COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Respiratory System Questions and Answers

Question 1

A 55-year-old male with a history of COPD presents with a 3-day history of productive cough, fever, and right-sided pleuritic chest pain.
A chest X-ray confirms a right middle lobe pneumonia.
From an osteopathic perspective, which of the following viscerosomatic reflex findings is most likely to be appreciated on physical examination?

Accepted Answer

C. Paraspinal tissue texture changes and hypertonicity at T2-T7 on the right.

Answer

A. Paraspinal tissue texture changes and hypertonicity at C3-C5 on the right.

Answer

B. Boggy and tender tissue texture changes at the T10-T11 spinous processes.

Answer

D. A tender anterior Chapman's point in the 7th intercostal space on the left.

Question 2

A 68-year-old female presents to the emergency department with the sudden onset of dyspnea and sharp, left-sided chest pain. She returned from an international flight 2 days ago. Her heart rate is 115/min, respiratory rate is 28/min, and oxygen saturation is 91% on room air. An EKG shows sinus tachycardia with an S1Q3T3 pattern. Which of the following is the most definitive diagnostic test for her suspected condition?

Accepted Answer

D. Computed tomography (CT) pulmonary angiography

Answer

A. D-dimer assay

Answer

B. Lower extremity venous Doppler ultrasound

Answer

C. Chest X-ray

Question 3

An osteopathic physician is treating a patient with pneumonia to improve lymphatic drainage and respiratory function. The physician focuses on treating the anatomical structure that serves as the primary muscle of respiration and whose proper function is critical for the pressure gradients that drive lymphatic flow. Dysfunction of which nerve would most directly impair this structure?

Accepted Answer

A. Phrenic nerve

Answer

B. Vagus nerve

Answer

C. Long thoracic nerve

Answer

D. Intercostal nerves

Question 4

A 28-year-old male complains of sharp pain near his sternum after a severe coughing fit. On examination, the anterior aspect of his right 4th rib moves superiorly during inhalation but is restricted during exhalation. This is identified as a pump-handle, inhaled rib somatic dysfunction. Which of the following best describes the primary motion of this rib group?

Accepted Answer

B. An increase in the anteroposterior (AP) diameter of the thorax.

Answer

A. An increase in the transverse diameter of the thorax, similar to a bucket handle.

Answer

C. A caliper-like motion where the free ends move towards the midline.

Answer

D. A torsional motion along the long axis of the rib.

Question 5

A 45-year-old patient is recovering from bronchitis and presents with persistent, localized right-sided chest wall pain that worsens with deep breathing. Osteopathic examination reveals a tender point over the 8th rib, which moves freely with inhalation but is restricted in its inferior motion during exhalation. This finding is consistent with an inhaled rib 8. Which muscle would be targeted using muscle energy technique (MET) to correct this dysfunction?

Accepted Answer

C. Latissimus dorsi

Answer

A. Pectoralis minor

Answer

B. Anterior scalene

Answer

D. Quadratus lumborum

Question 6

An osteopathic physician is developing a treatment plan for an elderly patient with pneumonia and significant pulmonary congestion. To maximize the efficacy of lymphatic drainage, the physician decides to first treat the area of terminal lymphatic drainage for the entire left side of the body and the right lower body. Which OMT technique most directly addresses this anatomical region?

Accepted Answer

B. Thoracic inlet myofascial release

Answer

A. Rib raising technique

Answer

C. Pedal pump technique

Answer

D. Sacral inhibition