COMLEX LEVEL 1 COMPREHENSIVE
STUDY GUIDE 2026–2027 With Practice
Questions, OMM Review & Detailed
Explanations
The Ultimate COMLEX Level 1 Preparation Resource — 270 Exam-Quality
Questions with Detailed Rationales
Question 1
A 45-year-old patient presents with low back pain. On examination, you note that
the patient has a restricted right side-bending and restricted right rotation of the
lumbar spine. According to Fryette's laws, which of the following best describes
this somatic dysfunction?
A. Type I somatic dysfunction
B. Type II somatic dysfunction
C. Type III somatic dysfunction
D. A neutral dysfunction
Correct: Type I = opposite sides (e.g., side-bending R, rotation L). Type II = same
side (side-bending R, rotation R). Since this patient has both restricted to the same
side (right), this is Type II.
Option A — Type I would be side-bending and rotation to opposite sides. Option
C — Type III does not exist in Fryette's classification. Option D — Neutral
dysfunction is a component of Type I but not a separate type.
Question 2
A 32-year-old woman presents with chronic headaches. On cranial examination,
you note that the sphenobasilar synchondrosis (SBS) is restricted in flexion. Which
of the following best describes the somatic dysfunction present?
,A. SBS flexion dysfunction
B. SBS extension dysfunction
C. SBS torsion dysfunction
D. SBS side-bending dysfunction
Correct Answer: B
Rationale: Cranial somatic dysfunction of the sphenobasilar synchondrosis (SBS)
in flexion occurs when the sphenoid and occiput move toward each other
anteriorly. This is characterized by a widening of the skull and a shortening of the
anteroposterior diameter. The patient would present with
a bilateral dysfunction. Option B — SBS extension is the opposite
motion. Option C — SBS torsion involves rotation around an anteroposterior
axis. Option D — SBS side-bending involves lateral flexion.
Question 3
During a structural examination, you identify a Chapman's reflex point at the
intercostal space between the 2nd and 3rd ribs, approximately 2 inches from the
sternum. This reflex point is associated with which organ?
A. Stomach
B. Liver
C. Gallbladder
D. Heart
Correct Answer: D
Rationale: Chapman's reflex points are neurolymphatic reflexes that correspond to
specific viscera. The reflex point for the heart is located at the 2nd and 3rd
intercostal spaces, approximately 2 inches from the sternum on
the left side. Option A — The stomach reflex is located at the 5th–6th intercostal
spaces on the left. Option B — The liver reflex is at the 6th–7th intercostal spaces
on the right. Option C — The gallbladder reflex is at the 5th intercostal space on
the right.
,Question 4
A 55-year-old patient presents with right upper quadrant abdominal pain. On
examination, you find a Chapman's reflex point at the 5th intercostal space on the
right side, 2 inches from the sternum. Which organ is most likely involved?
A. Liver
B. Gallbladder
C. Stomach
D. Pancreas
Correct Answer: B
Rationale: The Chapman's reflex point for the gallbladder is located at the 5th
intercostal space on the right side, approximately 2 inches from the
sternum. Option A — The liver reflex is at the 6th–7th intercostal spaces on the
right. Option C — The stomach reflex is at the 5th–6th intercostal spaces on the
left. Option D — The pancreas reflex is at the 7th intercostal space on the left.
Question 5
A patient presents with a history of chronic constipation. On examination, you find
a Chapman's reflex point at the inferior angle of the scapula on the left side. This
finding is most consistent with dysfunction of which organ?
A. Kidney
B. Spleen
C. Colon
D. Bladder
Correct Answer: C
Rationale: The Chapman's reflex point for the colon is located at the inferior
angle of the scapula (both sides, but the left side is more commonly associated
with the descending colon). Option A — The kidney reflex is at the 1st–2nd
lumbar vertebrae. Option B — The spleen reflex is at the 8th–9th ribs on the
left. Option D — The bladder reflex is at the 1st sacral segment.
, Question 6
A 40-year-old patient presents with acute low back pain after lifting a heavy
object. On examination, you note that the patient has a pelvic tilt with the left ilium
rotated anteriorly and the right ilium rotated posteriorly. Which of the following is
the most likely somatic dysfunction?
A. Left anterior innominate
B. Right anterior innominate
C. Left posterior innominate
D. Bilateral innominate dysfunction
Correct Answer: A
Rationale: An anterior innominate dysfunction occurs when the ilium
rotates anteriorly on the sacrum. The patient presents with a left anterior
innominate because the left ilium is rotated anteriorly. Option B — Right anterior
innominate would involve the right ilium. Option C — Left posterior innominate
would involve the left ilium rotating posteriorly. Option D — Bilateral
dysfunction would involve both sides.
Question 7
According to Fryette's laws, which of the following is true regarding Type I
somatic dysfunction?
A. The vertebrae are in a non-neutral position (flexion or extension).
B. Side-bending and rotation occur to the same side.
C. Side-bending and rotation occur to opposite sides.
D. The dysfunction involves only a single vertebra.
Correct Answer: C
Rationale: Fryette's Type I (Group I) somatic dysfunction states that when the
spine is in a neutral position, side-bending and rotation occur to opposite sides.
This typically involves a group of vertebrae (3–5 segments). Option A — Non-
neutral position describes Type II. Option B — Same-side rotation describes Type
II. Option D — Type I involves multiple vertebrae, not a single segment.
STUDY GUIDE 2026–2027 With Practice
Questions, OMM Review & Detailed
Explanations
The Ultimate COMLEX Level 1 Preparation Resource — 270 Exam-Quality
Questions with Detailed Rationales
Question 1
A 45-year-old patient presents with low back pain. On examination, you note that
the patient has a restricted right side-bending and restricted right rotation of the
lumbar spine. According to Fryette's laws, which of the following best describes
this somatic dysfunction?
A. Type I somatic dysfunction
B. Type II somatic dysfunction
C. Type III somatic dysfunction
D. A neutral dysfunction
Correct: Type I = opposite sides (e.g., side-bending R, rotation L). Type II = same
side (side-bending R, rotation R). Since this patient has both restricted to the same
side (right), this is Type II.
Option A — Type I would be side-bending and rotation to opposite sides. Option
C — Type III does not exist in Fryette's classification. Option D — Neutral
dysfunction is a component of Type I but not a separate type.
Question 2
A 32-year-old woman presents with chronic headaches. On cranial examination,
you note that the sphenobasilar synchondrosis (SBS) is restricted in flexion. Which
of the following best describes the somatic dysfunction present?
,A. SBS flexion dysfunction
B. SBS extension dysfunction
C. SBS torsion dysfunction
D. SBS side-bending dysfunction
Correct Answer: B
Rationale: Cranial somatic dysfunction of the sphenobasilar synchondrosis (SBS)
in flexion occurs when the sphenoid and occiput move toward each other
anteriorly. This is characterized by a widening of the skull and a shortening of the
anteroposterior diameter. The patient would present with
a bilateral dysfunction. Option B — SBS extension is the opposite
motion. Option C — SBS torsion involves rotation around an anteroposterior
axis. Option D — SBS side-bending involves lateral flexion.
Question 3
During a structural examination, you identify a Chapman's reflex point at the
intercostal space between the 2nd and 3rd ribs, approximately 2 inches from the
sternum. This reflex point is associated with which organ?
A. Stomach
B. Liver
C. Gallbladder
D. Heart
Correct Answer: D
Rationale: Chapman's reflex points are neurolymphatic reflexes that correspond to
specific viscera. The reflex point for the heart is located at the 2nd and 3rd
intercostal spaces, approximately 2 inches from the sternum on
the left side. Option A — The stomach reflex is located at the 5th–6th intercostal
spaces on the left. Option B — The liver reflex is at the 6th–7th intercostal spaces
on the right. Option C — The gallbladder reflex is at the 5th intercostal space on
the right.
,Question 4
A 55-year-old patient presents with right upper quadrant abdominal pain. On
examination, you find a Chapman's reflex point at the 5th intercostal space on the
right side, 2 inches from the sternum. Which organ is most likely involved?
A. Liver
B. Gallbladder
C. Stomach
D. Pancreas
Correct Answer: B
Rationale: The Chapman's reflex point for the gallbladder is located at the 5th
intercostal space on the right side, approximately 2 inches from the
sternum. Option A — The liver reflex is at the 6th–7th intercostal spaces on the
right. Option C — The stomach reflex is at the 5th–6th intercostal spaces on the
left. Option D — The pancreas reflex is at the 7th intercostal space on the left.
Question 5
A patient presents with a history of chronic constipation. On examination, you find
a Chapman's reflex point at the inferior angle of the scapula on the left side. This
finding is most consistent with dysfunction of which organ?
A. Kidney
B. Spleen
C. Colon
D. Bladder
Correct Answer: C
Rationale: The Chapman's reflex point for the colon is located at the inferior
angle of the scapula (both sides, but the left side is more commonly associated
with the descending colon). Option A — The kidney reflex is at the 1st–2nd
lumbar vertebrae. Option B — The spleen reflex is at the 8th–9th ribs on the
left. Option D — The bladder reflex is at the 1st sacral segment.
, Question 6
A 40-year-old patient presents with acute low back pain after lifting a heavy
object. On examination, you note that the patient has a pelvic tilt with the left ilium
rotated anteriorly and the right ilium rotated posteriorly. Which of the following is
the most likely somatic dysfunction?
A. Left anterior innominate
B. Right anterior innominate
C. Left posterior innominate
D. Bilateral innominate dysfunction
Correct Answer: A
Rationale: An anterior innominate dysfunction occurs when the ilium
rotates anteriorly on the sacrum. The patient presents with a left anterior
innominate because the left ilium is rotated anteriorly. Option B — Right anterior
innominate would involve the right ilium. Option C — Left posterior innominate
would involve the left ilium rotating posteriorly. Option D — Bilateral
dysfunction would involve both sides.
Question 7
According to Fryette's laws, which of the following is true regarding Type I
somatic dysfunction?
A. The vertebrae are in a non-neutral position (flexion or extension).
B. Side-bending and rotation occur to the same side.
C. Side-bending and rotation occur to opposite sides.
D. The dysfunction involves only a single vertebra.
Correct Answer: C
Rationale: Fryette's Type I (Group I) somatic dysfunction states that when the
spine is in a neutral position, side-bending and rotation occur to opposite sides.
This typically involves a group of vertebrae (3–5 segments). Option A — Non-
neutral position describes Type II. Option B — Same-side rotation describes Type
II. Option D — Type I involves multiple vertebrae, not a single segment.
