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COMSAE Phase 1 Form 114 Test Bank |
200+ Practice Questions with Bold Italic
Answers & Rationales – NBOME
Osteopathic Medical Knowledge Self-
Assessment Prep.
Exam Information
- Target Exam: COMSAE Phase 1 Form 114 (NBOME)
- Format: Single-best-answer multiple choice
- Content Areas: Osteopathic Principles & Practice (OPP), Anatomy, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology, Behavioral Science
- Verified Answers: Yes ( bold italic format), with detailed rationales in italics
Section 1: Osteopathic Principles & Practice (Questions 1-20) Q1. A 45-year-old male presents with low back pain after lifting a box. On examination, the standing flexion test shows superior movement of the right PSIS. Which somatic dysfunction is most likely? A) Right anterior innominate B) Left posterior innominate C) Right sacral torsion on a left oblique axis D) Bilateral innominate rotation Answer: A Rationale: The standing flexion test is positive on the side of an iliosacral dysfunction. Superior movement of the PSIS on the right indicates that the right ilium is fixed in a posterior position relative to the sacrum. However, the most common finding with a positive test is an anterior rotated innominate on the same side due to a functional short leg. For a right anterior innominate, the right ASIS is more inferior, causing a functional short right leg and a positive standing flexion test on the right. Q2. A 28-year-old female presents with chronic headaches and cervical spine tenderness. The OA joint is restricted in flexion and sidebending to the right. What is the most appropriate osteopathic manipulative treatment (OMT) for this dysfunction? A) High-velocity low-amplitude (HVLA) thrust in the direction of restriction B) Muscle energy technique (MET) for the restrictive barrier C) Balanced ligamentous tension (BLT) with a compression force D) Counterstrain for the anterior tender point
Answer: D Rationale: Chapman's reflexes for the colon are located at the tips of the 11th and 12th ribs. The right 12th rib corresponds to the cecum and appendix region. These reflexes are used in osteopathic diagnosis to identify visceral dysfunction. Q5. In muscle energy technique (MET), the patient's contraction force should be: A) Maximal effort against resistance B) Mild to moderate effort (approximately 20-25% of maximal force) C) Brief isometric contraction at maximal force D) No resistance, just active movement Answer: B Rationale: MET uses a mild to moderate isometric contraction (approximately 20-25% of maximal force) from the patient against a counterforce applied by the physician. This low-force contraction helps facilitate relaxation of the targeted muscle and allows for barrier engagement without activating protective spasms . Q6. Anterior Chapman reflexes for the lungs are located in the: A) Intercostal spaces near the sternum (anterior) B) Posterior iliac crests C) Medial epicondyles of the humerus D) Lateral epicondyles of the humerus Answer: A
Rationale: Chapman reflexes for the lungs and bronchial tree are located anteriorly in the intercostal spaces near the sternum. Tension at T2-T5 with rib restriction suggests a pulmonary Chapman reflex . Q7. Which condition is an absolute contraindication to HVLA thrust manipulation of the cervical spine? A) Muscle spasm B) Rheumatoid arthritis with atlantoaxial instability C) Chronic whiplash D) Tension headache Answer: B Rationale: Ligamentous laxity from rheumatoid arthritis (especially atlantoaxial instability) is an absolute contraindication to HVLA due to risk of spinal cord injury. Muscle spasm and whiplash are relative contraindications, not absolute. Q8. A patient presents with a somatic dysfunction of the left fibular head that is "posterior." This dysfunction will demonstrate a restriction in which direction? A) Anterior glide B) Posterior glide C) Lateral glide D) Medial glide Answer: A
Rationale: The sympathetic nervous system (the "thoracolumbar" division) originates from the intermediolateral cell column of the spinal cord from T1 to L2. The preganglionic neurons in these levels give rise to the sympathetic chain and splanchnic nerves. Q11. The "Spencer technique" is indicated for which joint dysfunction? A) Knee joint B) Hip joint C) Shoulder joint (glenohumeral) D) Ankle joint Answer: C Rationale: The Spencer technique is a series of seven osteopathic manipulative techniques designed to treat shoulder (glenohumeral) joint dysfunction, including adhesive capsulitis ("frozen shoulder"). It addresses all ranges of motion of the shoulder. Q12. A patient presents with chronic headaches and you find restriction of the occipito-atlantal (OA) joint in extension. Which barrier is restricted? A) Flexion barrier B) Extension barrier C) Sidebending barrier D) Rotation barrier Answer: B
Rationale: If the OA joint is restricted in extension, the patient cannot fully extend the head on the atlas. The barrier to motion is in the direction of extension. Treatment would involve engaging the restrictive barrier in extension. Q13. In cranial osteopathy, the "sphenobasilar synchondrosis" (SBS) is the articulation between which bones? A) Sphenoid and temporal B) Sphenoid and occiput C) Sphenoid and ethmoid D) Sphenoid and parietal Answer: B Rationale: The sphenobasilar synchondrosis (SBS) is the cartilaginous joint between the sphenoid bone and the basilar portion of the occiput. This articulation is central to cranial osteopathic motion assessment. Q14. The sympathetic innervation to the heart and lungs originates from which spinal cord levels? A) C3-C B) T1-T C) T6-T D) T10-L Answer: B Rationale: The sympathetic preganglionic neurons for the cardiopulmonary region are located in the intermediolateral cell column
Rationale: In the seated flexion test, superior movement of the PSIS on one side indicates dysfunction on that side. The test helps differentiate between iliac and sacral causes of dysfunction. Q17. A patient with a diagnosis of "somatic dysfunction, anterior tibia" would have a restriction of which motion? A) Posterior glide of the tibia on the femur B) Anterior glide of the tibia on the femur C) Internal rotation of the tibia D) External rotation of the tibia Answer: A Rationale: In a somatic dysfunction diagnosis, the name indicates the direction of restriction. An "anterior tibia" means the tibia is "stuck" in an anterior position, thus restricted in moving posteriorly (posterior glide). Q18. A patient with asthma presents with an "exhaled" rib dysfunction of the right 5th rib. Which OMT technique is most appropriate? A) Direct HVLA thrust to the left rib during inhalation B) Indirect myofascial release of the rib C) Direct HVLA thrust to the right rib (exhaled rib) D) Counterstrain for the right scalenes Answer: C
Rationale: An exhaled rib (stuck inferiorly) is treated with a direct HVLA thrust during exhalation to engage the restrictive barrier. This restores rib elevation during inhalation, improving respiratory mechanics in asthma. Q19. According to Fryette's third principle, initiation of sidebending in a neutral spinal position will produce what motion in the vertebral segments? A) Sidebending to the opposite side B) Rotation to the same side C) Rotation to the opposite side D) No rotation occurs Answer: C Rationale: Fryette's third principle states that when sidebending is initiated in a neutral spine (as the first motion in a neutral segment), rotation will occur to the opposite side. This is consistent with Type I mechanics. Q20. During a cranial examination, a physician notes that the sphenobasilar synchondrosis (SBS) is "flexed." What does this mean in cranial osteopathic terms? A) The sphenoid and occiput are compressed B) The sphenoid has moved superiorly and anteriorly relative to the occiput C) The sphenoid has moved inferiorly and posteriorly relative to the
B) Hyperkalemia C) Hyponatremia D) Hypercalcemia Answer: B Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to decreased aldosterone secretion. Since aldosterone promotes potassium excretion, lower levels result in potassium retention and a risk for hyperkalemia. Q23. A 70-year-old with atrial fibrillation is at risk for thrombus formation in which location? A) Right ventricle B) Left atrial appendage C) Pulmonary artery D) Coronary sinus Answer: B Rationale: Blood stasis in the left atrial appendage predisposes to clot formation in atrial fibrillation. This is why patients with non-valvular atrial fibrillation are anticoagulated to prevent embolic stroke. Q24. Which heart sound is associated with heart failure? A) S B) S C) S D) S
Answer: C Rationale: S3 ("ventricular gallop") occurs in early diastole and is associated with increased left ventricular filling pressures, commonly seen in heart failure. S4 is associated with reduced ventricular compliance (hypertrophy). Q25. Beta-blockers decrease blood pressure by: A) Increasing cardiac output B) Blocking β-receptors C) Increasing renin D) Vasoconstriction Answer: B Rationale: Beta-blockers reduce blood pressure by blocking β receptors in the heart, which decreases heart rate and contractility (reducing cardiac output). They also block β2 receptors (less relevant to BP) and reduce renin release from the kidneys . Q26. Which condition causes widened pulse pressure? A) Aortic stenosis B) Aortic regurgitation C) Mitral stenosis D) Pericardial tamponade Answer: B Rationale: Aortic regurgitation increases systolic pressure (due to increased stroke volume from regurgitant volume) and decreases
Q29. Aortic stenosis murmur radiates to: A) Axilla B) Neck (carotids) C) Back D) Left sternal border Answer: B Rationale: The crescendo-decrescendo systolic murmur of aortic stenosis radiates to the neck (carotid arteries). Mitral regurgitation radiates to the axilla. Q30. A patient with a history of DVT presents with sudden chest pain, dyspnea, and hypoxia. The most likely diagnosis is: A) Myocardial infarction B) Pulmonary embolism C) Pneumonia D) Pericarditis Answer: B Rationale: Pulmonary embolism should be suspected in any patient with risk factors for DVT presenting with acute dyspnea, chest pain, and hypoxia. Approximately 90% of PEs arise from DVT. Q31. A patient with left-sided heart failure presents with difficulty breathing and crackles on auscultation. Which additional sign is most consistent with this diagnosis? A) Jugular venous distension
B) Hepatomegaly C) Pulmonary edema on chest x-ray D) Peripheral edema Answer: C Rationale: Left-sided heart failure leads to increased left atrial and pulmonary venous pressures, resulting in pulmonary congestion and edema. Right-sided heart failure presents with JVD, hepatomegaly, and peripheral edema. Q32. The Frank-Starling mechanism relates to: A) Heart rate B) Stroke volume and preload C) Blood pressure D) Oxygenation Answer: B Rationale: The Frank-Starling mechanism describes how increased preload (end-diastolic volume) leads to increased stroke volume by optimizing overlap of actin and myosin filaments. This allows the heart to match output to venous return. Q33. Which ECG finding is characteristic of hyperkalemia? A) U waves B) Peaked T waves C) ST elevations D) Prolonged PR interval only
Rationale: Preload is the volume of blood in the ventricles at the end of diastole. Fluid infusion increases venous return, increasing preload. Hemorrhage, vasodilation, and diuretics decrease preload. Section 3: Pulmonology (Questions 36-50) Q36. A patient with a 40-pack-year smoking history presents with a chronic cough, dyspnea on exertion, and a barrel-shaped chest. Spirometry shows an FEV1/FVC ratio of 60%. What is the most likely diagnosis? A) Asthma B) COPD C) Pulmonary fibrosis D) Bronchiectasis Answer: B Rationale: COPD is defined by irreversible or partially reversible airflow obstruction, indicated by a post-bronchodilator FEV1/FVC ratio of less than 0.70. The patient's history of smoking and physical exam findings (barrel chest from hyperinflation) are highly consistent with this diagnosis . Q37. Which condition is characterized by reversible airway obstruction? A) COPD B) Emphysema C) Asthma D) Pulmonary fibrosis
Answer: C Rationale: Asthma is characterized by reversible airway obstruction triggered by bronchospasm, inflammation, and mucus production. Unlike COPD, the obstruction in asthma can improve with bronchodilators or over time. Q38. Emphysema is characterized by: A) Fibrosis B) Alveolar destruction C) Fluid accumulation D) Infection Answer: B Rationale: Emphysema involves destruction of alveolar walls due to proteolytic enzyme imbalance, leading to decreased gas exchange surface area and air trapping. This results in loss of elastic recoil and hyperinflation. Q39. Chronic bronchitis is defined clinically by: A) A single episode of productive cough B) Productive cough for at least 3 months in 2 consecutive years C) Dry cough with hemoptysis D) Productive cough for 1 month annually Answer: B
