Free COMAT Osteopathic Principles Questions and Answers — Questions and Answers
Question 1: A 32-year-old woman presents with chronic low back pain. On physical examination, you note hypertonicity of the paraspinal muscles at L3-L5 and a positive standing flexion test on the right. What is the most likely diagnosis?
- Sacroiliac dysfunction on the right
- Lumbar somatic dysfunction at L3-L5 (Correct answer)
- Iliopsoas syndrome
- Piriformis syndrome
Correct answer: Lumbar somatic dysfunction at L3-L5
The patient presents with hypertonicity of the paraspinal muscles at L3-L5 and a positive standing flexion test on the right, which are direct indicators of somatic dysfunction in the lumbar spine. A positive standing flexion test on one side suggests an ipsilateral iliosacral or sacroiliac dysfunction, but the primary finding of hypertonicity at L3-L5 points more directly to a lumbar somatic dysfunction. Sacroiliac dysfunction would typically be indicated by a positive standing flexion test and tenderness specifically over the SI joint, while iliopsoas or piriformis syndromes involve specific muscle findings and pain patterns not fully described here as the primary diagnosis.
Question 2: A 45-year-old man presents with right shoulder pain that radiates to his elbow. He has a restricted range of motion and tenderness over the right trapezius muscle. You diagnose a somatic dysfunction involving the clavicle. Which osteopathic technique would best address this dysfunction?
- Muscle energy technique (Correct answer)
- High-velocity, low-amplitude (HVLA)
- Balanced ligamentous tension (BLT)
- Myofascial release (MFR)
Correct answer: Muscle energy technique
Muscle energy technique (MET) is an osteopathic manipulative treatment that uses the patient's own muscle contractions against a controlled counterforce from the physician. It is particularly effective for treating somatic dysfunctions involving restricted range of motion and muscle hypertonicity, such as a clavicular dysfunction with restricted motion and tenderness. MET helps to restore normal joint mechanics and muscle length by engaging the patient's active participation.
Question 3: A 60-year-old woman with a history of migraines reports new-onset headaches following a neck strain. She describes the pain as occipital and reports tenderness over the occiput. Which cranial dysfunction is most likely contributing to her symptoms?
- Temporal bone dysfunction
- Sphenoid bone dysfunction
- Occipitoatlantal (OA) dysfunction (Correct answer)
- Parietal bone dysfunction
Correct answer: Occipitoatlantal (OA) dysfunction
The patient's symptoms of new-onset occipital headaches and tenderness over the occiput following a neck strain strongly suggest a dysfunction at the occipitoatlantal (OA) joint. The OA joint is the articulation between the occiput and the atlas (C1 vertebra), and dysfunction here commonly manifests as occipital pain and headaches. This area is a frequent site of somatic dysfunction following trauma or strain to the neck.
Question 4: A 28-year-old runner presents with right-sided hip pain after training for a marathon. Examination reveals tenderness over the greater trochanter and a positive Ober’s test. What osteopathic diagnosis is most likely?
- Piriformis syndrome
- Iliotibial (IT) band syndrome (Correct answer)
- Sacral torsion
- Psoas syndrome
Correct answer: Iliotibial (IT) band syndrome
The patient's presentation of right-sided hip pain, tenderness over the greater trochanter, and a positive Ober's test are classic signs of iliotibial (IT) band syndrome. Ober's test specifically assesses for tightness of the IT band, and tenderness over the greater trochanter is common due to friction of the IT band over the bony prominence. This condition is frequently seen in runners due to repetitive stress.
Question 5: A 50-year-old man presents with symptoms of gastroesophageal reflux disease (GERD). You decide to apply osteopathic manipulative treatment (OMT) to improve autonomic tone. Which ganglion should you primarily target?
- Superior cervical ganglion
- Celiac ganglion (Correct answer)
- Superior mesenteric ganglion
- Inferior mesenteric ganglion
Correct answer: Celiac ganglion
The celiac ganglion is a major sympathetic ganglion that innervates the upper gastrointestinal tract, including the stomach and esophagus. In patients with gastroesophageal reflux disease (GERD), addressing sympathetic hyperactivity to the stomach can help improve autonomic tone and potentially alleviate symptoms. Osteopathic manipulative treatment targeting the celiac ganglion aims to modulate this sympathetic input.
