COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Osteopathic Principles and Practice Questions and Answers — Questions and Answers
Question 1: A 58-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath and a productive cough. On osteopathic structural exam, you note boggy, edematous tissue texture changes and tenderness over the anterior chest at the 2nd intercostal spaces bilaterally, near the sternum. These findings are most consistent with viscerosomatic reflexes related to which of the following?
- Myocardium
- Lungs and bronchi (Correct answer)
- Esophagus
- Thyroid gland
Correct answer: Lungs and bronchi
The anterior Chapman's points for the lungs and bronchi are located in the 2nd, 3rd, and 4th intercostal spaces near the sternum. The finding of boggy, edematous tissue in a patient with a COPD exacerbation is a classic presentation of a viscerosomatic reflex, where visceral pathology (the lungs) causes somatic changes (the tissue texture abnormalities). The points for the myocardium are typically on the left in the 2nd intercostal space, the esophagus in the 2nd intercostal space, and the thyroid in the 2nd intercostal space, but the bilateral nature and strong clinical correlation with COPD point specifically to the lungs and bronchi.
Question 2: Which of the following core tenets of osteopathic medicine best describes the principle that the human body has an inherent capacity to defend, repair, and heal itself?
- The body is a unit; the person is a unit of body, mind, and spirit.
- Structure and function are reciprocally interrelated.
- The body is capable of self-regulation, self-healing, and health maintenance. (Correct answer)
- Rational treatment is based on an understanding of body unity, self-regulation, and the interrelationship of structure and function.
Correct answer: The body is capable of self-regulation, self-healing, and health maintenance.
The tenet that 'The body is capable of self-regulation, self-healing, and health maintenance' specifically articulates the osteopathic principle of the body's innate healing capacity. Osteopathic manipulative treatment (OMT) is often aimed at removing somatic barriers to allow this inherent capacity to function optimally. The other options are also core tenets but do not specifically address the self-healing mechanism.
Question 3: A 34-year-old patient presents with acute right-sided sacroiliac joint pain after lifting a heavy box. Physical examination reveals a positive standing flexion test on the right, a deep sacral sulcus on the left, and a posterior and inferior inferior lateral angle (ILA) on the right. This combination of findings is most indicative of what type of sacral somatic dysfunction?
- Right-on-right sacral torsion (Correct answer)
- Left-on-right sacral torsion
- Right unilateral sacral flexion
- Left-on-left sacral torsion
Correct answer: Right-on-right sacral torsion
In a right-on-right sacral torsion, the sacrum is rotated right on a right oblique axis. This results in the left sacral sulcus feeling deeper (more anterior) and the right ILA feeling more posterior and inferior. The positive standing flexion test on the right indicates the side of sacroiliac dysfunction. These three findings together are the classic presentation for a right-on-right forward sacral torsion.
Question 4: A 75-year-old female with severe osteoporosis presents for osteopathic manipulative treatment (OMT) for lumbar pain. Which of the following OMT modalities is considered a relative to absolute contraindication in this patient?
- Counterstrain
- Myofascial Release
- High-Velocity, Low-Amplitude (HVLA) (Correct answer)
- Balanced Ligamentous Tension
Correct answer: High-Velocity, Low-Amplitude (HVLA)
High-Velocity, Low-Amplitude (HVLA) techniques involve a rapid, therapeutic force of brief duration that travels a short distance within the anatomic range of motion. Due to the risk of fracture in patients with compromised bone integrity, severe osteoporosis is a well-established contraindication for HVLA. The other listed techniques are indirect or soft tissue modalities that are generally considered safe in this population.
Question 5: Muscle energy technique (MET) is a direct and active form of osteopathic manipulative treatment. The primary physiologic principle that allows MET to be effective in relaxing a hypertonic muscle is:
- Reciprocal inhibition
- Post-isometric relaxation (Correct answer)
- Crossed extensor reflex
- Autogenic inhibition
Correct answer: Post-isometric relaxation
Post-isometric relaxation is the key principle behind the most common form of muscle energy technique. After a patient performs a sustained, gentle isometric contraction against a physician's counterforce, a refractory state occurs in the muscle, allowing for a new, greater range of motion to be achieved during the subsequent relaxation phase. While autogenic and reciprocal inhibition are related neurologic principles, post-isometric relaxation specifically describes the phenomenon utilized in this MET application.
Question 6: An osteopathic physician is performing a structural exam and notes tissue texture changes, asymmetry, restriction of motion, and tenderness in the T5-T9 paraspinal region on the right. These findings, known by the acronym TART, are the diagnostic criteria for:
- Viscerosomatic reflex
- Somatic dysfunction (Correct answer)
- Chapman's point
- Myofascial trigger point
Correct answer: Somatic dysfunction
The acronym TART (Tissue texture change, Asymmetry, Restriction of motion, and Tenderness) represents the cardinal findings used to diagnose somatic dysfunction, which is defined as impaired or altered function of related components of the body's framework. While a viscerosomatic reflex can cause a somatic dysfunction, TART is the diagnosis itself. Chapman's points and trigger points are specific palpatory findings but do not encompass all four elements of the TART criteria.
COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Osteopathic Principles and Practice Questions and Answers
A 58-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath and a productive cough.
On osteopathic structural exam, you note boggy, edematous tissue texture changes and tenderness over the anterior chest at the 2nd intercostal spaces bilaterally, near the sternum.
These findings are most consistent with viscerosomatic reflexes related to which of the following?