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

Question 1: 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 2: According to Fryette's Law I, sidebending and rotation in a neutral spine occur to opposite sides.

True (Correct answer)
True, but Law I only applies to the thoracic spine
Fryette's Laws do not address neutral spine mechanics
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 3: A rib that cannot expand fully during inspiration is classified as which type of rib dysfunction?

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

Correct answer: Inhalation restriction

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

Question 4: The respiratory-circulatory model of osteopathic care emphasizes the importance of which factor for maintaining health?

Vertebral alignment alone
Muscle strength and conditioning
Unobstructed fluid movement and breathing mechanics (Correct answer)
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 5: Which OMM technique uses slow, rhythmic passive joint motion at approximately 1-2 cycles per second to restore range of motion?

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

Correct answer: Articulatory technique

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

Question 6: Which osteopathic finding is most associated with the sympathetic spinal level T1–T4?

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

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

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

Correct answer: True

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

Question 8: The osteopathic behavioral model is most relevant when treating patients with which condition?

Traumatic fractures
Isolated hypertension without psychosocial factors
Osteoporosis
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 9: Following the 2020 single accreditation system merger, DO graduates can apply to ACGME-accredited residency programs on equal footing with MD graduates.

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

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

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

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

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

Correct answer: Minimum pain (greatest comfort)

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

Question 12: Osteopathic medical school curriculum differs from allopathic curriculum only in the addition of OMM coursework.

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

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

Fluoroquinolones
Tetracyclines (Correct answer)
Aminoglycosides
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 14: Which of the following best describes the osteopathic five-model approach to patient care?

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

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

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

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

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

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 17: 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)
Young competitive athletes only
Pediatric patients only
Patients with hypertension 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 18: 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:

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

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 19: 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 20: Loss of cervical lordosis on lateral cervical X-ray always indicates serious pathology requiring immediate intervention.

Cervical lordosis can only be accurately assessed by MRI, not plain X-ray
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)

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

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

Correct answer: Unyielding (isometric) resistance

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

Question 22: The dorsal horn of the spinal cord processes which types of afferent signals most relevant to somatic dysfunction?

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

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

Post-surgical edema and respiratory infections (Correct answer)
Acute bone fracture stabilization
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 24: 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 rotates torso while physician holds the rib in neutral
Patient exhales against physician resistance; physician moves rib inferiorly after relaxation
Physician applies HVLA thrust posteriorly during peak inhalation
Patient inhales against physician resistance; physician repositions rib superiorly after each breath (Correct answer)

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 25: 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?

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

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

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

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

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

Correct answer: True

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

Question 28: 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)
Severe
Mild
Profound

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 29: Which organization administers the COMLEX-USA examination series?

ACGME
USMLE
NBOME (Correct answer)
NBME

Correct answer: NBOME

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

Question 30: Which subtest of the WAIS-IV is considered the single best predictor of Full Scale IQ?

Digit Span
Matrix Reasoning
Coding
Vocabulary (Correct answer)

Correct answer: Vocabulary

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

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.

Questions

35 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds