COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Musculoskeletal System Questions and Answers — Questions and Answers
Question 1: A 45-year-old male presents with acute, colicky right upper quadrant pain that is exacerbated by fatty meals. On osteopathic structural exam, you note tissue texture changes and paraspinal hypertonicity from T5 to T9 on the right. Which of the following anterior Chapman's points would most likely be present in this patient?
- In the 2nd intercostal space near the sternum on the right
- In the 5th intercostal space from the mid-mammary line to the sternum on the left
- In the 6th intercostal space on the right at the mid-mammary line (Correct answer)
- On the tip of the twelfth rib on the right
Correct answer: In the 6th intercostal space on the right at the mid-mammary line
The patient's presentation is classic for biliary colic, likely due to cholelithiasis or cholecystitis. The viscerosomatic reflex for the gallbladder corresponds to spinal levels T5-T9. The anterior Chapman's point for the gallbladder is located in the 6th intercostal space on the right at the mid-mammary line. The 2nd intercostal space relates to the myocardium, the 5th on the left to the stomach, and the tip of the 12th rib to the appendix.
Question 2: A 28-year-old female presents with low back pain and constipation. Osteopathic examination reveals a sacral somatic dysfunction. Which of the following osteopathic manipulative treatment (OMT) techniques would be particularly effective for addressing both the somatic dysfunction and the patient's visceral symptoms?
- Cervical spine muscle energy
- Thoracic spine high-velocity, low-amplitude (HVLA)
- Sacral rocking (articulatory technique) (Correct answer)
- Rib raising
Correct answer: Sacral rocking (articulatory technique)
Sacral rocking is an articulatory technique that is often indicated for sacral somatic dysfunctions. It is particularly beneficial for patients presenting with pelvic symptoms related to visceral organs, such as constipation or dysmenorrhea, due to its influence on the pelvic parasympathetic nerves (S2-S4). The other techniques listed target different regions and would not be the most direct or effective for this patient's combination of symptoms.
Question 3: Which of the following describes the physiological principle behind the muscle energy technique (MET) of post-isometric relaxation?
- Activating the Golgi tendon organ to induce reflex muscle inhibition (Correct answer)
- Stretching the muscle spindle to cause a reflex muscle contraction
- Applying deep pressure to a tender point to release muscle tension
- Using the respiratory cycle to influence fascial tension
Correct answer: Activating the Golgi tendon organ to induce reflex muscle inhibition
Post-isometric relaxation, a common form of muscle energy technique, involves having the patient perform an isometric contraction against the physician's counterforce. This contraction activates the Golgi tendon organs within the muscle's tendon, which then send inhibitory signals to the spinal cord, leading to a reflex relaxation (lengthening) of the muscle immediately following the contraction. This period of relaxation allows the physician to gently move the joint further into the restrictive barrier.
Question 4: A 65-year-old female with a history of rheumatoid arthritis presents with symmetrical pain, swelling, and stiffness in the small joints of her hands and feet, which is worse in the morning. Which of the following physical exam findings would be most specific for this patient's condition?
- Heberden's nodes
- Boutonnière and swan-neck deformities (Correct answer)
- Positive Finkelstein's test
- Crepitus on passive range of motion
Correct answer: Boutonnière and swan-neck deformities
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of synovial joints. Boutonnière (flexion of the PIP joint and hyperextension of the DIP joint) and swan-neck (hyperextension of the PIP joint and flexion of the DIP joint) deformities are characteristic, though often later, findings in RA due to inflammation and damage to the extensor tendons. Heberden's nodes are seen in osteoarthritis, Finkelstein's test is for de Quervain's tenosynovitis, and crepitus is a non-specific finding common in many arthropathies.
Question 5: A patient is diagnosed with a left unilateral sacral flexion. During the osteopathic structural exam, which of the following findings would be expected?
- Positive seated flexion test on the right, deep sacral sulcus on the left, and posterior/inferior ILA on the left
- Positive seated flexion test on the right, deep sacral sulcus on the right, and posterior/inferior ILA on the right
- Positive seated flexion test on the left, shallow sacral sulcus on the left, and anterior/superior ILA on the left
- Positive seated flexion test on the left, deep sacral sulcus on the left, and posterior/inferior ILA on the left (Correct answer)
Correct answer: Positive seated flexion test on the left, deep sacral sulcus on the left, and posterior/inferior ILA on the left
In a left unilateral sacral flexion, the sacrum is flexed on the left side. This results in the left sacral base (sulcus) moving anteriorly, making it feel deeper on palpation. The left inferior lateral angle (ILA) moves posterior and inferior. The side of dysfunction is the side that moves first and furthest during the seated flexion test, indicating sacroiliac joint restriction on that side. Therefore, the seated flexion test will be positive on the left.
Question 6: A patient complains of mid-back pain. Layer-by-layer palpation reveals ropy, hypertonic paraspinal muscles at the T5-T9 level on the left, along with skin that feels boggy and moist. The patient has a history of gastritis. This clinical picture is most representative of which of the following phenomena?
- Somato-somatic reflex
- Viscero-somatic reflex (Correct answer)
- Chapman's reflex
- Somato-visceral reflex
Correct answer: Viscero-somatic reflex
A viscero-somatic reflex occurs when visceral pathology (e.g., gastritis) causes reflex changes in segmentally related somatic tissues. The stomach's sympathetic innervation comes from T5-T9. Therefore, irritation of the stomach can lead to palpable tissue texture changes, asymmetry, restricted motion, and tenderness (TART changes) in the paraspinal tissues of this region, as described in the vignette.
COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Musculoskeletal System Questions and Answers
A 45-year-old male presents with acute, colicky right upper quadrant pain that is exacerbated by fatty meals.
On osteopathic structural exam, you note tissue texture changes and paraspinal hypertonicity from T5 to T9 on the right.
Which of the following anterior Chapman's points would most likely be present in this patient?