COMLEX-USA Level 1: verified correct Questions with
Answers and Rationales
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Question 1
A 45-year-old male presents with chronic low back pain. During evaluation, you note a Type I
(neutral) somatic dysfunction in the lumbar spine. According to Fryette's principles, how would you
describe this dysfunction?
A) A group of vertebrae is flexed or extended with restricted side bending in one direction and
rotation to the opposite side
B) A single vertebra is dysfunctional in a flexed or extended position
C) A group of vertebrae is side bent and rotated in opposite directions
D) A group of vertebrae is side bent and rotated in the same direction
Answer: D
Rationale: Fryette's Type I dysfunction (neutral mechanics) occurs when a group of vertebrae in a
neutral position (neither flexed nor extended) exhibits side bending and rotation in the same
direction. This is characteristic of group curve dysfunctions, such as a right thoracic curve (sidebent
right, rotated right). Type II (non-neutral) involves a single vertebra with side bending and rotation in
opposite directions when the spine is flexed or extended.
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Question 2
A 28-year-old female presents with right-sided tension headaches. On examination, you find
tenderness at the medial aspect of the right knee, approximately 2 cm proximal to the joint line. This
finding is most consistent with which Chapman's reflex point?
A) Gallbladder
B) Appendix
C) Stomach
D) Liver
,Answer: A
Rationale: The anterior Chapman reflex for the gallbladder is located at the 5th intercostal space,
right sternal border, but there is also a gallbladder reflex point near the medial right knee. Chapman's
points are organ-specific gangliform contractions located deep within fascia in regions related by
dermatome to the dysfunctional viscera.
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Question 3
You place your hands on a patient's head with your thenar eminences on the greater wings of the
sphenoid and your fingers resting along the temporal bones. You then assess the flexion-extension
motion of the sphenobasilar synchondrosis (SBS). This hand placement describes which cranial
technique?
A) Vault Hold
B) Frontal Lift
C) Temporal Lift
D) Occipito-Atlantal Decompression
Answer: A
Rationale: The Vault Hold (also called the Sphenobasilar Hold) uses the thenar eminences on the
greater wings of the sphenoid with fingers resting on the temporal bones to assess the inherent
rhythmic motion (Cranial Rhythmic Impulse) of the sphenobasilar synchondrosis. This is a
foundational cranial osteopathic technique.
---
Question 4
A 32-year-old patient involved in a rear-end collision several weeks ago presents with neck pain. You
diagnose an acute Type II restriction of C4 on C5. According to Fryette's principles, what are the
expected motion restrictions at this segment?
A) Flexed or extended with rotation and side bending to opposite sides
B) Neutral with rotation and side bending to the same side
C) Non-neutral with rotation and side bending to the same side
,D) Neutral with rotation and side bending to opposite sides
Answer: A
Rationale: Fryette's Type II dysfunction occurs in a non-neutral position (flexion or extension). In this
condition, a single vertebra is rotated and side bent to opposite sides, with the rotation occurring
toward the side of convexity. Type I (neutral) involves side bending and rotation to the same side in a
group of vertebrae.
---
Question 5
A patient presents with a deep, dull ache localized to the right iliac fossa. Palpation of the right
anterior abdominal wall near McBurney's point reveals a small, tender nodule. This is most likely a
Chapman's reflex point for which organ?
A) Right Kidney
B) Appendix
C) Cecum
D) Right Ovary
Answer: B
Rationale: The Chapman's reflex point for the appendix is classically described on the right side of
the abdomen near McBurney's point (anterior), as well as at the medial right knee. It presents as a
small, tender, firm nodule in the deep fascia. This reflects the visceral-somatic reflex relationship
between the appendix and the associated somatic structures.
---
Question 6
The diagnosis of somatic dysfunction requires identification of which of the following elements?
A) Tenderness only
B) Asymmetry only
C) Range of motion abnormality only
, D) All of the above, with motion restriction plus one other component
Answer: D
Rationale: The diagnosis of somatic dysfunction is based on the TART criteria: Tenderness,
Asymmetry (of bony landmarks or posture), Range of motion abnormality (restriction), and Tissue
texture changes (e.g., warmth, bogginess, fibrosis, or increased tone). Positive findings of motion
restriction coupled with one other component (tissue texture changes, asymmetry, or tenderness)
supports the diagnosis. One component alone does not signify somatic dysfunction.
---
Question 7
An osteopathic physician palpates paraspinal tissues at T6 and notes a "ropy" and "stringy" texture.
This finding suggests:
A) Acute somatic dysfunction
B) Chronic somatic dysfunction
C) Normal tissue texture
D) Active infection
Answer: B
Rationale: Tissue texture changes reflect the stage of somatic dysfunction. Acute dysfunction feels
warm, tender, and boggy due to edema and vasodilation. Chronic dysfunction feels cool, dry, ropey,
or stringy due to fibrosis and fascial restriction. The described ropy and stringy texture is
characteristic of chronic somatic dysfunction.
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Question 8
A patient presents with tenderness, asymmetry, and tissue texture changes in the thoracic spine, but
full range of motion. Can somatic dysfunction be diagnosed?
A) Yes, because TART requires only three components
B) No, because motion restriction must be present with at least one other component
Answers and Rationales
---
Question 1
A 45-year-old male presents with chronic low back pain. During evaluation, you note a Type I
(neutral) somatic dysfunction in the lumbar spine. According to Fryette's principles, how would you
describe this dysfunction?
A) A group of vertebrae is flexed or extended with restricted side bending in one direction and
rotation to the opposite side
B) A single vertebra is dysfunctional in a flexed or extended position
C) A group of vertebrae is side bent and rotated in opposite directions
D) A group of vertebrae is side bent and rotated in the same direction
Answer: D
Rationale: Fryette's Type I dysfunction (neutral mechanics) occurs when a group of vertebrae in a
neutral position (neither flexed nor extended) exhibits side bending and rotation in the same
direction. This is characteristic of group curve dysfunctions, such as a right thoracic curve (sidebent
right, rotated right). Type II (non-neutral) involves a single vertebra with side bending and rotation in
opposite directions when the spine is flexed or extended.
---
Question 2
A 28-year-old female presents with right-sided tension headaches. On examination, you find
tenderness at the medial aspect of the right knee, approximately 2 cm proximal to the joint line. This
finding is most consistent with which Chapman's reflex point?
A) Gallbladder
B) Appendix
C) Stomach
D) Liver
,Answer: A
Rationale: The anterior Chapman reflex for the gallbladder is located at the 5th intercostal space,
right sternal border, but there is also a gallbladder reflex point near the medial right knee. Chapman's
points are organ-specific gangliform contractions located deep within fascia in regions related by
dermatome to the dysfunctional viscera.
---
Question 3
You place your hands on a patient's head with your thenar eminences on the greater wings of the
sphenoid and your fingers resting along the temporal bones. You then assess the flexion-extension
motion of the sphenobasilar synchondrosis (SBS). This hand placement describes which cranial
technique?
A) Vault Hold
B) Frontal Lift
C) Temporal Lift
D) Occipito-Atlantal Decompression
Answer: A
Rationale: The Vault Hold (also called the Sphenobasilar Hold) uses the thenar eminences on the
greater wings of the sphenoid with fingers resting on the temporal bones to assess the inherent
rhythmic motion (Cranial Rhythmic Impulse) of the sphenobasilar synchondrosis. This is a
foundational cranial osteopathic technique.
---
Question 4
A 32-year-old patient involved in a rear-end collision several weeks ago presents with neck pain. You
diagnose an acute Type II restriction of C4 on C5. According to Fryette's principles, what are the
expected motion restrictions at this segment?
A) Flexed or extended with rotation and side bending to opposite sides
B) Neutral with rotation and side bending to the same side
C) Non-neutral with rotation and side bending to the same side
,D) Neutral with rotation and side bending to opposite sides
Answer: A
Rationale: Fryette's Type II dysfunction occurs in a non-neutral position (flexion or extension). In this
condition, a single vertebra is rotated and side bent to opposite sides, with the rotation occurring
toward the side of convexity. Type I (neutral) involves side bending and rotation to the same side in a
group of vertebrae.
---
Question 5
A patient presents with a deep, dull ache localized to the right iliac fossa. Palpation of the right
anterior abdominal wall near McBurney's point reveals a small, tender nodule. This is most likely a
Chapman's reflex point for which organ?
A) Right Kidney
B) Appendix
C) Cecum
D) Right Ovary
Answer: B
Rationale: The Chapman's reflex point for the appendix is classically described on the right side of
the abdomen near McBurney's point (anterior), as well as at the medial right knee. It presents as a
small, tender, firm nodule in the deep fascia. This reflects the visceral-somatic reflex relationship
between the appendix and the associated somatic structures.
---
Question 6
The diagnosis of somatic dysfunction requires identification of which of the following elements?
A) Tenderness only
B) Asymmetry only
C) Range of motion abnormality only
, D) All of the above, with motion restriction plus one other component
Answer: D
Rationale: The diagnosis of somatic dysfunction is based on the TART criteria: Tenderness,
Asymmetry (of bony landmarks or posture), Range of motion abnormality (restriction), and Tissue
texture changes (e.g., warmth, bogginess, fibrosis, or increased tone). Positive findings of motion
restriction coupled with one other component (tissue texture changes, asymmetry, or tenderness)
supports the diagnosis. One component alone does not signify somatic dysfunction.
---
Question 7
An osteopathic physician palpates paraspinal tissues at T6 and notes a "ropy" and "stringy" texture.
This finding suggests:
A) Acute somatic dysfunction
B) Chronic somatic dysfunction
C) Normal tissue texture
D) Active infection
Answer: B
Rationale: Tissue texture changes reflect the stage of somatic dysfunction. Acute dysfunction feels
warm, tender, and boggy due to edema and vasodilation. Chronic dysfunction feels cool, dry, ropey,
or stringy due to fibrosis and fascial restriction. The described ropy and stringy texture is
characteristic of chronic somatic dysfunction.
---
Question 8
A patient presents with tenderness, asymmetry, and tissue texture changes in the thoracic spine, but
full range of motion. Can somatic dysfunction be diagnosed?
A) Yes, because TART requires only three components
B) No, because motion restriction must be present with at least one other component
