COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Osteopathic Principles and Practice 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?

Accepted Answer

Lungs and bronchi

Answer

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?

Accepted Answer

The body is capable of self-regulation, self-healing, and health maintenance.

Answer

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?

Accepted Answer

Right-on-right sacral torsion

Answer

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?

Accepted Answer

High-Velocity, Low-Amplitude (HVLA)

Answer

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:

Accepted Answer

Post-isometric relaxation

Answer

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.

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Osteopathic Principles and Practice Questions and Answers