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COMSAE Phase 1 Form 114 Real Exam
Questions And Well Graded Solutions With
Rationales Updated 2026- 2027
Ace your boards with this comprehensive study guide for the COMSAE Phase 1 Form 114 exam. It features complete, verified multiple-choice questions with correct answers highlighted. Each item includes deep, high-yield clinical rationales covering high-stakes topics: Type I & II spinal mechanics, cranial strain patterns, sacral torsions, high-yield pathology, and pharmacology. Perfect for osteopathic medical students seeking to meet school benchmarks and secure solid COMLEX Level 1 pass predictability. Question 1: A 24-year-old male presents with acute lower back pain after lifting heavy boxes. Physical examination reveals that the right L4 transverse process is more posterior than the left. The asymmetry worsens during lumbar flexion and normalizes during lumbar extension. What is the correct somatic dysfunction? A) L4 Neutral, Rotated Right, Sidebent Left B) L4 Flexed, Rotated Left, Sidebent Left C) L4 Extended, Rotated Right, Sidebent Right D) L4 Extended, Rotated Left, Sidebent Left E) L4 Neutral, Rotated Left, Sidebent Right
Rationale
The asymmetry normalizes in extension, indicating an extension (E) somatic dysfunction (Type II mechanics). Type II mechanics dictate that rotation and sidebending occur to the same side. Because the right transverse process is posterior, the vertebra is rotated right (R_R) and sidebent right (S_R).
- Choices A, B, D, and E do not match these criteria. Question 2: Which of the following cranial techniques is specifically designed to enhance the amplitude of the cranial rhythmic impulse (CRI)? A) Venous sinus traction B) Bulb compression (CV4) C) V-spread technique D) Frontal lift E) Parietal lift
Rationale
Compression of the fourth ventricle (CV4) is explicitly utilized to encourage fluid movement, enhance the amplitude of the CRI, and assist with autonomic nervous system balancing.
- Choices A, C, D, and E target specific sutural restrictions or venous drainage but do not primarily amplify the CRI. Question 3: A 45-year-old female presents with pain along the medial aspect of her right knee. Palpation reveals a tender point on the medial surface of the tibia, approximately 2 cm below the joint line, at the insertion of the pes anserinus. Which
position is used for counterstrain treatment? A) Flexion, Abduction, External Rotation B) Flexion, Adduction, Internal Rotation C) Extension, Abduction, External Rotation D) Extension, Adduction, Internal Rotation E) Pure Abduction without flexion
Rationale
The medial knee tender point (often associated with the medial meniscus or pes anserinus) is treated with hip/knee flexion, adduction, and internal rotation of the tibia.
- Choices A, C, D, and E will stretch the tissue rather than shorten it, worsening the tender point. Question 4: A 19-year-old college student presents with a sore throat, fever, and generalized fatigue. Physical examination reveals posterior cervical lymphadenopathy and splenomegaly. A heterophile antibody test is positive. Which virus is the most likely causative agent? A) Cytomegalovirus B) Human Herpesvirus 6 C) Epstein-Barr Virus D) Adenovirus E) Coxsackievirus A
Rationale
The clinical presentation of fever, sore throat, lymphadenopathy, splenomegaly, and a positive heterophile antibody (Monospot) test is diagnostic for Infectious Mononucleosis caused by the Epstein-Barr Virus (EBV).
- Choice A causes a similar syndrome but is heterophile negative. Choices B, D, and E do not match this classic diagnostic profile. Question 5: A 32-year-old pregnant female at 28 weeks gestation presents with heartburn. Autonomic reflex pathways would predict somatic manifestations from the stomach to map to which of the following spinal cord segments? A) T5-T B) T10-T C) T12-L D) C3-C E) T1-T
Rationale
The stomach receives its sympathetic innervation from the greater splanchnic nerve, which originates from the T5-T9 segments of the spinal cord.
- Choices B, C, D, and E represent lower GI tracts, pelvic structures, the diaphragm, or head/neck structures respectively. Question 6: During a newborn examination, the physician notes that the infant’s occiput is compressed anteriorly against the atlas. This condition can compress which of the following cranial nerves passing through the jugular foramen? A) CN VII
C) Fistula formation D) Primary sclerosing cholangitis E) Ischemic colitis
Rationale
The description points to Crohn's Disease (transmural inflammation, terminal ileum, noncaseating granulomas). Transmural inflammation predisposes patients to penetrating disease and fistula tract formations.
- Choices A, B, and D are more heavily associated with Ulcerative Colitis. Question 10: An 8-year-old boy presents with a high fever, a barking cough, and inspiratory stridor. A neck X-ray demonstrates subglottic narrowing (the steeple sign). What is the most likely viral etiology? A) Parainfluenza virus B) Respiratory syncytial virus C) Influenza A virus D) Rhinovirus E) Coronavirus
Rationale
Laryngotracheobronchitis (croup) presents with a barking cough, stridor, and the "steeple sign" on X-ray, caused predominantly by Parainfluenza virus.
- Choice B causes bronchiolitis in younger infants. Choices C, D, and E do not typically cause classic croup. Question 11: A patient is diagnosed with a somatic dysfunction where the right innominate is rotated anteriorly. Which muscle can be utilized as the activating force during Muscle Energy technique to correct this? A) Rectus femoris B) Iliopsoas C) Hamstrings D) Gluteus medius E) Tensor fascia lata
Rationale
To correct an anterior innominate dysfunction, the innominate must be pulled posteriorly. The hamstring muscles originate on the ischial tuberosity and will pull the innominate posteriorly when contracted against resistance.
- Choice B would pull it further anteriorly. Question 12: A 65-year-old male presents with progressive vision loss. Fundoscopic exam reveals drusen deposits in the macula. What is the primary pathophysiologic mechanism of this disease? A) Increased intraocular pressure B) Degeneration of the retinal pigment epithelium C) Glycation of the lens proteins D) Retinal detachment E) Autoimmune uveitis
Rationale
Drusen accumulation under the retinal pigment epithelium is the hallmark of dry Age- related Macular Degeneration (AMD).
- Choice A describes glaucoma. Choice C describes cataracts. Question 13: A 38-year-old male experiences sharp pain along his lateral thigh down to his foot. On examination, he has diminished sensation on the dorsum of his foot and weakness in foot dorsiflexion. Which nerve root is most likely compressed? A) L B) L C) L D) S E) S
Rationale
The L5 nerve root supplies the dermatome over the dorsum of the foot and mediates foot dorsiflexion (via the deep fibular nerve powering tibialis anterior) and toe extension.
- Choice B involves the knee extension/patellar reflex. Choice D involves plantarflexion/Achilles reflex. Question 14: A 55-year-old male with a history of hyperuricemia presents with acute, severe pain in his left great toe. Synovial fluid analysis reveals needle-shaped, negatively birefringent crystals. What is the mechanism of action of the first-line medication used to abort this acute attack? A) Inhibition of microtubule polymerization B) Inhibition of xanthine oxidase C) Inhibition of urate transporter 1 (URAT1) D) Urate oxidase conversion to allantoin E) Irreversible binding of COX-1 and COX- 2
Rationale
Colchicine inhibits microtubule polymerization to manage acute gout flareups. Alternatively, NSAIDs are used. Xanthine oxidase inhibitors (Choice B) are for chronic management and can worsen acute attacks. Question 15: Structural examination of a 30-year-old male reveals that his left somatic sacral base moves anteriorly during inhalation and posteriorly during exhalation. The L5 vertebra is rotated left. What sacral diagnosis does this represent? A) Right-on-Right Forward Torsion B) Left-on-Left Forward Torsion C) Right-on-Left Backward Torsion D) Left-on-Right Backward Torsion E) Bilateral Sacral Flexion
Rationale
According to sacral rules, L5 and the sacral rotation are always in opposite directions for forward torsions. Since L5 is rotated left, the sacrum must rotate right or left depending on the axis. Furthermore, a left sacral base moving anteriorly during inhalation means the left base is free, implying a left axis (Left-on-Left).
Rationale
Acute pancreatitis leads to the escape of activated lipases, which break down triglycerides into fatty acids that combine with calcium (saponification), presenting as fat necrosis. Question 20: A 72-year-old male with long-standing hypertension presents with sudden onset chest pain radiating to his back, described as "tearing." His blood pressure is 190/110 mmHg. What structural layer breakdown directly permits this condition? A) Rupture of the vasa vasorum B) Tear of the aortic intima C) Destruction of the internal elastic lamina D) Hyperplastic arteriolosclerosis E) Atherosomatous plaque rupture
Rationale
An aortic dissection is caused by an intimal tear that allows blood to track into a false lumen within the aortic media. Question 21: A patient presents with restricted motion of the right fibular head. It resists anterior gliding during passive testing. What ankle movement restriction matches this somatic dysfunction? A) Restriction in plantarflexion B) Restriction in dorsiflexion C) Restriction in eversion D) Restriction in inversion E) Restriction in internal rotation
Rationale
The proximal fibular head moves anteriorly with dorsiflexion/eversion of the foot. A restriction in anterior glide corresponds to a posterior fibular head position, which restricts dorsiflexion. Question 22: A 26-year-old male presents with a painless hard testicular mass. Laboratories reveal elevated serum alpha-fetoprotein (AFP) and beta-hCG. Biopsy shows sheets of pleomorphic cells with Schiller-Duval bodies. What is the diagnosis? A) Seminoma B) Choriocarcinoma C) Yolk sac tumor D) Leydig cell tumor E) Teratoma
Rationale
Schiller-Duval bodies (glomeruloid-like structures) and elevated AFP are pathognomonic for yolk sac (endodermal sinus) tumors. Question 23: A patient exhibits an asymmetric pelvic slice. Chapman’s reflex points for the appendix are evaluated to narrow a differential diagnosis. Where is the anterior Chapman point for the appendix located?
A) At the umbilicus B) At the tip of the right 12th rib C) Between the 2nd and 3rd intercostal spaces D) On the superior pubic ramus E) At the tip of the left 11th rib
Rationale
The anterior Chapman point for the appendix is located at the tip of the right 12th rib, while the posterior point is located at the transverse process of T11. Question 24: A 4-year-old child presents with perianal pruritus that worsens at night. A cellophane tape test demonstrates asymmetric, football-shaped eggs. What is the most appropriate pharmacotherapy? A) Praziquantel B) Ivermectin C) Pyrantel pamoate D) Albendazole E) Metronidazole
Rationale
The presentation is classic for Enterobius vermicularis (pinworm). First-line treatments include pyrantel pamoate or albendazole. Question 25: Examination of the thoracic spine reveals a group dysfunction from T to T6. In a neutral standing position, T3-T6 are rotated right and sidebent left. If treated via Spencer technique modifications or standard Muscle Energy, which principle of Fryette applies? A) Type I mechanics B) Type II mechanics C) Type III mechanics D) Law of Reciprocal Inhibition E) Wolff's Law
Rationale
Group dysfunctions occurring in neutral positions where rotation and sidebending happen to opposite sides follow Fryette's Type I mechanics. Question 26: A 58-year-old female presents with a new lump in her left breast. Biopsy shows invasive ductal carcinoma. The tumor cells are noted to have down- regulated E-cadherin expressions. This molecular change directly promotes which step of metastasis? A) Intravasation B) Angiogenesis C) Detachment from neighboring cells D) Extravasation E) Micrometastasizing growth
Rationale
Rationale
The anterior and middle scalene muscles insert onto the 1st rib and can cause its superior subluxation/elevation when hypertonic. Question 31: A 14-year-old girl presents with progressive lateral curvature of the spine. Radiographs confirm a Cobb angle of 18 degrees. What is the recommended management strategy? A) Observation and serial monitoring B) Spinal bracing C) Surgical spinal fusion D) High-velocity low-amplitude manual therapy twice weekly E) Rigid nocturnal orthotic casting
Rationale
Mild scoliosis with a Cobb angle under 20 degrees is managed conservatively via regular observation and monitoring for progression. Question 32: A 35-year-old man is treated with a medication that blocks the conversion of angiotensin I to angiotensin II. Which side effect is driven by the concomitant accumulation of bradykinin? A) Hyperkalemia B) Acute kidney injury C) Dry cough D) Angioedema secondary to hypokalemia E) Postural hypotension
Rationale
ACE inhibitors prevent the breakdown of bradykinin, which can irritate the respiratory tract and induce a classic dry cough. Question 33: A patient presents with a positive Thomas test on the left side. This finding indicates hypertonicity or contracture of which muscle? A) Gluteus maximus B) Iliopsoas C) Rectus femoris D) Biceps femoris E) Piriformis
Rationale
The Thomas test evaluates for psoas syndrome or flexor contracture of the hip, specifically targeting the iliopsoas muscle. Question 34: A 48-year-old male with a history of intravenous drug use presents with fever and a new heart murmur. Echocardiography shows vegetations on the tricuspid valve. What is the most common causative organism? A) Streptococcus viridans B) Staphylococcus aureus C) Enterococcus faecalis
D) Coxiella burnetii E) Streptococcus bovis
Rationale
Staphylococcus aureus is the leading cause of acute endocarditis in intravenous drug users, frequently targeting the right-sided heart valves. Question 35: A physical exam demonstrates that a patient's cranium has a decreased vertical diameter and feels wide and flat. This corresponds to which SBS strain? A) Flexion dysfunction B) Extension dysfunction C) Superior vertical strain D) Compression strain E) Lateral strain
Rationale
A compression strain reduces the expansile feel of the CRI, leaving the head feeling hard, non-yielding, or globally restricted/flattened. Question 36: A 23-year-old female presents with an unprovoked deep vein thrombosis. Labs show a normal prothrombin time and partial thromboplastin time, but resistance to activated protein C. What is the diagnosis? A) Antithrombin III deficiency B) Factor V Leiden mutation C) Protein S deficiency D) Antiphospholipid syndrome E) Prothrombin G20210A mutation
Rationale
Factor V Leiden produces a mutated Factor V that resists cleavage and inactivation by activated Protein C, promoting a hypercoagulable state. Question 37: A patient presents with a tender point located on the posterior aspect of the acromioclavicular joint. Which strain-counterstrain positioning is appropriate? A) Extension, adduction, internal rotation B) Flexion, abduction, external rotation C) Flexion, adduction, internal rotation D) Extension, abduction, external rotation E) Pure horizontal abduction
Rationale
Posterior shoulder/AC joint points generally require extension combined with internal rotation and slight adduction to achieve maximal comfort. Question 38: A 6-month-old infant is brought to the clinic due to poor feeding and chronic constipation. Examination shows a large tongue, umbilical hernia, and hypotonia. What is the underlying cause? A) Phenylketonuria B) Maternal iodine toxicity
on his palms and soles. What is the treatment of choice? A) Oral azithromycin B) Intravenous ceftriaxone C) Intramuscular penicillin G benzathine D) Oral doxycycline E) Intravenous acyclovir
Rationale
The patient has primary transitioning to secondary syphilis, caused by Treponema pallidum. Intramuscular Penicillin G benzathine remains the gold standard treatment. Question 43: A patient presents with restriction in internal rotation of the right hip. Which muscle group is most likely hypertonic? A) Gluteus minimus B) Tensor fascia lata C) Piriformis and external rotators D) Iliopsoas and rectus femoris E) Adductor longus
Rationale
Restriction in internal rotation means the hip prefers external rotation, which implicates hypertonicity of the external rotators like the piriformis. Question 44: A 3-year-old child presents with bruising, petechiae, and a low platelet count of 22,000/uL following a viral illness. Coagulation profiles (PT and PTT) are normal. What is the pathogenesis? A) Anti-GpIIb/IIIa antibody-mediated destruction B) Deficiency of ADAMTS C) Shiga-like toxin-induced endothelial damage D) Factor VIII deficiency E) Vitamin K deficiency
Rationale
Immune Thrombocytopenic Purpura (ITP) features autoantibodies directed against platelet surface glycoproteins like GpIIb/IIIa following a viral trigger. Question 45: An SBS strain is discovered where the sphenoid and occiput have rotated in opposite directions around a vertical axis. What type of strain is this? A) Torsion strain B) Vertical strain C) Lateral strain D) Sidebending/Rotation strain E) Compression strain
Rationale
Lateral strains occur around two vertical axes where the sphenoid and occiput rotate in opposite directions, named by the direction the basisphenoid moves. Question 46: A 61-year-old male presents with painless gross hematuria. He has a 40 pack-year smoking history. What is the most likely diagnosis?
A) Renal cell carcinoma B) Urothelial (transitional cell) carcinoma C) Acute glomerulonephritis D) Nephrolithiasis E) Benign prostatic hyperplasia
Rationale
Painless gross hematuria in an older male smoker is highly suspicious for urothelial carcinoma of the bladder. Question 47: A patient is found to have a posterior tender point for the third lumbar vertebra (PL3). Where is this point physically located? A) On the tip of the spinous process of L B) On the lateral aspect of the spinous process of L C) At the interspinous ligament between L3 and L D) On the posterior superior iliac spine (PSIS) E) On the anterior superior iliac spine (ASIS)
Rationale
Posterior lumbar tender points (PL1-PL5) are typically located on the lateral sides of the corresponding spinous processes or interspinous lines. Question 48: A 36-year-old female presents with generalized weakness, a malar rash, and joint pain. Labs confirm positive antinuclear antibodies (ANA) and anti- double-stranded DNA (anti-dsDNA). Which hypersensitivity type matches this condition? A) Type I B) Type II C) Type III D) Type IV E) Type V
Rationale
Systemic Lupus Erythematosus (SLE) is a classic Type III hypersensitivity reaction mediated by immune complex deposition. Question 49: Structural evaluation shows that a patient's right shoulder is lower than the left, and the right scapula is protracted. Which muscle is likely weak or under- inhibited? A) Pectoralis minor B) Rhomboids and middle trapezius C) Serratus anterior D) Latissimus dorsi E) Subscapularis
Rationale
Protraction of the scapula occurs when the retractors (rhomboids and middle trapezius) are weak or out-powered by protractors like the serratus anterior.
An anteriorly rotated innominate moves the ASIS inferiorly and the PSIS superiorly on the affected side. Question 54: A 19-year-old male presents with a presentation highly suggestive of a primary immunodeficiency. Labs show a complete absence of B cells but normal T cell counts. What is the inheritance pattern? A) Autosomal dominant B) Autosomal recessive C) X-linked recessive D) X-linked dominant E) Mitochondrial
Rationale
X-linked agammaglobulinemia (Bruton's) presents with a lack of B cells due to a defect in Bruton tyrosine kinase, inherited in an X-linked recessive manner. Question 55: A patient is diagnosed with an inhalation rib dysfunction of Rib 7 on the left. What is the key rib to treat during exhalation-focused direct treatment? A) Rib 1 B) Rib 6 C) Rib 7 D) Rib 10 E) Rib 12
Rationale
In an inhalation rib dysfunction, the ribs are stuck in inhalation. The key rib to treat is the lowest rib of the dysfunctional group, which in this case is Rib 7. Question 56: A 53-year-old female presents with tremors that improve with alcohol consumption. There is no rigidity or bradykinesia. What is the first-line medication? A) Levodopa B) Pramipexole C) Propranolol D) Trihexyphenidyl E) Amantadine
Rationale
An essential tremor characteristically improves with alcohol. First-line medical therapies include beta-blockers like propranolol or primidone. Question 57: Evaluation of the thoracic spine reveals a single vertebral dysfunction: T5 is rotated left and sidebent left. This somatic dysfunction normalizes when the patient slumps into flexion. What diagnosis does this represent? A) T5 Neutral, Rotated Left, Sidebent Right B) T5 Flexed, Rotated Left, Sidebent Left C) T5 Extended, Rotated Left, Sidebent Left D) T5 Flexed, Rotated Right, Sidebent Left E) T5 Extended, Rotated Right, Sidebent Right
Rationale
The dysfunction normalizes in flexion, meaning it is a flexed (F) dysfunction following Type II mechanics (rotation and sidebending to the same side). Question 58: A 33-year-old female presents with proximal muscle weakness and a heliotrope rash around her eyes. What antibody is most specific for this condition? A) Anti-dsDNA B) Anti-Smith C) Anti-Jo- 1 D) Anti-centromere E) Anti-histone
Rationale
Dermatomyositis presents with proximal muscle weakness and skin signs like a heliotrope rash. Anti-Jo-1 (anti-tRNA synthetase) is a characteristic antibody marker. Question 59: A patient presents with an acute exacerbation of asthma. Which of the following osteopathic treatments would help reduce sympathetic tone to the lungs? A) Rib raising to ribs 1- 5 B) Inhibitory pressure to the T2-T7 paravertebral sympathetic ganglia C) Thoracic pump lymphatic drainage D) Suboccipital release E) C4 Myofascial Release
Rationale
Inhibitory pressure or rib raising applied to the T2-T7 thoracic paraspinal regions targets the sympathetic chain ganglia to reduce hypersympathetic outflow to the pulmonary tree. Question 60: A 44-year-old male presents with severe headaches, sweating, and palpitations. His blood pressure is 210/120 mmHg. A 24-hour urine collection shows elevated metanephrines. From which embryological structure is this tumor derived? A) Surface ectoderm B) Endoderm C) Neural crest cells D) Mesoderm E) Notochord
Rationale
Pheochromocytomas arise from the chromaffin cells of the adrenal medulla, which are derived from neural crest cells. Question 61: A 28-year-old female presents with episodic palpitations, sweating, and tremors. Her symptoms resolve rapidly after consuming fruit juice or candy. Laboratory evaluation reveals a fasting glucose level of 42 mg/dL, an elevated serum insulin level, and an elevated C-peptide level. Which of the following is the most likely diagnosis? A) Exogenous insulin abuse B) Insulinoma C) Glucagonoma
B) Extension somatic dysfunction C) Torsion somatic dysfunction D) Superior vertical strain E) Compression strain
Rationale
During the extension phase of the CRI (or an extension somatic dysfunction), the SBS moves inferiorly, which causes the greater wings of the sphenoid to move inferiorly/medially, and the paired bones (like the temporal bones) to undergo internal rotation.
- Choice A describes the opposite motion. Choices C, D, and E involve different directional axes. Question 65: A 4-year-old boy presents with progressive muscle weakness, calf pseudohypertrophy, and a positive Gower sign. Genetic analysis reveals a frameshift mutation in the gene encoding a structural protein that anchors the cellular cytoskeleton. Which protein is affected? A) Dystrophin B) Titin C) Myosin heavy chain D) Actin E) Desmin
Rationale
Duchenne muscular dystrophy is an X-linked recessive disorder caused by a frameshift mutation in the DMD gene, leading to a complete absence of the dystrophin protein. Dystrophin anchors the intracellular actin cytoskeleton to the extracellular matrix.
- Choices B, C, D, and E are structural or contractile proteins but are not the root cause of Duchenne muscular dystrophy. Question 66: Structural examination of a 55-year-old male reveals a rigid thoracic curve. Palpation of T7 indicates that the right transverse process is posterior relative to the left transverse process in a neutral posture. The asymmetry worsens when the patient is asked to extend his spine, but completely normalizes when he slumps forward into flexion. What is the correct somatic dysfunction? A) T7 Neutral, Rotated Right, Sidebent Left B) T7 Flexed, Rotated Right, Sidebent Right C) T7 Extended, Rotated Left, Sidebent Left D) T7 Flexed, Rotated Left, Sidebent Left E) T7 Extended, Rotated Right, Sidebent Right
Rationale
The asymmetry normalizes in flexion, which classifies it as a flexed (F) somatic dysfunction (Type II mechanics). Type II mechanics state that a single vertebra will rotate and sidebend to the same side. Because the right transverse process is posterior, the vertebra is rotated right (R_R) and sidebent right (S_R).
- Choices A, C, D, and E do not align with these specific parameters.
Question 67: A 62-year-old male smoker presents with a persistent cough, hemoptysis, and a 20-lb weight loss. Laboratory studies reveal a serum calcium level of 12.8 mg/dL. A chest X-ray shows a central hilar mass. What is the most likely histological diagnosis? A) Adenocarcinoma B) Squamous cell carcinoma C) Small cell carcinoma D) Large cell carcinoma E) Bronchioloalveolar carcinoma
Rationale
Squamous cell carcinoma of the lung is classically central, associated with smoking, and frequently secretes parathyroid hormone-related protein (PTHrP), resulting in hypercalcemia.
- Choice A is typically peripheral and not associated with PTHrP hypercalcemia. Choice C is central and associated with smoking, but typically causes SIADH or Cushing syndrome rather than hypercalcemia. Question 68: A patient is diagnosed with an exhalation somatic dysfunction involving ribs 3 through 5 on the right side. During a direct Muscle Energy treatment, which muscle is used as the primary activating force to pull the key rib into place? A) Anterior scalene B) Posterior scalene C) Pectoralis minor D) Serratus anterior E) Latissimus dorsi
Rationale
For an exhalation rib dysfunction, the rib group is stuck "down" in exhalation. The key rib to treat is the top rib of the group (Rib 3). The pectoralis minor muscle inserts onto ribs 3, 4, and 5 and is leveraged to elevate Rib 3 when the patient contracts against resistance.
- Choices A and B target ribs 1 and 2. Choice D targets ribs 6-9. Choice E targets ribs 10 - 11. Question 69: A 45-year-old male presents with worsening shortness of breath and a nonproductive cough. A high-resolution CT scan of the chest demonstrates bilateral subpleural honeycombing and interstitial fibrosis. A lung biopsy shows fibroblastic foci interspersed with normal lung architecture. What is the diagnosis? A) Idiopathic pulmonary fibrosis B) Sarcoidosis C) Hypersensitivity pneumonitis D) Silicosis E) Asbestosis
Rationale
The clinical and radiological combination of honeycombing and heterogeneous interstitial fibrosis with fibroblastic foci is pathognomonic for usual interstitial pneumonia (UIP), which manifests clinically as Idiopathic Pulmonary Fibrosis.
