COMLEX-USA Practice Test — Questions and Answers

Question 1: 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?

Radial (Correct answer)
Musculocutaneous
Axillary
Median

Correct answer: Radial

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

Question 2: 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 Pt would be requested to rotate his torso to the L against isometric contraction when using a muscular energy (post-isometric relaxation) approach.
In the stretched posture, L5 will oppose L-rotation. (Correct answer)
A group dysfunction of the high Lumbar area will be present because to the non-neutral L5 SD.
This patient has psoas syndrome on the right side.

Correct answer: In the stretched posture, L5 will oppose L-rotation.

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.

Question 3: 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?

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.
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.
Palpation reveals a dull ache. Straight leg raising test results were positive.
Warm tissue alterations, hypertonic muscles, and reduced L-Spine ROM (Correct answer)

Correct answer: Warm tissue alterations, hypertonic muscles, and reduced L-Spine ROM

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.

Question 4: 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?

R is sidebent T12.
T12 is flexed
T12 is rotated R and sidebent R. (Correct answer)
T12 is rotated to the left.

Correct answer: T12 is rotated R and sidebent R.

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.

Question 5: In which plane(s) does the 1st cervical segment (AA) have the most degree of freedom?

Sagittal
Oblique
Transverse & Coronal
Transverse (Correct answer)

Correct answer: Transverse

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.

Question 6: Which of the following is regarded the most frequent L-Spine congenital anomaly?

Facet tropism (Correct answer)
Spina bifida occulta
Lumbarization
Facet hypertorphy

Correct answer: Facet tropism

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.

Question 7: Guyon's canal nerve entrapment is likely to result in:

Weakness in wrist flexion
Weakness in wrist adduction
Weakness in the thumb abductor
Weakness in finger abduction (Correct answer)

Correct answer: Weakness in finger abduction

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.

Question 8: 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?

Release of celiac ganglion
To the thoraco-lumbar junction, rib raising & paraspinal inhibition (Correct answer)
Sacral inhibition
Release of the pelvic diaphragm

Correct answer: To the thoraco-lumbar junction, rib raising & paraspinal inhibition

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.

Question 9: Chronic renal insufficiency affects a 45-year-old diabetic male. An analysis of the structure is likely to reveal:

T5 and T6 have severe acute tender points.
Ropy paraspinals at C3
T10 - L1 ropy paraspinals (Correct answer)
T8 and T9 fibrotic paraspinals

Correct answer: T10 - L1 ropy paraspinals

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

Question 10: Leg edema affects a 25-year-old woman in her 36th week of pregnancy. What is the most effective first treatment

Thoracic inlet release (Correct answer)
L1 - L3 muscle energy
Pedal pump
Rib raising to the thoraco-lumbar junction

Correct answer: Thoracic inlet release

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.

Question 11: 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?

T4
T10
T8
L2 (Correct answer)

Correct answer: L2

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

Question 12: What level of the spine should a patient with a parathyroid adenoma have checked for a viscerosomatic reflex?

T5 - T6
T10 - T12
T1 - T3 (Correct answer)
T12 - L2

Correct answer: T1 - T3

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

Question 13: 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:

E Rleft Sleft
F Rleft Sleft
F Rright Sright (Correct answer)
N Rright Sleft

Correct answer: F Rright Sright

The finding "L thumb is more anterior than your R" indicates that the left transverse process is anterior, meaning the vertebra is rotated to the right (Rright). The statement "discomfort is too strong to inspect the Pt in extension" suggests a restriction in extension, implying the vertebra is stuck in flexion (F). According to Fryette's Type II mechanics for non-neutral dysfunctions, rotation and sidebending occur to the same side. Therefore, if the vertebra is flexed and rotated right, it must also be sidebent right (Sright), leading to a diagnosis of F Rright Sright.

Question 14: 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:

Peptic ulcer disease
Mallory Weiss syndrome
Dyspepsia
GERD (Correct answer)

Correct answer: GERD

The patient's chronic symptoms of pyrosis (heartburn) and regurgitation after meals, persisting despite antacid and H2 blocker use, are classic indicators of Gastroesophageal Reflux Disease (GERD). Lifestyle factors like daily alcohol, coffee, and cigarette consumption are known to exacerbate GERD symptoms. While other conditions like peptic ulcer disease or dyspepsia can share some symptoms, the chronic nature and specific presentation of heartburn and regurgitation strongly point to GERD.

Question 15: 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?

Ideal posture (Correct answer)
Flat back posture
Anterior postural deviation
Military posture

Correct answer: Ideal posture

The described path of the imaginary plum line through specific anatomical landmarks (posterior to coronal suture, through external meatus, C-spine bodies, shoulder joint, L-spine bodies, posterior to hip axis, anterior to knee joint, and through external malleolus) precisely defines ideal posture. This alignment minimizes stress on joints and muscles, indicating optimal biomechanical balance. Any significant deviation from this line would characterize other postural types like flat back or military posture.

Question 16: 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?

Posterior Scalene
Sternocleidomastoid
Anterior Scalene (Correct answer)
Longus Colli

Correct answer: Anterior Scalene

The question describes a muscle originating from the transverse processes of cervical vertebrae and attaching to the first rib. This anatomical description perfectly matches the anterior scalene muscle, which typically originates from the transverse processes of C3-C6 and inserts onto the first rib. The middle scalene also attaches to the first rib but usually originates from C2-C7, while the posterior scalene attaches to the second rib.

Question 17: 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?

T10's L TP is more caudad compared to its R (Correct answer)
T9's R TP is more anterior
Ribs 7 - 12 are limited in exhalation on the L
T9 is Rotated right, Sidebent right

Correct answer: T10's L TP is more caudad compared to its R

A convexity to the right in the thoracic spine (T8-T12) indicates that the spine is sidebent to the left (Sleft). For a group dysfunction (Type I mechanics), sidebending and rotation occur in opposite directions. Therefore, if sidebent left, the group is rotated right (Rright). In a sidebent left dysfunction, the transverse processes on the left side become more caudad (inferior) compared to the right, as the left side of the vertebral bodies approximates. Thus, T10's L TP being more caudad than its R is consistent with sidebending left.

Question 18: 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?

In flexion, Sidebent left, Rotated right
In flexion, Sidebent right, Rotated right (Correct answer)
In extension, Sidebent right, Rotated right
In extension, Sidebent left, Rotated left

Correct answer: In flexion, Sidebent right, Rotated right

The dysfunction described as "C3 is bent to the left, sidebent, and rotated to the left" implies that the vertebra is stuck in an extended position, sidebent left, and rotated left (E Sleft Rleft). For a direct muscle energy (ME) approach, the patient is positioned into the restrictive barrier. The restrictive barriers for an E Sleft Rleft dysfunction are flexion, sidebending right, and rotation right. Therefore, the correct position for direct ME treatment is in flexion, sidebent right, and rotated right.

Question 19: 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?

The AA joint is Rotated right
C2 is flexed
C5 is Rotated left (Correct answer)
C2 is Rotated left

Correct answer: C5 is Rotated left

The finding that "C5 is resistant to L lateral translation" means that the vertebral body is shifted to the right, indicating it is sidebent to the left (Sleft). In the cervical spine, sidebending and rotation are coupled to the same side (Type II mechanics). Therefore, if C5 is sidebent left, it is also rotated left (Rleft). This makes 'C5 is Rotated left' a direct and accurate deduction from the given physical exam information.

Question 20: Which of the following biomechanical or structural anomalies best explains why a COPD patient has a larger AP chest diameter?

The ribs will be pulled superiorly by continuous auxiliary muscle action, resulting in an enlarged thoracic cage.
As a compensatory strategy for chronic deoxygenation of peripheral tissues, the thoracic cage expands physiologically.
Chronic hypoxia causes fibrotic alterations in the diaphragm, resulting in a flattened diaphragm and greater overall lung capacity.
Permanent inhaled rib positions come from the loss of elastic fibers and continuous air trapping. (Correct answer)

Correct answer: Permanent inhaled rib positions come from the loss of elastic fibers and continuous air trapping.

In COPD, the loss of elastic fibers in the lungs and airways leads to chronic air trapping and hyperinflation. This persistent hyperinflation causes the diaphragm to flatten and the ribs to be held in a continuously elevated, inhaled position. This sustained 'inhaled' rib position is what contributes to the characteristic increase in the anterior-posterior (AP) chest diameter, commonly known as a barrel chest.

Question 21: 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?

Presence of incontinence (Correct answer)
Down-going plantar response w/ Babinski's testing
Unilateral loss of cremasteric reflex
Loss of Achilles reflex

Correct answer: Presence of incontinence

The spread of low back pain to the lower extremities, combined with the presence of incontinence, is a critical red flag for Cauda Equina Syndrome. This condition involves compression of the nerve roots in the lumbar spine, leading to neurological deficits including bowel and bladder dysfunction. Cauda Equina Syndrome is a surgical emergency requiring immediate diagnosis and intervention to prevent permanent neurological damage, making incontinence the most impactful information for immediate diagnosis and treatment.

Question 22: Direct compression of which of the following peripheral nerves can be caused by a posterior fibular head dysfunction?

Sciatic
Tibial
Common fibular (aka common peroneal) (Correct answer)
Sural

Correct answer: Common fibular (aka common peroneal)

The common fibular nerve (also known as the common peroneal nerve) is particularly vulnerable to compression as it wraps superficially around the neck of the fibula, just distal to the fibular head. A posterior fibular head dysfunction involves the fibular head being displaced backward, which can directly impinge upon and compress this nerve. Compression of the common fibular nerve can lead to symptoms such as foot drop and sensory deficits in the anterolateral leg and dorsum of the foot.

Question 23: Which of the following motions will be most affected by plexopathy involving the medial chord of the brachial plexus?

Finger abduction (Correct answer)
Shoulder abduction
Elbow flexion
Shoulder external rotation

Correct answer: Finger abduction

The medial cord of the brachial plexus gives rise to the ulnar nerve and the medial root of the median nerve. The ulnar nerve is responsible for innervating most of the intrinsic muscles of the hand, including the dorsal and palmar interossei, which are crucial for finger abduction and adduction. Therefore, plexopathy involving the medial cord would most significantly affect finger abduction due to ulnar nerve compromise.

Question 24: Which of the following statements about a patient with an anterior fibular head SD is correct?

The SD will enhance the amount of plantar flexion that is passive.
It can cause a foot drop.
The synovial articulation of the tibio-fibular joint resists posterior glide. (Correct answer)
It's very common in typical ankle sprains.

Correct answer: The synovial articulation of the tibio-fibular joint resists posterior glide.

An anterior fibular head somatic dysfunction means the fibular head is displaced anteriorly relative to the tibia. In this position, the proximal tibiofibular joint, which is a synovial articulation, will be at its anterior limit of motion. Consequently, any attempt to move the fibular head posteriorly (a posterior glide) will be met with resistance, as it is already restricted in that direction.

Question 25: 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?

Heberden node
DeQuervain's disease
Bouchard's node
Dupuytren's contracture (Correct answer)

Correct answer: Dupuytren's contracture

The patient's symptoms of tender lumps along the distal palmar crease, subcutaneous lumps, and palmar fascia contracture, particularly affecting the ring finger, are classic signs of Dupuytren's contracture. This condition involves progressive fibrosis and shortening of the palmar fascia, leading to flexion deformities of the fingers. The patient's history of alcoholism is also a known risk factor for Dupuytren's contracture.

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?