COMLEX-USA Level 3 Licensure Exam V2 COMLEX USA Level 3 Licensure Exam V2

COMLEX-USA Level 3 Licensure Exam V2 COMLEX-
USA Level 3 Licensure Exam V2
1. A 68-year-old male with a history of congestive heart failure and chronic obstructive

pulmonary disease presents for a routine check-up. Physical examination reveals a positive

seated flexion test on the right, a deep sacral sulcus on the right, and a posterior inferior

lateral angle (ILA) on the left. Which of the following is the most likely diagnosis?

A. Right unilateral sacral flexion


B. Right-on-right forward sacral torsion


C. Left-on-left forward sacral torsion


D. Right unilateral sacral extension


Correct Answer: A


Explanation: A positive seated flexion test indicates the side of the sacral dysfunction,

which in this case is the right. A deep sulcus on the right and a posterior ILA on the left are

findings consistent with a right unilateral sacral flexion. Clinically, unilateral shears often

occur after a sudden jarring motion or fall onto the buttocks and can significantly impact

pelvic mechanics. Distinguishing shears from torsions is a common pitfall; remember that

in a shear, the sulcus and ILA findings occur on the same side relative to the neutral

position, but here, the deep sulcus and posterior ILA on the involved side characterize

flexion.

,2. A 45-year-old female presents to the clinic complaining of chronic headaches. During the

osteopathic structural examination, the physician notes that the sphenobasilar synchondrosis

(SBS) feels as though the base of the sphenoid and the base of the occiput have moved

superiorly, resulting in a decreased feel of the primary respiratory mechanism (PRM)

expansion. Which of the following cranial strains is most likely present?

A. Sidebending rotation


B. Inferior strain


C. Torsion


D. Superior strain


Correct Answer: D


Explanation: A superior strain occurs when the base of the sphenoid moves superiorly

relative to the base of the occiput. This motion is named for the direction of the base of the

sphenoid. Clinical symptoms of cranial strains often include headaches and fatigue, and the

physical exam typically reveals a ‘parallelogram’ or specific shift in the feel of the SBS.

Understanding the axes of motion for vertical strains (two transverse axes) is essential for

correct diagnosis and board performance.


3. A 28-year-old G1P0 at 38 weeks gestation presents with a headache and blurry vision. Her

blood pressure is 165/110 mmHg. Urinalysis reveals 3+ protein. What is the most appropriate

next step in the management of this patient?

A. Expectant management until 39 weeks

,B. Intravenous magnesium sulfate and delivery


C. Immediate administration of nitroprusside


D. Oral labetalol and discharge with home monitoring


Correct Answer: B


Explanation: This patient meets the criteria for preeclampsia with severe features based

on her blood pressure and neurologic symptoms (headache, blurry vision). In a term

pregnancy (37 weeks or more), the definitive treatment is delivery to prevent progression

to eclampsia or HELLP syndrome. Magnesium sulfate is administered for seizure

prophylaxis, which is a critical standard of care in the prevention of maternal morbidity.

Failure to recognize severe features of preeclampsia and delaying delivery is a common

clinical and examination error.


4. A 55-year-old male with a history of hypertension and diabetes presents with sudden onset

of weakness in his right arm and leg, along with difficulty speaking. His symptoms began 2

hours ago. A non-contrast CT scan of the head is negative for hemorrhage. What is the most

appropriate next step?

A. Initiate heparin infusion


B. Start high-dose aspirin


C. Perform an urgent MRI of the brain


D. Administer intravenous alteplase


Correct Answer: D

, Explanation: The patient is presenting with signs of an acute ischemic stroke within the 3

to 4.5-hour window for thrombolytic therapy. Since the CT scan has ruled out intracranial

hemorrhage, intravenous alteplase (tPA) is the treatment of choice to improve neurologic

outcomes. Timely intervention is critical because ‘time is brain,’ and the risk of permanent

disability increases with every minute of delay. Clinicians must strictly adhere to the

contraindications for tPA, such as recent surgery or anticoagulation, to avoid life-

threatening complications.


5. A 34-year-old male presents with acute mid-back pain after lifting a heavy box. Physical

examination reveals a tender point 2 cm lateral to the spinous process of T6 on the right side.

The segment T6 is found to be flexed, rotated right, and sidebent right. Which of the

following is the most appropriate initial position for Muscle Energy treatment?

A. Extension, sidebending right, rotation right


B. Flexion, sidebending right, rotation right


C. Extension, sidebending left, rotation left


D. Flexion, sidebending left, rotation left


Correct Answer: C


Explanation: Muscle Energy is a direct technique, meaning the patient is moved into the

restrictive barrier. For a T6 segment that is Flexed, Rotated Right, and Sidebent Right (T6

FRRSR), the restrictive barrier is in the opposite directions: Extension, Rotation Left, and

Sidebending Left. The physician engages the barrier in all three planes before the patient

performs an isometric contraction against the physician’s resistance. It is vital to correctly