Prep for High COMLEX Scores: Test Your Knowledge with These Sample COMLEX Questions

Visit MomMD's NBOME COMLEX page for general COMLEX information and resources or, if you've already been hard at work with your COMLEX prep, you may be ready to test your knowledge with this sampling of over 60 case-based COMLEX questions. Answers are provided below.

Case 1 (Sample COMLEX Questions 1 through 4)

1. A 47 year-old woman presents to your office reporting shortness of breath. During the course of the physical examination, you note that there is an increased thoracic kyphosis. As you auscultate the chest, you also note that the kyphosis remains unchanged with inhalation. The normal motion of the thoracic spine with inhalation is:

A. Increasing kyphosis

B. Decreasing kyphosis

C. Kyphosis remains unchanged

2. As you auscultate the heart, you note an irregularly irregular rhythm consistent with atrial fibrillation. At what spinal levels would you expect to find viscerosomatic reflex changes as a result of this cardiac condition?

A. T1 to T4

B. T5 to

C. T10 to L2

D. L3 to S1

E. S2 to S4

3. As you palpate the paravertebral tissues at the involved spinal levels, what changes would you expect to find if this cardiac dysrhythmia were due to an acute myocardial infarction?

A. Skin warm, fascia tense immobile, muscle hard and ropy, slight dull tenderness

B. Skin warm, increased muscle tension, superficial tenderness, edematous feel

C. Tenderness elicited on deep palpation, skin cool to touch, fascias fibrotic

D. Joint ankylosis, warm skin, superficial tenderness, edema

E. Tenderness on deep palpation, muscles feel boggy or doughy, fascia fibrotic

4. On examining this patient's cervical region, you discover segmental dysfunction at C3, C4, and C5. A somatosomatic reflex from these segments could cause hyper tonicity and dysfunction of which of the following muscles:

A. Extensor carpi radialis longus and brevis mm.

B. Triceps m.

C. Flexor digitorum superficialis m.

D. Diaphragm

E. Rectus capitis obliquius m.

Case 2 (Sample COMLEX Question 5)

5. A 75 year-old woman presents to your office with pain in the shoulder. On examining the shoulder, you find no evidence of shoulder pathology. On auscultation of the chest, you discover a pleural rub in the lung base. The innervation of the pleura covering the central tendon of the diaphragm is:

A. The sixth intercostal nerve

B. The right vagus

C. The eighth intercostals nerve

D. The phrenic nerve

E. The tenth intercostals nerve

Case 3 (Sample COMLEX Questions 6 through 7)

6. A 53 year-old man presents to your office with facial pain which follows the maxillary division of the trigeminal nerve. The pain is sudden and lancinating and makes the patient wince and on occasion cry out with sudden distress. It is triggered by chewing, talking and even breezes blowing on the face. Lightly touching the patient's cheek reproduces the pain. Diagnosis:

A. Trigeminal neuralgia

B. Facial neuralgia

C. Glossopharyngeal neuralgia

D. C2 radiculitis

E. Optic neuritis

7. The pain began following extraction of a lower molar three months ago. This extraction commonly causes which of the following cranial bone dysfunctions?

A. Zygoma

B. Palatines

C. Ethmoid

D. Frontal

E. Temporal

8. Dysfunction of the radial head most commonly causes loss of which of the following motions:

A. Elbow flexion

B. Wrist flexion

C. Shoulder abduction

D. Forearm supination

E. Elbow extension

Case 4 (Sample COMLEX Question 9)

9. A 36 year-old man presents to your office 24-hours after being involved in a motor vehicle accident and sustaining a whiplash type injury to his neck. He was driving a 1995 American vehicle. He was restrained by both seat belt and shoulder harness. His car was struck behind by a fully loaded lumber truck. The rear axle of his car was pushed forward until it was positioned just behind his headrest. In addition to neck pain, he is also experiencing chest discomfort and palpitations. Cardiac auscultation reveals a regular heart rate of 40 bpm. Injury which irritates this structure during the whiplash mechanism could be the source of his bradycardia?

A. Phrenic nerve

B. Esophagus

C. Cardiophrenic ligament

D. Brachial plexus

E. Vagus nerve

Case 5 (Sample COMLEX Question 10)

10. A 40 year-old woman is seen in your office with chronic headaches as her primary symptom. The headache is described as continuous and non-pulsatile. It is occipito-frontal in location and creates a tightness or squeezing sensation in the head. It is worst in the morning and again in the late afternoon. The headache is relieved by rest, has no premonitory signs or symptoms and is unassociated with nausea, photophobia or hyperacusis. Neurologic examination of this patient is normal. Diagnosis:

A. Classic migraine headache

B. Muscle contraction headache

C. Common migraine

D. Cluster headache

E. Cephalgia fugax

Case 6 (Sample COMLEX Questions 11 through 13)

11. A 60 year-old man presents to the emergency room with chest pain and shortness of breath. ECG findings are suggestive of myocardial ischemia, but not definitive. While waiting for coronary enzymes to come back you examine the patient structurally. He is only 45 minutes from the onset of his pain. You would expect to find which of the following if he has an acute cardiac ischemic event?





E. R2InR

12. Enzymes come back consistent with acute myocardial infarction. Manipulative support of the patient who has suffered an acute MI should consist of:

A. HVLA techniques directed only at levels of viscerosomatic reflex activity.

B. Thoracic pump techniques to improve rib cage mobility, especially if CPR has been previously necessary.

C. Indirect techniques to reduce the risk of hypersympathecotonia.

D. Muscle energy techniques directed to any costal dysfunctions.

E. Sphenobasilar decompression and synchronous rotation of the temporal bones.

13. Structural examination of this patient should also pay special attention to which of the following areas because of the impact of dysfunction on the parasympathetic nerve supply to the heart:

A. Thoracolumbar junction

B. Mid-thoracic region

C. Upper thoracic spine

D. Typical cervical segments (C3 to C7)

E. Suboccipital region

Case 7 (Sample COMLEX Questions 14 through 15)

14. Your patient presents to you with symptoms of medial elbow pain and decreased grip strength. Your only finding on the physical examination is flattening of the palmar arches. Disease involving which of the following nerve roots would result in this set of findings?

A. C6

B. C3

C. T1

D. C7

E. C5

15. On further systemic examination you note that the patient has findings consistent with a Horner's syndrome on the same side as the elbow pain. You now suspect which of the following diagnoses?

A. Paraneoplastic syndrome

B. Thoracic outlet syndrome due to the first rib held in an inhalation position

C. Pancoast tumor

D. Thoracic outlet syndrome due to caudad displacement of the distal clavicle

E. Pseudotumor cerebri

16. Which of the following diagnoses is consistent with a Positive Lumbar Spring Test?

A. Anterior sacral torsion about a left oblique axis

B. Bilaterally extended sacrum

C. Unilaterally flexed sacrum

D. Sacral base anterior

E. Anterior rotation of the in nominate

17. Genu varum is associated with which of the following conditions?

A. Pes planus

B. Fibular nerve compression

C. Slipped capital femoral epiphyses

D. Foot drop

E. Anterior displacement of the proximal fibula

18. Which of the following is NOT a diagnostic criterion for osteoarthritis?

A. Age over 50 years

B. Joint stiffness after periods of inactivity lasting less than 30 minutes

C. Warm, fluctuant swelling

D. Crepitus with motion

E. Bony enlargement

Case 8 (Sample COMLEX Question 19)

19. A 53 year-old man comes to your office complaining of vertex headaches. He was struck in the head 6 months ago by a 40 pound pipe, which fell from an overhead storage rack. The blow was struck to the left superior frontal area. When asked to point to his areas of pain, he indicates a line extending from the lambda to the bregma and then for an inch or so along the left coronal suture. On physical examination he appears to be suffering from simple sutural compression. Which of the following cranial techniques would NOT be appropriate for this case?

A. Direct sutural disengagement

B. Molding technique

C. Combined technique, starting indirect exaggeration and finishing with direct disengagement

D. Direction of fluid technique

E. Oppose physiologic motion

Case 9 (Sample COMLEX Question 20)

20. A 72 year-old man presents to your office with lower back pain localized to the sacral region. He was walking down the street window shopping. When he reached the end of the block, there was a large puddle in the street that he leapt over. As soon as his right heel struck the pavement, he experienced acute sharp lower back pain. He has had pain and a limp ever since. On physical examination there is a moderate increase in the lumbar lordosis. Standing flexion test is negative. Seated flexion test is positive on the right. Lumbar spring test is negative. The sacral sulcus is deeper on the right. The inferior lateral angle is caudad and posterior on the left. Transverse process of L5 is posterior on the right. Diagnosis:

A. Anterior sacral torsion about a left oblique axis

B. Right on right sacral torsion

C. Posterior sacral torsion about a right oblique axis

D. Left on right sacral torsion

E. Anterior sacral torsion about a right oblique axis

Case 10 (Sample COMLEX Question 21)

21. A four year-old child is brought to you with an acute pharyngitis. In addition to appropriate medical management, you treat him with osteopathic techniques to enhance his immune responses to the infection. Shortly after they arrive home, the child spikes a fever to 102 degrees F. The parents call you wanting to know what this sudden fever means. You reply:

A. It is normal following osteopathic treatment of an acute infection in a child and will subside and return to normal very soon.

B. It means the infection has spread and the child should be re-examined immediately.

C. It means there has been spread of the infection to the meninges and the child should be taken to the nearest emergency room immediately.

D. It means the antibiotic is not working and you need to switch to another anti infective agent.

E. It means the child is allergic to the antibiotic and a change in drug should be made.

Case 11 (Sample COMLEX Questions 22 through 25)

22. A 72 year-old man presents to your office following a fall at home three days age. He has injured his shoulder. X-rays obtained in the emergency room revealed no evidence of fracture and the orthopedic surgeon told him it was a simple muscle strain. He was given acetaminophen 325 mg with codeine 30 mg to be used as needed for pain. This morning he woke to discover an erythematous, multiracial rash on both anterior shin regions. You feel the patient is having an allergic reaction, most likely to codeine. At what spinal levels might you expect to find somatic dysfunction which could have contributed to reflex trophic influences that resulted in the rash "choosing" this location?

A. L4 & L5

B. Sacroiliac joint

C. L1, L2 &L3

D. T6 to T9

E. T1 to T5

23. Many patients in this age group have impaired circulation in the lower extremities. Segmental dysfunction at what spinal levels would cause increased vasoconstriction in the legs?

A. T11 to L2

B. L3 to S1

C. S2 to S4

D. S5 & Coccygeal nn.

E. Occiput, C1 & C2

24. To promote improved lymphatic drainage of the lower extremities, attention should first be directed to the site of terminal lymphatic drainage at the:

A. Cisterna chili

B. Inguinal lymph nodes

C. Thoracic inlet

D. Diaphragm

E. Pelvic diaphragm

25. One commonly used technique which promotes venous and lymphatic drainage of the lower extremities, is the pedal pump (Dalrymple technique). Which of the following is a contraindication to use of this technique?

A. Psoriasis

B. Venous insufficiency of the lower extremities

C. Deep vein thrombophlebitis of the calf

D. Compensated congestive heart failure

E. Tearing of the medial meniscus

Case 12 (Sample COMLEX Questions 26 through 27)

26. A 51 year-old man presents to your office following a minor motor vehicle accident in which his car was tapped from behind while he was stopped at a toll booth. There was no damage to either vehicle. He felt no pain immediately after the accident, but awoke the next morning with some neck stiffness. The following day his neck was quite stiff and painful. You diagnose a "Jolt Syndrome" in which the force of the impact was low, but the driver's seat back acted as a spring catapult, magnifying the effect of the impact. Physical examination reveals a somatic dysfunction at the occipitoatlantal level. While positioning this patient to correct the dysfunction using a thrust technique, the patient develops a diplopia and sees flashing lights. Vertigo follows along with dysarthria. This indicates which of the following?

A. Normal response to a severe OA dysfunction

B. Strong emotional overlay complicating the minor injuries

C. Positional vertebral basilar insufficiency, abort the technique

D. OA dysfunction creating secondary cranial dysfunction with neurologic symptomatology

E. None of the above

27. Your patient is not a dwarf, but x-rays of the cervical spine reveal a grade 1 spondylolisthesis of C4 on C5. The most common etiology of spondylolisthesis in this location is:

A. Pars interarticularis defect

B. Degenerative disc disease

C. Fracture subluxation

D. Facet dislocation with overriding

E. Congenital elongation of the pedicles

Case 13 (Sample COMLEX Questions 28 through 31)

28. A 23 year-old man presents to your office six months after being struck in the head by a line drive while playing baseball. He was facing away from the batter for a moment and was struck squarely in the back of the head just above the inion. He was knocked unconscious for about 15 minutes and taken to the local hospital for evaluation. Neurologic exam was normal and he was discharged with a diagnosis of cerebral concussion. He is now experiencing profound depression, distractibility, increased sensitivity to lack of sleep, fatigue, noise, stress and the effects of medications or alcohol. He finds he has no drive and lacks initiative. He is frequently impatient with others, which is not like he used to be. He has experienced a distressing loss of his libido. He has frequent episodes of double vision. He has constant headaches which wax and wane in intensity. His coordination is off; he would not even attempt to play baseball now. Diagnosis:

A. Suspicion of epidural hematoma

B. Chronic subdural hematoma

C. Subdural hygroma

D. Post-concussion syndrome

E. Traumatic frontal lobe infarction

29. In this case cranial manipulation is:

A. Not indicated

B. Indicated to treat the headache, but of no help for the other symptoms

C. Dangerous and may cause neurologic deterioration or death

D. Somewhat helpful

E. Curative

30. Evaluation of the cranial base reveals a fixed extension pattern. The cranial rhythmic impulse has a rate of 5 cpm with a very poor amplitude. This is consistent with sphenobasilar:

A. Torsion

B. Sidebending

C. Compression

D. Lateral strain

E. Vertical strain

31. This patient has also been experiencing gastrointestinal upset since the head trauma. At first he was told it was due to the concussion and headache, but it has persisted. Cranial dysfunction impinging on which of the following foramina could be responsible for these symptoms?

A. Optic foramen

B. Foramen rotundum

C. Foramen ovale

D. Stylomastoid foramen

E. Jugular foramen

Case 14 (Sample COMLEX Question 32)

32. A 24 year-old woman presents to your office reporting inability to achieve orgasm. She has been thoroughly evaluated for physical disease and none has been found. A series of sessions with a psychologist likewise failed to reveal any psychological reason for this condition. She is now inquiring as to whether manipulation of some sort might be helpful for this problem. On physical examination you discover the following:

  • Standing flexion test Negative
  • Seated flexion test Positive on the right
  • Sacral sulcus Deep on the left
  • Inferior lateral angle Posterior & inferior on the right
  • Lumbar spring test Positive
  • Palpation of the sacral sulci in the Sphinx position exaggerates the asymmetry of the sacral sulci
  • Transverse process of L5 Posterior on the left


A. Anterior sacral torsion on a right oblique axis

B. Left on right sacral torsion

C. Posterior sacral torsion on a left oblique axis

D. Unilateral flexed sacrum on the right

E. Unilateral extended sacrum on the right

Case 15 (Sample COMLEX Questions 33 through 34)

33. Should a patient develop complications from the use of NSAID's to treat a disease, which of the following dysfunctions would be the result of a viscerosomatic reflex emanating from gastric mucosal erosion or ulceration?






34. A somatic dysfunction designated T11ESRRR should indicate NSAID induced toxicity of which of the following organs?

A. Lower lungs

B. Kidneys

C. Duodenum

D. Liver

E. Heart

Case 16 (Sample COMLEX Questions 35 through 36)

35. A four week old infant is brought to you with difficulty feeding. The child has a weak suck response and spits up after every feeding. Forceps were used in the delivery of the child. What common cranial dysfunction would adversely affect the function of the hypoglossal nerve?

A. Sphenobasilar compression

B. Condylar compression

C. Superior vertical strain

D. External rotation of the frontal bones

E. Sagittal compression

36. The glossopharyngeal nerve may be responsible for the symptoms described via entrapment in which of the following foramina due to fixed internal rotation of the temporal bone?

A. Foramen rotundum

B. Styloid foramen

C. Foramen spinosum

D. Jugular foramen

E. Foramen ovale

Case 17 (Sample COMLEX Questions 37 through 41)

37. A 19 year-old runner turns her ankle on uneven ground. She sustains a fairly typical, but severe, lateral ankle sprain. There is exquisite pain just proximal to the ankle joint on the anterior surface of the leg. This pain is relieved by compressing the medical and lateral malleoli together. This is diagnostic of an injury to the:

A. Inferior extensor retinaculum

B. Extensor digit rum longus tendon

C. Tibiocalcaneal ligament

D. Tibiofibular syndosmosis

E. Calcaneofibular ligament

38. You discover a fairly typical dysfunction which commonly accompanies the lateral ankle sprain:

A. Posterior displacement of the proximal fibula

B. Anterior displacement of the tibia on the talus

C. Anterior displacement of the proximal fibula

D. Posterior displacement of the tibia on the talus

E. Plantar displacement of the third cuneiform

39. Four weeks after the injury, this patient is still experiencing pain beyond what would be expected for this time in her recovery. Her pain is localized to the area just beneath the anterior talofibular ligament. This is the location of the:

A. Mortise and tenon joint of the ankle

B. Upward extension of the calcaneal bursa

C. Sinus tarsi

D. Anterior enthesopathy from ulcerative colitis

E. Tibiofibular nerve

40. Pain in this location may be due to a trigger point located in the:

A. Soleus m.

B. Extensor digit rum brevis m.

C. Fibularis (Peroneus) longus m.

D. Fibular is (Peroneus) brevis m.

E. Abductor digiti minimi m.

41. The Fibularis (Peroneus) longus tendon may be put under increased tension by which of the following dysfunctions commonly associated with lateral ankle sprain?

A. Posterior displacement of the proximal fibula

B. Plantar displacement of the styloid end of the fifth metatarsal

C. Plantar rotation of the cuboids

D. Plantar rotation of the navicular

E. Plantar displacement of the proximal end of the third metatarsal

Case 18 (Sample COMLEX Questions 42 through 45)

42. A 78 year-old patient presents with coronary insufficiency and chronic congestive heart failure. Today he is experiencing increased dyspnea due to pulmonary edema. The pulmonary lymphatic tree empties into the systemic venous circulation:

A. Through the right lymphatic duct

B. Through the left lymphatic duct

C. At the hilum

D. Through the aortic hiatus of the diaphragm, emptying into the cisterna chili

E. Directly into the superior vena cava

43. Pulmonary edema may be the result of obstruction to lymphatic drainage by dysfunction in which of the following areas?

A. T5 to T9 left

B. First rib right

C. Left sternocleidomastoid m.

D. Diaphragmatic flattening

E. Sacrum

44. The pulmonary edema may be reduced by techniques which enhance lymphatic flow. This includes:

A. Pectoral traction

B. Treatment of any dysfunction at the C2 level

C. CV-4

D. Paraspinal inhibition applied to T1 to T6

E. Indirect techniques applied to any cervical segmental dysfunction

45. Many elderly, especially women, suffer from an increasing thoracic kyphosis as part of the aging process and accompanying osteoporosis. At what Cobb angle does venous return to the heart become significantly impaired by the structural deformity?

A. 60 degrees

B. 50 degrees

C. 40 degrees

D. 30 degrees

E. 20 degrees

Case 19 (Sample COMLEX Questions 46 through 48)

46. What should be the daily intake of an osteoporitic woman?

A. 1000 mg of elemental calcium daily

B. 1500 mg of elemental calcium daily

C. 2000 mg of elemental calcium daily

D. 2000 mg of calcium carbonate daily

E. 3000 mg of calcium carbonate daily

47. In the presence of normal laboratory values, the best form of exercise for a patient of this age and in this condition is:

A. Aquatic exercise

B. Use of an exercycle

C. Use of a cross country ski machine

D. Williams flexion exercises

E. Walking ½ mile daily to every other day

48. Which of the following coexisting conditions could have contributed to her current osteopenic condition?

A. Hypergonadism

B. Hypoadrenocorticism

C. Hypoparathyroidism

D. Hyperthyroidism

E. Chronic coumarin administration

Case 20 (Sample COMLEX Questions 49 through 52)

49. A 47 year-old woman presents to your office with painful paresthesias of her right hand. She is a golf professional on the women's PGA tour and plays at least one round of golf almost daily. She is currently under treatment for hypothyroidism. Physical examination reveals atrophy of the radial side of the thenar eminence, and sensory changes I the first 3 ½ digits of the right hand. Phalen's test is positive. Prayer sign or reverse Phalen test is also positive. Tinel's sign at the median nerve is negative. Diagnosis:

A. Cubital tunnel syndrome

B. Dupuytren's contracture

C. Thoracic outlet syndrome

D. Volkmann's ischemic contracture

E. Carpal tunnel syndrome

50. Severity of this condition can be determines using:

A. Electromyography

B. MRI of the region

C. Nerve Conduction Velocities

D. CT of the region

E. Plain film x-rays

51. Osteopathic manipulative treatment to help this condition would include:

A. Treatment of somatic dysfunction at Occiput to C2 to remove potential vagal influences

B. Treatment of somatic dysfunction at C3 to C5 to reduce spinal cord facilitation of the sensory nucleus of the trigeminal nerve

C. Treatment of somatic dysfunction at C5 to T1 to remove somatosomatic reflex neurotrophic effects

D. Treatment of somatic dysfunction at T1 to T4 to eliminate viscerosomatic reflexeffects on the condition

E. Treatment of somatic dysfunction at T5 to T9 to reduce gastric acidity and enhance absorption of the medications needed for this condition

52. Another local form of osteopathic manipulative treatment can also be used:

A. Articulatory technique for radial head dysfunction

B. Correction of first rib dysfunction

C. Spencer techniques

D. Bougie type dilation of the carpal tunnel

E. Transverse tarsal ligament release

Case 21 (Sample COMLEX Questions 53 through 56)

53. A 42 year-old man presents to your office for evaluation of a rash on his thigh. It began as a red macule and expanded to form an annular lesion with a bright red outer border and partial central clearing. There is local lymphadenopathy of the inguinal lymph nodes. On further questioning he admits to migratory joint pain without joint swelling. The knee on the affected leg is particularly sore. He had also had an intense headache with a stiff neck and a sore throat. He lives in an urban townhouse and has not traveled extensively in the past eighteen months. Diagnosis:

A. Syphilitic arthritis

B. Mycoplasma arthritis

C. Tuberculous arthritis

D. Lyme disease

E. Eastern Equine Encephalitis

54. The name of the rash is:

A. Rash of secondary syphilis

B. Pityriasis rosea

C. Nummular eczema

D. Contact dermatitis

E. Erythema chronicum migrans

55. Since this is an infectious condition, what manipulative technique may be used to create a generalized enhancement of the immune response?

A. Thoracic pump

B. CV-4

C. Mesenteric release

D. Sacral rock

E. Hepatic pump

56. Normalization of which of the following regions is essential for normal lymphatic drainage of the affected skin region?

A. Hip joint

B. Upper lumbar spine

C. Lower rib cage diaphragmatic attachments

D. Left thoracic inlet

E. Cranial base

Case 22 (Sample COMLEX Questions 57 through 60)

57. A 19 year-old woman presents with severe dysmenorrhea which she finds incapacitating for two to three days each cycle. This began five months ago after returning from a summer trip with a church group during which they were refurbishing homes for the poor. Since she was taller than many other teens there, she ended up doing a lot of ceiling painting, standing working over her head with a long handled roller.

Pelvic examination is normal. The lumbar lordosis is increased. There is tenderness over the superior pole of the sacroiliac joints bilaterally. There is increased tension and tenderness in the sacrotuberous ligaments. There is symmetrically increased tension in the pelvic floor musculature. Standing flexion test is negative. Seated flexion test is negative. Direct motion induction of the sacrum indicates that it moves easily into flexion and resists extension. The sacral sulci are deeper than average bilaterally. Lumbar spring test is negative. Diagnosis:

A. Bilaterally extended sacrum

B. Anteriorly translated sacrum

C. Bilaterally flexed sacrum

D. Posteriorly translated sacrum

E. Normal sacrum with increased lumbar lordosis

58. Further examination reveals a "step off" between the spinous processes of L4 and L5. Pressure on the spinous process of L4 produces lower back pain. There is deep tenderness on palpation over the iliolumbar ligaments. Which of the following conditions do you suspect?

A. Transitional lumbosacral segment with pseudoarthrosis

B. Lumbosacral facet tropism

C. Occult spina bifida

D. Spondylolisthesis

E. Herniated lumbar disc

59. Correction of the sacral dysfunction resulted in near total relief of the dysmenorrhea. The probable mechanism by which sacral somatic dysfunction produces dysmenorrhea is:

A. Somatosomatic reflex

B. Viscerosomatic reflex

C. Somatosensory reflex

D. Somatovisceral reflex

E. Somatopsychic reflexes

60. Restriction of motion of the pelvic floor would be expected to produce a similar restriction in which of the following structures?

A. Psoas muscles

B. Floor of the femoral triangle

C. Respiratory diaphragm

D. Floor of the orbit

E. Cervical spine

Case 23 (Sample COMLEX Questions 61 through 63)

61. A 53 year-old man presents to your office with right lower back pain and sciatica. The pelvis is sideshifted to the right. L2FSLRL. In the supine position, left leg appears shorter and is externally rotated. There are characteristic tender points in the right piriformis muscle. The sciatica is relieved by passive flexion and external rotation of the right leg. Diagnosis:

A. Piriformis syndrome

B. Lumbosacral syndrome

C. Syndrome of persistent sciatic artery

D. Psoas syndrome

E. Hamstring syndrome

62. The most common sacral dysfunction found in this condition is:

A. Unilateral flexed sacrum right

B. Anterior torsion about a left oblique axis

C. Unilateral extended sacrum left

D. Sacral base posterior

E. Posterior torsion about a right oblique axis

63. If there were a counterstrain tenderpoint associated with the muscle responsible for this condition, it would be located:

A. One inch lateral to the anterior superior iliac spine

B. Deep to the paravertebral muscles posteriorly at the L3 level

C. In the iliac fossa about two inches medial to the anterior superior iliac spine

D. One inch caudad to the anterior inferior iliac spine

E. In the adductor attachments to the pubic bone


1. B

2. A

3. B

4. D

5. D

6. A

7. E

8. D

9. E

10. B

11. B

12. C

13. E

14. C

15. C

16. B

17. A

18. C

19. B

20. A

21. A

22. A

23. A

24. C

25. C

26. C

27. B

28. D

29. A

30. C

31. E

32. C

33. E

34. B

35. B

36. D

37. D

38. A

39. C

40. B

41. C

42. A

43. D

44. A

45. A

46. B

47. E

48. D

49. E

50. C

51. C

52. D

53. D

54. E

55. A

56. D

57. C

58. D

59. D

60. C

61. D

62. E

63. C

Visit MomMD's COMLEX page for more COMLEX information and resources.

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