Download COMSAE 1 CERTIFICATION EVALUATION GUIDE 2026 FULL SOLUTION and more Exams Reasoning in PDF only on Docsity!
COMSAE 1 CERTIFICATION EVALUATION GUIDE
2026 FULL SOLUTION
◉ C7 sensation. Answer: Middle finger ◉ C7 motor. Answer: Triceps and wrist flexors ◉ C8 sensation. Answer: Little finger and middle forearm ◉ C8 motor. Answer: Wrist flexors and interossi ◉ T1 sensation. Answer: Medial elbow and medial arm ◉ T1 motor. Answer: Interossi ◉ Abduction of shoulder. Answer: Supraspinatus and deltoid ◉ Adduction of shoulder. Answer: Pect major, lat dorsi ◉ Flexion of shoulder. Answer: Coracobrachialis, anterior deltoid
◉ Extension of shoulder. Answer: Lat dorsi, teres major, post deltoid ◉ External rotation of shoulder. Answer: Infraspinatus, teres minor ◉ Internal rotation of shoulder. Answer: Subscapularis, pect major, teres major, lat dorsi ◉ Carrying angle of arm increases. Answer: When wrist adducts and ulna abducts ◉ Innervation: Flexors of the wrist and hand besides flexor carpi ulnaris (ulnar nerve). Answer: Median nerve ◉ Innervation: Extensors of wrist and hand. Answer: Radial nerve ◉ Innervation: Primary supinators of forearm. Answer: Biceps: musculocutaneous n Supinator: Radial n ◉ Innervation: Primary pronators of forearm. Answer: Pronator teres and pronator quadratus: radial n
◉ L3 motor and sensation. Answer: Adductors, quads; Anterior thigh just above knee ◉ L4 motor and sensation. Answer: Anterior tibialis; Medial malleolus ◉ L5 motor and sensation. Answer: Extensor hallicus longus, quads; Dorsal aspect of foot and big toe ◉ S1 motor and sensation. Answer: Peroneus longus and brevus, gastrocnemius; Lateral malleolus ◉ Rib muscles for tx. Answer: Rib 1: Ant and mid scalenes 2: Post scalene 3 - 5: Pect minor 6 - 9: Serratus anterior 10 - 12: Lat dorsi ◉ HVLA contraindications. Answer: Absolute: Osteoporosis, osteomyelitis, fractures in area of thrust (spondys), bone metastasis, severe RA, Down's syndrome (cervicals) Relative: Acute whiplash, pregnancy, post surgery, herniated disc, pts on anti-coags, vertebral artery ischemia (cervical)
◉ Psoas syndrome findings. Answer: Backward sacral torsion Nonneutral L Ipsilateral psoas spasm Contralateral pelvic shift and piriformis spasm Exaggerated lumbar lordosis when supine Positive thomas test ◉ Ribs. Answer: Atypical: 1, 2, 11, 12 Typical: 3- 10 True: 1- 7 False: 8- 12 Pump: 1- 5 Bucket: 6- 10 Caliper: 11- 12 ◉ Axis vs plane. Answer: Axis is like the pole that the bone rotates across, plane is the field where the bone is moving in ◉ Disc herniation. Answer: Affects the nerve of the lower spinal segment, unless above C7 (affects top segment)
◉ Scoliosis classifications. Answer: <20 is mild, 20-45 is moderate,
45 is severe. Mild and moderate tx with OMT or bracing, severe requires surgery. Resp compromise > Cardiac compromise > ◉ Myokymia that progresses downward. Answer: Due to internally rotated temporal bone of same side ◉ Craniosacral motion. Answer: Occurs at superior transverse axis, or the respiratory axis at level of S2. During CS flexion, sacrum counternutates and AP diameter shortens ◉ Nerve impingements. Answer: C5: Numbness at lateral elbow and diminished biceps reflex C6: Numbness at lateral forearm, thumb, wrist extensors, and diminished brachioradialis C7: Numbness of middle finger, weakness of finger and elbow extensors, diminished triceps reflex ◉ Vault hold. Answer: Index on greater wings of sphenoid Middle on zygomatic process of temporal bone (ant to ear) Ring on mastoid process of temporal bone (post to ear) Little finger on occiput
Thumbs over sagittal suture ◉ Spencer's technique. Answer: 1. Extend shoulder
- Flexion of shoulder with elbow extension
- Circumduction w/ compression
- Circumduction w/ extraction
- Abduct shoulder
- Internal and external rotation
- Pump shoulder ◉ Unpasteurized goat cheese. Answer: Brucella ◉ Laxative abuse. Answer: electrolyte imbalance severe dehydration dependency stretched or "lazy" colon ◉ balantidium coli. Answer: protozoa that causes GI infection, ingest cysts thru infected water or food produces hyalonuridase and creates ulcers in mucosal walls
◉ enterovirus 17. Answer: notable cause of hand, foot and mouth disease ◉ Menkes syndrome. Answer: inborn error where body cannot absorb copper brittle hair, metaphyseal widening ◉ Middle ear. Answer: C1 laterally/ insertion of SCM ◉ Pharynx. Answer: C2 spinous process ◉ Tongue. Answer: C2 spinous process ◉ Larynx. Answer: C2 spinous process ◉ Sinuses. Answer: C2 spinous process ◉ Arms. Answer: C2 spinous process ◉ Esophagus. Answer: T ◉ Bronchus. Answer: T
- ◉ Thyroid. Answer: T
- ◉ Upper lung and myocardium. Answer: T
- ◉ Lower lung. Answer: T
- ◉ Acidity of stomach. Answer: Left T
- ◉ Liver. Answer: Right T5-T
- ◉ Gallbladder. Answer: Right T
- ◉ Spleen. Answer: Left T
- ◉ Pancreas. Answer: Right T
- ◉ Small intestines. Answer: T8-T
- ◉ Adrenals. Answer: T
- ◉ Kidneys. Answer: L
◉ Liver. Answer: Right 5th and 6th ICS ◉ Gallbladder. Answer: Right 6th ICS ◉ Spleen. Answer: Left 7th ICS ◉ Pancreas. Answer: Right 7th ICS ◉ Thyroid gland. Answer: Sternum at 2nd ICS ◉ Esophagus. Answer: Sternum at 2nd ICS ◉ Myocardium. Answer: Sternum at 2nd ICS ◉ Bronchi. Answer: Sternum at 2nd ICS ◉ Pharynx. Answer: Rib 1 ◉ Eye. Answer: Lateral humerus ◉ Cerebellum. Answer: Coracoid process
◉ Colon. Answer: Upside down over IT band of thighs ◉ Ovaries. Answer: Superior to pubic tubercle ◉ Uterus. Answer: Pubic symphysis ◉ Rectum. Answer: Antero-medial thigh ◉ Prostate. Answer: Posterior IT band ◉ Dysgerminoma. Answer: Ovarian Germ Cell Tumor. Malignant, equivalent to male seminoma but rarer. Associated with Turner Syndrome. Tumor markers are hCG, LDH. Sheets of uniform cells. Large Cells with clear cytoplasm and central nuclie. Most common malignant germ cell tumor. is of many egg like germ cells. good prognosis to radiotherapy. ◉ Choriocarcinoma. Answer: Ovarian Germ Cell tumor. Rare but malignant. can develop during or after malignancy of trophoblastic tissue chorionic villi are NOT present. Increased frequency of theca- lutein cysts. Along with moles, comprise spectrum of gestational trophoblastic neoplasia. Early Hematogenous spread to lungs. Tumor marker is hCG. Is a malignant proliferation of trophobolastic tissue with no villi. It can spread quickly cause it is genetically
mucin secreting signet cell adenocarcinoma. a signet cell is a cell where the nucleas is pushed off to the side. ◉ Serous Cystadenoma. Answer: ovarian non germ cell tumor. is cystic and from surface epithelium. is from water and is benign. frequently bilateral, lined with fallopian tube - like epithelium. which have an increase in CA-125 which is the general ovarian cancer marker. good for monitoring progression, not for screening. single cyst with flat lining usually 30-40 years old, surface epithelium. present late, poor prognosis and extend to involve peritoneam. ◉ Serious Cystadenocarcinoma. Answer: ovarian non germ cell tumors. is cystic and is from surface epithelium. malignant and frequently bilateral. psammoma bodies are seen on histology. risk factors include BRCA - 1 BRCA - 2 and HNPCC. significant genetic predisposition makes family history the most important risk factor. malignant clear invasion of cells in CT. larger tumor with complicated cysts with thick shaggy lining. usually post menopausal women 60-70 years of age. ◉ Mucinous Cystadenoma. Answer: ovarian non germ cell tumor. mucous, from surface epithelium. multiocular cyst lined by mucous secreting epithelium. benign, intestine like tissue.
◉ Mucinous Cystadenocarcinoma. Answer: malignant. pseudomyxoma peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor ◉ Fibromas. Answer: non ovarian germ cell tumors. sex cord stromal. Fibromas,. bundles of spindle shaped fibroblasts. meigs' syndrome - triad of ovarian fibroma, ascites and hydrothorax. with a pulling sensation of the groin. ◉ Granulosa theca cell tumor.. Answer: ovarian non germ cell tumor. sex chord stromal. develops in many ages. secretes estrogen - precosious puberty in young kids. can cause endometrial hyperplasia or carcinoma in adults. call exner bodies - small follicles filled with eosinophilic secretions. abnormal uterine bleeding in adults. ◉ leuprolide. Answer: GnRH analog with agonist properties when used in a pulsatile fashion; antagonist properties when used in continuous fashion (down regulates GnRH receptor in pituitary which leads to a decrease in FSH/LH. used for infertility (pulsatile), prostate cancer (continuous - with flutamade), uterine fibroids (continuous), precocious puberty (continuous). toxicity - antiandrogen, nausea, vomiting.
decreases CYP 450 side effects of gynecomastia and amenorrhea ◉ spironolactone. Answer: inhibits steroid binding used to prevent hirsutism. side effects of gynecomastia and amenorrhea used in the treatment of PCOS ◉ Tamsulosin. Answer: alpha 1 antagonist used to treast BPH by inhibiting smooth muscle contraction. selective alpha 1 A,D receptors (found on prostate) vs vascular alpha 1B receptors ◉ Progestins. Answer: bind progesterone receptors, reduce growth and increase in vascularization of endometrium. used clinically in oral contraceptives and in the treatment of endometrial cancer and abnormal uterine bleeding. ◉ Terbutaline. Answer: a beta 2 agonist that relaxes the uterus reduces premature uterine contractions. ◉ mifepristone (RU - 486). Answer: competitive inhibitor of progestins at progesterone receptors. used clinically to terminate pregnancy. is administered with misoprostol (PGE1)
toxicity includes heavy bleeding, GI effects (nausa, vomiting, anorexia), and abdominal pain. ◉ Anastrozole, Letrozole, Exemestane. Answer: Aromatase inhibitors used in postmenopausal women with breast cancer. ◉ Hormone Replacement Therapy. Answer: used for relief or prevention of menopausal symptoms (e.g. hot flashes, vaginal atrophy) and osteoporosis (increased estrogen, decreased osteoclast activity) unopposed estrogen replacement therapy (ERT) increases the risk of endometrial cancer so progesterone is added. Possible increase in CV risk. ◉ Tamoxifen. Answer: SERM antagonist on breast tissue used to treat and prevent recurrence of ER-Positive breast cancer. ◉ Raloxifene. Answer: SERM - Agonist on bone; reduces resorption of bonel used to treat osteoporosis. ◉ Clomiphene. Answer: SERM - Partial agonist at estrogen receptors in hypothalamus. prevents normal feedback inhibition and increased release of LH and FSH from pituitary, which stimulates ovulation. Used to treat infertility and polycystic ovarian syndrome. may cause
