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COMSAE Phase 1 Form 112 Practice Exam
Questions And Well Graded Solutions With
Rationales Updated 2026- 2027
Ace your COMLEX Level 1 preparation with the ultimate study guide for the COMSAE Phase 1 Form 112 exam. This high-yield document features verified multiple-choice questions, accurate answers, and comprehensive, step-by-step rationales. Master tricky NBOME-style topics including complex OMM diagnostics, viscerosomatic levels, pathology, and neuroanatomy. Perfect for DO students struggling with ambiguous stems or experiencing score drops. Download now to verify your readiness and pass
- A 45-year-old male presents with acute epigastric pain radiating to his back, accompanied by nausea and vomiting. Laboratory values reveal markedly elevated serum lipase. An osteopathic structural examination is performed. At which of the following spinal levels would you most likely expect to find tissue texture changes associated with a viscerosomatic reflex for this acute condition? A) T1–T B) T5–T C) T10–T D) T12–L B) T5–T Rationale: The patient's clinical presentation is highly suggestive of acute pancreatitis. The pancreas is a foregut organ, and its sympathetic innervation originates from the T5–T9 spinal levels via the greater splanchnic nerve. Somatic manifestations (tissue texture changes, hypertonicity) will manifest within this corresponding spinal region. T1–T4 corresponds to the head and neck, heart, and lungs. T10–T11 corresponds to midgut organs. T12–L2 corresponds to hindgut structures.
- A 32-year-old female accountant presents with deep, aching pain in her right buttock that radiates down the posterior aspect of her right thigh to the level of the knee. She notes the pain worsens after sitting at her desk for more than 30 minutes. Physical examination reveals exquisite tenderness to deep palpation in the middle of the right gluteal region, and internal rotation of the right hip reproduces her symptoms. Which of the following muscles is most likely responsible for her condition? A) Gluteus medius B) Piriformis C) Obturator internus D) Tensor fasciae latae
B) Piriformis Rationale: The clinical vignette describes piriformis syndrome, where hypertrophy, spasm, or inflammation of the piriformis muscle compresses the adjacent sciatic nerve. The piriformis muscle originates on the anterior surface of the sacrum and inserts on the greater trochanter of the femur. It acts as an external rotator of the hip when the hip is extended. Pain exacerbated by prolonged sitting and passive internal rotation (which stretches the spasmed muscle) are classic diagnostic indicators.
- During an osteopathic structural examination of a 22-year-old athlete, the physician notes that the patient's right anterior superior iliac spine (ASIS) is inferior compared to the left, and the right posterior superior iliac spine (PSIS) is superior compared to the left. A standing flexion test is positive on the right. Which of the following is the most likely diagnosis? A) Right posterior innominate rotation B) Left anterior innominate rotation C) Right anterior innominate rotation D) Right superior innominate shear C) Right anterior innominate rotation Rationale: A positive standing flexion test localizes the somatic dysfunction to the right sacroiliac joint. An innominate dysfunction is named by comparing the positional landmarks of the ipsilateral side. An inferior ASIS paired with a superior PSIS on the same side indicates that the right innominate bone has rotated anteriorly around a transverse axis.
4. A physician is using muscle energy technique to treat a patient with a Type II lumbar
somatic dysfunction named L3 Flexed, Rotated Right, and Sidebent Right ( ). To correctly position the patient for this post-isometric relaxation treatment, how should the physician place the L3 segment relative to the restrictive barrier? A) Flexed, rotated right, sidebent right B) Extended, rotated left, sidebent left C) Neutral, rotated right, sidebent left D) Extended, rotated right, sidebent left B) Extended, rotated left, sidebent left Rationale: Muscle energy is a direct, active technique. Direct techniques require positioning the patient's dysfunctional segment directly into its restrictive barrier
C) Popliteal fossa D) Pelvic diaphragm B) Thoracic inlet Rationale: According to osteopathic lymphatic treatment models, distal lymphatic congestion cannot be efficiently cleared until proximal obstructions are removed. The entire lymphatic system drains into the venous system at the subclavian veins via the thoracic ducts, which pass directly through the thoracic inlet (superior thoracic aperture). Therefore, the thoracic inlet must be treated first to open the pathway.
- A 28-year-old female presents with lateral right knee pain that began after she increased her running mileage for a marathon. Structural examination demonstrates a positive Ober test on the right. If the physician utilizes a counterstrain protocol to treat the associated tender point located on the lateral aspect of the right knee, what is the correct positioning for treatment? A) Hip flexion and internal rotation B) Hip abduction and mild flexion C) Hip adduction and extension D) Knee flexion and external rotation B) Hip abduction and mild flexion Rationale: A positive Ober test indicates tightness of the iliotibial (IT) band or tensor fasciae latae muscle. The counterstrain tender point for the IT band is located along the lateral aspect of the thigh or knee. To treat a tender point using counterstrain, the tissue must be placed into a position of ease (shortening the muscle). For the IT band, this is achieved via passive hip abduction with a small degree of flexion.
- A patient is diagnosed with a sacral somatic dysfunction. Structural evaluation shows a positive seated flexion test on the left. The spring test is negative (indicating good spring at the sacral base). Lumbar examination reveals that L5 is rotated to the right. Which of the following is the most likely sacral diagnosis? A) Left-on-Left forward sacral torsion B) Right-on-Left backward sacral torsion C) Right-on-Right forward sacral torsion D) Left-on-Right backward sacral torsion A) Left-on-Left forward sacral torsion Rationale: A negative spring test means the sacral base is able to spring anteriorly, pointing to a forward (flexed) sacral torsion (either Left-on-Left or Right-on-Right). A positive seated flexion test on the left indicates the dysfunction is on the left side, meaning the axis must be the opposite side (Right axis) or the dysfunction is a unilateral shear. In a Left-on-Left torsion, the left sacral base moves anteriorly, L rotates to the opposite side of the sacral rotation (L5 rotates right when the sacrum
rotates left), and the seated flexion test is positive on the left because it is the non- axis side that fails to move smoothly.
- A 38-year-old female with a history of chronic constipation presents for evaluation. The physician wishes to apply the collateral mesenteric ganglion release technique to address her lower GI symptoms. Over which abdominal location should the physician apply posterior pressure to target the inferior mesenteric ganglion? A) Immediately inferior to the xiphoid process B) Midway between the xiphoid process and the umbilicus C) Approximately 1 to 2 inches superior to the umbilicus D) Approximately 1 to 2 inches inferior to the umbilicus D) Approximately 1 to 2 inches inferior to the umbilicus Rationale: The three main midline prevertebral collateral ganglia are the celiac, superior mesenteric, and inferior mesenteric ganglia. The celiac ganglion is found just below the xiphoid process. The superior mesenteric ganglion is found midway between the xiphoid and umbilicus. The inferior mesenteric ganglion, which provides sympathetic innervation to the hindgut (including the descending colon, sigmoid colon, and rectum), is located prevertebrally approximately 1 to 2 inches inferior to the umbilicus. Questions 11–20: Microbiology & Immunology
- A 4-year-old boy is brought to the emergency department because of a sore throat, difficulty swallowing, and a low-grade fever. Physical examination reveals a dense, gray, leather-like pseudomembrane tightly adherent to the posterior pharyngeal wall. The physician attempts to scrape the membrane, which causes local bleeding. What is the primary mechanism of action of the toxin produced by the causative organism? A) Cleavage of desmoglein- 1 B) Inactivation of elongation factor-2 (EF-2) C) Activation of adenylate cyclase via Gs stimulation D) Inhibition of glycine release from inhibitory interneurons B) Inactivation of elongation factor-2 (EF-2) Rationale: The patient is presenting with diphtheria, caused by Corynebacterium diphtheriae. The hallmark clinical sign is the gray, adherent pharyngeal pseudomembrane. The pathogenicity is driven by diphtheria toxin, an AB exotoxin that catalyzes the ADP-ribosylation of elongation factor-2 (EF-2), completely halting protein synthesis within host cells and leading to cell death.
- A 68-year-old male with a history of severe alcohol use disorder presents with a 3-day history of productive cough with thick, gelatinous, blood-tinged ("currant
B) Picornaviridae C) Reoviridae D) Coronaviridae C) Reoviridae Rationale: Rotavirus is the most common cause of severe, watery diarrhea in infants and young children worldwide, particularly in daycare settings. It belongs to the Reoviridae family, which is explicitly characterized by an unenveloped, icosahedral capsid enclosing a segmented (11 segments), double-stranded RNA genome.
15. A 34-year-old male HIV-positive patient with a CD4+ T-lymphocyte count of
presents to the emergency department with a 2-week history of progressive dyspnea, nonproductive cough, and low-grade fever. Arterial blood gas shows mild hypoxemia. A silver stain of a bronchoalveolar lavage specimen reveals multiple crushed, cup-shaped cysts. Which of the following is the first-line pharmacotherapy for both treatment and prophylaxis of this condition? A) Azithromycin B) Trimethoprim-sulfamethoxazole C) Amphotericin B D) Fluconazole B) Trimethoprim-sulfamethoxazole Rationale: The clinical picture and silver stain findings are diagnostic for Pneumocystis jirovecii pneumonia (PCP), an opportunistic fungal infection occurring in immunocompromised individuals when CD4 counts drop below
. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line medication for both the active treatment of PCP and its primary prophylaxis.
- A 25-year-old female presents with a painless, indurated ulcer (chancre) on her vulva that appeared approximately 5 days ago. She admits to unprotected sexual intercourse with a new partner 3 weeks ago. Darkfield microscopy of scrapings from the ulcer reveals motile, corkscrew-shaped spirochetes. Which of the following serologic tests is considered a specific, treponemal-confirmatory test for this disease?
A) VDRL (Venereal Disease Research Laboratory) B) RPR (Rapid Plasma Reagin) C) FTA-ABS (Fluorescent Treponemal Antibody Absorption) D) Rheumatoid Factor C) FTA-ABS (Fluorescent Treponemal Antibody Absorption) Rationale: The patient has primary syphilis, caused by Treponema pallidum. Screening tests like VDRL and RPR detect nonspecific antibodies against cardiolipin-lecithin-cholesterol antigens and carry a high rate of false positives. Confirmation requires a specific treponemal test like the FTA-ABS or TP-PA (T. pallidum particle agglutination) test, which directly measures antibodies against T. pallidum antigens.
- A 7-year-old girl is brought to her pediatrician because of an itchy, red rash on her scalp. Physical examination shows a well-demarcated, scaly, circular patch of hair loss with small "black dots" representing broken hair shafts. A Wood's lamp examination is negative. Microscopic evaluation of a hair scraping with potassium hydroxide (KOH) shows arthroconidia. What is the primary mechanism of action of griseofulvin, an oral medication used to treat this condition? A) Inhibition of squalene epoxidase B) Inhibition of 14-alpha-demethylase C) Disruption of the mitotic spindle by binding to microtubules D) Binding to ergosterol to form membrane pores C) Disruption of the mitotic spindle by binding to microtubules Rationale: The patient has tinea capitis, a superficial dermatophyte infection of the scalp. Oral therapy is mandatory because topical antifungals do not effectively penetrate the hair shaft. Griseofuvin is a fungistatic drug that deposits selectively in keratin precursor cells and disrupts fungal cell mitosis by binding directly to microtubules, inhibiting mitotic spindle assembly.
- A 40-year-old male develops a severe skin rash with blistering and peeling over 35% of his body surface area 10 days after starting allopurinol for gout. He is diagnosed with Toxic Epidermal Necrolysis (TEN). This severe hypersensitivity reaction is mediated primarily by the activation and degranulation of which immune cell type? A) Mast cells B) CD8+ Cytotoxic T lymphocytes C) Eosinophils D) Plasma cells B) CD8+ Cytotoxic T lymphocytes Rationale: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
- A 62-year-old male with a long-standing history of poorly controlled hypertension presents to the emergency department complaining of sudden-onset, tearing chest pain that radiates to his back between his scapulae. His blood pressure is 185/105 mmHg, and a chest radiograph shows a widened mediastinum. What is the primary underlying histopathological process responsible for this patient's acute life-threatening event? A) Atherosclerotic plaque rupture B) Cystic medial degeneration C) Transmural granulomatous inflammation D) Mononuclear cell infiltration of the epicardium B) Cystic medial degeneration Rationale: The patient is experiencing an acute aortic dissection, which is strongly associated with chronic hypertension. Hypertension causes mechanical stress that leads to cystic medial degeneration—the fragmentation of elastic fibers and loss of smooth muscle cells within the tunica media of the aorta. This creates a structural weakness that allows an intimal tear to propagate into a false lumen.
- A 53-year-old female presents to her primary care physician due to a painless, firm lump in her right breast that she noticed during a self-examination. A mammogram confirms a irregular, stellate mass with microcalcifications. A core needle biopsy reveals cords and nests of malignant epithelial cells surrounded by a dense, fibrous, scirrhous stroma that have breached the basement membrane. Which of the following is the most likely diagnosis? A) Ductal carcinoma in situ B) Invasive ductal carcinoma C) Fibroadenoma D) Invasive lobular carcinoma B) Invasive ductal carcinoma Rationale: Invasive ductal carcinoma (IDC) is the most common form of breast cancer. Histologically, it is characterized by malignant ductal epithelial cells invading through the basement membrane into the local stroma, often inciting a marked desmoplastic (dense fibrous) reaction that gives the tumor its firm, hard texture. Microcalcifications on mammography further support this diagnosis.
- A 45-year-old male with a history of chronic gastroesophageal reflux disease (GERD) undergoes an upper endoscopy. Biopsies taken from the distal esophagus show a replacement of the normal stratified squamous epithelium with simple columnar epithelium containing specialized goblet cells. This cellular alteration represents which of the following forms of cellular adaptation? A) Hyperplasia
B) Dysplasia C) Metaplasia D) Atrophy C) Metaplasia Rationale: The replacement of one adult differentiated cell type by another adult differentiated cell type in response to chronic irritation or stress is defined as metaplasia. In Barrett's esophagus, the chronic acid reflux forces the esophageal stratified squamous lining to convert into a columnar epithelium with goblet cells (intestinal metaplasia) to better resist the acidic environment.
- A 29-year-old female presents with a 2-month history of a painless mass on the right side of her neck. A lymph node biopsy is performed, revealing large, abnormal B cells with bilobed nuclei and prominent eosinophilic nucleoli, giving them an "owl-eye" appearance. The background tissue shows a mixed inflammatory infiltrate. Which of the following surface markers is typically positive on these characteristic neoplastic cells? A) CD19 and CD B) CD3 and CD C) CD15 and CD D) CD5 and CD C) CD15 and CD Rationale: The "owl-eye" cells are Reed-Sternberg cells, the diagnostic hallmark of Hodgkin lymphoma. Unlike normal B cells, classic Reed-Sternberg cells characteristically lose typical B-cell markers (like CD20) and instead express CD and CD30.
- A 72-year-old male with a 50 pack-year smoking history presents with a chronic cough, progressive shortness of breath, and significant weight loss over the past 3 months. A chest CT scan reveals a large central hilar mass. A biopsy of the mass demonstrates sheets of small, round blue cells with minimal cytoplasm, fine granular chromatin ("salt-and-pepper"), and extensive areas of necrosis. Which of the following paraneoplastic syndromes is most tightly linked to this specific histological type of lung cancer? A) Hypercalcemia due to PTHrP secretion B) Hypertrophic osteoarthropathy C) Lambert-Eaton myasthenic syndrome D) Erythrocytosis due to EPO secretion C) Lambert-Eaton myasthenic syndrome Rationale: The biopsy describes small cell lung carcinoma (SCLC), a highly aggressive neuroendocrine tumor located centrally. SCLC is strongly associated with
- A 16-year-old boy presents to his family physician due to progressive muscle weakness. His parents note that he has difficulty climbing stairs and uses his hands to walk up his own legs to stand upright from a sitting position. Gowers' sign is positive. Genetic testing reveals a deletion mutation in the gene encoding a structural protein that anchors the cellular cytoskeleton to the extracellular matrix. Which of the following proteins is defective? A) Dystrophin B) Actin C) Myosin D) Desmin A) Dystrophin Rationale: The clinical picture describes Duchenne Muscular Dystrophy (DMD), an X-linked recessive disorder. The disease is caused by a frameshift deletion mutation in the DMD gene, causing a complete absence of the dystrophin protein. Dystrophin is crucial for structural integrity because it anchors the actin cytoskeleton of skeletal muscle fibers to the extracellular matrix via the dystroglycan complex. Without it, muscle fibers undergo progressive necrosis.
29. A 58-year-old male with chronic hepatitis C virus infection and cirrhosis
presents with worsening abdominal distension, shifting dullness on percussion, and mild confusion. On physical exam, he exhibits a flapping tremor (asterixis) when extending his wrists. Accumulation of which of the following substances in the central nervous system is responsible for his neurological symptoms? A) Bilirubin B) Ammonia C) Urea D) Lactate B) Ammonia Rationale: The patient has hepatic encephalopathy secondary to decompensated liver cirrhosis. When the liver cannot properly clear metabolic waste products via the urea cycle, systemic levels of ammonia ( ) rise significantly. Ammonia crosses the blood-brain barrier, where astrocytes convert it into glutamine. This buildup causes osmotic swelling, astrocyte dysfunction, and altered neurotransmission, manifesting as asterixis and altered mental status.
- A 50-year-old female presents with dry eyes and a dry mouth that have progressed over the last year. She notes that she must drink water constantly to swallow dry food and feels like she has "sand in her eyes." Physical examination
reveals parotid gland enlargement bilaterally. Lab testing shows positive anti-Ro (SS-A) and anti-La (SS-B) autoantibodies. Which of the following histopathological findings would be expected on a biopsy of her minor salivary glands? A) Extensive caseating granulomas B) Diffuse lymphocytic infiltration with acinar destruction C) Amyloid deposition with apple-green birefringence D) Intracellular inclusion bodies within ductal cells B) Diffuse lymphocytic infiltration with acinar destruction Rationale: This patient is presenting with Sjögren syndrome, a chronic autoimmune disease characterized by the immune-mediated destruction of exocrine glands, specifically the lacrimal and salivary glands. Biopsy of the lip/minor salivary glands is a definitive diagnostic step, demonstrating periductal focal lymphocytic infiltrates (primarily CD4+ T cells) that lead to architectural destruction of the functional glandular acini.
- A 45-year-old female presents with chronic, dull right upper quadrant abdominal pain that worsens after eating fatty meals. A right-sided somatic dysfunction is noted at the posterior thoracic paraspinal region. Which of the following spinal levels is the most likely location for this patient's viscerosomatic reflex? A) T1–T B) T5–T C) T10–T D) T12–L
- B) T5–T
- Rationale: The patient's clinical presentation is highly suggestive of gallbladder disease (e.g., chronic cholecystitis or biliary colic). Viscerosomatic reflexes for upper gastrointestinal structures, including the stomach, liver, gallbladder, spleen, and portions of the duodenum, are mediated by sympathetic innervations arising from the T5–T9 spinal levels via the greater splanchnic nerve.
35. Question 32
- A 62-year-old male with a history of chronic smoking presents with sudden-onset, severe, tearing chest pain radiating to his back. His blood pressure is 170/105 mmHg in the right arm and 130/85 mmHg in the left arm. Transesophageal echocardiography confirms an aortic dissection. Autonomic hypertonicity is most likely to be palpated at which of the following osteopathic levels?
B) T10–T
C) L1–L
D) L3–L
47. C) L1–L
- Rationale: The lower gastrointestinal tract is divided by its embryonic origins and autonomic innervations. The distal third of the transverse colon down to the upper rectum arises from the hindgut and receives its sympathetic innervation from the L1–L2 spinal levels via the inferior mesenteric ganglion. The proximal two-thirds of the transverse colon is midgut-derived and innervated by T10–T11.
50. Question 35
- A 3 5 - year-old female presents to the clinic with an asymmetric gait. Structural examination reveals a right superior innominate shear. Which of the following physical exam findings is most consistent with this diagnosis? A) The right ASIS is inferior and the right PSIS is superior B) The right medial malleolus is inferior and the right ischial tuberosity is superior C) The right ASIS is superior and the right PSIS is superior D) The right ASIS is inferior and the right PSIS is inferior
- C) The right ASIS is superior and the right PSIS is superior
- Rationale: An innominate shear occurs when an entire pelvic bone is displaced superiorly or inferiorly along the sacroiliac joint. In a superior shear (upslip), all landmarks on the affected side—including the anterior superior iliac spine (ASIS), posterior superior iliac spine (PSIS), and ischial tuberosity—are displaced superiorly relative to the contralateral side. The medial malleolus on the affected side would appear superior (shorter leg).
55. Question 36
- A 50-year-old male with a history of alcohol abuse presents with severe epigastric pain that radiates directly to his back, accompanied by nausea and vomiting. Laboratory evaluation shows an elevated serum lipase level. A diagnostic viscerosomatic reflex for this acute condition would most likely be found at which of the following locations? A) Left T5–T9 paraspinal region B) Right T10–T11 paraspinal region C) Right T5–T9 paraspinal region D) Left T10–T11 paraspinal region
- A) Left T5–T9 paraspinal region
- Rationale: This patient is presenting with acute pancreatitis. The pancreas is an upper gastrointestinal structure derived from the foregut, meaning its sympathetic visceral afferent fibers travel back to the T5–T spinal segments. Because the tail and body of the pancreas are left-sided structures, the resulting tissue texture changes and viscerosomatic changes present predominantly on the left side of the T5–T9 paraspinal region.
60. Question 37
- A 19-year-old female cross-country runner presents with localized pain over the lateral aspect of her right knee. She notes that the pain is sharp and occurs primarily when her heel strikes the ground. Examination reveals exquisite tenderness over the lateral femoral condyle. Which of the following muscles is most directly involved in this pathology? A) Biceps femoris B) Tensor fasciae latae C) Gastrocnemius D) Rectus femoris
- B) Tensor fasciae latae
- Rationale: The clinical scenario describes Iliotibial Band (ITB) Friction Syndrome, which is highly common in runners due to repetitive friction of the IT band over the lateral femoral epicondyle. The tensor fasciae latae muscle inserts directly into the iliotibial tract; hypertonicity or overuse of this muscle increases tension along the band, precipitating the friction injury.
65. Question 38
- A 29-year-old male presents with acute neck stiffness after sleeping in an awkward position. Structural examination reveals that C4 is rotated right and sidebent right. When the cervical spine is flexed, the asymmetry resolves completely. Which of the following is the correct diagnosis for this somatic dysfunction? A) C4 Flexed Sidebent Right Rotated Right B) C4 Flexed Sidebent Left Rotated Left C) C4 Extended Sidebent Right Rotated Right D) C4 Neutral Sidebent Right Rotated Right
- A) C4 Flexed Sidebent Right Rotated Right
- Rationale: Somatic dysfunctions of typical cervical vertebrae (C2–C7) always follow Type II-like motion principles, meaning that rotation and
release or decompression of the OA joint can help normalize vagal parasympathetic hyperactivity and alleviate symptoms of nausea.
80. Question 41
- A 42-year-old construction worker presents with sharp pain in his right groin that radiates down the anterior aspect of his thigh. Structural examination reveals a tender point located 2 cm medial to the right anterior superior iliac spine (ASIS). Deep palpation reproduces his pain. Which of the following is the correct treatment position for this counterstrain tender point? A) Patient prone, right hip extended and externally rotated B) Patient supine, right hip flexed, abducted, and externally rotated C) Patient supine, right hip flexed, adducted, and internally rotated D) Patient prone, right hip flexed and abducted
- B) Patient supine, right hip flexed, abducted, and externally rotated
- Rationale: The location described—2 cm medial to the ASIS— corresponds to the anterior lumbar tender point for L1 or the iliopsoas counterstrain tender point. Treatment of the iliopsoas tender point requires the patient to be supine with bilateral hip flexion, abduction, and external rotation (often shortened as F_ABD_ER), which shortens and unloads the iliopsoas muscle.
85. Question 42
- A 17-year-old female high school tennis player presents with pain over the medial epicondyle of her right humerus. The pain is exacerbated when she flexes her wrist against resistance. Which of the following somatic dysfunctions is most commonly associated with this clinical presentation? A) Posterior radial head B) Anterior radial head C) Abducted ulna D) Adducted ulna
- A) Posterior radial head
- Rationale: Repetitive wrist flexion and pronation stress the medial epicondyle (medial epicondylitis). Pronation of the forearm causes the radial head to glide posteriorly. If the radial head becomes restricted in this position, it results in a posterior radial head somatic dysfunction, which presents with a restriction in anterior gliding (restricted supination).
90. Question 43
- A 68-year-old female presents to the emergency department with acute shortness of breath and an irregular pulse. Electrocardiogram reveals atrial fibrillation with rapid ventricular response. A myocardial viscerosomatic reflex is suspected. Which of the following tissue changes would be expected upon structural examination? A) Decreased skin temperature at T1–T4 on the left B) Boggy, cool paraspinal tissues at T5–T9 on the right C) Increased tissue fullness and warmth at T1–T4 on the left D) Rhythmic pulsations along the cervical sympathetic chain
- C) Increased tissue fullness and warmth at T1–T4 on the left
- Rationale: Acute visceral pathology, such as atrial fibrillation or myocardial ischemia, creates acute viscerosomatic reflexes. These present as acute tissue texture changes including warmth, hypertonicity, moisture, and boggy fullness. The sympathetic innervation to the heart arises from T1–T4, and myocardial reflexes present predominantly on the left side.
95. Question 44
- During a routine newborn examination, an osteopathic physician notes that the infant has a poor suck reflex. Cranial evaluation reveals compression of the condylar parts of the occiput, limiting lateral motion of the occipital bone. Which of the following cranial nerves is most likely compressed by this somatic dysfunction? A) CN VII B) CN IX C) CN XII D) CN X
- C) CN XII
- Rationale: The hypoglossal nerve (CN XII) exits the skull through the hypoglossal canal, which is located entirely within the occipital bone near the condylar parts. Compression or somatic dysfunction of the occipital condyles (such as condylar compression from birth trauma) can entrap CN XII, leading to poor tongue coordination and a weak or dysfunctional suck reflex.
100. Question 45
- A 38-year-old male runner presents with sharp pain on the plantar surface of his left heel that is worst during his first few steps in the morning. Examination reveals exquisite tenderness over the medial tubercle of the calcaneus. A somatic dysfunction of the foot is identified where the cuboid
