COMLEX LEVEL 3 BOARD EXAM PREP 2026–2027 The Ultimate
Comprehensive Osteopathic Medical Licensing Examination
Study Guide Practice Questions Featuring Clinical Decision-
Making (CDM) Cases, OMT/OPP, Patient Management & Exam
Success Strategies Aligned with the Latest NBOME COMLEX-USA
Level 3 Blueprint (2026–2027)
1. A 45-year-old male presents with chronic low back pain. On
examination, you note a right posterior innominate rotation. The
standing flexion test is positive on the right, and the seated flexion test is
positive on the left. Which of the following is the most likely sacral
diagnosis?
• A) Right-on-right sacral torsion
• B) Left-on-left sacral torsion
• C) Right unilateral sacral flexion
• D) Bilateral sacral extension
• E) Left unilateral sacral extension
2. A 62-year-old female with a history of COPD is admitted with acute
atelectasis on hospital day 2. Which osteopathic manipulative treatment
(OMT) technique is most appropriate to improve rib excursion and
facilitate lymphatic drainage?
• A) Thoracic lymphatic pump and rib raising
• B) High-velocity low-amplitude (HVLA) thrust to the thoracic spine
• C) Cranial osteopathic manipulation
• D) Muscle energy technique to the cervical spine
• E) Counterstrain to the lumbar spine
3. A 35-year-old male presents with right lower back pain after moving
furniture. Neurologic examination is normal. On structural examination,
,you identify a right sacral torsion on an oblique axis. Which of the
following is the most appropriate OMT approach?
• A) Muscle energy technique to correct the sacral torsion
• B) Counterstrain to the piriformis muscle
• C) Myofascial release to the lumbar paraspinals
• D) HVLA thrust to the lumbosacral junction
• E) Cranial osteopathic manipulation
4. Which of the following best describes the difference between direct
and indirect OMT approaches in the context of managing a patient with
acute somatic dysfunction?
• A) Direct techniques engage the restrictive barrier; indirect
techniques move away from the restrictive barrier
• B) Direct techniques are always high-velocity; indirect techniques are
always low-velocity
• C) Direct techniques are used only for chronic dysfunctions; indirect
techniques are used only for acute dysfunctions
• D) Direct techniques require patient cooperation; indirect techniques do
not
• E) Direct techniques are applied to the cranium; indirect techniques are
applied to the spine
5. A 55-year-old female with chronic tension headaches has suboccipital
tenderness and restriction. Which cranial bone is most likely restricted,
and which OMT technique is most appropriate?
• A) Occiput; CV-4 (cranial vault hold) technique
• B) Sphenoid; muscle energy technique
• C) Temporal; counterstrain
• D) Frontal; HVLA thrust
• E) Parietal; myofascial release
,6. A 28-year-old female presents with acute torticollis. On examination,
you find a tender point at the mid-belly of the right sternocleidomastoid
muscle. Which OMT technique is most appropriate?
• A) Counterstrain
• B) HVLA thrust
• C) Muscle energy
• D) Myofascial release
• E) Lymphatic pump
7. A 70-year-old male with a history of benign prostatic hyperplasia
presents with chronic pelvic pain. On examination, you find a Chapman's
reflex point at the tip of the 12th rib on the right. This viscerosomatic
reflex is most likely associated with which organ?
• A) Colon
• B) Kidney
• C) Gallbladder
• D) Stomach
• E) Prostate
8. In Fryette's Type I (group) somatic dysfunction, which of the following
is a characteristic finding?
• A) Sidebending and rotation occur to opposite sides in neutral
position
• B) Sidebending and rotation occur to the same side in non-neutral
position
• C) Involves a single vertebra
• D) Occurs only in the lumbar spine
• E) Sidebending and rotation are independent of each other
, 9. A 42-year-old female with a history of asthma has a Chapman's reflex
point at the 2nd intercostal space, right parasternal region. This reflex
point is most likely associated with which organ system?
• A) Lung/bronchial dysfunction
• B) Cardiac dysfunction
• C) Gastric dysfunction
• D) Renal dysfunction
• E) Hepatic dysfunction
10. A 38-year-old male presents with acute low back pain after lifting a
heavy object. On examination, you find tissue texture changes,
asymmetry, restriction of motion, and tenderness at the L5 segment. The
mnemonic TART stands for:
• A) Tissue texture abnormality, Asymmetry, Restriction of motion,
Tenderness
• B) Tenderness, Asymmetry, Rotation, Tone
• C) Tissue, Articulation, Restriction, Tenderness
• D) Tenderness, Alignment, Restriction, Tone
• E) Texture, Asymmetry, Restriction, Tenderness
11. A 50-year-old male with chronic constipation has a tender point at
the tip of the 12th rib on the left. Which viscerosomatic reflex is most
likely involved?
• A) Splenic flexure of the colon
• B) Stomach
• C) Gallbladder
• D) Kidney
• E) Liver
12. Which of the following is a contraindication to HVLA (high-velocity
low-amplitude) technique in the cervical spine?
Comprehensive Osteopathic Medical Licensing Examination
Study Guide Practice Questions Featuring Clinical Decision-
Making (CDM) Cases, OMT/OPP, Patient Management & Exam
Success Strategies Aligned with the Latest NBOME COMLEX-USA
Level 3 Blueprint (2026–2027)
1. A 45-year-old male presents with chronic low back pain. On
examination, you note a right posterior innominate rotation. The
standing flexion test is positive on the right, and the seated flexion test is
positive on the left. Which of the following is the most likely sacral
diagnosis?
• A) Right-on-right sacral torsion
• B) Left-on-left sacral torsion
• C) Right unilateral sacral flexion
• D) Bilateral sacral extension
• E) Left unilateral sacral extension
2. A 62-year-old female with a history of COPD is admitted with acute
atelectasis on hospital day 2. Which osteopathic manipulative treatment
(OMT) technique is most appropriate to improve rib excursion and
facilitate lymphatic drainage?
• A) Thoracic lymphatic pump and rib raising
• B) High-velocity low-amplitude (HVLA) thrust to the thoracic spine
• C) Cranial osteopathic manipulation
• D) Muscle energy technique to the cervical spine
• E) Counterstrain to the lumbar spine
3. A 35-year-old male presents with right lower back pain after moving
furniture. Neurologic examination is normal. On structural examination,
,you identify a right sacral torsion on an oblique axis. Which of the
following is the most appropriate OMT approach?
• A) Muscle energy technique to correct the sacral torsion
• B) Counterstrain to the piriformis muscle
• C) Myofascial release to the lumbar paraspinals
• D) HVLA thrust to the lumbosacral junction
• E) Cranial osteopathic manipulation
4. Which of the following best describes the difference between direct
and indirect OMT approaches in the context of managing a patient with
acute somatic dysfunction?
• A) Direct techniques engage the restrictive barrier; indirect
techniques move away from the restrictive barrier
• B) Direct techniques are always high-velocity; indirect techniques are
always low-velocity
• C) Direct techniques are used only for chronic dysfunctions; indirect
techniques are used only for acute dysfunctions
• D) Direct techniques require patient cooperation; indirect techniques do
not
• E) Direct techniques are applied to the cranium; indirect techniques are
applied to the spine
5. A 55-year-old female with chronic tension headaches has suboccipital
tenderness and restriction. Which cranial bone is most likely restricted,
and which OMT technique is most appropriate?
• A) Occiput; CV-4 (cranial vault hold) technique
• B) Sphenoid; muscle energy technique
• C) Temporal; counterstrain
• D) Frontal; HVLA thrust
• E) Parietal; myofascial release
,6. A 28-year-old female presents with acute torticollis. On examination,
you find a tender point at the mid-belly of the right sternocleidomastoid
muscle. Which OMT technique is most appropriate?
• A) Counterstrain
• B) HVLA thrust
• C) Muscle energy
• D) Myofascial release
• E) Lymphatic pump
7. A 70-year-old male with a history of benign prostatic hyperplasia
presents with chronic pelvic pain. On examination, you find a Chapman's
reflex point at the tip of the 12th rib on the right. This viscerosomatic
reflex is most likely associated with which organ?
• A) Colon
• B) Kidney
• C) Gallbladder
• D) Stomach
• E) Prostate
8. In Fryette's Type I (group) somatic dysfunction, which of the following
is a characteristic finding?
• A) Sidebending and rotation occur to opposite sides in neutral
position
• B) Sidebending and rotation occur to the same side in non-neutral
position
• C) Involves a single vertebra
• D) Occurs only in the lumbar spine
• E) Sidebending and rotation are independent of each other
, 9. A 42-year-old female with a history of asthma has a Chapman's reflex
point at the 2nd intercostal space, right parasternal region. This reflex
point is most likely associated with which organ system?
• A) Lung/bronchial dysfunction
• B) Cardiac dysfunction
• C) Gastric dysfunction
• D) Renal dysfunction
• E) Hepatic dysfunction
10. A 38-year-old male presents with acute low back pain after lifting a
heavy object. On examination, you find tissue texture changes,
asymmetry, restriction of motion, and tenderness at the L5 segment. The
mnemonic TART stands for:
• A) Tissue texture abnormality, Asymmetry, Restriction of motion,
Tenderness
• B) Tenderness, Asymmetry, Rotation, Tone
• C) Tissue, Articulation, Restriction, Tenderness
• D) Tenderness, Alignment, Restriction, Tone
• E) Texture, Asymmetry, Restriction, Tenderness
11. A 50-year-old male with chronic constipation has a tender point at
the tip of the 12th rib on the left. Which viscerosomatic reflex is most
likely involved?
• A) Splenic flexure of the colon
• B) Stomach
• C) Gallbladder
• D) Kidney
• E) Liver
12. Which of the following is a contraindication to HVLA (high-velocity
low-amplitude) technique in the cervical spine?
