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

Question 1: When a test has high specificity, a positive result is most useful for:

Ruling OUT disease
Determining treatment dosage
Confirming prognosis
Ruling IN disease (SpPin) (Correct answer)

Correct answer: Ruling IN disease (SpPin)

A highly specific test has few false positives, so a positive result strongly indicates true disease and is used to rule IN the diagnosis (SpPin mnemonic).

Question 2: In clinical practice, a decision threshold (test threshold) represents the probability at which:

Treatment should begin regardless of test results
Further testing always occurs regardless of current probability
All patients receive the same diagnostic workup
Testing is warranted based on pre-test probability and test risk/benefit (Correct answer)

Correct answer: Testing is warranted based on pre-test probability and test risk/benefit

The test threshold is the pre-test probability below which testing is unnecessary, while the treatment threshold is the probability above which treatment proceeds without testing.

Question 3: Which preventive intervention has the greatest impact on reducing infant mortality in the US?

Early introduction of solid foods
Routine vitamin K injection at birth
Safe sleep practices (back sleeping, firm mattress, no bed-sharing) (Correct answer)
Neonatal hearing screening

Correct answer: Safe sleep practices (back sleeping, firm mattress, no bed-sharing)

The 'Back to Sleep' campaign (now Safe to Sleep) dramatically reduced SIDS deaths by promoting supine infant sleeping position.

Question 4: A patient taking warfarin is started on rifampin. How should warfarin dosing be adjusted?

Switch to heparin immediately
Decrease warfarin dose; rifampin inhibits CYP450 enzymes
Increase warfarin dose; rifampin induces CYP450 enzymes (Correct answer)
No adjustment needed

Correct answer: Increase warfarin dose; rifampin induces CYP450 enzymes

Rifampin is a potent CYP450 inducer that accelerates warfarin metabolism, reducing its anticoagulant effect and requiring a higher dose.

Question 5: Which of the following is the largest and most complicated articulation in the body?

Hip joint
Shoulder joint
Elbow joint
Knee (Correct answer)

Correct answer: Knee

The knee joint is widely recognized as the largest and most complicated articulation in the human body. It is a modified hinge joint that allows for flexion and extension, along with some rotational movements, and is stabilized by a complex network of ligaments, menisci, and muscles. Its intricate structure makes it susceptible to various injuries and conditions.

Question 6: In craniosacral therapy, the practitioner monitors the 'primary respiratory mechanism,' which has a normal rate of approximately how many cycles per minute?

12–20 cycles per minute
6–12 cycles per minute (Correct answer)
20–30 cycles per minute
1–3 cycles per minute

Correct answer: 6–12 cycles per minute

The craniosacral rhythm, reflecting the primary respiratory mechanism, normally oscillates at 6–12 cycles per minute.

Question 7: Which of the following statements is NOT true about ‘Clinical Guidelines’?

They are evidence-based statements.
They assist practitioners in making decisions for a clinical circumstance.
They are based solely on personal opinions of healthcare providers. (Correct answer)
They provide recommendations to optimize patient care.

Correct answer: They are based solely on personal opinions of healthcare providers.

Clinical guidelines are evidence-based statements developed to optimize patient care and assist practitioners in making informed decisions. They are systematically formulated using the best available research evidence and expert consensus, rather than being based solely on individual opinions. This ensures a standardized, high-quality, and objective approach to clinical practice.

Question 8: Soft tissue technique in OMM achieves its effect primarily through which mechanism?

Isometric patient contraction against resistance
Repositioning to shorten the muscle
High-speed joint cavitation
Stretching and kneading muscles and fascia to reduce tension (Correct answer)

Correct answer: Stretching and kneading muscles and fascia to reduce tension

Soft tissue technique uses sustained pressure, stretching, and kneading to lengthen hypertonic muscles and improve local circulation.

Question 9: What is identified as the earliest and most common cause of disease according to the principle of osteopathic medicine?

Nutritional deficiencies.
Environmental factors.
A disturbance in the mechanical functioning of the body. (Correct answer)
Genetic predisposition.

Correct answer: A disturbance in the mechanical functioning of the body.

According to osteopathic principles, the earliest and most common cause of disease is identified as a disturbance in the mechanical functioning of the body. These mechanical dysfunctions, often called somatic dysfunctions, can impede the body's natural ability to heal and regulate itself. By addressing these structural and functional imbalances, osteopathic medicine aims to restore optimal health.

Question 10: What is a Working Diagnosis?

A temporary diagnosis based solely on patient history.
Likely causes for presenting signs and symptoms, including precipitating and maintaining factors. (Correct answer)
A definitive diagnosis that is confirmed through extensive testing.
An irrelevant label placed on a patient without any clinical significance.

Correct answer: Likely causes for presenting signs and symptoms, including precipitating and maintaining factors.

A working diagnosis is an initial, provisional diagnosis based on the presenting signs and symptoms, including potential precipitating and maintaining factors. It serves as a guide for immediate management and further diagnostic steps, acknowledging that it may be refined or changed as more information becomes available. It represents the most likely explanation for the patient's condition at a given point.

Question 11: Regarding the femorotibial joint, the meniscus is semicircular with its anterior end attaching to the anterior intercondylar area in front of the cruciate ligament.

Medial; Anterior (Correct answer)
Medial; Lateral
Lateral; Anterior
Lateral; Posterior

Correct answer: Medial; Anterior

Regarding the femorotibial joint, the medial meniscus is semicircular (C-shaped) and its anterior end attaches to the anterior intercondylar area of the tibia. This attachment point is specifically located in front of the anterior cruciate ligament (ACL). This anatomical relationship is crucial for the stability and proper biomechanics of the knee joint.

Question 12: Which of the following is an extensor, NOT a flexor of the knee joint?

Hamstrings
Gastrocnemius
Quadriceps femoris (Correct answer)
Sartorius

Correct answer: Quadriceps femoris

The quadriceps femoris is a powerful group of muscles located on the anterior (front) aspect of the thigh, and its primary action is to extend the knee joint. In contrast, the hamstrings and gastrocnemius are primarily knee flexors, and the sartorius also contributes to knee flexion. Thus, the quadriceps femoris is the correct answer for an extensor.

Question 13: Which of the following is the first step in the assessment of a particular anatomical region?

Special tests - Orthopedic/neurological tests.
Passive range of motion - DO moves patient without assistance.
Palpation - Sense somatic dysfunction through touch.
Active range of motion - Patient moves independently. (Correct answer)

Correct answer: Active range of motion - Patient moves independently.

In the assessment of an anatomical region, observing the patient's active range of motion is the crucial first step. This allows the practitioner to evaluate how the patient moves independently, identify any pain or limitations they experience voluntarily, and gain initial insights into their functional capacity. It provides valuable information before the practitioner intervenes with passive movements or special tests.

Question 14: Which antibiotic class is associated with QT prolongation and must be used cautiously in patients on antiarrhythmics?

Fluoroquinolones (Correct answer)
Carbapenems
Penicillins
Aminoglycosides

Correct answer: Fluoroquinolones

Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) can prolong the QT interval, increasing the risk of torsades de pointes especially with other QT-prolonging drugs.

Question 15: A patient prescribed an SSRI for depression develops agitation, hyperthermia, and clonus after adding tramadol. What syndrome is occurring?

Serotonin syndrome (Correct answer)
Anticholinergic toxicity
Malignant hyperthermia
Neuroleptic malignant syndrome

Correct answer: Serotonin syndrome

Tramadol inhibits serotonin reuptake, and when combined with an SSRI, excessive serotonergic activity causes serotonin syndrome.

Question 16: Thiazide diuretics cause which electrolyte abnormality as a common side effect?

Hypernatremia
Hypokalemia (Correct answer)
Hyperkalemia
Hypercalcemia

Correct answer: Hypokalemia

Thiazides increase sodium and water excretion while also enhancing potassium secretion in the distal tubule, leading to hypokalemia.

Question 17: The Still technique in OMM is best described as which type of combined approach?

Isotonic resistive exercise
Indirect followed by direct with a dynamic thrust (Correct answer)
Pure indirect positioning only
Purely passive craniosacral rhythm

Correct answer: Indirect followed by direct with a dynamic thrust

The Still technique first moves toward ease (indirect), then through the barrier with a dynamic corrective force.

Question 18: According to Dr. Schleip, what factor contributes to the immediate tissue changes observed with techniques like Myofascial Release (MFR)?

The presence of a dense network of mechanoreceptors within the fascia. (Correct answer)
The client's emotional state during the procedure.
The use of heat to relax the fascia before treatment.
Immediate fascial plasticity can be fully explained by the mechanical properties of the fascia.

Correct answer: The presence of a dense network of mechanoreceptors within the fascia.

Dr. Schleip suggests that immediate tissue changes observed with techniques like Myofascial Release are significantly influenced by the dense network of mechanoreceptors within the fascia. These sensory receptors allow for rapid neurophysiological responses, influencing muscle tone and tissue stiffness through reflex pathways. This explains why changes can be felt almost immediately, rather than solely relying on the slower mechanical properties of fascial stretching.

Question 19: Which of the following is NOT a correct definition of Somatic Dysfunction (SD)?

An alteration in the physiological function of the body's soft tissues and related structures.
A disturbance in the normal function of the body's musculoskeletal system.
A condition characterized by the complete absence of movement in a joint. (Correct answer)
Impaired or altered function of the somatic systems, including skeletal, arthrodial (joints), myofascial structures, and related vascular, lymphatic, and neural elements.

Correct answer: A condition characterized by the complete absence of movement in a joint.

Somatic Dysfunction (SD) refers to impaired or altered function of the body's somatic system, including musculoskeletal and related elements, characterized by a restriction or alteration in movement. It does not mean a complete absence of movement, which would indicate a more severe condition like ankylosis or fusion. SD describes a nuanced functional impairment rather than total immobility.

Question 20: Sensitivity of a screening test measures its ability to correctly identify:

True positives (patients who have the disease) (Correct answer)
True negatives (patients who do not have the disease)
The proportion of positive tests that are correct
The overall accuracy of the test

Correct answer: True positives (patients who have the disease)

Sensitivity = TP / (TP + FN); a highly sensitive test rarely misses true cases and is ideal for ruling OUT disease when the result is negative.

Question 21: A 30-year-old woman develops sudden paralysis of her left arm following a traumatic car accident. Neurological examination and brain MRI are normal. She appears surprisingly unconcerned about the deficit. What is the most likely diagnosis?

Malingering
Factitious Disorder
Conversion Disorder (Functional Neurological Symptom Disorder) (Correct answer)
Somatic Symptom Disorder

Correct answer: Conversion Disorder (Functional Neurological Symptom Disorder)

Conversion Disorder presents with neurological symptoms incompatible with known neurological disease, often following psychological stress, and may include la belle indifférence (apparent unconcern).

Question 22: Clopidogrel is a prodrug that requires activation by which enzyme system to inhibit platelet aggregation?

CYP2C19 (Correct answer)
CYP3A4
CYP1A2
CYP2D6

Correct answer: CYP2C19

Clopidogrel is converted to its active thiol metabolite by CYP2C19; poor metabolizers (common in certain populations) have reduced platelet inhibition.

Question 23: Relative risk (RR) of 1.0 in an epidemiological study indicates:

A 100% increase in disease risk
No association between exposure and outcome (Correct answer)
The exposure doubles the risk of disease
The exposure halves the risk of disease

Correct answer: No association between exposure and outcome

RR = 1.0 means the risk in the exposed group equals the risk in the unexposed group, indicating no association between the exposure and outcome.

Question 24: Which of the following is NOT a characteristic of DIRECT technique procedures?

An example is the Muscle Energy Technique.
Engage the restrictive barrier.
Apply some force to move the barrier in the direction of motion lost.
Avoid any interaction with the patient's discomfort. (Correct answer)

Correct answer: Avoid any interaction with the patient's discomfort.

Direct technique procedures in osteopathic manipulative treatment involve engaging the restrictive barrier and applying force *into* that barrier in the direction of motion loss. This process inherently means the patient may experience some discomfort as the restriction is addressed. Therefore, avoiding any interaction with the patient's discomfort is not characteristic of direct techniques, unlike indirect techniques that move away from the barrier.

Question 25: A 32-year-old veteran presents with intrusive flashbacks, nightmares, hypervigilance, emotional numbing, and avoidance of combat-related stimuli persisting for 6 months post-deployment. What is the first-line pharmacological treatment?

Risperidone
Sertraline or paroxetine (Correct answer)
Benzodiazepines
Propranolol

Correct answer: Sertraline or paroxetine

SSRIs (sertraline and paroxetine) are the only FDA-approved medications for PTSD, and are recommended as first-line pharmacotherapy.

Question 26: Which drug class is used to treat opioid-induced constipation by acting as a peripherally restricted mu-opioid receptor antagonist?

Docusate sodium
Bisacodyl
Polyethylene glycol
Methylnaltrexone (PAMORA) (Correct answer)

Correct answer: Methylnaltrexone (PAMORA)

PAMORAs like methylnaltrexone block peripheral gut opioid receptors without crossing the blood-brain barrier, relieving constipation without reversing analgesia.

Question 27: Which class of medications is first-line for managing hypertension in a patient with concurrent type 2 diabetes and proteinuria?

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

Correct answer: ACE inhibitors or ARBs

ACE inhibitors and ARBs are first-line in diabetic patients with proteinuria because they reduce intraglomerular pressure and slow nephropathy progression.

Question 28: A systematic review that mathematically pools data from multiple RCTs to increase statistical power is called a:

Meta-analysis (Correct answer)
Cohort synthesis
Scoping review
Narrative review

Correct answer: Meta-analysis

Meta-analysis combines quantitative data from multiple studies using statistical methods to derive more precise pooled estimates of treatment effects.

Question 29: A 35-year-old woman presents with persistent sadness, anhedonia, insomnia, fatigue, difficulty concentrating, and feelings of worthlessness for 3 weeks. What is the minimum number of symptoms required to diagnose Major Depressive Disorder per DSM-5?

4 symptoms for at least 1 week
7 symptoms for at least 2 weeks
5 symptoms for at least 2 weeks (Correct answer)
3 symptoms for at least 1 week

Correct answer: 5 symptoms for at least 2 weeks

DSM-5 requires at least 5 of 9 specified symptoms present for at least 2 weeks, with depressed mood or anhedonia being mandatory.

Question 30: In research ethics, the Belmont Report established which three core principles?

Truthfulness, beneficence, and non-maleficence
Consent, privacy, and equity
Respect for persons, beneficence, and justice (Correct answer)
Autonomy, non-maleficence, and beneficence

Correct answer: Respect for persons, beneficence, and justice

The 1979 Belmont Report identified respect for persons (autonomy), beneficence, and justice as the foundational principles guiding ethical human subjects research.

COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination)

The COMLEX-USA is the three-level licensing examination series administered by the NBOME for osteopathic physicians, testing medical knowledge, patient care, osteopathic principles, and manipulative treatment across biomedical and clinical sciences.

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