COMSAE 114 EXAM / LATEST COMSAE 114 APPROVED EXAM 2026/2027
HIGH YIELD PRACTICE QUESTIONS AND CURRENT UPDATED STUDY
GUIDE COMPLETE ACCURATE QUESTIONS WITH WELL ELABORATED
ANSWERS PLUS RATIONALES (100% EXPERT VERIFIED SOLUTIONS)
LATEST UPDATED VERSION 2026 EDITION |GUARANTEED SUCCESS A+
|FULL REVISED COMSAE 114 EXAM
1. A 45-year-old male presents with chronic low back pain that worsens with
prolonged sitting and improves with walking. On examination, you note a right
iliac crest that is inferior compared to the left when the patient is supine. The right
anterior superior iliac spine (ASIS) is also inferior. Which of the following somatic
dysfunctions is most likely?
A) Right posterior innominate
B) Left posterior innominate
CORRECT ANSWER: B) Left posterior innominate
C) Right anterior innominate
D) Left anterior innominate
E) Bilateral anterior innominate
Rationale: In a posterior innominate, the ASIS is superior and the posterior
superior iliac spine (PSIS) is inferior relative to the contralateral side. The question
states the right ASIS is inferior, meaning the left ASIS is relatively superior.
Therefore, the left innominate is rotated posteriorly (left posterior innominate). A
right anterior innominate would have the right ASIS inferior, but the description of
the iliac crest being inferior on the right indicates a combination; however, the
ASIS inferior on the right suggests right anterior or left posterior. Given the iliac
crest inferior on the right, the left posterior innominate is the best fit because the
left innominate rotates posteriorly, making its ASIS superior, thus the right ASIS
appears inferior. Typical presentation: patient with left posterior innominate will
have right ASIS inferior on standing or supine.
,2. A 28-year-old female with a history of recurrent urinary tract infections presents
with dysuria, frequency, and suprapubic pain. Urinalysis shows leukocyte esterase
and nitrites. Which of the following is the most appropriate first-line antibiotic for
an uncomplicated cystitis in this patient, assuming no drug allergies?
A) Ciprofloxacin
B) Amoxicillin
C) Trimethoprim-sulfamethoxazole
CORRECT ANSWER: C) Trimethoprim-sulfamethoxazole
D) Doxycycline
E) Ceftriaxone
Rationale: For uncomplicated cystitis in women, first-line agents according to
current guidelines include nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-
SMX) if local resistance <20%, or fosfomycin. TMP-SMX is a common first-line
choice. Fluoroquinolones (ciprofloxacin) are reserved for more complicated
infections due to resistance and side effects. Amoxicillin is not effective due to
high E. coli resistance. Doxycycline is for atypical pathogens. Ceftriaxone is
parenteral, not oral first-line.
3. During a structural examination, you palpate a tender point at the medial aspect
of the right patella. The patient reports that the pain began after a twisting injury to
the knee. Using counterstain technique, which of the following positions would be
most appropriate to treat this tender point?
A) Flexion and external rotation of the hip
B) Extension and internal rotation of the hip
C) Flexion, abduction, and external rotation of the hip
CORRECT ANSWER: C) Flexion, abduction, and external rotation of the hip
D) Extension, adduction, and internal rotation of the hip
,E) Flexion, adduction, and internal rotation of the hip
Rationale: The medial patella tender point corresponds to the vast us medial is
muscle. The counterstain position for the vast us medial is is hip flexion,
abduction, and external rotation (FABER position) with the knee flexed. This
position shortens the muscle to relieve the strain. The other positions would stretch
or not adequately shorten the vast us medial is.
4. A 55-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a chronic cough. Chest CT shows a 4 cm caviar
lesion in the right upper lobe. Sputum cytology reveals malignant cells with keratin
pearls. Which of the following is the most likely diagnosis?
A) Small cell lung cancer
B) Adenocarcinoma
C) Large cell carcinoma
D) Squamous cell carcinoma
CORRECT ANSWER: D) Squamous cell carcinoma
E) Carcinoid tumor
Rationale: Squamous cell carcinoma is strongly associated with smoking and often
presents as a central caviar lesion. Histologically, it shows keratin pearls and
intercellular bridges. Small cell lung cancer is central but does not form keratin
pearls. Adenocarcinoma is more peripheral and often has Leipsic growth. Large
cell carcinoma lacks differentiation. Carcinoid tumors are low-grade
neuroendocrine tumors.
5. A 32-year-old pregnant woman at 28 weeks’ gestation complains of right-sided
low back pain that radiates to the anterior thigh. On examination, the right iliac
crest is higher than the left when standing. The pain is relieved when she sits on the
, toilet. Which of the following somatic dysfunctions is most consistent with her
presentation?
A) Right anterior innominate
B) Left anterior innominate
C) Right posterior innominate
CORRECT ANSWER: C) Right posterior innominate
D) Left posterior innominate
E) Right up slip
Rationale: A posterior innominate on the right causes the iliac crest to be higher on
the right (due to the posterior rotation making the PSIS more inferior and ASIS
more superior? Wait, careful: In a posterior innominate, the ASIS moves superiorly
and posteriorly, and the PSIS moves inferiorly. The iliac crest height: when the
innominate rotates posteriorly, the iliac crest actually moves slightly superiorly?
Typically, a posterior innominate results in a higher iliac crest on the same side.
The patient's right iliac crest is higher, suggesting a right posterior innominate or
left anterior innominate. However, the pain relief when sitting on a toilet (which
involves hip flexion) suggests a posterior innominate because hip flexion reduces
the strain on the sacroiliac joint. Anterior innominate would worsen with flexion.
Right posterior innominate is classic for pregnancy-related pelvic girdle pain.
6. A 67-year-old male with a history of hypertension and diabetes presents with
acute onset of right-sided weakness and aphasia. Non-contrast head CT is normal.
Which of the following is the most appropriate next step?
A) Administer IV tape
B) Repeat head CT in 24 hours
C) Obtain MRI with diffusion-weighted imaging
CORRECT ANSWER: C) Obtain MRI with diffusion-weighted imaging
D) Lumbar puncture
E) Carotid ultrasound
HIGH YIELD PRACTICE QUESTIONS AND CURRENT UPDATED STUDY
GUIDE COMPLETE ACCURATE QUESTIONS WITH WELL ELABORATED
ANSWERS PLUS RATIONALES (100% EXPERT VERIFIED SOLUTIONS)
LATEST UPDATED VERSION 2026 EDITION |GUARANTEED SUCCESS A+
|FULL REVISED COMSAE 114 EXAM
1. A 45-year-old male presents with chronic low back pain that worsens with
prolonged sitting and improves with walking. On examination, you note a right
iliac crest that is inferior compared to the left when the patient is supine. The right
anterior superior iliac spine (ASIS) is also inferior. Which of the following somatic
dysfunctions is most likely?
A) Right posterior innominate
B) Left posterior innominate
CORRECT ANSWER: B) Left posterior innominate
C) Right anterior innominate
D) Left anterior innominate
E) Bilateral anterior innominate
Rationale: In a posterior innominate, the ASIS is superior and the posterior
superior iliac spine (PSIS) is inferior relative to the contralateral side. The question
states the right ASIS is inferior, meaning the left ASIS is relatively superior.
Therefore, the left innominate is rotated posteriorly (left posterior innominate). A
right anterior innominate would have the right ASIS inferior, but the description of
the iliac crest being inferior on the right indicates a combination; however, the
ASIS inferior on the right suggests right anterior or left posterior. Given the iliac
crest inferior on the right, the left posterior innominate is the best fit because the
left innominate rotates posteriorly, making its ASIS superior, thus the right ASIS
appears inferior. Typical presentation: patient with left posterior innominate will
have right ASIS inferior on standing or supine.
,2. A 28-year-old female with a history of recurrent urinary tract infections presents
with dysuria, frequency, and suprapubic pain. Urinalysis shows leukocyte esterase
and nitrites. Which of the following is the most appropriate first-line antibiotic for
an uncomplicated cystitis in this patient, assuming no drug allergies?
A) Ciprofloxacin
B) Amoxicillin
C) Trimethoprim-sulfamethoxazole
CORRECT ANSWER: C) Trimethoprim-sulfamethoxazole
D) Doxycycline
E) Ceftriaxone
Rationale: For uncomplicated cystitis in women, first-line agents according to
current guidelines include nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-
SMX) if local resistance <20%, or fosfomycin. TMP-SMX is a common first-line
choice. Fluoroquinolones (ciprofloxacin) are reserved for more complicated
infections due to resistance and side effects. Amoxicillin is not effective due to
high E. coli resistance. Doxycycline is for atypical pathogens. Ceftriaxone is
parenteral, not oral first-line.
3. During a structural examination, you palpate a tender point at the medial aspect
of the right patella. The patient reports that the pain began after a twisting injury to
the knee. Using counterstain technique, which of the following positions would be
most appropriate to treat this tender point?
A) Flexion and external rotation of the hip
B) Extension and internal rotation of the hip
C) Flexion, abduction, and external rotation of the hip
CORRECT ANSWER: C) Flexion, abduction, and external rotation of the hip
D) Extension, adduction, and internal rotation of the hip
,E) Flexion, adduction, and internal rotation of the hip
Rationale: The medial patella tender point corresponds to the vast us medial is
muscle. The counterstain position for the vast us medial is is hip flexion,
abduction, and external rotation (FABER position) with the knee flexed. This
position shortens the muscle to relieve the strain. The other positions would stretch
or not adequately shorten the vast us medial is.
4. A 55-year-old man with a 30-pack-year smoking history presents with
hemoptysis, weight loss, and a chronic cough. Chest CT shows a 4 cm caviar
lesion in the right upper lobe. Sputum cytology reveals malignant cells with keratin
pearls. Which of the following is the most likely diagnosis?
A) Small cell lung cancer
B) Adenocarcinoma
C) Large cell carcinoma
D) Squamous cell carcinoma
CORRECT ANSWER: D) Squamous cell carcinoma
E) Carcinoid tumor
Rationale: Squamous cell carcinoma is strongly associated with smoking and often
presents as a central caviar lesion. Histologically, it shows keratin pearls and
intercellular bridges. Small cell lung cancer is central but does not form keratin
pearls. Adenocarcinoma is more peripheral and often has Leipsic growth. Large
cell carcinoma lacks differentiation. Carcinoid tumors are low-grade
neuroendocrine tumors.
5. A 32-year-old pregnant woman at 28 weeks’ gestation complains of right-sided
low back pain that radiates to the anterior thigh. On examination, the right iliac
crest is higher than the left when standing. The pain is relieved when she sits on the
, toilet. Which of the following somatic dysfunctions is most consistent with her
presentation?
A) Right anterior innominate
B) Left anterior innominate
C) Right posterior innominate
CORRECT ANSWER: C) Right posterior innominate
D) Left posterior innominate
E) Right up slip
Rationale: A posterior innominate on the right causes the iliac crest to be higher on
the right (due to the posterior rotation making the PSIS more inferior and ASIS
more superior? Wait, careful: In a posterior innominate, the ASIS moves superiorly
and posteriorly, and the PSIS moves inferiorly. The iliac crest height: when the
innominate rotates posteriorly, the iliac crest actually moves slightly superiorly?
Typically, a posterior innominate results in a higher iliac crest on the same side.
The patient's right iliac crest is higher, suggesting a right posterior innominate or
left anterior innominate. However, the pain relief when sitting on a toilet (which
involves hip flexion) suggests a posterior innominate because hip flexion reduces
the strain on the sacroiliac joint. Anterior innominate would worsen with flexion.
Right posterior innominate is classic for pregnancy-related pelvic girdle pain.
6. A 67-year-old male with a history of hypertension and diabetes presents with
acute onset of right-sided weakness and aphasia. Non-contrast head CT is normal.
Which of the following is the most appropriate next step?
A) Administer IV tape
B) Repeat head CT in 24 hours
C) Obtain MRI with diffusion-weighted imaging
CORRECT ANSWER: C) Obtain MRI with diffusion-weighted imaging
D) Lumbar puncture
E) Carotid ultrasound
