COMLEX-USA Level 1 (Doctor of Osteopathic Medicine Board Examination) — Questions and Answers

Question 1: 'Structure and function are interrelated' is one of the four core osteopathic principles.

This principle was added to osteopathy in 1980
It is one of five osteopathic principles
False
True (Correct answer)

Correct answer: True

Structure and function are interrelated is indeed one of the four foundational osteopathic tenets established by Andrew Taylor Still.

Question 2: Osteopathic medicine has been practiced for more than a century!

True (Correct answer)
False

Correct answer: True

Osteopathic medicine was founded in the late 19th century by Andrew Taylor Still, with the first school established in 1892. This means the practice has been in existence for well over a century, evolving and integrating into mainstream medicine while retaining its core principles. Its long history demonstrates its established presence and development within the healthcare landscape.

Question 3: A patient with an IQ of 68 and significant adaptive deficits is being evaluated for informed consent to participate in a research study. The most appropriate first step is:

Obtain consent only from the legal guardian without involving the patient
Administer a higher-stakes alternative consent form
Exclude the patient from research participation entirely
Assess the patient's specific decision-making capacity for this protocol (Correct answer)

Correct answer: Assess the patient's specific decision-making capacity for this protocol

Decision-making capacity is task-specific; IQ alone does not determine capacity — the physician must assess understanding, appreciation, reasoning, and communication for this specific decision.

Question 4: Which cranial nerve is most closely associated with the parasympathetic supply to the parotid gland?

CN VII (facial nerve)
CN V3 (mandibular branch)
CN X (vagus nerve)
CN IX (glossopharyngeal nerve) (Correct answer)

Correct answer: CN IX (glossopharyngeal nerve)

CN IX (glossopharyngeal nerve) carries preganglionic parasympathetic fibers via the lesser petrosal nerve to the otic ganglion, which then sends postganglionic fibers to the parotid gland.

Question 5: The primary respiratory mechanism (PRM) in craniosacral therapy operates at approximately how many cycles per minute?

6–12 (Correct answer)
18–24
30–40
60–72

Correct answer: 6–12

The primary respiratory mechanism operates at 6–12 cycles per minute, far slower than normal pulmonary respiration.

Question 6: A physician is assessing an adult who sustained a traumatic brain injury. Pre-injury IQ is estimated using what method?

Test of Memory Malingering (TOMM)
Trail Making Test
Digit span subtests from the WAIS
Word reading tests such as WTAR or NART (Correct answer)

Correct answer: Word reading tests such as WTAR or NART

Word reading tests (e.g., WTAR, NART) estimate premorbid IQ because word reading is relatively preserved after brain injury.

Question 7: Increased palpatory skin drag (resistance) over a spinal segment indicates which physiological change?

Increased sympathetic (sudomotor) activity causing moisture changes in the skin (Correct answer)
Decreased sympathetic activity
Normal skin elasticity variation
Peripheral nerve damage

Correct answer: Increased sympathetic (sudomotor) activity causing moisture changes in the skin

Increased palpatory drag reflects sudomotor (sweat gland) activity from sympathetic activation over a facilitated spinal segment.

Question 8: The sinuvertebral (recurrent meningeal) nerve is clinically significant in osteopathic medicine because it innervates which structures?

Spinal cord motor neurons
Spinal cord autonomic centers
Facet joint capsules only
The dura mater and posterior longitudinal ligament, contributing to deep spinal pain (Correct answer)

Correct answer: The dura mater and posterior longitudinal ligament, contributing to deep spinal pain

The sinuvertebral nerve supplies the dura mater, posterior longitudinal ligament, and disc annulus, contributing to the deep, poorly localized pain of spinal conditions.

Question 9: When diagnosing pelvic somatic dysfunction, asymmetric iliac crest height combined with an asymmetric PSIS position most suggests which finding?

Sacral torsion without pelvic involvement
Innominate (hip bone) somatic dysfunction (Correct answer)
Lumbar scoliosis only
Normal anatomic variation

Correct answer: Innominate (hip bone) somatic dysfunction

Asymmetric iliac crest heights combined with PSIS asymmetry indicate innominate somatic dysfunction such as rotation or upslip.

Question 10: What is the primary mechanism of action of metformin in treating type 2 diabetes mellitus?

Stimulates insulin secretion from pancreatic beta cells
Inhibits intestinal alpha-glucosidase
Blocks renal SGLT-2 transporter to enhance glucose excretion
Activates AMPK to reduce hepatic gluconeogenesis (Correct answer)

Correct answer: Activates AMPK to reduce hepatic gluconeogenesis

Metformin activates AMP-activated protein kinase (AMPK), which suppresses hepatic glucose production without directly stimulating insulin secretion.

Question 11: The 2020 AOA/ACGME single accreditation merger primarily affected which aspect of DO graduate training?

Medical school curriculum standards only
Residency accreditation, allowing DOs to train in ACGME programs without a separate AOA track (Correct answer)
State licensure examination requirements
COMLEX examination format and scoring

Correct answer: Residency accreditation, allowing DOs to train in ACGME programs without a separate AOA track

The 2020 merger unified residency accreditation so DO and MD graduates compete in the same pool of ACGME-accredited programs.

Question 12: A medical student on rotation notes that a patient's right shoulder is higher than the left when standing. Further exam reveals the right iliac crest is also higher. What is the most likely underlying cause?

Left sacral shear dysfunction
True anatomic short left leg causing left pelvic drop (Correct answer)
Right thoracic scoliosis with compensatory pelvic shift
Functional leg length discrepancy from right iliac crest elevation

Correct answer: True anatomic short left leg causing left pelvic drop

A true short left leg causes the left side of the pelvis to drop (left iliac crest lower), making the right iliac crest appear higher, with compensatory spinal curves including right shoulder elevation.

Question 13: What is the primary structural finding that distinguishes a Type II (Fryette's Law II) vertebral dysfunction from a Type I?

Type II dysfunction does not involve coupled motion
Type II involves a group of vertebrae rather than a single vertebra
Type II always involves the lumbar spine only
Type II occurs in flexion or extension with sidebending and rotation to the same side (Correct answer)

Correct answer: Type II occurs in flexion or extension with sidebending and rotation to the same side

Fryette's Second Law applies to a single vertebral segment in flexion or extension, where sidebending and rotation couple to the SAME side — the opposite of the neutral (Type I) mechanics.

Question 14: A standard score has a mean of 100 and SD of 15. What is the probability of randomly selecting an individual with an IQ between 85 and 115?

99.7%
95%
50%
68% (Correct answer)

Correct answer: 68%

Scores between 85–115 fall within one standard deviation of the mean (100 ± 15), encompassing approximately 68% of a normally distributed population.

Question 15: A.T. Still's approach to medicine was partly a rejection of which dominant medical practice of the 19th century?

Excessive and harmful use of drugs (Correct answer)
Surgical techniques
Anatomical study
Physical examination

Correct answer: Excessive and harmful use of drugs

Still was critical of the heavy, often toxic drug treatments prevalent in 19th-century medicine and sought natural healing methods instead.

Question 16: Lymphatic OMM techniques are most indicated in which clinical scenario?

Acute bone fracture stabilization
Post-surgical edema and respiratory infections (Correct answer)
Acute psychosis
Hypertensive crisis management

Correct answer: Post-surgical edema and respiratory infections

Lymphatic OMM is indicated to reduce post-surgical edema and to improve immune function and drainage during respiratory infections.

Question 17: Lead exposure during early childhood most directly impacts IQ scores by affecting which brain structure?

Prefrontal cortex and hippocampus (Correct answer)
Occipital cortex
Cerebellum
Brainstem reticular formation

Correct answer: Prefrontal cortex and hippocampus

Lead preferentially damages the prefrontal cortex and hippocampus, disrupting executive function, working memory, and learning — core IQ-related domains.

Question 18: A patient is being switched from fluoxetine to phenelzine. Why must a 5-week washout period be observed before starting the MAOI?

Fluoxetine permanently occupies serotonin transporters for several weeks
Fluoxetine induces hepatic enzymes that activate phenelzine to toxic metabolites
Fluoxetine irreversibly inhibits MAO enzymes for 5 weeks
Fluoxetine and its active metabolite norfluoxetine have exceptionally long half-lives (Correct answer)

Correct answer: Fluoxetine and its active metabolite norfluoxetine have exceptionally long half-lives

Fluoxetine has a half-life of 1-4 days and its active metabolite norfluoxetine has a half-life of up to 1 week, requiring a 5-week washout to prevent serotonin syndrome.

Question 19: A rib that cannot expand fully during inspiration is classified as which type of rib dysfunction?

Inhalation restriction (Correct answer)
Costochondritis
Structural rib fracture
Exhalation restriction

Correct answer: Inhalation restriction

An inhalation restriction (inhalation rib) is a rib stuck in exhalation that cannot move fully outward during inspiration.

Question 20: Full DO medical licensure in all 50 US states requires passing which combination of examinations?

USMLE Steps 1, 2, and 3 only
COMLEX Level 2-CE only
COMLEX Level 1 only
COMLEX Levels 1, 2-CE, and 3 together (Correct answer)

Correct answer: COMLEX Levels 1, 2-CE, and 3 together

Passing all three levels of COMLEX-USA (or USMLE equivalents) together constitutes the complete licensing pathway for DOs.

Question 21: The thoracolumbar fascia is significant in OMM because it connects which structures?

Only thoracic vertebrae to ribs
Abdominal muscles to the femur
Thoracic/lumbar spine to pelvis, gluteal muscles, and upper extremity via latissimus dorsi (Correct answer)
Cervical spine directly to sacrum

Correct answer: Thoracic/lumbar spine to pelvis, gluteal muscles, and upper extremity via latissimus dorsi

The thoracolumbar fascia is a broad connective tissue sheet integrating the spine, pelvis, gluteals, and upper body muscles into a force-transfer unit.

Question 22: A 25-year-old presents with recurrent headaches originating at the occiput. The physician finds restriction of the occipito-atlantal (OA) joint in extension. Using muscle energy technique, the patient should actively:

Flex the head while the physician prevents motion, then the physician moves into extension (Correct answer)
Rotate the head while holding neutral position to engage the rotational barrier
Perform deep breathing to use respiratory assist with extension
Extend the head against resistance, then the physician moves further into flexion toward ease

Correct answer: Flex the head while the physician prevents motion, then the physician moves into extension

For an OA restriction in extension, muscle energy positions the joint in flexion (toward the barrier), has the patient resist into extension (isometric contraction), then after relaxation, the physician moves further into flexion to gain range.

Question 23: Like MDs, DOs can get a license to practice in all 50 states.

True (Correct answer)
False

Correct answer: True

Both Doctors of Osteopathic Medicine (DOs) and Medical Doctors (MDs) are fully licensed physicians who can practice medicine and surgery in all 50 states and internationally. Their training is rigorous and comprehensive, allowing them to prescribe medication, perform surgery, and practice in all medical specialties. This ensures that DOs have the same legal and professional standing as MDs.

Question 24: Which clinical presentation most warrants assessment of Chapman's reflex points for the kidney?

Anterior chest pain and T5 tenderness
Epigastric pain with T7 changes
Flank pain with posterior T10–T11 tissue texture changes (Correct answer)
Headache with suboccipital tenderness

Correct answer: Flank pain with posterior T10–T11 tissue texture changes

Kidney Chapman's points are located posteriorly at T10–T11 and anteriorly in the lateral flank, correlating with renal sympathetic innervation.

Question 25: Manipulation by osteopaths Doctors of osteopathic medicine employ treatment, a hands-on method, to promote wellness and recovery.

True (Correct answer)
False

Correct answer: True

This statement is true. Doctors of osteopathic medicine employ Osteopathic Manipulative Treatment (OMT), a distinctive hands-on method, to diagnose, treat, and prevent illness or injury. OMT involves using various manual techniques to restore normal body function, reduce pain, and promote the body's natural healing capabilities, aligning with the holistic philosophy of osteopathic medicine.

Question 26: Chapman's reflex points are considered to represent which type of reflex?

Myotatic reflexes
Proprioceptive reflexes
Viscerosomatic reflexes in the lymphatic system (Correct answer)
Cutaneous withdrawal reflexes

Correct answer: Viscerosomatic reflexes in the lymphatic system

Chapman's points are gangliform contractions believed to represent viscerosomatic reflex activity within lymphatic tissue.

Question 27: A physician diagnoses a patient with a 'sprung rib' (rib 6 on the left). Inhalation is restricted. The rib is held in exhalation position. Correct muscle energy treatment involves:

Patient exhales against physician resistance; physician moves rib inferiorly after relaxation
Patient inhales against physician resistance; physician repositions rib superiorly after each breath (Correct answer)
Patient rotates torso while physician holds the rib in neutral
Physician applies HVLA thrust posteriorly during peak inhalation

Correct answer: Patient inhales against physician resistance; physician repositions rib superiorly after each breath

For an inhalation-restricted rib (held in exhalation), muscle energy has the patient inhale (engaging inhalation musculature) against the physician's resistance, and after relaxation the physician repositions the rib upward toward inhalation.

Question 28: In the TART mnemonic used for somatic dysfunction diagnosis, what does the 'A' represent?

Autonomic changes including sweating and temperature
Asymmetry of bony landmarks or tissue texture (Correct answer)
Atrophy of paraspinal muscles
Articular crepitus on range of motion testing

Correct answer: Asymmetry of bony landmarks or tissue texture

TART stands for Tissue texture changes, Asymmetry of position, Restriction of motion, and Tenderness — the four cardinal signs used to identify and document somatic dysfunction.

Question 29: A 7-year-old is referred for evaluation of learning difficulties. Her performance IQ is 95 but verbal IQ is 72. This significant discrepancy most suggests evaluation for which condition?

ADHD, combined type
Dyscalculia
Dyslexia or language-based learning disability (Correct answer)
Autism spectrum disorder

Correct answer: Dyslexia or language-based learning disability

A large verbal-performance IQ discrepancy with low verbal IQ is classically associated with language-based learning disabilities such as dyslexia.

Question 30: A DO student is asked to explain 'balanced ligamentous tension' (BLT). Which statement best captures this osteopathic indirect technique?

The physician stretches shortened ligaments by moving the joint repeatedly through its full range
The patient contracts specific ligament-attached muscles while the physician holds the joint in extension
The physician applies a direct thrust to rupture adhesions within joint ligaments
The physician guides the joint to a position of equal tension in all supporting ligaments, allowing inherent forces to restore normal motion (Correct answer)

Correct answer: The physician guides the joint to a position of equal tension in all supporting ligaments, allowing inherent forces to restore normal motion

BLT is an indirect technique in which the physician positions the joint at the point of balanced tension in all ligaments — the 'still point' — allowing the body's inherent forces to resolve the somatic dysfunction.

Question 31: Who founded osteopathic medicine?

Carl Philip McConnell
John Martin Littlejohn
Andrew Taylor Still (Correct answer)
William Garner Sutherland

Correct answer: Andrew Taylor Still

Andrew Taylor Still (A.T. Still) founded osteopathic medicine in 1874, with his first school established in Kirksville, Missouri in 1892.

Question 32: A physician suspects malingering during an IQ evaluation of a patient claiming disability benefits. Which test is MOST appropriate to assess effort validity?

Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
Beck Anxiety Inventory (BAI)
Hamilton Depression Scale
Test of Memory Malingering (TOMM) (Correct answer)

Correct answer: Test of Memory Malingering (TOMM)

The TOMM is a widely used performance validity test specifically designed to detect inadequate effort or malingering during cognitive evaluations.

Question 33: A patient presents with acetaminophen overdose 4 hours after ingestion. What is the correct antidote and its mechanism?

N-acetylcysteine — replenishes glutathione stores (Correct answer)
Pralidoxime — regenerates acetylcholinesterase
Flumazenil — benzodiazepine receptor antagonist
Fomepizole — inhibits alcohol dehydrogenase

Correct answer: N-acetylcysteine — replenishes glutathione stores

N-acetylcysteine provides cysteine as a glutathione precursor, allowing hepatocytes to detoxify NAPQI before it causes irreversible oxidative damage.

Question 34: The diaphragm is central to osteopathic respiratory-circulatory treatment because of which combined roles?

Hormone secretion
Cardiac pacing
Respiration only
Respiration, lymphatic pumping, venous return assistance, and thoracoabdominal pressure regulation (Correct answer)

Correct answer: Respiration, lymphatic pumping, venous return assistance, and thoracoabdominal pressure regulation

Each diaphragmatic excursion simultaneously drives breathing, pumps lymphatics, assists venous return, and regulates intrathoracic/abdominal pressure.

Question 35: Which of the following best describes the neurological model of osteopathic care?

Optimizing neural input/output to support body self-regulation and remove interference from somatic dysfunction (Correct answer)
Using nerve blocks for pain management
Treating only brain and spinal cord pathology
Prescribing neurological medications

Correct answer: Optimizing neural input/output to support body self-regulation and remove interference from somatic dysfunction

The neurological model addresses how somatic dysfunction impairs normal neural signaling and how OMM restores optimal nervous system function.

Question 36: Facilitated positional release (FPR) uses which combination to resolve somatic dysfunction?

Thrust and sustained pressure
Indirect positioning combined with a compressive or torsional facilitating force (Correct answer)
Muscle contraction and stretching
Direct force and rotation

Correct answer: Indirect positioning combined with a compressive or torsional facilitating force

FPR uses indirect positioning combined with a facilitating force (compression or torsion) to achieve rapid tissue release.

Question 37: A patient stabilized on warfarin is started on rifampin for latent TB. What is the expected effect on INR?

INR remains unchanged
INR fluctuates unpredictably
INR decreases significantly (Correct answer)
INR increases significantly

Correct answer: INR decreases significantly

Rifampin is a potent CYP450 inducer that accelerates warfarin metabolism, significantly reducing INR and increasing clot risk.

Question 38: The AOA not only acts as the main certification authority for DOs, but it also accredits all osteopathic medical schools and hospitals.

American Osteopathic Association (Correct answer)
OMT-osteopathic manipulative treatment
Specialty Training Programs
Accreditation

Correct answer: American Osteopathic Association

The American Osteopathic Association (AOA) is the primary professional organization for osteopathic physicians in the United States. It plays a critical role in maintaining the standards of osteopathic medicine by accrediting all osteopathic medical schools and hospitals. Additionally, the AOA serves as the main certification authority for DOs, ensuring the quality and integrity of the profession.

Question 39: A 4-year-old child cannot be reliably tested with standard IQ measures. Which assessment approach is most appropriate for evaluating intellectual functioning in this case?

Beck Depression Inventory
Minnesota Multiphasic Personality Inventory (MMPI)
WAIS-IV administered with extended time
Vineland Adaptive Behavior Scales (Correct answer)

Correct answer: Vineland Adaptive Behavior Scales

The Vineland Adaptive Behavior Scales assess real-world functioning and are appropriate when standardized IQ testing is not feasible or reliable.

Question 40: In Fryette's mechanics, Type II (non-neutral) dysfunction is characterized by which coupling pattern?

Sidebending and rotation to opposite sides
Rotation without sidebending
Sidebending without rotation
Sidebending and rotation to the same side (Correct answer)

Correct answer: Sidebending and rotation to the same side

Type II (non-neutral) mechanics occur at a single segment in flexion or extension, coupling sidebending and rotation to the same side.

Question 41: The 'four tenets of osteopathic medicine' include which of the following?

The body is a unit; structure and function are interrelated; the body has self-healing mechanisms; rational treatment is based on these principles (Correct answer)
The nervous system controls all healing; lymphatics are unimportant; fascia is the primary somatic structure; drugs should be avoided
Disease is purely somatic; the mind has no effect on the body; manipulation cures all disease; osteopathic and allopathic medicine are incompatible
All disease originates in the spine; the cranium is immobile; nutrition is the basis of health; surgery is never necessary

Correct answer: The body is a unit; structure and function are interrelated; the body has self-healing mechanisms; rational treatment is based on these principles

A.T. Still's four tenets are: (1) the body is a unit of body, mind, and spirit; (2) structure and function are reciprocally interrelated; (3) the body is capable of self-regulation, self-healing, and health maintenance; (4) rational treatment is based on these principles.

Question 42: A patient receiving IV vancomycin develops flushing and erythema over the face, neck, and chest. What is the mechanism?

T-cell mediated delayed hypersensitivity
Direct mast cell degranulation causing histamine release (Correct answer)
Complement system activation
IgE-mediated allergic reaction

Correct answer: Direct mast cell degranulation causing histamine release

Red man syndrome results from non-immune direct mast cell degranulation and histamine release, which is rate-dependent and not a true allergy.

Question 43: The following are the objectives of osteopathic manipulation.

None of the above
Alleviate Pain
Restore Motion
Both Restore Motion and Alleviate Pain (Correct answer)

Correct answer: Both Restore Motion and Alleviate Pain

The primary objectives of osteopathic manipulation (OMT) are to restore normal motion in restricted joints and tissues and to alleviate pain associated with somatic dysfunctions. By addressing musculoskeletal imbalances, OMT helps improve overall body function, reduce discomfort, and support the body's natural healing processes. It aims to enhance the body's ability to self-regulate and heal.

Question 44: DO graduates who pass COMLEX-USA can apply to which residency programs in the current single accreditation system?

Neither; additional fellowship training is required first
Only AOA-accredited programs
Both AOA and ACGME-accredited programs (Correct answer)
Only ACGME-accredited programs

Correct answer: Both AOA and ACGME-accredited programs

Since the 2020 single accreditation merger, DO graduates can apply to both AOA and ACGME-accredited residency programs.

Question 45: Which beta-blocker is most cardioselective and preferred when a beta-blocker is necessary in a patient with mild COPD?

Metoprolol (Correct answer)
Labetalol
Propranolol
Carvedilol

Correct answer: Metoprolol

Metoprolol selectively blocks beta-1 receptors with minimal beta-2 activity, reducing the risk of bronchospasm compared to non-selective agents.

Question 46: OMM treatment is relatively contraindicated in which of the following situations?

Chronic neck pain
Mild costochondritis
Acute disc herniation with radiculopathy (Correct answer)
Tension headache

Correct answer: Acute disc herniation with radiculopathy

Acute disc herniation with neurological deficits is a relative contraindication for OMM — especially HVLA — due to risk of worsening nerve compression.

Question 47: This does not prevent doctors from pursuing specialty training through residencies or, as of recent years.

Osteopathic medicine (Correct answer)
Osteopathic Curriculum
Selection Factors
Osteopathic medicine courses

Correct answer: Osteopathic medicine

Osteopathic medicine is a fully recognized branch of medicine, and holding a Doctor of Osteopathic Medicine (DO) degree does not prevent physicians from pursuing specialty training. In recent years, the residency match systems for MDs and DOs have integrated, allowing osteopathic physicians full access to all specialty training programs. This ensures DOs can specialize in any field, just like their MD counterparts.

Question 48: When the body mobilizes immune cells to fight infection, this demonstrates which osteopathic tenet?

Rational treatment
Self-healing and self-regulatory mechanisms (Correct answer)
Body unity
Structure-function relationship

Correct answer: Self-healing and self-regulatory mechanisms

The body's innate immune response exemplifies the osteopathic tenet that the body has inherent self-healing and self-regulatory mechanisms.

Question 49: A D.O. doctor should be shadowed as part of your clinical exposure or experience, according to several osteopathic colleges.

Schools
Osteopathic medicine courses
Selection Factors (Correct answer)
Degree / Major

Correct answer: Selection Factors

Shadowing a D.O. doctor is often considered a crucial 'selection factor' or admissions requirement by many osteopathic colleges. This experience allows applicants to gain firsthand insight into the unique philosophy and practice of osteopathic medicine, particularly its holistic approach and the use of Osteopathic Manipulative Treatment (OMT). It demonstrates a genuine interest and understanding of the DO profession.

Question 50: During osteopathic structural exam, a patient is found to have a right-on-right sacral torsion. Which combination of findings is expected?

Right sacral sulcus deep, left ILA posterior, positive right seated flexion test
Right sacral sulcus deep, right ILA posterior, positive right seated flexion test (Correct answer)
Left sacral sulcus deep, right ILA posterior, positive left seated flexion test
Left sacral sulcus shallow, left ILA posterior, negative seated flexion test

Correct answer: Right sacral sulcus deep, right ILA posterior, positive right seated flexion test

A right-on-right sacral torsion has the right sacral sulcus deep (sacrum rotating right around a right oblique axis), right ILA posterior/inferior, and a positive right seated flexion test (right ilium restricted).

Question 51: Which of the following is classified as an INDIRECT OMM technique?

Counterstrain (Correct answer)
HVLA
Articulatory technique
Muscle energy

Correct answer: Counterstrain

Counterstrain is an indirect technique because it moves the body away from the restrictive barrier toward the position of ease.

Question 52: Which state is considered the birthplace of osteopathic medicine?

Missouri (Correct answer)
Kansas
Illinois
Ohio

Correct answer: Missouri

Kirksville, Missouri is where A.T. Still established the first osteopathic school, making it the birthplace of the profession.

Question 53: A physician performing craniosacral therapy notes the cranial rhythmic impulse (CRI) has a rate of approximately 6 cycles per minute. This rate is considered:

Unrelated to osteopathic cranial treatment
Below normal and suggests CNS depression
Within the normal range of 6-12 cycles per minute (Correct answer)
Markedly elevated and indicates intracranial pathology

Correct answer: Within the normal range of 6-12 cycles per minute

The cranial rhythmic impulse (CRI) normally cycles at 6-12 times per minute; rates outside this range may reflect autonomic or CNS dysfunction and guide craniosacral treatment.

Question 54: Which subtest of the WAIS-IV is considered the single best predictor of Full Scale IQ?

Digit Span
Vocabulary (Correct answer)
Matrix Reasoning
Coding

Correct answer: Vocabulary

Vocabulary is consistently the highest g-loaded subtest on the WAIS and the best single predictor of Full Scale IQ.

Question 55: The tenet of 'rational treatment based on the above principles' means which of the following in practice?

Prescribing only natural remedies
Using only evidence-based treatments
Applying all therapeutic approaches — including OMM, medications, and surgery — logically based on the other three tenets (Correct answer)
Avoiding pharmaceutical treatment entirely

Correct answer: Applying all therapeutic approaches — including OMM, medications, and surgery — logically based on the other three tenets

Rational treatment means the physician logically applies all available therapeutic tools — guided by body unity, self-healing, and structure-function principles.

Question 56: Which of the following best describes somatic dysfunction?

A neurological motor deficit
An autoimmune musculoskeletal disease
Impaired or altered function of the skeletal, arthrodial, and myofascial structures (Correct answer)
A fracture in the musculoskeletal system

Correct answer: Impaired or altered function of the skeletal, arthrodial, and myofascial structures

Somatic dysfunction is defined as impaired or altered function of related components of the somatic (body framework) system.

Question 57: In Counterstrain technique, the position of comfort must be maintained for exactly 90 seconds before slow return to neutral.

True, but only for anterior tender points
The hold time in Counterstrain is 45 seconds
False — the hold time is 30 seconds
True (Correct answer)

Correct answer: True

Counterstrain requires holding the position of maximal comfort for 90 seconds to allow the shortened muscle spindles to reset.

Question 58: Facilitated spinal segments are characterized by which physiological state?

Complete sensory nerve block
Parasympathetic dominance
Decreased neural excitability
Increased neural excitability from sustained afferent input (Correct answer)

Correct answer: Increased neural excitability from sustained afferent input

Facilitated segments have a chronically lowered firing threshold due to persistent afferent bombardment, making them hyperreactive.

Question 59: Following osteopathic manipulation, a patient may not see a reduction in pain or an increase in function for some time. This depends on the type of condition, how long it has been, and how each person's body is different.

False
True (Correct answer)

Correct answer: True

This statement is true. The response to Osteopathic Manipulative Treatment (OMT) can vary significantly among individuals and conditions. Factors such as the chronicity and severity of the condition, as well as individual physiological differences, influence the timeline for pain reduction and functional improvement. It's not always an immediate fix, and multiple sessions may be required for optimal results.

Question 60: A patient on phenelzine (MAOI) eats aged cheddar cheese and develops a severe hypertensive crisis. What is the mechanism?

Tyramine directly stimulates alpha-1 adrenergic receptors
Tyramine increases renal renin secretion
Tyramine inhibits catecholamine reuptake transporters
Tyramine displaces stored catecholamines from presynaptic vesicles (Correct answer)

Correct answer: Tyramine displaces stored catecholamines from presynaptic vesicles

Without GI MAO to metabolize it, tyramine is absorbed systemically and enters presynaptic terminals where it displaces stored norepinephrine, causing massive NE release.

Question 61: The COMLEX-USA examination series was designed specifically for osteopathic medical students and graduates.

False — COMLEX is taken by all medical students in the US
COMLEX is only required for DOs entering primary care specialties
True (Correct answer)
True, but DOs must also pass the USMLE to obtain licensure

Correct answer: True

COMLEX-USA is the osteopathic-specific licensing exam series; DOs may also choose to take the USMLE but are not required to do so for licensure.

Question 62: Which spinal region provides sympathetic innervation to the pelvic organs and lower extremities?

T1–T4
L3–L5
T10–L2 (Correct answer)
T5–T9

Correct answer: T10–L2

The thoracolumbar sympathetic chain from T10–L2 innervates the pelvic organs and lower extremities.

Question 63: A patient has a Chapman's reflex point palpated at the intercostal space between ribs 5 and 6 anteriorly on the right. This finding is most associated with pathology of which organ?

Small intestine
Right kidney
Gallbladder (Correct answer)
Liver

Correct answer: Gallbladder

The Chapman's reflex point for the gallbladder is located in the right intercostal space between ribs 5 and 6 anteriorly; these fascial ganglia reflect viscerosomatic reflexes from the associated organ.

Question 64: Which drug class is the first-line treatment for hypertension in a patient with type 2 diabetes and proteinuria?

Beta-blockers
Thiazide diuretics
Calcium channel blockers
ACE inhibitors (Correct answer)

Correct answer: ACE inhibitors

ACE inhibitors reduce intraglomerular pressure and have renoprotective effects in diabetic nephropathy by blocking the renin-angiotensin-aldosterone system.

Question 65: Which of the four osteopathic tenets holds that 'the person is a unit of body, mind, and spirit'?

Rational treatment
Self-healing mechanisms
Structure-function relationship
Body unity (Correct answer)

Correct answer: Body unity

The tenet of body unity holds that all body systems are interdependent and the person must be treated as an integrated whole.

Question 66: Which IQ test is most widely used for assessing adults aged 16–90 in clinical neuropsychological evaluations in the US?

Stanford-Binet Intelligence Scale
Wechsler Adult Intelligence Scale (WAIS) (Correct answer)
Kaufman Assessment Battery for Children
Raven's Progressive Matrices

Correct answer: Wechsler Adult Intelligence Scale (WAIS)

The WAIS (currently WAIS-IV) is the gold-standard adult IQ test used in clinical and neuropsychological settings.

Question 67: On COMLEX, a question stem mentioning 'somatic dysfunction' or asking for 'most appropriate osteopathic treatment' signals which type of content?

Radiology interpretation question
Surgical technique question
OMM-specific knowledge required in the answer (Correct answer)
Pure pharmacology question

Correct answer: OMM-specific knowledge required in the answer

Osteopathic-specific language in the stem — such as 'somatic dysfunction' or 'OMM treatment' — signals that OMM knowledge is being tested.

Question 68: A 10-year-old child scores 70 on a standardized IQ test. According to DSM-5 criteria, which additional finding is required to diagnose intellectual disability?

Brain imaging showing cortical atrophy
A score below 65 on a second IQ test
Onset of symptoms before age 5
Deficits in adaptive functioning in at least one domain (Correct answer)

Correct answer: Deficits in adaptive functioning in at least one domain

DSM-5 requires both intellectual deficits AND deficits in adaptive functioning (conceptual, social, or practical domains) with onset during the developmental period.

Question 69: Approximately how many DOs are currently practicing in the United States?

50,000
180,000 (Correct answer)
100,000
500,000

Correct answer: 180,000

Approximately 180,000 DOs practice in the United States, representing about 25% of the total US physician workforce.

Question 70: In muscle energy technique, the patient actively contracts their muscles against which type of resistance?

No resistance
Gravity only
Unyielding (isometric) resistance (Correct answer)
Yielding resistance

Correct answer: Unyielding (isometric) resistance

Muscle energy technique requires the patient to contract isometrically against an unyielding resistance provided by the physician.

Question 71: Which osteopathic finding is most associated with the sympathetic spinal level T1–T4?

Lower extremity pain
Gastrointestinal disorders
Cardiac and pulmonary conditions (Correct answer)
Urological conditions

Correct answer: Cardiac and pulmonary conditions

The upper thoracic spine (T1–T4) provides sympathetic innervation to the heart and lungs, making it relevant to cardiopulmonary conditions.

Question 72: Which of the following is a key limitation of using IQ scores alone to determine competency to stand trial?

Competency requires functional legal understanding, not just cognitive ability (Correct answer)
IQ tests are not standardized for adults
Competency assessments require an IQ above 80
IQ scores are not admissible in US courts

Correct answer: Competency requires functional legal understanding, not just cognitive ability

Competency to stand trial requires the functional ability to understand proceedings and assist counsel — IQ scores are one data point but do not solely determine competency.

Question 73: Loss of cervical lordosis on lateral cervical X-ray always indicates serious pathology requiring immediate intervention.

True
True, but only in patients over 50 years old
False — it is a common finding with muscle spasm, positioning, or poor posture (Correct answer)
Cervical lordosis can only be accurately assessed by MRI, not plain X-ray

Correct answer: False — it is a common finding with muscle spasm, positioning, or poor posture

Loss of cervical lordosis is frequently a benign finding associated with muscle spasm, patient positioning during imaging, or habitual posture and does not mandate urgent intervention.

Question 74: Thoracic lymphatic pump technique enhances lymphatic flow by applying rhythmic compression forces to the thoracic cage.

Lymphatic pump techniques are restricted to abdominal application only
True, but it only increases venous, not lymphatic flow
True (Correct answer)
False — thoracic pump compresses only the thoracic inlet, not the cage

Correct answer: True

Thoracic lymphatic pump uses rhythmic compression of the thoracic cage to create pressure gradients that drive lymphatic and immune fluid flow.

Question 75: The greater splanchnic nerve (T5–T9) carries preganglionic fibers to the celiac ganglion.

The greater splanchnic nerve supplies the inferior mesenteric ganglion
False — the celiac ganglion is supplied by T10–T12
True (Correct answer)
True, but the celiac ganglion also receives parasympathetic fibers

Correct answer: True

The greater splanchnic nerve (T5–T9) provides preganglionic sympathetic fibers to the celiac ganglion, which innervates the upper abdominal organs.

Question 76: A 68-year-old man with both hypertension and benign prostatic hyperplasia (BPH) asks about a single drug that can treat both conditions. Which drug class is appropriate?

Selective beta-1 blockers
Alpha-1 adrenergic blockers (Correct answer)
Non-dihydropyridine calcium channel blockers
ACE inhibitors

Correct answer: Alpha-1 adrenergic blockers

Alpha-1 blockers (e.g., doxazosin, terazosin) relax vascular smooth muscle to lower blood pressure and relax prostatic smooth muscle to improve urinary flow.

Question 77: A 35-year-old with Down syndrome presents with rapidly declining IQ scores and memory loss. Which diagnosis should be prioritized in the differential?

Alzheimer's disease (Correct answer)
Hypothyroidism
Vitamin B12 deficiency
Major depressive disorder

Correct answer: Alzheimer's disease

Individuals with Down syndrome have an extremely high lifetime risk of Alzheimer's disease, often presenting in the 40s–50s, due to triplication of the APP gene on chromosome 21.

Question 78: Which foundational osteopathic concept holds that health is the natural state of the body and disease represents a departure from optimal self-regulation?

The inherent self-healing and self-regulatory capacity of the body (Correct answer)
Allostatic load theory
Germ theory
Homeostatic failure theory

Correct answer: The inherent self-healing and self-regulatory capacity of the body

A.T. Still believed the body possesses inherent self-healing mechanisms and that the physician's role is to remove obstacles to this natural process.

Question 79: During a structural exam, how is a 'neutral' lumbar somatic dysfunction (Type I) characterized?

Single segment, same-side sidebending and rotation
Single segment, no rotation
Multiple segments, opposite-side sidebending and rotation (Correct answer)
Multiple segments, pure flexion restriction

Correct answer: Multiple segments, opposite-side sidebending and rotation

Type I (neutral) lumbar dysfunction affects multiple segments with sidebending and rotation coupled in opposite directions per Fryette's Law I.

Question 80: Which immunosuppressant used in solid organ transplantation works by forming a complex with cyclophilin that inhibits calcineurin?

Cyclosporine (Correct answer)
Azathioprine
Sirolimus (rapamycin)
Mycophenolate mofetil

Correct answer: Cyclosporine

Cyclosporine binds cyclophilin; this complex inhibits calcineurin phosphatase, preventing dephosphorylation of NFAT and blocking IL-2 transcription needed for T-cell activation.

Question 81: Which condition is most commonly associated with an IQ in the moderate intellectual disability range (35–49)?

Down syndrome (trisomy 21) (Correct answer)
Phenylketonuria (untreated)
Fragile X syndrome
Williams syndrome

Correct answer: Down syndrome (trisomy 21)

Down syndrome typically produces IQ scores in the moderate range (35–70), though there is variability; it is the most common chromosomal cause of intellectual disability.

Question 82: A 30-year-old woman with asthma is treated with osteopathic manipulative treatment targeting the upper thoracic region. The primary goal of treating T1-T4 is to:

Increase parasympathetic tone via the recurrent laryngeal nerve
Reduce afferent pain signals from the lung parenchyma
Improve lymphatic drainage through the thoracic duct
Normalize sympathetic outflow to the bronchopulmonary tree (Correct answer)

Correct answer: Normalize sympathetic outflow to the bronchopulmonary tree

The sympathetic innervation to the lungs originates from T1-T4 spinal levels; somatic dysfunction here can cause facilitated segments that increase bronchial smooth muscle tone, and OMT aims to normalize this sympathetic outflow.

Question 83: Osteopathic medical schools in the United States are accredited by the Liaison Committee on Medical Education (LCME).

False — DO schools are accredited by COCA (Commission on Osteopathic College Accreditation) (Correct answer)
True
DO schools are self-accrediting with no external oversight body
True, the LCME accredits both MD and DO programs

Correct answer: False — DO schools are accredited by COCA (Commission on Osteopathic College Accreditation)

DO medical schools are accredited by the COCA under the AOA, while allopathic (MD) schools are accredited by the LCME.

Question 84: Osteopathic medical schools in the United States are accredited by which body?

LCME
Commission on Osteopathic College Accreditation (COCA) (Correct answer)
ACGME
AMA Council on Medical Education

Correct answer: Commission on Osteopathic College Accreditation (COCA)

The COCA, operating under the AOA, is the accrediting body for osteopathic (DO) medical schools in the United States.

Question 85: Which heritability estimate for IQ in adults, derived from twin studies, is most consistent with the current scientific literature?

20–30%
40–50%
60–80% (Correct answer)
95–100%

Correct answer: 60–80%

Twin and adoption studies consistently estimate IQ heritability in adults at approximately 60–80%, with environmental factors accounting for the remainder.

Question 86: During a lymphatic pump technique, the physician places their hands on the patient's chest and applies rhythmic compressions timed with respiration. The primary goal is to:

Stretch intercostal muscles to improve respiratory excursion
Increase intrathoracic pressure oscillations to enhance lymphatic flow (Correct answer)
Stimulate the autonomic nervous system via the anterior chest wall
Reduce sympathetic tone to the heart and lungs

Correct answer: Increase intrathoracic pressure oscillations to enhance lymphatic flow

The thoracic lymphatic pump creates alternating pressure gradients that propel lymph through the thoracic duct and right lymphatic duct into the subclavian veins, enhancing immune function and lymphatic drainage.

Question 87: Which of the following is an absolute contraindication to HVLA manipulation of the cervical spine?

Moderate osteoarthritis of C4-C5
Down syndrome with atlanto-axial instability (Correct answer)
Chronic cervicogenic headache
Acute muscle spasm with limited ROM

Correct answer: Down syndrome with atlanto-axial instability

Down syndrome is associated with atlanto-axial instability due to ligamentous laxity; HVLA at the cervical spine in this setting carries high risk of spinal cord injury and is absolutely contraindicated.

Question 88: AOA (American Osteopathic Association) specialty board certification was discontinued after the 2020 merger and is no longer available to DO graduates.

False — AOA board certification continues to exist alongside ABMS certification (Correct answer)
True, all DOs must now pursue ABMS board certification exclusively
AOA certification was discontinued in 2015, not 2020
True

Correct answer: False — AOA board certification continues to exist alongside ABMS certification

The 2020 merger unified residency accreditation under ACGME but did not eliminate AOA specialty boards; DOs may still obtain AOA board certification in addition to or instead of ABMS certification.

Question 89: Which of the following best describes the Still technique in osteopathic manipulative medicine?

A direct inhibitory pressure applied to hypertonic muscles for 90 seconds
An indirect technique using the patient's breathing to disengage fascial restrictions
A passive positioning technique relying solely on inherent tissue forces
A combination of direct and indirect positioning followed by an activating force through the barrier (Correct answer)

Correct answer: A combination of direct and indirect positioning followed by an activating force through the barrier

The Still technique is an indirect-then-direct method: the physician first unloads the joint indirectly, adds compression or traction, then applies a direct activating arc of motion through the restrictive barrier.

Question 90: A patient with Parkinson's disease is prescribed levodopa/carbidopa. Why is carbidopa included in the formulation?

Carbidopa prevents renal excretion of levodopa
Carbidopa inhibits peripheral DOPA decarboxylase, preserving levodopa for CNS conversion (Correct answer)
Carbidopa crosses the blood-brain barrier and converts to dopamine centrally
Carbidopa blocks central dopamine receptors to modulate levodopa effect

Correct answer: Carbidopa inhibits peripheral DOPA decarboxylase, preserving levodopa for CNS conversion

Carbidopa inhibits aromatic amino acid decarboxylase (DOPA decarboxylase) in peripheral tissues but does not cross the blood-brain barrier, reducing peripheral dopamine side effects and increasing CNS levodopa availability.

Question 91: An osteopathic physician notices that a patient from a low socioeconomic background scores 10 points lower than expected on IQ testing. Which environmental factor has the STRONGEST evidence for depressing IQ scores?

Urban air pollution from nitrogen dioxide
Excess dietary sugar intake
Lack of vitamin C supplementation
Chronic psychosocial stress and poverty (Correct answer)

Correct answer: Chronic psychosocial stress and poverty

Chronic poverty and psychosocial stress are among the strongest environmental suppressors of IQ, mediated by cortisol effects on developing brain architecture and reduced cognitive stimulation.

Question 92: Which antibiotic class inhibits the 30S ribosomal subunit, is contraindicated in children under 8, and frequently causes photosensitivity?

Aminoglycosides
Tetracyclines (Correct answer)
Fluoroquinolones
Macrolides

Correct answer: Tetracyclines

Tetracyclines chelate calcium in developing teeth and bone and cause phototoxic skin reactions; they are contraindicated in children under 8 and pregnant women.

Question 93: Which of the following best describes the 'Two Dimensions' framework of COMLEX-USA?

Level 1 and Level 2 examinations
Written and practical examination components
Osteopathic principles/OMM dimension and clinical presentation dimension (Correct answer)
Basic science and clinical science

Correct answer: Osteopathic principles/OMM dimension and clinical presentation dimension

Every COMLEX question is structured around two dimensions: osteopathic principles/OMM and a clinical presentation.

Question 94: An osteopathic physician is evaluating a patient with an IQ of 55. Under DSM-5, this level of intellectual disability is classified as:

Moderate (Correct answer)
Mild
Profound
Severe

Correct answer: Moderate

DSM-5 classifies intellectual disability with IQ 35–49 as moderate, IQ 50–70 as mild, and IQ 20–34 as severe.

Question 95: Which muscle is the primary hip flexor and is most frequently implicated in lumbar somatic dysfunction?

Piriformis
Quadratus lumborum
Psoas major (Correct answer)
Gluteus maximus

Correct answer: Psoas major

The psoas major attaches to L1–L5 vertebral bodies, and its tightness commonly causes lumbar somatic dysfunction.

Question 96: Doctors of Osteopathic Medicine (DOs) in the United States have full prescribing authority and scope of practice equivalent to MDs.

DOs can prescribe but are not licensed to perform surgery
True, but only in states that have passed DO equivalency laws
False — DOs have more limited prescribing rights than MDs
True (Correct answer)

Correct answer: True

In all 50 U.S. states, DOs hold full and unrestricted medical licenses with the same prescribing rights, surgical privileges, and scope of practice as MDs.

Question 97: Approximately what percentage of US medical students are currently enrolled in osteopathic (DO) programs?

40%
5%
10%
25% (Correct answer)

Correct answer: 25%

DO students now represent approximately 25% of all US medical students, reflecting the significant growth of osteopathic medicine.

Question 98: A physician suspects a facilitated segment at T5-T6 in a patient with recurrent gastric ulcers. Which finding on palpation would support this diagnosis?

Decreased skin drag, cool skin temperature, and flaccid paraspinal muscles at T5-T6
Increased skin drag, warm skin temperature, and hypertonic paraspinal muscles at T5-T6 (Correct answer)
Bilateral paraspinal tenderness from T1 to T12 with no focal changes
Posterior rib angles more prominent on the right at T3-T4

Correct answer: Increased skin drag, warm skin temperature, and hypertonic paraspinal muscles at T5-T6

A facilitated segment shows signs of increased sympathetic activity: increased skin drag (altered sweating), warmth (vasodilation/hyperemia), and paraspinal muscle hypertonicity due to lowered neural thresholds at that spinal level.

Question 99: Andrew Taylor Still founded osteopathic medicine in Kirksville, Missouri, in 1874.

True, but he founded it in 1890
False — Still founded osteopathy in Kansas City, Kansas
True (Correct answer)
Still was a British physician who introduced osteopathy to America

Correct answer: True

Andrew Taylor Still developed osteopathic medicine in 1874 in Missouri and later established the American School of Osteopathy in Kirksville in 1892.

Question 100: A 2-year-old child is found to have an IQ equivalent of 40. The MOST important next diagnostic step is:

Comprehensive etiological workup including genetic and metabolic testing (Correct answer)
Repeat IQ testing at age 5
Enroll in speech therapy and monitor for 12 months
MRI of the brain as the only necessary test

Correct answer: Comprehensive etiological workup including genetic and metabolic testing

An etiological workup including chromosomal microarray, metabolic screening, and neuroimaging is recommended to identify treatable causes and inform prognosis.

Question 101: Which neurotransmitter system has been most consistently linked to cognitive enhancement and IQ-related performance in pharmacological research?

Histaminergic system
Dopaminergic and cholinergic systems (Correct answer)
GABAergic system
Serotonergic system exclusively

Correct answer: Dopaminergic and cholinergic systems

Dopamine and acetylcholine are central to working memory, attention, and executive function — the cognitive domains most closely correlated with IQ scores.

Question 102: The 'red reflex' in osteopathic palpatory diagnosis refers to which finding?

Skin erythema persisting after a palpatory drag, indicating sympathetic activity (Correct answer)
Deep tendon reflex grading
Vascular finding in the fingernail beds
Fundoscopic eye examination finding

Correct answer: Skin erythema persisting after a palpatory drag, indicating sympathetic activity

The red reflex (or red response) is skin erythema persisting after palpatory stroking, reflecting sympathetically mediated changes over a facilitated segment.

Question 103: Fryette's Law I states that in a neutral lumbar spine, when a group of vertebrae sidebend, rotation occurs:

To the opposite side of sidebending (Correct answer)
Only in the presence of flexion
To the same side as sidebending
Independently of sidebending direction

Correct answer: To the opposite side of sidebending

Fryette's First Law: in the neutral (non-flexed, non-extended) position, sidebending and rotation of a vertebral group occur to opposite sides (coupled motion).

Question 104: Myofascial trigger points differ from osteopathic counterstrain tender points in which key way?

Trigger points refer pain to distant sites; tender points are locally tender without referral (Correct answer)
They are identical findings with different names
Trigger points occur only in spinal muscles
Tender points refer pain distally; trigger points are purely local

Correct answer: Trigger points refer pain to distant sites; tender points are locally tender without referral

Myofascial trigger points characteristically reproduce referred pain in distant areas when pressed, while Jones (counterstrain) tender points are locally tender only.

Question 105: A DO student who fails COMLEX Level 1 on the first attempt must wait how long before retaking it?

90 days (Correct answer)
60 days
180 days
30 days

Correct answer: 90 days

The NBOME requires a 90-day waiting period between COMLEX examination attempts.

Question 106: What distinguishes a doctor of medicine (MD) from a doctor of osteopathic medicine (DO)?

DOs believe in more of a holistic (whole person-mind, body, and spirit) approach (Correct answer)
MDs have more of a holistic (whole person-mind, body, and spirit) approach than DOs
There is no difference

Correct answer: DOs believe in more of a holistic (whole person-mind, body, and spirit) approach

The primary philosophical distinction between a Doctor of Medicine (MD) and a Doctor of Osteopathic Medicine (DO) is that DOs emphasize a holistic, 'whole person' approach to patient care. While both are fully licensed physicians, DOs receive additional training in Osteopathic Manipulative Treatment (OMT) and are taught to consider the interconnectedness of the body, mind, and spirit in diagnosis and treatment, promoting the body's innate healing abilities.

Question 107: Which statement about the relationship between IQ and academic achievement is most accurate?

IQ and academic achievement are not correlated after controlling for socioeconomic status
IQ accounts for approximately 25–50% of variance in academic achievement (Correct answer)
IQ accounts for approximately 10% of variance in academic achievement
IQ accounts for over 90% of variance in academic achievement

Correct answer: IQ accounts for approximately 25–50% of variance in academic achievement

Meta-analyses consistently show IQ explains approximately 25–50% of the variance in academic achievement, leaving substantial variance explained by motivation, teaching quality, and other factors.

Question 108: During a developmental assessment, a 6-year-old achieves a mental age of 9 years. Using the ratio IQ formula, what is this child's IQ?

120
133
115
150 (Correct answer)

Correct answer: 150

Ratio IQ = (mental age / chronological age) × 100 = (9/6) × 100 = 150.

Question 109: Which statement about COMLEX and USMLE scores is most accurate?

USMLE scores are always numerically higher than COMLEX scores
They are directly interchangeable on a 1:1 basis
COMLEX scores can be precisely converted to USMLE equivalents by a published formula
They measure overlapping but distinct competencies and cannot be directly compared (Correct answer)

Correct answer: They measure overlapping but distinct competencies and cannot be directly compared

COMLEX and USMLE use different scales and test partially different competency domains, making direct numerical comparison invalid.

Question 110: Muscle Energy Technique (MET) requires the patient to actively contract specific muscles against a physician-applied counterforce.

True, but only for lumbar somatic dysfunction
False — MET is a passive technique requiring no patient effort
True (Correct answer)
MET uses the physician's muscle contraction, not the patient's

Correct answer: True

MET is a direct, active technique in which the patient voluntarily contracts specific muscles on request against a precisely controlled counterforce applied by the physician.

Question 111: Which OMM technique uses slow, rhythmic passive joint motion at approximately 1-2 cycles per second to restore range of motion?

Fascial unwinding
Articulatory technique (Correct answer)
Lymphatic pump
Balanced ligamentous tension

Correct answer: Articulatory technique

Articulatory technique repetitively moves joints through their passive range of motion to stretch restrictive tissues.

Question 112: A patient's Full Scale IQ (FSIQ) score is 100. What percentile does this represent in a normally distributed population?

75th percentile
84th percentile
25th percentile
50th percentile (Correct answer)

Correct answer: 50th percentile

An FSIQ of 100 is the mean of the normative sample, corresponding to the 50th percentile by definition.

Question 113: Many osteopathic institutions send their students to work with doctors as early as the first year.

Osteopathic medicine
Osteopathic curriculum (Correct answer)
Entrance Requirements
Selection Factors

Correct answer: Osteopathic curriculum

The osteopathic curriculum often integrates early clinical exposure, with many osteopathic institutions sending their students to work with doctors as early as the first year. This hands-on approach allows students to apply foundational knowledge, develop clinical skills, and gain practical experience in patient care much earlier. This reinforces the practical, patient-centered nature of osteopathic medical education.

Question 114: Since doctors of osteopathy may manipulate the spine physically to aid in the body's healing, they are frequently mistaken for chiropractors.

False
True (Correct answer)

Correct answer: True

This statement is true. Doctors of osteopathy are frequently mistaken for chiropractors because both professions utilize manual techniques, including spinal manipulation, to address musculoskeletal issues. However, DOs are fully licensed physicians with a broad scope of practice, able to prescribe medication, perform surgery, and treat all medical conditions, which distinguishes them significantly from chiropractors.

Question 115: A patient presents with an acutely herniated L4-L5 disc causing right leg radiculopathy. Which osteopathic technique would be MOST appropriate as a conservative first-line approach?

Cervical muscle energy to reduce sympathetic tone
HVLA thrust at L4-L5
Counterstrain or indirect myofascial release (Correct answer)
Sacral inhibition with heavy axial traction

Correct answer: Counterstrain or indirect myofascial release

Gentle indirect techniques such as counterstrain or indirect myofascial release reduce muscle spasm and neural irritation without direct loading of the disc, making them the safest initial OMT approach for acute disc herniation.

Question 116: The cisterna chyli is important in osteopathic lymphatic treatment because of which role?

It filters cerebrospinal fluid
It is the main collecting reservoir for lymph from the lower body, emptying into the thoracic duct (Correct answer)
It stores blood for the spleen
It is the primary lymphatic valve in the heart

Correct answer: It is the main collecting reservoir for lymph from the lower body, emptying into the thoracic duct

The cisterna chyli collects lymph from the lower extremities and abdomen and passes it into the thoracic duct for return to circulation.

Question 117: Which cranial nerve is most closely associated with craniosacral mechanics due to its broad autonomic influence?

CN I (Olfactory)
CN VII (Facial)
CN X (Vagus) (Correct answer)
CN II (Optic)

Correct answer: CN X (Vagus)

The vagus nerve (CN X) is closely influenced by cranial base mechanics and carries parasympathetic signals to thoracic and abdominal organs.

Question 118: An osteopathic physician evaluates a patient post-operatively and notes restricted motion of the thoracic inlet. Which of the following structures passes through the thoracic inlet and is most affected by fascial restrictions in this area?

Vagus nerve, esophagus, trachea, subclavian vessels, and thoracic duct (Correct answer)
The azygos vein and intercostal nerves exclusively
Only the phrenic nerve and internal mammary vessels
Brachial plexus and subclavian vessels only

Correct answer: Vagus nerve, esophagus, trachea, subclavian vessels, and thoracic duct

The thoracic inlet is traversed by the vagus nerve, esophagus, trachea, subclavian arteries and veins, thoracic duct, brachial plexus, and other structures — fascial restriction here can impair multiple systems simultaneously.

Question 119: What is the mechanism by which unfractionated heparin exerts its anticoagulant effect?

Inhibits vitamin K-dependent synthesis of clotting factors II, VII, IX, and X
Blocks fibrin polymerization by binding fibrinogen
Directly inhibits thrombin and factor Xa independently
Potentiates antithrombin III, accelerating inactivation of thrombin and factor Xa (Correct answer)

Correct answer: Potentiates antithrombin III, accelerating inactivation of thrombin and factor Xa

Heparin binds antithrombin III via a specific pentasaccharide sequence, inducing a conformational change that increases antithrombin's inhibitory activity against thrombin and Xa by up to 1000-fold.

Question 120: The goal of osteopathic medicine is to aid the body in healing itself.

FALSE
TRUE (Correct answer)

Correct answer: TRUE

This statement is true. A fundamental principle of osteopathic medicine is the belief in the body's inherent capacity for self-regulation and self-healing. Osteopathic physicians aim to facilitate this natural healing process by addressing structural imbalances, improving physiological function, and promoting overall wellness, rather than solely focusing on symptom suppression or disease management.

Question 121: Which ethical principle is most directly violated if a clinician uses IQ testing results from a culturally biased instrument to place a minority child in a special education program?

Beneficence
Non-maleficence
Justice (Correct answer)
Autonomy

Correct answer: Justice

Justice requires fair treatment and non-discriminatory practices; using a biased instrument to make placement decisions disproportionately harms minority populations.

Question 122: According to Fryette's Law I, sidebending and rotation in a neutral spine occur to opposite sides.

Fryette's Laws do not address neutral spine mechanics
True (Correct answer)
True, but Law I only applies to the thoracic spine
False — they occur to the same side in Law I

Correct answer: True

Fryette's Law I states that in a neutral (non-flexed, non-extended) spine, sidebending and rotation couple to opposite sides and involve a group of vertebrae.

Question 123: The suboccipital muscles are clinically important in osteopathic medicine primarily because of which feature?

They primarily rotate the thorax
They extend the thoracic spine
They have an unusually high density of muscle spindles, making them critical for proprioception and head-position control (Correct answer)
They control extraocular eye movements

Correct answer: They have an unusually high density of muscle spindles, making them critical for proprioception and head-position control

The suboccipital muscles contain the highest density of muscle spindles in the body, making them essential for proprioceptive feedback and postural control.

Question 124: During the flexion phase of the primary respiratory mechanism, the occiput and sacrum move in the same direction.

True, but only during inhalation
False — they move in opposite directions (occiput flexes, sacrum extends) (Correct answer)
The sacrum does not move during the primary respiratory mechanism
True

Correct answer: False — they move in opposite directions (occiput flexes, sacrum extends)

During PRM flexion, the occiput moves into flexion while the sacrum moves into extension (counternutation), representing opposite motions.

Question 125: Balanced Ligamentous Tension (BLT) is an indirect technique because the physician moves the joint away from the restrictive barrier.

True (Correct answer)
False — BLT moves toward the barrier and is therefore direct
BLT is classified as neither direct nor indirect
True, but only for cranial BLT applications

Correct answer: True

BLT is indirect because the physician positions the joint away from the restrictive barrier toward the point of balanced ligamentous tension, allowing inherent body forces to restore motion.

Question 126: A patient presents with a tender point in the anterior thigh. Using counterstrain, the physician should position the patient to achieve maximum:

Extension of the hip
Adduction and internal rotation only
Neutral position with traction
Flexion of the hip with slight abduction (Correct answer)

Correct answer: Flexion of the hip with slight abduction

Counterstrain for anterior thigh tender points typically involves flexion of the hip with slight abduction and external rotation to shorten the involved muscle and reduce afferent nociceptive activity.

Question 127: A patient on carbamazepine for epilepsy presents with hyponatremia. What is the most likely mechanism?

Renal wasting of sodium via mineralocorticoid antagonism
Inhibition of aldosterone synthesis
Stimulation of ADH secretion and enhanced ADH activity causing SIADH (Correct answer)
Osmotic diuresis leading to free water retention

Correct answer: Stimulation of ADH secretion and enhanced ADH activity causing SIADH

Carbamazepine stimulates ADH release and potentiates its action on V2 receptors in renal collecting ducts, causing SIADH and hyponatremia.

Question 128: A woman on oral contraceptives is prescribed an antibiotic for a UTI. Which antibiotic poses the greatest risk of reducing OCP efficacy?

Nitrofurantoin
Cephalexin
Rifampin (Correct answer)
Trimethoprim-sulfamethoxazole

Correct answer: Rifampin

Rifampin strongly induces CYP3A4, dramatically increasing the hepatic metabolism of estrogen and progestin components of OCPs.

Question 129: A 45-year-old male presents with acute low back pain after lifting. Palpation reveals L3 NSLRL. What does this notation indicate?

L3 is non-neutral, sidebent left, rotated left
L3 is neutral, sidebent left, rotated left (Correct answer)
L3 is non-neutral, sidebent right, rotated left
L3 is neutral, sidebent right, rotated left

Correct answer: L3 is neutral, sidebent left, rotated left

NSLRL stands for Neutral, Sidebent Left, Rotated Left — a Type I (Fryette's) neutral group curve dysfunction following the rule that rotation and sidebending occur to opposite sides in extension.

Question 130: Instead of focusing only on the ailment, osteopathic doctors address the patient as a whole. <br> Answer: Osteopathic medicine

False
True (Correct answer)

Correct answer: True

This statement is true and reflects a core principle of osteopathic medicine. Osteopathic doctors (DOs) are trained to adopt a holistic approach, viewing the patient as an integrated unit of mind, body, and spirit, rather than just focusing on isolated symptoms or diseases. This comprehensive perspective aims to promote the body's natural ability to heal and maintain overall wellness.

Question 131: A physician treating a patient with profound intellectual disability (IQ < 20) is determining appropriate pain assessment tools. Which approach is MOST appropriate?

Visual analog scale (VAS)
Standard numeric pain rating scale (0–10)
Self-report only; no proxy measures are valid
Behavioral observation scales such as NCCPC or FLACC (Correct answer)

Correct answer: Behavioral observation scales such as NCCPC or FLACC

Patients with profound intellectual disability cannot use self-report scales; behavioral observation tools like the NCCPC or FLACC are validated for assessing pain in non-verbal patients.

Question 132: The occipito-atlantal (OA) joint primarily permits which cervical motion?

Only sidebending
Flexion and extension (the 'yes' nodding motion) (Correct answer)
Equal motion in all planes
Axial rotation (the 'no' motion)

Correct answer: Flexion and extension (the 'yes' nodding motion)

The OA joint (occiput on atlas) is shaped for flexion/extension (nodding yes), while the AA joint below primarily permits rotation.

Question 133: What is the maximum number of attempts allowed for each level of COMLEX-USA?

3
6 (Correct answer)
2
4

Correct answer: 6

The NBOME allows up to 6 total attempts per level of COMLEX-USA, with mandatory waiting periods between attempts.

Question 134: The sacrotuberous and sacrospinous ligaments are clinically important in OMM because they perform which function?

Directly connect lumbar vertebrae to the femur
Form the posterior hip capsule
Stabilize the sacroiliac joint and resist excessive sacral nutation (Correct answer)
Support the knee joint capsule

Correct answer: Stabilize the sacroiliac joint and resist excessive sacral nutation

These two ligaments are primary stabilizers of the SI joint, resisting excessive sacral nutation (forward flexion).

Question 135: Which of the following best describes the role of the dura mater in the primary respiratory mechanism (PRM) according to osteopathic cranial concept?

The dura is rigid and limits all cranial motion
The dura generates the cranial rhythmic impulse independently of the CNS
The dura connects only adjacent vertebrae and does not transmit force to the sacrum
The reciprocal tension membrane (dura) transmits and balances fluctuations in CSF motion between cranium and sacrum (Correct answer)

Correct answer: The reciprocal tension membrane (dura) transmits and balances fluctuations in CSF motion between cranium and sacrum

In cranial osteopathy, the dural membrane system — including the falx cerebri, tentorium cerebelli, and spinal dura — acts as a reciprocal tension membrane that transmits motion of the primary respiratory mechanism from the cranium to the sacrum.

Question 136: Which opioid analgesic is contraindicated in renal failure due to accumulation of a toxic active metabolite?

Methadone
Morphine (Correct answer)
Fentanyl
Buprenorphine

Correct answer: Morphine

Morphine-6-glucuronide, a potent active metabolite, accumulates in renal failure and causes prolonged sedation and respiratory depression.

Question 137: Viscerosomatic reflexes in osteopathic medicine describe which phenomenon?

Muscle contractions altering organ function
Neural blockade of visceral pain signals
Joint pain referring to distant joints
Organ disease causing palpable musculoskeletal changes in the body wall (Correct answer)

Correct answer: Organ disease causing palpable musculoskeletal changes in the body wall

Viscerosomatic reflexes occur when dysfunctional organs create detectable tissue texture changes and tenderness in the overlying somatic tissues.

Question 138: Instead of educating researchers or experts, __ is a community-focused profession that primarily trains primary care practitioners.

Osteopathic curriculum
Osteopathic medicine (Correct answer)
Osteopathic medicine courses
Specialty training programs

Correct answer: Osteopathic medicine

Osteopathic medicine is traditionally a community-focused profession that primarily trains primary care practitioners. While DOs can pursue any specialty, the osteopathic philosophy often emphasizes holistic patient care and serving underserved communities. This focus makes primary care a significant and foundational aspect of their educational mission, distinguishing it from a sole emphasis on research or highly specialized expertise.

Question 139: A 68-year-old with congestive heart failure receives osteopathic treatment. Which technique would be MOST appropriate to avoid in this patient due to risk of fluid overload?

Soft tissue technique to the lumbar region
Counterstrain to paraspinal muscles
Thoracic lymphatic pump (Correct answer)
Myofascial release of the thoracic inlet

Correct answer: Thoracic lymphatic pump

The thoracic lymphatic pump mobilizes large volumes of lymph into venous circulation rapidly, which in CHF patients can precipitate acute decompensation and pulmonary edema.

Question 140: Additionally trained in the physical diagnosis and care of musculoskeletal system doctors in osteopathic medicine.

FALSE
TRUE (Correct answer)

Correct answer: TRUE

This statement is true. Doctors of osteopathic medicine receive extensive additional training in the physical diagnosis and care of the musculoskeletal system. This specialized education includes the application of Osteopathic Manipulative Treatment (OMT), allowing them to diagnose and treat somatic dysfunctions and recognize the profound interconnectedness of the body's structure and its overall function.

Question 141: A 'left on left' sacral torsion describes which specific sacral motion?

Sacrum rotating left on a left oblique axis (Correct answer)
Sacrum rotating left on a right oblique axis
Sacrum rotating right on a left oblique axis
Forward flexion of the entire sacrum

Correct answer: Sacrum rotating left on a left oblique axis

Sacral torsion nomenclature follows: rotation direction first, then oblique axis — so 'left on left' means left rotation on the left oblique axis.

Question 142: Which of the following best describes the 'ease-bind' concept in osteopathic diagnosis?

Bind describes fascial planes; ease describes joint motion
Ease and bind refer to respiratory phases during OMT
Ease is the direction of maximum restriction; bind is the barrier
The direction of maximum restriction is the bind; ease is the opposite direction (Correct answer)

Correct answer: The direction of maximum restriction is the bind; ease is the opposite direction

In osteopathic palpation, 'bind' is the direction of motion restriction or resistance, while 'ease' is the direction of least resistance — somatic dysfunction is named for the ease (freedom) direction.

Question 143: COMLEX Level 3 is typically taken during which stage of a physician's training?

PGY-2 of residency
PGY-1 of residency (Correct answer)
Fourth year of DO school (MS4)
After completing residency

Correct answer: PGY-1 of residency

Most DO physicians take COMLEX Level 3 during their first postgraduate year (PGY-1) to complete licensure requirements.

Question 144: A physician is counseling parents whose child has an IQ of 65. Which educational placement is MOST appropriate under IDEA in the US?

Home-bound instruction only
Full-time residential placement in a special school
Standard classroom with no modifications
Least restrictive environment with individualized education plan (IEP) (Correct answer)

Correct answer: Least restrictive environment with individualized education plan (IEP)

IDEA mandates that students with disabilities receive education in the least restrictive environment with appropriate IEP supports.

Question 145: Which of the following conditions may OMT treat?

All of the above (Correct answer)
Back and neck Pain
Headache
Infant colic

Correct answer: All of the above

Osteopathic Manipulative Treatment (OMT) is a versatile, hands-on diagnostic and therapeutic tool that can be applied to a wide range of conditions. It is commonly used to treat musculoskeletal pain like back and neck pain, but can also be effective for conditions such as headaches and even infant colic. OMT addresses underlying somatic dysfunctions to promote the body's self-healing mechanisms.

Question 146: The dorsal horn of the spinal cord processes which types of afferent signals most relevant to somatic dysfunction?

Endocrine regulatory signals
Nociception and proprioception from musculoskeletal tissues (Correct answer)
Autonomic efferent commands
Motor commands only

Correct answer: Nociception and proprioception from musculoskeletal tissues

The dorsal horn processes incoming pain (nociception) and position sense (proprioception) signals from muscles, joints, and skin.

Question 147: A physician applies a muscle energy technique to the cervical spine. The patient actively contracts against the physician's unyielding resistance for 3-5 seconds. This technique relies primarily on which physiological mechanism?

Gate control theory of pain modulation
Golgi tendon organ activation causing stretch reflex
Joint mechanoreceptor stimulation reducing gamma motor neuron firing
Post-isometric relaxation and reciprocal inhibition (Correct answer)

Correct answer: Post-isometric relaxation and reciprocal inhibition

Muscle energy technique uses post-isometric relaxation (the muscle relaxes after isometric contraction) and reciprocal inhibition (antagonist relaxes when agonist contracts) to improve range of motion.

Question 148: What personal experience significantly motivated A.T. Still to develop osteopathic medicine?

Financial ruin from medical practice
Losing three children to meningitis and frustration with contemporary medicine's ineffectiveness (Correct answer)
A serious personal injury
Military surgical failures

Correct answer: Losing three children to meningitis and frustration with contemporary medicine's ineffectiveness

Still lost three children to spinal meningitis, and his frustration with the limitations of 19th-century medicine drove him to develop osteopathy.

Question 149: How long is the osteopathic medical school curriculum before residency?

5 years
3 years
4 years (Correct answer)
2 years

Correct answer: 4 years

DO students complete 4 years of osteopathic medical school — matching MD programs — before entering residency training.

Question 150: Osteopathic medicine was founded by William Osler in the late 19th century.

True
True, but he called it 'manipulative therapy'
False — it was founded by Andrew Taylor Still (Correct answer)
Osteopathic medicine was founded in the early 20th century

Correct answer: False — it was founded by Andrew Taylor Still

Andrew Taylor Still founded osteopathic medicine in 1874; William Osler was a renowned allopathic physician with no role in osteopathy's founding.

Question 151: Following the 2020 single accreditation system merger, DO graduates can apply to ACGME-accredited residency programs on equal footing with MD graduates.

True (Correct answer)
The merger only affects students who graduated after 2025
False — DOs must first complete an AOA-accredited residency before applying to ACGME programs
True, but only for primary care residencies

Correct answer: True

The 2020 unification of the AOA and ACGME accreditation systems eliminated the parallel residency track, allowing DO graduates to compete equally for ACGME-accredited positions.

Question 152: Osteopathic physicians (DOs) are not TRUE physicians.

FALSE (Correct answer)
TRUE

Correct answer: FALSE

This statement is false. Osteopathic physicians (DOs) are fully licensed medical doctors in all 50 states and internationally, with the same rights and responsibilities as allopathic physicians (MDs). They complete medical school, residencies, and are qualified to practice in any specialty, prescribe medication, and perform surgery, making them true and complete physicians.

Question 153: Thoracic pump OMM technique is contraindicated in which of the following conditions?

Tension headache
Chronic sinusitis
Acute pulmonary abscess (Correct answer)
Mild ankle edema

Correct answer: Acute pulmonary abscess

The thoracic pump is contraindicated in acute pulmonary abscess because pumping can spread the infection systemically.

Question 154: The psoas major muscle can produce low back and flank pain that mimics renal colic due to its retroperitoneal location.

The psoas only refers pain to the anterior thigh and groin
True, but only when completely ruptured
False — the psoas does not refer pain to the flank
True (Correct answer)

Correct answer: True

The psoas major lies adjacent to the ureter and kidney; spasm or trigger points in this muscle can refer pain to the flank and low back, mimicking renal colic.

Question 155: What minimum score is required to pass COMLEX-USA Level 1?

450
400 (Correct answer)
350
500

Correct answer: 400

A score of 400 is the NBOME-established minimum passing standard for COMLEX-USA Level 1.

Question 156: The metabolic-energy model of osteopathic care is most appropriate for which patient population?

Patients with chronic fatigue, post-surgical recovery, or fibromyalgia (Correct answer)
Patients with hypertension only
Young competitive athletes only
Pediatric patients only

Correct answer: Patients with chronic fatigue, post-surgical recovery, or fibromyalgia

The metabolic-energy model addresses how somatic dysfunction increases energy expenditure; resolving it frees metabolic resources needed for healing in fatigued patients.

Question 157: In what year did A.T. Still establish the first school of osteopathic medicine?

1874
1882
1892 (Correct answer)
1900

Correct answer: 1892

A.T. Still founded the American School of Osteopathy in Kirksville, Missouri in 1892, about 18 years after developing his osteopathic theory.

Question 158: What does the acronym TART stand for in osteopathic physical diagnosis?

Tension, Alignment, Rotation, Testing
Tissue texture change, Asymmetry, Restriction, Tenderness (Correct answer)
Traction, Articulation, Range, Tone
Treatment, Assessment, Release, Therapy

Correct answer: Tissue texture change, Asymmetry, Restriction, Tenderness

TART stands for Tissue texture change, Asymmetry, Restriction of motion, and Tenderness — the four diagnostic criteria for somatic dysfunction.

Question 159: OMT procedures might be uncomfortable.

False (Correct answer)
True

Correct answer: False

This statement is false. While some OMT techniques might involve pressure or stretching, they are generally not designed to be painful or uncomfortable. The goal is to gently restore motion and function, and practitioners are trained to work within a patient's comfort level. If a patient experiences discomfort, the technique should be adjusted to ensure a therapeutic and tolerable experience.

Question 160: The respiratory-circulatory model of osteopathic care emphasizes the importance of which factor for maintaining health?

Unobstructed fluid movement and breathing mechanics (Correct answer)
Muscle strength and conditioning
Vertebral alignment alone
Neural firing rates

Correct answer: Unobstructed fluid movement and breathing mechanics

The respiratory-circulatory model holds that proper breathing mechanics and unobstructed fluid flow are essential to health and healing.

Question 161: Preganglionic sympathetic fibers supplying the heart originate from spinal cord levels T1–T4.

True, and these same fibers also innervate the lungs
False — cardiac sympathetics arise from T5–T9
Cardiac sympathetics originate solely from the cervical ganglia
True (Correct answer)

Correct answer: True

Preganglionic cardiac sympathetic fibers arise from T1–T4, synapsing in the cervical and upper thoracic sympathetic ganglia before innervating the heart.

Question 162: The osteopathic behavioral model is most relevant when treating patients with which condition?

Isolated hypertension without psychosocial factors
Osteoporosis
Traumatic fractures
Psychological stress, anxiety, or lifestyle-related somatic conditions (Correct answer)

Correct answer: Psychological stress, anxiety, or lifestyle-related somatic conditions

The behavioral model addresses how psychological, social, and lifestyle factors contribute to somatic dysfunction and overall health outcomes.

Question 163: The TART criteria for diagnosing somatic dysfunction stands for: Tissue texture, Asymmetry, Range of motion restriction, and Tenderness.

True (Correct answer)
TART applies only to cervical spine diagnosis
True, but Tissue texture is not included
False — TART stands for something different

Correct answer: True

TART correctly stands for Tissue texture changes, Asymmetry, Range of motion restriction, and Tenderness — the four hallmarks of somatic dysfunction.

Question 164: Which nerve passes inferior to (or through) the piriformis and is compressed in piriformis syndrome?

Sciatic nerve (Correct answer)
Femoral nerve
Ilioinguinal nerve
Obturator nerve

Correct answer: Sciatic nerve

The sciatic nerve typically exits inferior to the piriformis; in some individuals it passes through it, making it vulnerable to piriformis compression.

Question 165: Osteopathic medical school curriculum differs from allopathic curriculum only in the addition of OMM coursework.

True
False — osteopathic education integrates whole-person care and prevention philosophy throughout all four years (Correct answer)
DO schools have reduced basic science content to accommodate OMM training
True, and OMM is only taught during the first two years

Correct answer: False — osteopathic education integrates whole-person care and prevention philosophy throughout all four years

Osteopathic education weaves holistic philosophy, preventive medicine, and patient-centered care throughout the entire curriculum, not merely appending OMM to standard content.

Question 166: Which OMM technique uses a high-velocity, low-amplitude thrust to restore joint motion?

Counterstrain
Myofascial release
HVLA (Correct answer)
Muscle energy

Correct answer: HVLA

HVLA (High-Velocity Low-Amplitude) uses a quick thrust directly into the restrictive barrier to restore joint motion.

Question 167: The knee-chest position is used in osteopathic treatment to place the sacrum in a position of ease (extension/counternutation).

The knee-chest position is used for lumbar, not sacral somatic dysfunction
True, but only for anterior sacral dysfunctions
True (Correct answer)
False — knee-chest places the sacrum in flexion (nutation)

Correct answer: True

In the knee-chest position, gravity allows the sacrum to drop into extension (counternutation), providing an indirect position of ease for certain sacral somatic dysfunctions.

Question 168: Osteoporosis is an absolute contraindication to High-Velocity Low-Amplitude (HVLA) technique in all cases.

True
HVLA is safe in all patients with osteoporosis
True, but only for spinal HVLA
False — osteoporosis is a relative contraindication that requires clinical judgment (Correct answer)

Correct answer: False — osteoporosis is a relative contraindication that requires clinical judgment

Osteoporosis is generally a relative contraindication to HVLA; severe osteoporosis may become absolute, but the determination must be individualized.

Question 169: A clinician uses the Flynn Effect to interpret an older IQ test score. What does the Flynn Effect describe?

Variability in IQ scores due to test-retest unreliability
Rising average IQ scores in populations over successive generations (Correct answer)
Regression of IQ scores toward the population mean over time
Declining IQ scores in populations with higher screen time

Correct answer: Rising average IQ scores in populations over successive generations

The Flynn Effect refers to the observed rise of approximately 3 IQ points per decade across generations in many countries, requiring periodic renorming of tests.

Question 170: The prone springing test is used to assess somatic dysfunction at which spinal region?

Thoracic spine
Cervical spine
Lumbar spine
Sacrum (Correct answer)

Correct answer: Sacrum

The prone springing test evaluates sacral mobility by applying posterior-to-anterior pressure over the sacrum with the patient prone.

Question 171: The osteopathic principle that 'structure governs function' means which of the following?

Function can exist independently of structure
Abnormal structural relationships impair normal physiological function (Correct answer)
Anatomy textbooks are more important than physiology
Only bones directly affect organ function

Correct answer: Abnormal structural relationships impair normal physiological function

This principle states that when anatomical structures are in optimal alignment, the body achieves its best physiological function.

Question 172: A patient with chronic gout is started on allopurinol. What is the mechanism by which allopurinol reduces serum uric acid?

Inhibits prostaglandin synthesis reducing inflammation
Inhibits xanthine oxidase reducing uric acid production (Correct answer)
Blocks URAT1 transporter preventing uric acid reabsorption
Increases renal uric acid excretion via OAT transporters

Correct answer: Inhibits xanthine oxidase reducing uric acid production

Allopurinol is a xanthine oxidase inhibitor that reduces conversion of hypoxanthine to xanthine and xanthine to uric acid, lowering uric acid production.

Question 173: Probenecid is sometimes co-administered with penicillin to enhance its therapeutic effect. What is the pharmacokinetic mechanism?

Probenecid inhibits renal tubular secretion of penicillin (Correct answer)
Probenecid inhibits penicillinase enzymes in bacteria
Probenecid increases intestinal absorption of penicillin
Probenecid displaces penicillin from plasma protein binding

Correct answer: Probenecid inhibits renal tubular secretion of penicillin

Probenecid blocks OAT (organic anion transporter) proteins in the proximal tubule, reducing secretion of penicillin into the urine and prolonging its half-life.

Question 174: Soft tissue technique in osteopathic medicine is classified as a direct, passive technique.

Soft tissue is classified separately from direct and indirect techniques
True (Correct answer)
False — soft tissue technique is indirect
True, but it also requires active patient participation

Correct answer: True

Soft tissue technique is direct and passive, with the physician applying kneading, stretching, and inhibitory pressure while the patient remains relaxed.

Question 175: What is the unique clinical contribution that osteopathic medicine has made to modern healthcare?

Creation of evidence-based clinical guidelines
Development of antibiotics
Integration of hands-on manipulative treatment into whole-person medical care (Correct answer)
Invention of the stethoscope

Correct answer: Integration of hands-on manipulative treatment into whole-person medical care

The systematic integration of OMM with standard medical and surgical care is the distinctive contribution of osteopathic medicine.

Question 176: Type II somatic dysfunction (Fryette's Law II) describes a single vertebral segment where sidebending and rotation occur to the same side.

True, but this only applies in the cervical spine
False — Type II involves rotation opposite to sidebending
True (Correct answer)
Type II dysfunction always involves multiple vertebrae

Correct answer: True

Fryette's Law II applies to a single non-neutral (flexed or extended) vertebral segment in which sidebending and rotation couple to the same side.

Question 177: The five osteopathic models of care include all of the following EXCEPT which?

Respiratory-circulatory model
Genetic inheritance model (Correct answer)
Metabolic-energy model
Biomechanical model

Correct answer: Genetic inheritance model

The five models are biomechanical, respiratory-circulatory, neurological, metabolic-energy, and behavioral — genetics is not one of them.

Question 178: Which cranial bone is considered the 'keystone' of the cranial base in craniosacral osteopathy?

Temporal bone
Frontal bone
Sphenoid bone (Correct answer)
Occipital bone

Correct answer: Sphenoid bone

The sphenoid is the keystone of the cranial base because it articulates with all other cranial bones.

Question 179: A DO student applying to a highly competitive ACGME residency should consider which additional examination?

PLEX
USMLE (Correct answer)
MCAT
NCLEX

Correct answer: USMLE

Many competitive ACGME programs request USMLE scores in addition to COMLEX scores when evaluating DO applicants.

Question 180: A patient on high-dose atorvastatin develops muscle pain and markedly elevated creatine kinase (CK). Which mechanism best explains statin-induced myopathy?

Direct membrane toxicity from accumulation of hydrophilic statin metabolites
Immune-mediated necrotizing myopathy triggered by anti-HMGCR antibodies
Depletion of coenzyme Q10 via mevalonate pathway inhibition impairing mitochondrial function (Correct answer)
Impaired sarcoplasmic reticulum calcium release causing muscle fiber contracture

Correct answer: Depletion of coenzyme Q10 via mevalonate pathway inhibition impairing mitochondrial function

Statins block the mevalonate pathway, reducing synthesis of coenzyme Q10 (ubiquinone) in addition to cholesterol, impairing mitochondrial electron transport and causing myocyte energy deficits.

Question 181: A.T. Still's famous statement that 'the role of the artery is supreme' emphasized the importance of which body system?

Cardiovascular and circulatory system (Correct answer)
Musculoskeletal system
Lymphatic system
Nervous system

Correct answer: Cardiovascular and circulatory system

Still believed that unobstructed arterial blood flow was essential to health and that restoring circulation was central to healing.

Question 182: Which subject area carries the greatest content weight on COMLEX Level 2-CE?

Pharmacology
Osteopathic manipulative medicine
Internal medicine (Correct answer)
Obstetrics and gynecology

Correct answer: Internal medicine

Internal medicine has the highest content weight on COMLEX Level 2-CE due to its broad clinical scope during rotations.

Question 183: Counterstrain technique involves positioning the patient at the point of what?

Maximum stretch
Neutral position
Minimum pain (greatest comfort) (Correct answer)
Maximum pain

Correct answer: Minimum pain (greatest comfort)

Counterstrain places the patient in the position of greatest comfort to release hypertonic tissues and tender points.

Question 184: Which OMM technique is MOST appropriate and safest for a fragile elderly patient with severe osteoporosis?

Both muscle energy and soft tissue (Correct answer)
Muscle energy
HVLA thrust
Soft tissue

Correct answer: Both muscle energy and soft tissue

Muscle energy and soft tissue techniques are safe alternatives in osteoporotic patients because they avoid forceful thrusts that risk fracture.

Question 185: Which spinal level is most associated with Chapman's reflex points for the heart?

L1–L3
T1–T2
T3–T5 (Correct answer)
T7–T9

Correct answer: T3–T5

Cardiac Chapman's points are located anteriorly between the 2nd and 3rd ribs and posteriorly at T3–T5, corresponding to sympathetic innervation.

Question 186: Facilitated segments at T6–T9 could produce which clinical manifestation via somatovisceral reflexes?

Upper gastrointestinal symptoms such as nausea or epigastric discomfort (Correct answer)
Urinary urgency
Cardiac arrhythmia
Headache

Correct answer: Upper gastrointestinal symptoms such as nausea or epigastric discomfort

T6–T9 provides sympathetic innervation to the stomach, liver, and gallbladder; facilitation here can alter upper GI function via somatovisceral pathways.

Question 187: Facilitated Positional Release (FPR) adds a compression or torsion vector to the indirect position of ease.

True (Correct answer)
False — FPR uses a distraction force only
True, but only when treating thoracic spine
FPR is identical to Counterstrain with no additional facilitating force

Correct answer: True

FPR adds a facilitating force (compression or torsion) to the position of ease, significantly shortening treatment time compared to Counterstrain.

Question 188: A patient on digoxin for heart failure develops nausea, yellow-green visual disturbances, and arrhythmias. Which electrolyte abnormality most potentiates digoxin toxicity?

Hypokalemia (Correct answer)
Hypophosphatemia
Hypernatremia
Hyperkalemia

Correct answer: Hypokalemia

Hypokalemia increases digoxin binding to Na+/K+-ATPase since potassium and digoxin compete for the same binding site, greatly potentiating toxicity.

Question 189: Which of the following best describes the osteopathic five-model approach to patient care?

Five levels of osteopathic training
Five medication classes used in osteopathic practice
Five separate disease categories
Five treatment models (biomechanical, respiratory-circulatory, neurological, metabolic-energy, behavioral) guiding OMM selection (Correct answer)

Correct answer: Five treatment models (biomechanical, respiratory-circulatory, neurological, metabolic-energy, behavioral) guiding OMM selection

The five osteopathic models guide clinical reasoning and OMM technique selection based on the dominant mechanism of the patient's condition.

Question 190: What is the mechanism underlying aspirin's antiplatelet effect that distinguishes it from other NSAIDs?

Reversible inhibition of cyclooxygenase-1 in platelets
Irreversible acetylation of COX-1 permanently blocking thromboxane A2 synthesis (Correct answer)
Inhibition of thromboxane A2 receptors on platelets
Competitive blockade of ADP receptors on platelet membranes

Correct answer: Irreversible acetylation of COX-1 permanently blocking thromboxane A2 synthesis

Aspirin irreversibly acetylates the serine residue of COX-1; since anucleate platelets cannot synthesize new enzyme, the antiplatelet effect persists for the platelet's 7-10 day lifespan.

Question 191: The COMLEX-USA examination series is philosophically built around which framework unique to osteopathic medicine?

The biopsychosocial model
The biomedical model
The four tenets of osteopathic medicine (Correct answer)
Evidence-based medicine hierarchy

Correct answer: The four tenets of osteopathic medicine

COMLEX content is organized around A.T. Still's four tenets: body unity, self-healing, structure-function relationship, and rational treatment.

Question 192: How does the scope of practice of a fully licensed DO in the United States compare to that of an MD?

More limited, restricted to musculoskeletal conditions
Requires MD supervision for all procedures
Equivalent scope with full practice rights, plus additional OMM training (Correct answer)
Limited to primary care only

Correct answer: Equivalent scope with full practice rights, plus additional OMM training

US DOs hold full and equal medical and surgical practice rights as MDs, with the addition of osteopathic manipulative medicine training.

Question 193: Chapman's reflex points are located exclusively on the posterior surface of the body.

True
Chapman's points are found only on extremities
False — they are found on both anterior and posterior surfaces (Correct answer)
True, but only in the lumbar region

Correct answer: False — they are found on both anterior and posterior surfaces

Chapman's reflex points exist on both the anterior and posterior body surfaces and represent viscerosomatic reflex relationships.

Question 194: Which of the following is a core osteopathic competency assessed across all COMLEX levels?

Advanced cardiac imaging interpretation
Osteopathic patient care integrating OMM principles (Correct answer)
Subspecialty surgical procedures
Molecular genetics research methodology

Correct answer: Osteopathic patient care integrating OMM principles

Osteopathic patient care — integrating OMM principles with medical care — is a core competency tested across all COMLEX levels.

Question 195: The pelvic splanchnic nerves (S2–S4) provide which type of innervation to pelvic organs?

Afferent pain innervation only
Parasympathetic innervation (Correct answer)
Somatic motor innervation
Sympathetic innervation

Correct answer: Parasympathetic innervation

The pelvic splanchnic nerves from S2–S4 carry parasympathetic fibers to the bladder, rectum, and reproductive organs.

Question 196: Numerous osteopathic medical schools at linked hospitals and clinics are funding this specialist training.

Specialty training programs (Correct answer)
Osteopathic medicine courses
Osteopathic medicine
Selection factors

Correct answer: Specialty training programs

Numerous osteopathic medical schools, often in collaboration with their linked hospitals and clinics, actively fund and support specialty training programs. This commitment ensures that graduates have ample opportunities to pursue advanced training in various medical specialties. It highlights the comprehensive nature of osteopathic medical education, extending beyond general practice to encompass all areas of medicine.

Question 197: Viscerosomatic reflexes can produce palpable somatic tissue changes detectable during osteopathic structural examination.

False
True (Correct answer)
Only in advanced end-stage organ disease
True, but only in patients who have not received prior OMT

Correct answer: True

Viscerosomatic reflexes result in palpable somatic changes including tissue texture abnormalities, tenderness, and restricted motion at predictable spinal levels.

Question 198: COMLEX-USA Level 1 is administered in approximately how much total testing time?

6 hours
12 hours
8 hours (Correct answer)
4 hours

Correct answer: 8 hours

COMLEX Level 1 is a single-day examination with approximately 8 hours of total testing time including scheduled breaks.

Question 199: The only difference between DOs and MDs is that DOs could take longer to assess the patient as a "whole."

False
True (Correct answer)

Correct answer: True

The distinguishing philosophical approach of DOs is their holistic view, which considers the patient as a whole person, including lifestyle and environment, not just symptoms. This comprehensive assessment can indeed take more time than a purely symptom-focused approach, and it's often cited as a key differentiator from the traditional MD model. While both are fully licensed, this philosophical emphasis is a primary distinction.

Question 200: Who developed craniosacral osteopathy and the concept of the primary respiratory mechanism?

Rollin Becker
Harold Magoun
William Garner Sutherland (Correct answer)
A.T. Still

Correct answer: William Garner Sutherland

William Garner Sutherland, a student of A.T. Still, developed cranial osteopathy and described the primary respiratory mechanism.

Question 201: The thoracic inlet is bounded posteriorly, laterally, and anteriorly by which structures?

T6 vertebra, third rib, xiphoid
T12 vertebra, twelfth rib, diaphragm
T4 vertebra, second rib, sternum body
T1 vertebra, first rib, manubrium (Correct answer)

Correct answer: T1 vertebra, first rib, manubrium

The thoracic inlet is the superior opening of the thorax, bounded by T1 posteriorly, the first rib laterally, and the manubrium anteriorly.

Question 202: Which organization administers the COMLEX-USA examination series?

NBOME (Correct answer)
NBME
ACGME
USMLE

Correct answer: NBOME

The National Board of Osteopathic Medical Examiners (NBOME) administers the COMLEX-USA licensing examination series.

Question 203: Somatic dysfunction can only exist in an acute form and cannot become chronic.

False — somatic dysfunction can be acute or chronic (Correct answer)
True
Only vertebral joints develop somatic dysfunction
True, but only in pediatric patients

Correct answer: False — somatic dysfunction can be acute or chronic

Somatic dysfunction can be classified as acute or chronic, distinguished by tissue texture changes (boggy vs. fibrotic) and other TART findings.

Question 204: Fryette's First Law describes spinal coupling in which position?

Full flexion or extension
Neutral (non-flexed, non-extended) position with opposite sidebending and rotation coupling (Correct answer)
Neutral position with same-side coupling
Hyperextension with same-side coupling

Correct answer: Neutral (non-flexed, non-extended) position with opposite sidebending and rotation coupling

Fryette's Law I states that in neutral spine, sidebending of multiple vertebrae is coupled with rotation to the opposite side.

Question 205: COMLEX-USA Level 1 primarily tests which domain?

Specialty-specific clinical knowledge
Patient communication skills
Basic biomedical sciences and osteopathic principles applied to clinical contexts (Correct answer)
Clinical procedural skills

Correct answer: Basic biomedical sciences and osteopathic principles applied to clinical contexts

COMLEX Level 1 assesses foundational biomedical and osteopathic sciences in clinically relevant contexts, taken after preclinical years.

Question 206: During the respiratory cycle, the sacrum moves in what direction during inhalation according to osteopathic craniosacral theory?

The sacral base moves anteriorly (counternutation) (Correct answer)
The sacral base moves superiorly with no rotation
The sacrum is fixed and does not move with respiration
The sacral base moves posteriorly (nutation)

Correct answer: The sacral base moves anteriorly (counternutation)

In craniosacral theory, during inhalation (flexion phase) the sacral base moves anteriorly (counternutation), synchronized with cranial flexion; during exhalation (extension phase) the base moves posteriorly (nutation).

Question 207: Lumbar zygapophyseal (facet) joint orientation primarily allows which type of spinal motion?

Axial rotation and lateral flexion
Flexion and extension (sagittal plane motion) (Correct answer)
Only axial rotation
Equal motion in all planes

Correct answer: Flexion and extension (sagittal plane motion)

Lumbar facets are oriented in the sagittal plane, permitting flexion/extension while significantly limiting axial rotation.

Question 208: Iodine deficiency during pregnancy is associated with which outcome in offspring?

Increased risk of ADHD only
No measurable cognitive effects if maternal diet is otherwise adequate
Autism spectrum disorder
Preventable intellectual disability (Correct answer)

Correct answer: Preventable intellectual disability

Iodine deficiency remains the world's leading preventable cause of intellectual disability, as thyroid hormones are essential for fetal brain development.

Question 209: A 40-year-old woman with irritable bowel syndrome (IBS) is treated with osteopathic techniques focused on the mesenteric plexus. The primary spinal levels targeted to modulate sympathetic tone to the large intestine are:

T5-T9
T1-T4
L3-S4
T10-L2 (Correct answer)

Correct answer: T10-L2

Sympathetic innervation to the large intestine (distal half of transverse colon through rectum) arises from T10-L2 spinal cord levels; normalizing somatic dysfunction at these levels can reduce viscerosomatic reflex activity contributing to IBS symptoms.

Question 210: Which single gene disorder is the most common inherited cause of intellectual disability in males?

Angelman syndrome
Fragile X syndrome (Correct answer)
Rett syndrome
Down syndrome

Correct answer: Fragile X syndrome

Fragile X syndrome, caused by CGG trinucleotide repeat expansion in the FMR1 gene on the X chromosome, is the most common inherited cause of intellectual disability.

Question 211: A child with phenylketonuria (PKU) who is maintained on a phenylalanine-restricted diet from birth is MOST likely to have:

Borderline intellectual functioning (IQ 70–79)
Moderate intellectual disability (IQ 35–49)
Severe intellectual disability (IQ < 20)
Near-normal IQ (Correct answer)

Correct answer: Near-normal IQ

Early and sustained dietary treatment of PKU prevents phenylalanine accumulation and allows near-normal cognitive development.

Question 212: Osteopathic manipulation is most strongly evidenced for which clinical condition?

Diabetic ketoacidosis
Myocardial infarction
Acute appendicitis
Chronic low back pain (Correct answer)

Correct answer: Chronic low back pain

Chronic low back pain has the strongest evidence base for osteopathic manipulative treatment among common clinical conditions.

Question 213: Which of the following best describes osteopathic medicine's guiding principles?

The body acts as a whole unit; not a sum of parts
The body as an innate ability to health itself
Structure and function are interrelated
All of the above (Correct answer)

Correct answer: All of the above

All the listed options—the body acts as a whole unit, structure and function are interrelated, and the body has an innate ability to heal itself—are fundamental guiding principles of osteopathic medicine. These tenets form the basis of the holistic approach taken by DOs. They influence their diagnostic and treatment strategies, emphasizing the interconnectedness of body systems and promoting the body's natural healing processes.

Question 214: A DO notes tissue texture changes at T6–T8 in a patient with epigastric pain. This represents which reflex?

Viscerosomatic reflex (Correct answer)
Cutaneous withdrawal reflex
Somatovisceral reflex
Myotatic stretch reflex

Correct answer: Viscerosomatic reflex

Viscerosomatic reflexes occur when gastric pathology (at T6–T9 innervation) produces somatic tissue changes in the corresponding thoracic region.

Question 215: A 55-year-old presents with right-sided neck pain and restricted rotation. Palpation reveals C5 ERSR. Which OMT technique uses a high-velocity, low-amplitude thrust directed to engage the motion barrier?

Facilitated positional release
Counterstrain
Myofascial release
High-velocity low-amplitude (HVLA) (Correct answer)

Correct answer: High-velocity low-amplitude (HVLA)

HVLA (high-velocity low-amplitude) technique directly engages and rapidly overcomes a restrictive barrier using a short, quick thrust to restore normal joint motion.

Question 216: Somatovisceral reflexes differ from viscerosomatic reflexes in which way?

There is no clinical difference
They are identical processes
Somatovisceral: somatic dysfunction alters organ function; viscerosomatic: organ disease creates somatic changes (Correct answer)
Somatovisceral: organ to muscle; viscerosomatic: muscle to organ

Correct answer: Somatovisceral: somatic dysfunction alters organ function; viscerosomatic: organ disease creates somatic changes

Somatovisceral reflexes occur when somatic dysfunction (e.g., thoracic restriction) alters organ function, while viscerosomatic reflexes flow in the opposite direction.

COMLEX-USA Level 1 (Doctor of Osteopathic Medicine Board Examination)

The COMLEX-USA Level 1 is administered by the National Board of Osteopathic Medical Examiners (NBOME) and assesses foundational biomedical and clinical sciences knowledge required for osteopathic medical practice, including osteopathic principles and manipulative medicine across seven competency domains.

400

Questions

480 min

Time Limit

70%

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