following is the most likely diagnosis?
• A) Flexion dysfunction
• B) Extension dysfunction
• C) Superior vertical shear
• D) Inferior vertical shear
• E) Torsion
Correct Answer: C) Superior vertical shear
Rationale: In a vertical shear dysfunction of the SBS, the sphenoid and occiput
move in opposite directions along two parallel transverse axes. In superior vertical
shear, the sphenoid base moves superiorly relative to the occipital base. This
differs from flexion (sphenoid anterior/inferior, occiput posterior/superior) and
extension (opposite). Torsion involves rotation around an AP axis.
Q2. An osteopathic structural exam on a 30-year-old female reveals a restricted T5
segment. The segment prefers rotation right and sidebending right. It improves
when the patient slumps forward into spinal flexion. What is the correct diagnosis?
• A) T5 Neutral SR RL
• B) T5 Extended RR SR
• C) T5 Flexed RR SR
• D) T5 Flexed RL SL
,Correct Answer: C) T5 Flexed RR SR
Rationale: The segment improves in flexion → it is a flexion (non-neutral)
dysfunction. According to Fryette's Second Law (Type II mechanics), rotation and
sidebending occur to the same side in a non-neutral (flexed or extended) position.
Rotation right and sidebending right = RR SR. Type II involves a single vertebral
segment.
Q3. A 45-year-old male with chronic gout is started on a new medication. Two
weeks later, he develops a severe skin rash with epidermal detachment involving
35% of his body surface area. Which medication was most likely started?
• A) Colchicine
• B) Probenecid
• C) Allopurinol
• D) Febuxostat
• E) Sulfinpyrazone
Correct Answer: C) Allopurinol
Rationale: Allopurinol is a known cause of Stevens-Johnson syndrome (SJS) and
toxic epidermal necrolysis (TEN), typically occurring within the first 4 weeks of
therapy. Risk is higher in patients with the HLA-B*5801 allele, more common in
Han Chinese, Thai, and Korean populations. Colchicine causes GI toxicity;
probenecid causes rash but rarely SJS/TEN.
Q4. A patient with chronic low back pain has a right short leg in supine. In prone,
the right iliac crest is superior to the left. What is the most likely innominate
dysfunction?
• A) Right anterior innominate
• B) Right posterior innominate
• C) Left anterior innominate
• D) Left posterior innominate
, • E) Bilateral anterior innominate
Correct Answer: B) Right posterior innominate
Rationale: A short leg in supine suggests a posterior innominate on that side (the
posterior rotation shortens the apparent leg length). In prone, a posterior
innominate presents with a superior iliac crest because the posterior rotation
elevates the crest. Anterior innominate would show an inferior iliac crest in prone.
Q5. Chapman's point at the right second intercostal space, just lateral to the
sternum, indicates pathology in which organ?
• A) Liver
• B) Gallbladder
• C) Stomach
• D) Appendix
• E) Lung
Correct Answer: C) Stomach
Rationale: Anterior Chapman's point for the stomach is at the right 2nd intercostal
space, near the sternum. The posterior gastric Chapman's point is at T5-T7
paravertebral. Liver is right 5th-6th ICS; gallbladder is right 6th-7th ICS; appendix
is right 8th-9th ICS.
Q6. During a cranial osteopathic exam, the examiner's index fingers are placed on
the greater wings of the sphenoid. During the flexion phase of the cranial rhythmic
impulse, what direction do the greater wings move?
• A) Laterally and superiorly
• B) Medially and inferiorly
• C) Laterally and inferiorly
• D) Medially and superiorly
• E) No movement
, Correct Answer: B) Medially and inferiorly
Rationale: In cranial flexion, the SBS opens superiorly and posteriorly. The
sphenoid greater wings move medially and inferiorly, while the occiput moves
posteriorly and superiorly. In extension, the greater wings move laterally and
superiorly.
Q7. A 55-year-old female with a history of asthma presents with increased
wheezing and shortness of breath. Osteopathic exam reveals restricted rib motion
on the left, with increased muscle tone in the left scalene muscles. Which of the
following is the most appropriate osteopathic treatment approach?
• A) HVLA to the left first rib
• B) Rib raising technique on the left
• C) Cervical traction
• D) Lumbar spine HVLA
• E) Sacral decompression
Correct Answer: B) Rib raising technique on the left
Rationale: Rib raising technique is used to treat rib somatic dysfunction associated
with pulmonary conditions like asthma. It addresses hypertonic intercostals and
scalenes, improves rib excursion, and can reduce sympathetic tone via inhibition of
paravertebral ganglia. HVLA to the first rib is more specific for first rib
dysfunction.
Q8. Fryette's First Law (Type I mechanics) applies to which of the following
spinal regions?
• A) Occiput to C2
• B) C3 to C7
• C) T1 to T12
• D) L1 to L5
• E) Entire vertebral column
