COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination) — Questions and Answers

Question 1: Which beta-blocker is cardioselective (beta-1 selective) and commonly used in heart failure?

Labetalol
Propranolol
Metoprolol succinate (Correct answer)
Carvedilol

Correct answer: Metoprolol succinate

Metoprolol succinate (extended-release) is a beta-1 selective blocker proven to reduce mortality in heart failure with reduced ejection fraction.

Question 2: A patient with nephrotic syndrome has massive proteinuria, hypoalbuminemia, and pitting edema. The most common cause in adults is:

Membranous nephropathy (Correct answer)
IgA nephropathy
Minimal change disease
Focal segmental glomerulosclerosis (FSGS)

Correct answer: Membranous nephropathy

Membranous nephropathy is the most common cause of nephrotic syndrome in adults, often idiopathic but associated with anti-PLA2R antibodies.

Question 3: What is the primary goal of lymphatic pump techniques in OMT?

Reduce cerebrospinal fluid pressure
Stretch thoracic fascia
Increase arterial blood pressure
Enhance lymphatic flow and immune function (Correct answer)

Correct answer: Enhance lymphatic flow and immune function

Lymphatic pump techniques (thoracic, pedal, abdominal) augment lymphatic circulation to reduce edema and support immune function.

Question 4: A patient refuses a blood transfusion on religious grounds despite life-threatening blood loss. The ethical principle guiding the physician to respect this decision is:

Autonomy (Correct answer)
Beneficence
Non-maleficence
Justice

Correct answer: Autonomy

Autonomy requires respecting a competent patient's right to make their own medical decisions, even when the physician disagrees with the choice.

Question 5: A 24-year-old woman presents with 6 weeks of amenorrhea, vaginal bleeding, and left lower quadrant pain. Beta-hCG is 1,500 mIU/mL and transvaginal ultrasound shows no intrauterine gestational sac. She is hemodynamically stable. Which is the most appropriate management?

Expectant management alone
Dilation and curettage
Methotrexate administration (Correct answer)
Immediate laparotomy

Correct answer: Methotrexate administration

Methotrexate is indicated for hemodynamically stable ectopic pregnancy with beta-hCG <5,000 mIU/mL and no fetal cardiac activity on ultrasound.

Question 6: The classic triad of Cushing's syndrome includes central obesity, hypertension, and:

Hyperpigmentation
Hypothyroidism
Hypocalcemia
Skin striae and muscle weakness (Correct answer)

Correct answer: Skin striae and muscle weakness

Cushing's syndrome classic features include central obesity, hypertension, purple striae, proximal muscle weakness, hirsutism, and easy bruising from excess cortisol.

Question 7: Which sleep stage is characterized by sleep spindles and K-complexes on EEG?

REM sleep
Stage N2 (NREM 2) (Correct answer)
Stage N1 (NREM 1)
Stage N3 (NREM 3)

Correct answer: Stage N2 (NREM 2)

Stage N2 NREM sleep features sleep spindles (12–14 Hz bursts) and K-complexes (large biphasic waves) and constitutes the largest portion of total sleep.

Question 8: Informed consent requires all of the following EXCEPT:

Patient agreement with the physician's recommendation (Correct answer)
Disclosure of risks and benefits
Patient comprehension
Voluntariness

Correct answer: Patient agreement with the physician's recommendation

Informed consent requires disclosure, comprehension, capacity, and voluntariness — it does not require the patient to agree with the physician; they retain the right to refuse.

Question 9: A patient repeatedly arrives late to appointments despite genuine attempts to be on time. Which defense mechanism best explains this behavior?

Rationalization
Projection
Intellectualization
Passive aggression (Correct answer)

Correct answer: Passive aggression

Passive aggression involves indirect expression of hostility through behaviors like tardiness, forgetfulness, or inefficiency.

Question 10: C3 is bent to the left, sidebent, and rotated to the left. How would you position C3 if you were to utilize a direct ME approach to fix this problem?

In extension, Sidebent left, Rotated left
In flexion, Sidebent right, Rotated right (Correct answer)
In extension, Sidebent right, Rotated right
In flexion, Sidebent left, Rotated right

Correct answer: In flexion, Sidebent right, Rotated right

The dysfunction described as "C3 is bent to the left, sidebent, and rotated to the left" implies that the vertebra is stuck in an extended position, sidebent left, and rotated left (E Sleft Rleft). For a direct muscle energy (ME) approach, the patient is positioned into the restrictive barrier. The restrictive barriers for an E Sleft Rleft dysfunction are flexion, sidebending right, and rotation right. Therefore, the correct position for direct ME treatment is in flexion, sidebent right, and rotated right.

Question 11: A 45-year-old woman has heavy menstrual bleeding, urinary frequency, and a 14-week-size uterus on exam. Ultrasound confirms multiple intramural fibroids. She wishes to maintain fertility. What is the most appropriate surgical treatment?

Endometrial ablation
Total abdominal hysterectomy
Uterine artery embolization
Myomectomy (Correct answer)

Correct answer: Myomectomy

Myomectomy removes fibroids while preserving the uterus and is the preferred surgical option for women who desire future fertility.

Question 12: What is the end result of successfully treating a somatic dysfunction using indirect OMT techniques?

Increased joint laxity
Resolution of all four TART criteria (Correct answer)
Joint cavitation
Muscle hypertrophy

Correct answer: Resolution of all four TART criteria

Successful OMT resolves somatic dysfunction, eliminating the TART findings: tissue texture changes, asymmetry, restriction, and tenderness.

Question 13: A child has recurrent pyogenic infections with bacteria and fungi. Flow cytometry shows absent CD18. Which condition is this?

Leukocyte adhesion deficiency (LAD) (Correct answer)
Chronic granulomatous disease
DiGeorge syndrome
Chediak-Higashi syndrome

Correct answer: Leukocyte adhesion deficiency (LAD)

LAD type I results from CD18 (beta-2 integrin) deficiency, preventing neutrophils from migrating to infection sites.

Question 14: Which type of somatic dysfunction is described as Type I (group) mechanics in the thoracic spine?

Multiple segments in flexion with same-side coupling
Single segment with side-bending and rotation same side
Multiple segments in neutral with side-bending and rotation opposite (Correct answer)
Single segment, flexed or extended, with rotation and side-bending opposite

Correct answer: Multiple segments in neutral with side-bending and rotation opposite

Type I (Fryette's first law) involves neutral, multiple vertebral segments where side-bending and rotation occur in opposite directions.

Question 15: Which complication of cirrhosis involves bacterial translocation causing spontaneous infection of ascitic fluid?

Spontaneous bacterial peritonitis (SBP) (Correct answer)
Hepatorenal syndrome
Hepatic encephalopathy
Hepatopulmonary syndrome

Correct answer: Spontaneous bacterial peritonitis (SBP)

SBP occurs when gut bacteria translocate into ascitic fluid; diagnosed by PMN count >250 cells/mm³ in ascites; treated with cefotaxime.

Question 16: Which condition presents with colicky flank pain radiating to the groin, hematuria, and nausea — often described as the worst pain of the patient's life?

Acute pyelonephritis
Ureterolithiasis (renal/ureteral stone) (Correct answer)
Renal cell carcinoma
Ovarian torsion

Correct answer: Ureterolithiasis (renal/ureteral stone)

Ureteral colic from a kidney stone causes severe colicky flank-to-groin pain, hematuria, and nausea due to ureteral obstruction and spasm.

Question 17: Which of the following is a positive symptom of schizophrenia?

Hallucinations (Correct answer)
Alogia
Flat affect
Avolition

Correct answer: Hallucinations

Hallucinations are positive symptoms of schizophrenia (additions to normal experience); flat affect, alogia, and avolition are negative symptoms (losses of normal function).

Question 18: Which of the following statements about a patient with an anterior fibular head SD is correct?

It can cause a foot drop.
The synovial articulation of the tibio-fibular joint resists posterior glide. (Correct answer)
The SD will enhance the amount of plantar flexion that is passive.
It's very common in typical ankle sprains.

Correct answer: The synovial articulation of the tibio-fibular joint resists posterior glide.

An anterior fibular head somatic dysfunction means the fibular head is displaced anteriorly relative to the tibia. In this position, the proximal tibiofibular joint, which is a synovial articulation, will be at its anterior limit of motion. Consequently, any attempt to move the fibular head posteriorly (a posterior glide) will be met with resistance, as it is already restricted in that direction.

Question 19: The mechanism of action of metformin in type 2 diabetes primarily involves:

Blocking SGLT-2 in the kidney
Stimulating insulin secretion from beta cells
Activating AMPK to reduce hepatic gluconeogenesis (Correct answer)
Inhibiting dipeptidyl peptidase-4

Correct answer: Activating AMPK to reduce hepatic gluconeogenesis

Metformin activates AMPK, which decreases hepatic gluconeogenesis and increases peripheral insulin sensitivity without causing hypoglycemia.

Question 20: Which finding on urinalysis is most suggestive of acute glomerulonephritis?

Fatty casts
Hyaline casts
Waxy casts
Red blood cell (RBC) casts (Correct answer)

Correct answer: Red blood cell (RBC) casts

RBC casts in the urine are pathognomonic for glomerulonephritis, indicating that red cells have passed through the damaged glomerular basement membrane into the tubular lumen.

Question 21: A 23-year-old competitive marathon runner presents with 4 months of secondary amenorrhea. Labs show low FSH, low LH, low estradiol, and normal prolactin. TSH is normal. What is the most likely diagnosis?

Polycystic ovary syndrome
Hypothalamic amenorrhea (Correct answer)
Premature ovarian insufficiency
Prolactinoma

Correct answer: Hypothalamic amenorrhea

Hypothalamic amenorrhea from excessive exercise causes suppression of GnRH, resulting in low FSH, low LH, and low estradiol, unlike POI (elevated FSH) or PCOS (elevated LH/androgens).

Question 22: The placebo effect in clinical trials is best controlled by which study design?

Cohort study
Randomized double-blind placebo-controlled trial (Correct answer)
Case-control study
Cross-sectional study

Correct answer: Randomized double-blind placebo-controlled trial

A randomized double-blind placebo-controlled trial controls for placebo effect by ensuring neither patients nor investigators know who received the active treatment.

Question 23: Chronic renal insufficiency affects a 45-year-old diabetic male. An analysis of the structure is likely to reveal:

T10 - L1 ropy paraspinals (Correct answer)
T5 and T6 have severe acute tender points.
T8 and T9 fibrotic paraspinals
Ropy paraspinals at C3

Correct answer: T10 - L1 ropy paraspinals

Explanation: <br> Tissue texture changes at the thoraco-lumbar junction have been linked to renal insufficiency. Ropy and fibrotic are two adjectives that describe chronic tissue texture alterations. T11-L1 Kidneys

Question 24: Which of the following biomechanical or structural anomalies best explains why a COPD patient has a larger AP chest diameter?

As a compensatory strategy for chronic deoxygenation of peripheral tissues, the thoracic cage expands physiologically.
Permanent inhaled rib positions come from the loss of elastic fibers and continuous air trapping. (Correct answer)
Chronic hypoxia causes fibrotic alterations in the diaphragm, resulting in a flattened diaphragm and greater overall lung capacity.
The ribs will be pulled superiorly by continuous auxiliary muscle action, resulting in an enlarged thoracic cage.

Correct answer: Permanent inhaled rib positions come from the loss of elastic fibers and continuous air trapping.

In COPD, the loss of elastic fibers in the lungs and airways leads to chronic air trapping and hyperinflation. This persistent hyperinflation causes the diaphragm to flatten and the ribs to be held in a continuously elevated, inhaled position. This sustained 'inhaled' rib position is what contributes to the characteristic increase in the anterior-posterior (AP) chest diameter, commonly known as a barrel chest.

Question 25: A patient on isoniazid (INH) develops peripheral neuropathy. Which supplement should be given to prevent this side effect?

Vitamin B6 (pyridoxine) (Correct answer)
Vitamin B12 (cobalamin)
Folate
Thiamine (B1)

Correct answer: Vitamin B6 (pyridoxine)

INH inhibits pyridoxine (B6) metabolism; supplementing pyridoxine prevents INH-induced peripheral neuropathy.

Question 26: You notice that the thoracic segments T8-T12 are convex to the R in a 41-year-old man with back pain. Which statement about this group's SD is the most accurate?

Ribs 7 - 12 are limited in exhalation on the L
T9's R TP is more anterior
T10's L TP is more caudad compared to its R (Correct answer)
T9 is Rotated right, Sidebent right

Correct answer: T10's L TP is more caudad compared to its R

A convexity to the right in the thoracic spine (T8-T12) indicates that the spine is sidebent to the left (Sleft). For a group dysfunction (Type I mechanics), sidebending and rotation occur in opposite directions. Therefore, if sidebent left, the group is rotated right (Rright). In a sidebent left dysfunction, the transverse processes on the left side become more caudad (inferior) compared to the right, as the left side of the vertebral bodies approximates. Thus, T10's L TP being more caudad than its R is consistent with sidebending left.

Question 27: A 54-year-old man comes into your office complaining of acute low back discomfort. The ache began while he was working on his automobile the day before yesterday and has now spread to his lower extremities. What additional information in this patient's Hx would have the most impact on the immediate Dx and Tx?

Down-going plantar response w/ Babinski's testing
Presence of incontinence (Correct answer)
Unilateral loss of cremasteric reflex
Loss of Achilles reflex

Correct answer: Presence of incontinence

The spread of low back pain to the lower extremities, combined with the presence of incontinence, is a critical red flag for Cauda Equina Syndrome. This condition involves compression of the nerve roots in the lumbar spine, leading to neurological deficits including bowel and bladder dysfunction. Cauda Equina Syndrome is a surgical emergency requiring immediate diagnosis and intervention to prevent permanent neurological damage, making incontinence the most impactful information for immediate diagnosis and treatment.

Question 28: A 22-year-old sexually active woman has lower abdominal pain, cervical motion tenderness, uterine tenderness, and mucopurulent cervical discharge with temperature of 38.3°C. Which organism is most likely responsible?

Treponema pallidum
Gardnerella vaginalis
Chlamydia trachomatis or Neisseria gonorrhoeae (Correct answer)
Trichomonas vaginalis

Correct answer: Chlamydia trachomatis or Neisseria gonorrhoeae

Pelvic inflammatory disease is most commonly caused by ascending infection from Chlamydia trachomatis and/or Neisseria gonorrhoeae.

Question 29: A 50-year-old man is experiencing low back pain. On examination, the TP of L5 is seen to be posterior on the R. The asymmetry is worsened by extending L5, but flexion restores rotational symmetry. Which of the following statements about this Pt's SD is the most accurate?

A group dysfunction of the high Lumbar area will be present because to the non-neutral L5 SD.
The Pt would be requested to rotate his torso to the L against isometric contraction when using a muscular energy (post-isometric relaxation) approach.
In the stretched posture, L5 will oppose L-rotation. (Correct answer)
This patient has psoas syndrome on the right side.

Correct answer: In the stretched posture, L5 will oppose L-rotation.

Explanation: <br> The patient flexed L5, twisted R, and sidebent R. When the spine is extended, the symmetry worsens and L5 resists the rotation of L.

Question 30: A 7-year-old boy cannot sit still in class, interrupts others, and forgets homework daily. Which diagnosis is most likely?

Autism spectrum disorder
ADHD combined type (Correct answer)
Conduct disorder
Oppositional defiant disorder

Correct answer: ADHD combined type

ADHD combined type presents with both inattention (forgetfulness) and hyperactivity-impulsivity (can't sit still, interrupting) in multiple settings.

COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination)

The COMLEX-USA is a series of three licensure examinations (Level 1, 2-CE, and 3) administered by the NBOME that assess osteopathic medical students and graduates on foundational biomedical sciences, clinical knowledge, and osteopathic principles for licensure in the United States.

Questions

40 min

Time Limit

70%

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