COMLEX-USA Practice Test

A patient appears with an absent triceps tendon reflex and weakness in the extensors of the hand, wrist, and elbow due to a neurological deficiency. Which nerve is the most likely to be affected?

A) Radial

B) Musculocutaneous

C) Axillary

D) Median

Correct! Wrong!

Explanation:
The radial nerve innervates the extensors of the upper extremity (elbow, triceps, wrist & hand). An absent triceps (C7) reflex & wrist drop will indicate radial nerve pathology

A 50-year-old man is experiencing low back pain. On examination, the TP of L5 is seen to be posterior on the R. The asymmetry is worsened by extending L5, but flexion restores rotational symmetry. Which of the following statements about this Pt's SD is the most accurate?

A) The Pt would be requested to rotate his torso to the L against isometric contraction when using a muscular energy (post-isometric relaxation) approach.

B) In the stretched posture, L5 will oppose L-rotation.

C) A group dysfunction of the high Lumbar area will be present because to the non-neutral L5 SD.

D) This patient has psoas syndrome on the right side.

Correct! Wrong!

Explanation:
The patient flexed L5, twisted R, and sidebent R. When the spine is extended, the symmetry worsens and L5 resists the rotation of L.

A 40-year-old man with diabetes presents to the emergency department with acute low back pain. He was sliding into home plate during a softball game earlier today when the pain began. The discomfort is acute and has spread to his right lower extremities. He says he feels an electric ache in his R foot. What are some of the things you'd anticipate to find if you examined him?

A) With palpation of Lumbar tissues, guarded ROM of the L-Spine, and enhanced deep tendon reflexes of the R lower extremities, there is severe, intense pain.

B) With palpation and full active ROM of the L-Spine, edematous, swampy tissue is seen. On the dorsum of the foot, there is a loss of sensation.

C) Palpation reveals a dull ache. Straight leg raising test results were positive.

D) Warm tissue alterations, hypertonic muscles, and reduced L-Spine ROM

Correct! Wrong!

Explanation:
The patient has a severe L-Spine SD. One of his lumbar discs had also herniated. Acute SD is linked to acute sharp pain (particularly when palpated). Edematous, erythematous, and swampy are common descriptions for acute tissue texture alterations. There is an increase in moisture on the surface of the skin, as well as associated hypertonic muscles. Muscle contraction and guarding will limit the range of motion in the affected areas.

The malfunctioning T12 segment has limitation in a transverse plane and around a transverse axis in a patient with low back pain. T12's position best describes which of the following dysfunctions?

A) R is sidebent T12.

B) T12 is flexed

C) T12 is rotated R and sidebent R.

D) T12 is rotated to the left.

Correct! Wrong!

Explanation:
Flexion and extension are the two types of vertebral motion around a transverse axis. As a result, T12 must be either flexed or stretched. In a transverse plane, vertebral motion is rotation. As a result, T12 needs to be rotated as well. If one understands Fryette's concepts, one must conclude that if a vertebra is flexed, extended, and rotated, it must also be sidebent to the same side.

In which plane(s) does the 1st cervical segment (AA) have the most degree of freedom?

A) Sagittal

B) Oblique

C) Transverse & Coronal

D) Transverse

Correct! Wrong!

Explanation:
Rotation is the motion in the transverse plain. The stated segment on the one below is traditionally defined as segmental motion. The initial cervical segment (the AA joint - the atlas on the axis) has the most degrees of freedom in the transverse plane because rotation is its primary motion.

Which of the following is regarded the most frequent L-Spine congenital anomaly?

A) Facet tropism

B) Spina bifida occulta

C) Lumbarization

D) Facet hypertorphy

Correct! Wrong!

Explanation:
A misalignment of the facet joint is known as facet tropism. It is the most common L-Spine abnormality, according to Osteopathic principles in practice.

Guyon's canal nerve entrapment is likely to result in:

A) Weakness in wrist flexion

B) Weakness in wrist adduction

C) Weakness in the thumb abductor

D) Weakness in finger abduction

Correct! Wrong!

Explanation:
Guyon's canal (pisohamate) is found at the wrist. The pisiform bone is on the medial border, the hamate is on the lateral border, the flexor retinaculum is on the roof, and the pisohamate ligament is on the floor. The Guyon's canal houses the ulnar nerve. The hypothenar muscles, adductor pollicis, interossi, and 3rd and 4th lumbricals would all be affected by nerve entrapment. Abduction and adduction of the fingers are controlled by the interossi.

During menses, a 16-year-old female experiences low, midline, wave-like cramping pelvic pain. The pain has been there for three months and has become increasingly severe. Her pain frequently radiates to her L-Spine and is accompanied by nausea. Which OMM approach, in conjunction to suitable oral drugs, can most successfully reduce the Pt's symptoms by modifying sympathetic tone?

A) Release of celiac ganglion

B) To the thoraco-lumbar junction, rib raising & paraspinal inhibition

C) Sacral inhibition

D) Release of the pelvic diaphragm

Correct! Wrong!

Explanation:
Dysmenorrhea symptoms and indicators are present in the patient. Pain is caused by uterine vasoconstriction, anoxia, and prostaglandin-mediated prolonged contractions. T10 - L2 segments supply sympathetic innervation to the uterus. Because rib elevation and paraspinal inhibition reduce sympathetic tone, these treatments successfully increase blood flow and relax the uterus, reducing pain.

Chronic renal insufficiency affects a 45-year-old diabetic male. An analysis of the structure is likely to reveal:

A) T5 and T6 have severe acute tender points.

B) Ropy paraspinals at C3

C) T10 - L1 ropy paraspinals

D) T8 and T9 fibrotic paraspinals

Correct! Wrong!

Explanation:
Tissue texture changes at the thoraco-lumbar junction have been linked to renal insufficiency. Ropy and fibrotic are two adjectives that describe chronic tissue texture alterations. T11-L1 Kidneys

Leg edema affects a 25-year-old woman in her 36th week of pregnancy. What is the most effective first treatment

A) Thoracic inlet release

B) L1 - L3 muscle energy

C) Pedal pump

D) Rib raising to the thoraco-lumbar junction

Correct! Wrong!

Explanation:
The thoracic inlet should be released prior to lymphatic pumping procedures to remove any impedance entering the thoracic duct and, ultimately, the central circulation.

A 30-year-old woman complains of abdominal pain, anorexia, exhaustion, and weakness. A physical examination indicates a hyperpigmented area in the palmar creases, as well as thin axillary hair. Low sodium levels, as well as high potassium and calcium levels, were discovered in the lab. What level of the spine would you expect tissue texture changes as a result of the above condition's viscerosomatic response?

A) T4

B) T10

C) T8

D) L2

Correct! Wrong!

Explanation:
This Pt has Addison's disease, which is a disease of the adrenal gland & would cause a viscerosomatic response at T10.

What level of the spine should a patient with a parathyroid adenoma have checked for a viscerosomatic reflex?

A) T5 - T6

B) T10 - T12

C) T1 - T3

D) T12 - L2

Correct! Wrong!

Explanation:
The viscerosomatic response from the heart, lungs, and esophagus is linked to spinal levels.

Your L thumb is more anterior than your R while analyzing a mid-thoracic SD. When the Pt is in flexion, your thumbs become more symmetrical; however, the discomfort is too strong to inspect the Pt in extension. The following is the most probable Dx:

A) E Rleft Sleft

B) F Rleft Sleft

C) F Rright Sright

D) N Rright Sleft

Correct! Wrong!

Explanation:
The correct Dx is flexed, rotated right, and sidebent right. The L thumb is more anterior in the static evaluation in the neutral position, indicating that the segment is rotated right. The freedoms of motion are flexion, right rotation, and left sidebending because the asymmetry at the segment was rectified with flexion.

For numerous years, a 56-year-old man has suffered with chronic pyrosis and regurgitation after meals. The patient has been taking antacids and over-the-counter famotidine, but they are no longer helping him. The patient admits to drinking five to six beers and four cups of coffee per day, as well as smoking half a pack of cigarettes every day.
These signs and symptoms are common in:

A) Peptic ulcer disease

B) Mallory Weiss syndrome

C) Dyspepsia

D) GERD

Correct! Wrong!

Explanation:
This patient suffers from gastroesophageal reflux disease (GERD). The most common symptom is heartburn, which is resistant to antacids and famotidine in this scenario. Chocolate, coffee, caffeine, fatty foods, peppermint, and alcohol all aggravate the problem.

A 35-year-old woman comes in for a typical PE. When examining her posture from the side, you notice that an imaginary plum line drawn from the ceiling to the floor would pass posterior to the apex of the coronal suture, through the external meatus, through most of the bodies of the C-Spine, through the shoulder joint, through the bodies of the L-Spine, just posterior to the axis of the hip, slightly anterior to the axis of the knee joint, and through the external meatus.
Which of the following statements most accurately characterizes this patient's posture?

A) Ideal posture

B) Flat back posture

C) Anterior postural deviation

D) Military posture

Correct! Wrong!

Explanation:
When observing a Pt from the side, this is a description of ideal posture.

Neck pain is reported by a patient. After a comprehensive examination, you discover that several muscles are in spasm. The most painful muscle arises from the cervical vertebra's TPs and attaches to rib 1.
What kind of muscle is it?

A) Posterior Scalene

B) Sternocleidomastoid

C) Anterior Scalene

D) Longus Colli

Correct! Wrong!

Explanation:
The anteror scalene arises from the posterior tubercle of the C3-C6 TPs and attaches to rib 1

You notice that the thoracic segments T8-T12 are convex to the R in a 41-year-old man with back pain. Which statement about this group's SD is the most accurate?

A) T10's L TP is more caudad compared to its R

B) T9's R TP is more anterior

C) Ribs 7 - 12 are limited in exhalation on the L

D) T9 is Rotated right, Sidebent right

Correct! Wrong!

Explanation:
There is a group dysfunction that is Sidebent left & Rotated right if T8 - T12 have a convexity to the R. Remember that group dysfunctions happen in the neutral plane, and they Sidebent and Rotate to opposing sides in that scenario. T10's left TP will be more caudad than its right TP if it is Sidebent left.

C3 is bent to the left, sidebent, and rotated to the left. How would you position C3 if you were to utilize a direct ME approach to fix this problem?

A) In flexion, Sidebent left, Rotated right

B) In flexion, Sidebent right, Rotated right

C) In extension, Sidebent right, Rotated right

D) In extension, Sidebent left, Rotated left

Correct! Wrong!

Explanation:
All three planes of C3 would be reversed if direct ME Tx was used (i.e. C3 would be placed in such a way that the segment is against its restrictive barrier in all 3 planes). The segment must be flexed, sidebent right, and rotated right in order to conduct conventional ME correctly.

The structural exam indicates the following in a patient with a history of tension HA's: C5 is resistant to L lateral translation. The R articular pillar of C2 resists anterior glide and has a right-sided fullness. What else is most likely true about PE based on the given information?

A) The AA joint is Rotated right

B) C2 is flexed

C) C5 is Rotated left

D) C2 is Rotated left

Correct! Wrong!

Explanation:
C5 resists right sidebending if it resists lateral translation to the L. It's Sidebent left if it resists R sidebending. It has to be Rotated left if it is Sidebent left. Type II mechanics are followed by C5.

Which of the following biomechanical or structural anomalies best explains why a COPD patient has a larger AP chest diameter?

A) The ribs will be pulled superiorly by continuous auxiliary muscle action, resulting in an enlarged thoracic cage.

B) As a compensatory strategy for chronic deoxygenation of peripheral tissues, the thoracic cage expands physiologically.

C) Chronic hypoxia causes fibrotic alterations in the diaphragm, resulting in a flattened diaphragm and greater overall lung capacity.

D) Permanent inhaled rib positions come from the loss of elastic fibers and continuous air trapping.

Correct! Wrong!

Explanation:
Years of smoking cause the destruction of elastic fibers (an emphysema type of COPD). Irritation of the lung parenchyma can cause an overproduction of mucus, obstructing the airway and trapping the air (chronic bronchitis & asthma type of COPD). These two factors expand the chest cavity and enhance lung capacity, causing the ribs to be permanently positioned in inhalation.

A 54-year-old man comes into your office complaining of acute low back discomfort. The ache began while he was working on his automobile the day before yesterday and has now spread to his lower extremities. What additional information in this patient's Hx would have the most impact on the immediate Dx and Tx?

A) Presence of incontinence

B) Down-going plantar response w/ Babinski's testing

C) Unilateral loss of cremasteric reflex

D) Loss of Achilles reflex

Correct! Wrong!

Explanation:
A patient's low back pain that spreads to both lower extremities could be neurogenic or musculoskeletal. The most crucial item to rule out of all the neurogenic or musculoskeletal possibilities is Cauda Equina Syndrome (CES). The CES is caused by the trapping of the SC's terminal nerve roots. This could be the result of a herniated central disc. Incontinence can occur if the S2-S4 nerve roots are affected. If this happens, surgical decompression should be performed right away. If decompression is delayed, incontinence may become irreversible.

Direct compression of which of the following peripheral nerves can be caused by a posterior fibular head dysfunction?

A) Sciatic

B) Tibial

C) Common fibular (aka common peroneal)

D) Sural

Correct! Wrong!

Explanation:
The common fibular nerve (also known as the common peroneal nerve) runs behind the fibular head. Foot drop can be caused by a posterior fibular head dysfunction that puts pressure on the common fibular nerve.

Which of the following motions will be most affected by plexopathy involving the medial chord of the brachial plexus?

A) Finger abduction

B) Shoulder abduction

C) Elbow flexion

D) Shoulder external rotation

Correct! Wrong!

Explanation:
C8, T1, and muscles innervated by the median and ulnar nerves are likely to be affected if the medial cord of the brachial plexus is injured. Finger abduction is controlled by the hand's interossi muscles. The interossi are innervated by the ulnar nerve.

Which of the following statements about a patient with an anterior fibular head SD is correct?

A) The SD will enhance the amount of plantar flexion that is passive.

B) It can cause a foot drop.

C) The synovial articulation of the tibio-fibular joint resists posterior glide.

D) It's very common in typical ankle sprains.

Correct! Wrong!

Explanation:
There are two articulations in the tibio-fibular joint. The distal articulation is syndesmotic, while the proximal articulation is synovial. The proximal tibio-fibular articulation will be shifted anteriorly and will resist posterior glide in an anterior fibular head dysfunction.

Tender lumps along the distal palmar crease of a 54-year-old alcoholic male Pt's hand. The ring finger has subcutaneous lumps and palmar fascia contracture, as seen on a PE. What is the most likely Dx?

A) Heberden node

B) DeQuervain's disease

C) Bouchard's node

D) Dupuytren's contracture

Correct! Wrong!

Explanation:
Dupuytren's contracture is seen in this patient. Palmar fascia contracture and nodule development define this syndrome. There appears to be a genetic predisposition to alcoholism, and it is common among alcoholics.

A patient appears with an absent triceps tendon reflex and weakness in the extensors of the hand, wrist, and elbow due to a neurological deficiency. Which nerve is the most likely to be affected?

A 50-year-old man is experiencing low back pain. On examination, the TP of L5 is seen to be posterior on the R. The asymmetry is worsened by extending L5, but flexion restores rotational symmetry. Which of the following statements about this Pt's SD is the most accurate?

The malfunctioning T12 segment has limitation in a transverse plane and around a transverse axis in a patient with low back pain. T12's position best describes which of the following dysfunctions?

In which plane(s) does the 1st cervical segment (AA) have the most degree of freedom?

Which of the following is regarded the most frequent L-Spine congenital anomaly?

Guyon's canal nerve entrapment is likely to result in:

Chronic renal insufficiency affects a 45-year-old diabetic male. An analysis of the structure is likely to reveal:

Leg edema affects a 25-year-old woman in her 36th week of pregnancy. What is the most effective first treatment

What level of the spine should a patient with a parathyroid adenoma have checked for a viscerosomatic reflex?

Your L thumb is more anterior than your R while analyzing a mid-thoracic SD. When the Pt is in flexion, your thumbs become more symmetrical; however, the discomfort is too strong to inspect the Pt in extension. The following is the most probable Dx:

Neck pain is reported by a patient. After a comprehensive examination, you discover that several muscles are in spasm. The most painful muscle arises from the cervical vertebra's TPs and attaches to rib 1. What kind of muscle is it?

You notice that the thoracic segments T8-T12 are convex to the R in a 41-year-old man with back pain. Which statement about this group's SD is the most accurate?

C3 is bent to the left, sidebent, and rotated to the left. How would you position C3 if you were to utilize a direct ME approach to fix this problem?

The structural exam indicates the following in a patient with a history of tension HA's: C5 is resistant to L lateral translation. The R articular pillar of C2 resists anterior glide and has a right-sided fullness. What else is most likely true about PE based on the given information?

Which of the following biomechanical or structural anomalies best explains why a COPD patient has a larger AP chest diameter?

Direct compression of which of the following peripheral nerves can be caused by a posterior fibular head dysfunction?

Which of the following motions will be most affected by plexopathy involving the medial chord of the brachial plexus?

Which of the following statements about a patient with an anterior fibular head SD is correct?

Tender lumps along the distal palmar crease of a 54-year-old alcoholic male Pt's hand. The ring finger has subcutaneous lumps and palmar fascia contracture, as seen on a PE. What is the most likely Dx?

Neck pain is reported by a patient. After a comprehensive examination, you discover that several muscles are in spasm. The most painful muscle arises from the cervical vertebra's TPs and attaches to rib 1.
What kind of muscle is it?