COMLEX-USA Practice Test Flashcards

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?

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

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?

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.

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?

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.

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?

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.

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

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.

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

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.

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

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.

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?

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.

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

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

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

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.

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?

Answer: L2

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?

Answer: T1 - T3

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:

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.

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:

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.

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?

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.

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?

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.

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?

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.

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?

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.

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?

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.

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

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.