Free COMLEX Level 1 Sample Questions

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Your First Free COMLEX Level 1 Practice Question

A 56-year-old female librarian with a medical history of hypertension and a transient ischemic attack comes in complaining of soreness of her left buttock and a shooting pain down the back of her left leg of 2 weeks’ duration. Examination reveals full strength, sensation, and intact reflexes. The FAIR test is positive on the left. An osteopathic structural exam reveals a positive seated flexion test on the left. The left sacral base is posterior, and the left inferior lateral angle is posterior and inferior. Palpation reveals a tender point in the likely muscle involved. To treat the most likely diagnosis with strain/counterstrain, a tender point would most likely be found in which location?

• A) between inferior lateral angle of the sacrum and greater trochanter
• B) on the ilium inferior to the posterior superior iliac spine
• C) 1 cm lateral to the pubic symphysis
• D) superior medial surface of the posterior superior iliac spine
• E) 2 to 3 cm lateral to the posterior superior iliac spine

The Answer and Explanation

Did you get it right? The correct answer is ‘A’.

The patient is experiencing piriformis syndrome as a result of piercing of the sciatic nerve by the piriformis muscle, which, when in spasm, causes irritation to the nerve and pain down the posterior thigh. Pain typically occurs with prolonged sitting or direct pressure to the muscle. A common palpatory finding with piriformis syndrome is a sausagelike mass lateral to the sacrum, which is the result of a muscle spasm. The FAIR test (hip flexion, adduction, internal rotation) puts tension on the piriformis and is positive in piriformis syndrome.

The piriformis muscle tender point is located at the midpoint between the inferior lateral angle (ILA) of the sacrum and the greater trochanter.

Treatment of a piriformis tender point involves the patient in the prone position with the hip and knee flexed. The thigh is then abducted and externally rotated.

Answer B: On the ilium inferior to the posterior superior iliac spine is the tender point for the lower pole of L5.

Answer C: 1 cm lateral to the pubic symphysis is the anterior tender point for L5.

Answer D: Superior medial surface of the posterior superior iliac spine is the tender point site for upper pole of L5.

Answer E: 2 to 3 cm lateral to the posterior superior iliac spine is the location of the high ilium sacroiliac tender point.

Bottom Line: A piriformis muscle spasm can cause a sacral torsion and irritation of the sciatic nerve, a condition called piriformis syndrome. The piriformis muscle tender point is located at the midpoint between the inferior lateral angle of the sacrum and the greater trochanter.

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