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Compilation Bundle For COMSAE Form 114
Practice Exams
Section 1: Osteopathic Principles and Practice (OPP) – Questions 1- 25 Q1. A 45-year-old male presents with low back pain after lifting a box. To diagnose somatic dysfunction of the SI joint using the standing flexion test, a positive test is indicated by: A) Anterior rotation of the ilium on the ipsilateral side B) Posterior rotation of the ilium on the ipsilateral side C) Superior movement of the PSIS on the ipsilateral side D) Inferior movement of the PSIS on the contralateral side
- Answer: C * Rationale: In the standing flexion test, the examiner places thumbs under the PSIS. As the patient bends forward, if the PSIS on one side moves superiorly (upward) more than the other, it indicates iliosacral dysfunction (often a fixed sacrum or ilium) on that side.
Q2. A 30-year-old female with chronic headaches undergoes OMM. You find that the right mastoid process is posterior and inferior compared to the left. Which somatic dysfunction best describes this finding? A) Right rotation, right sidebending (Type I) B) Left rotation, right sidebending (Type II) C) Right rotation, left sidebending (Type II) D) Left rotation, left sidebending (Type I)
- Answer: B * Rationale: The mastoid process moving posterior indicates rotation to the opposite side. The mastoid moving inferior indicates sidebending to the same side (Type II mechanics: rotation and sidebending occur in opposite directions). Here, right mastoid is posterior/inferior → rotation to the left, sidebending to the right. Q3. According to Fryette's first principle (Type I mechanics), when multiple vertebral segments are in a neutral position, which of the following occurs? A) Sidebending and rotation occur to the same side B) Sidebending and rotation occur to opposite sides C) Rotation occurs without sidebending D) Sidebending occurs without rotation
- Answer: B * Rationale: Fryette's first principle describes that when the spine is in a neutral position, sidebending and rotation occur in opposite directions. This applies to group (multiple vertebrae) dysfunctions. Type II
Q6. 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: A "posterior fibular head" means the fibula is fixed in a posterior position relative to the tibia; therefore, its motion toward the anterior direction is restricted. Treatment aims to restore anterior glide. Q7. The Chapman reflex point at the tip of the right 12th rib is associated with which organ? A) Stomach B) Liver C) Appendix D) Cecum
- 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/appendix region . Q8. 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 without activating protective spasms . Q9. 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 . Q10. 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 rotates anteriorly and the occiput rotates posteriorly B) The sphenoid rotates posteriorly and the occiput rotates anteriorly C) The lateral angles of the sphenoid move superiorly D) The SBS is locked in neutral
- Answer: B *
rib elevation during inhalation, improving respiratory mechanics in asthma. Q13. Which best describes the "Strain-Counterstrain" (SCS) technique? A) Locating a tenderpoint and positioning the patient to maximally shorten that muscle B) Locating a tenderpoint and stretching the associated muscle to its restrictive barrier C) Applying a high-velocity, low-amplitude thrust to a tenderpoint D) Using a muscle energy technique to release a tenderpoint
- Answer: A * Rationale: Strain-Counterstrain is an indirect technique. It involves finding a tenderpoint and then passively positioning the patient into a position of comfort that minimizes the muscle spasm, typically by shortening it. Q14. A patient with diagnosis "anterior tibia" would have 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 somatic dysfunction diagnosis, the name indicates the direction of restriction. "Anterior tibia" means the tibia is "stuck" in an anterior position, thus restricted in moving posteriorly (posterior glide).
Q15. The "splanchnic" outflow for the sympathetic nervous system originates from which spinal cord levels? A) T1-L B) C1-C C) S2-S D) L5-S
- 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. Q16. A patient presents with chronic headaches and 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. Q17. In cranial osteopathy, the "sphenobasilar synchondrosis" (SBS) is the articulation between which bones?
- 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. Q20. A patient presents with sacral dysfunction. You perform a seated flexion test and find that the right PSIS moves superiorly more than the left. This indicates: A) Left sacral dysfunction B) Right sacral dysfunction C) Bilateral sacral dysfunction D) Lumbar dysfunction, not sacral
- Answer: B * 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. Q21. The "rib raising" technique primarily affects which nervous system division? A) Parasympathetic B) Somatic motor C) Sympathetic D) Enteric
- Answer: C *
Rationale: Rib raising applies inhibitory pressure to sympathetic chain ganglia, reducing sympathetic outflow. This technique is often used for pulmonary conditions such as asthma. Q22. A 35-year-old female has chronic headaches and cervical spine tenderness. The OA joint is restricted in flexion and sidebending to the right. The most appropriate OMT is: A) HVLA to the OA joint B) Myofascial release of trapezius only C) Counterstrain of C2 only D) Muscle energy of the lumbar spine
- Answer: A * Rationale: OA joint restrictions are common in patients with whiplash and chronic headaches. HVLA is an appropriate direct technique for restoring OA joint motion when no contraindications exist. Q23. In the seated flexion test, a finding of superior movement of the PSIS on the right indicates: A) Normal movement bilaterally B) Sacral dysfunction on the right C) Lumbar spine dysfunction only D) Thoracic spine dysfunction
- Answer: B * Rationale: The seated flexion test is used to diagnose sacral somatic dysfunction. When the patient is seated (fixing the pelvis), superior movement of one PSIS indicates sacral dysfunction on that side.
A) Right coronary artery B) Left circumflex C) Left anterior descending (LAD) D) Posterior descending artery
- Answer: C * Rationale: ST-segment elevations in the precordial leads V1-V4 localize to the anterior wall of the left ventricle, which is supplied by the left anterior descending (LAD) artery. This is often referred to as the "widowmaker" infarction . Q27. A 67-year-old man with hypertension presents with sudden tearing chest pain radiating to the back. BP is 188/102 mm Hg in the right arm and 160/88 mm Hg in the left arm. Which is the most likely diagnosis? A) Acute pericarditis B) Aortic dissection C) Pulmonary embolism D) Myocardial infarction
- Answer: B * Rationale: Aortic dissection classically presents with abrupt, severe "tearing" chest pain and a pulse deficit or blood pressure difference between arms. This finding is highly suggestive of an aortic dissection, a life-threatening emergency. Q28. A patient with hypertension is started on an ACE inhibitor. Which electrolyte abnormality is most important to monitor for?
A) Hypokalemia 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. Q29. 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). Q30. Which condition causes widened pulse pressure? A) Aortic stenosis B) Aortic regurgitation C) Mitral stenosis D) Pericardial tamponade
- Answer: B *
Q33. A patient with left-sided heart failure presents with difficulty breathing and crackles on auscultation. Which additional sign is most consistent? 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. Q34. Which ECG finding is characteristic of hyperkalemia? A) U waves B) Peaked T waves C) ST elevations D) Prolonged PR interval only
- Answer: B * Rationale: Peaked (tented) T waves are the earliest ECG finding in hyperkalemia. As potassium continues to rise, QRS widening, PR prolongation, and ultimately a sine wave pattern occur. U waves are characteristic of hypokalemia. Q35. Which ECG finding is characteristic of hypokalemia? A) Peaked T waves B) U waves
C) ST elevations D) Q waves
- Answer: B * Rationale: Hypokalemia produces flattened T waves and prominent U waves (best seen in precordial leads). This classic finding is important to recognize, as U waves are associated with an increased risk of torsades de pointes. Q36. The primary mechanism of action of beta-blockers in lowering blood pressure is: A) Vasodilation B) Increased cardiac output C) Blocking β-receptors (decreased HR and contractility) D) Increased renin release
- Answer: C * Rationale: Beta-blockers reduce blood pressure by blocking β receptors in the heart, which decreases heart rate and contractility (reducing cardiac output). They also reduce renin release from the kidneys . Q37. The Frank-Starling mechanism relates to: A) Heart rate B) Stroke volume and preload C) Blood pressure D) Oxygenation
- Answer: B *
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. Section 3: Pulmonology – Questions 41- 55 Q41. A patient with a 40-pack-year smoking history presents with 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 barrel chest from hyperinflation are highly consistent . Q42. 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. Q43. 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. Q44. A patient with sudden chest pain and dyspnea likely has: A) Asthma B) Pneumothorax C) Bronchitis D) Tuberculosis
- Answer: B *
