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COMLEX-USA LEVEL 3 PRACTICE EXAM – 2026/2027
COMPLETE (150) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
COMLEX-USA
Prepare effectively for the COMLEX-USA Level 3 Exam with this focused study
resource. It supports review of foundational medical sciences, osteopathic principles,
anatomy, physiology, pathology, pharmacology, microbiology, and clinical concepts.
Use the material to reinforce your knowledge, review high-yield topics, and identify
areas that may require additional study. This resource is suited for osteopathic
medical students and candidates preparing for the COMLEX-USA Level 3 examination.
MULTIPLE CHOICE.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OMM/OPP)
(Questions 1–20)
Question #1
A 45-year-old male presents with chronic low back pain that is worse in the
morning and improves with activity. On examination, you note a sacral torsion
R-on-L with a positive spring test. According to Fryette's laws, which of the
following is the correct characterization of this dysfunction?
A. Neutral mechanics with groups of vertebrae
B. Non-neutral mechanics with single vertebrae
C. Neutral mechanics with single vertebrae
D. Non-neutral mechanics with groups of vertebrae
E. Cannot be determined from the information given
Correct Answer: B
Rationale: R-on-L is a backward sacral torsion with a positive spring test.
Backward torsions are non-neutral mechanics with single vertebrae,
according to Fryette's laws. Forward torsions (L-on-L, R-on-R) have negative
spring tests and are also non-neutral. Type I mechanics are neutral with
groups of vertebrae; Type II mechanics are non-neutral with single vertebrae.
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Question #2
A 58-year-old female with a history of chronic cholecystitis presents with right
upper quadrant pain that radiates to the right shoulder. On examination, you
note a tender anterior Chapman point at the right 5th intercostal space.
Which posterior spinal segments are most likely associated with this
viscerosomatic reflex?
A. T1–T3
B. T3–T5
C. T5–T7
D. T7–T9
E. T9–T11
Correct Answer: C
Rationale: The gallbladder is associated with spinal segments T5–T7. The
anterior Chapman reflex for the gallbladder is located at the right 5th
intercostal space. Viscerosomatic reflexes are a key OMM concept on
COMLEX. Dysfunction in these spinal segments may indicate gallbladder
pathology.
Question #3
A 32-year-old female with chronic constipation has a tender anterior
Chapman point at the tip of the left 12th rib. Which part of the colon is most
likely affected?
A. Ascending colon
B. Transverse colon
C. Descending colon
D. Sigmoid colon
E. Cecum
Correct Answer: C
Rationale: The anterior Chapman reflex for the descending colon is
located at the tip of the left 12th rib. The ascending colon corresponds to
the right 11th rib; the transverse colon reflexes are located near the umbilicus.
This is a classic viscerosomatic reflex pattern on COMLEX.
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Question #4
During a cranial osteopathic examination, you note that the sphenoid is flexed
and the paired bones are externally rotated. This finding is consistent with
which phase of the primary respiratory mechanism?
A. Cranial flexion
B. Cranial extension
C. Cranial torsion
D. Lateral strain
E. Vertical strain
Correct Answer: A
Rationale: During cranial flexion, the midline bones (sphenoid, occiput)
flex, and the paired bones (temporals, parietals) externally rotate. During
extension, the pattern reverses: midline bones extend and paired bones
internally rotate. This is a foundational concept in cranial osteopathy.
Question #5
A 28-year-old male presents with right-sided neck pain and headache after a
motor vehicle collision. On examination, you find a right rotated, right
sidebent C2 with restriction in flexion. According to Fryette's laws, which of
the following is the correct diagnosis?
A. Type I dysfunction at C2
B. Type II dysfunction at C2
C. Type I dysfunction at C3–C5
D. Type II dysfunction at C3–C5
E. Neutral dysfunction at C2
Correct Answer: B
Rationale: C2 is a single vertebral segment with restriction in flexion (non-
neutral) and sidebending and rotation to the same side (right-right). This is
a Type II dysfunction (Non-Neutral, Single segment, Same side) . Type I
mechanics involve groups of vertebrae and sidebending/rotation to opposite
sides.
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Question #6
A 65-year-old male with a history of COPD presents with chronic dyspnea. On
examination, you note somatic dysfunction at T1–T4 with tissue texture
changes. This is most likely a:
A. Somatovisceral reflex
B. Viscerosomatic reflex from the lungs
C. Viscerosomatic reflex from the heart
D. Viscerosomatic reflex from the esophagus
E. Somatic dysfunction unrelated to visceral pathology
Correct Answer: B
Rationale: The sympathetic innervation to the lungs originates from T1–T4.
Viscerosomatic reflexes are a key OMM concept on COMLEX. Dysfunction in
these spinal segments may indicate lung pathology such as COPD, asthma, or
infection.
Question #7
Which of the following is a direct osteopathic manipulative technique?
A. Counterstrain
B. High-velocity, low-amplitude (HVLA)
C. Facilitated positional release
D. Myofascial release
E. Still technique
Correct Answer: B
Rationale: HVLA is a direct technique that engages the restrictive barrier
and applies a high-velocity, low-amplitude thrust. Counterstrain, facilitated
positional release, myofascial release, and Still technique are indirect
techniques. Direct techniques move the dysfunctional segment toward the
restrictive barrier; indirect techniques move away from the barrier.
COMLEX-USA LEVEL 3 PRACTICE EXAM – 2026/2027
COMPLETE (150) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
COMLEX-USA
Prepare effectively for the COMLEX-USA Level 3 Exam with this focused study
resource. It supports review of foundational medical sciences, osteopathic principles,
anatomy, physiology, pathology, pharmacology, microbiology, and clinical concepts.
Use the material to reinforce your knowledge, review high-yield topics, and identify
areas that may require additional study. This resource is suited for osteopathic
medical students and candidates preparing for the COMLEX-USA Level 3 examination.
MULTIPLE CHOICE.
SECTION 1: OSTEOPATHIC PRINCIPLES & PRACTICE (OMM/OPP)
(Questions 1–20)
Question #1
A 45-year-old male presents with chronic low back pain that is worse in the
morning and improves with activity. On examination, you note a sacral torsion
R-on-L with a positive spring test. According to Fryette's laws, which of the
following is the correct characterization of this dysfunction?
A. Neutral mechanics with groups of vertebrae
B. Non-neutral mechanics with single vertebrae
C. Neutral mechanics with single vertebrae
D. Non-neutral mechanics with groups of vertebrae
E. Cannot be determined from the information given
Correct Answer: B
Rationale: R-on-L is a backward sacral torsion with a positive spring test.
Backward torsions are non-neutral mechanics with single vertebrae,
according to Fryette's laws. Forward torsions (L-on-L, R-on-R) have negative
spring tests and are also non-neutral. Type I mechanics are neutral with
groups of vertebrae; Type II mechanics are non-neutral with single vertebrae.
, Page 2 of 68
Question #2
A 58-year-old female with a history of chronic cholecystitis presents with right
upper quadrant pain that radiates to the right shoulder. On examination, you
note a tender anterior Chapman point at the right 5th intercostal space.
Which posterior spinal segments are most likely associated with this
viscerosomatic reflex?
A. T1–T3
B. T3–T5
C. T5–T7
D. T7–T9
E. T9–T11
Correct Answer: C
Rationale: The gallbladder is associated with spinal segments T5–T7. The
anterior Chapman reflex for the gallbladder is located at the right 5th
intercostal space. Viscerosomatic reflexes are a key OMM concept on
COMLEX. Dysfunction in these spinal segments may indicate gallbladder
pathology.
Question #3
A 32-year-old female with chronic constipation has a tender anterior
Chapman point at the tip of the left 12th rib. Which part of the colon is most
likely affected?
A. Ascending colon
B. Transverse colon
C. Descending colon
D. Sigmoid colon
E. Cecum
Correct Answer: C
Rationale: The anterior Chapman reflex for the descending colon is
located at the tip of the left 12th rib. The ascending colon corresponds to
the right 11th rib; the transverse colon reflexes are located near the umbilicus.
This is a classic viscerosomatic reflex pattern on COMLEX.
, Page 3 of 68
Question #4
During a cranial osteopathic examination, you note that the sphenoid is flexed
and the paired bones are externally rotated. This finding is consistent with
which phase of the primary respiratory mechanism?
A. Cranial flexion
B. Cranial extension
C. Cranial torsion
D. Lateral strain
E. Vertical strain
Correct Answer: A
Rationale: During cranial flexion, the midline bones (sphenoid, occiput)
flex, and the paired bones (temporals, parietals) externally rotate. During
extension, the pattern reverses: midline bones extend and paired bones
internally rotate. This is a foundational concept in cranial osteopathy.
Question #5
A 28-year-old male presents with right-sided neck pain and headache after a
motor vehicle collision. On examination, you find a right rotated, right
sidebent C2 with restriction in flexion. According to Fryette's laws, which of
the following is the correct diagnosis?
A. Type I dysfunction at C2
B. Type II dysfunction at C2
C. Type I dysfunction at C3–C5
D. Type II dysfunction at C3–C5
E. Neutral dysfunction at C2
Correct Answer: B
Rationale: C2 is a single vertebral segment with restriction in flexion (non-
neutral) and sidebending and rotation to the same side (right-right). This is
a Type II dysfunction (Non-Neutral, Single segment, Same side) . Type I
mechanics involve groups of vertebrae and sidebending/rotation to opposite
sides.
, Page 4 of 68
Question #6
A 65-year-old male with a history of COPD presents with chronic dyspnea. On
examination, you note somatic dysfunction at T1–T4 with tissue texture
changes. This is most likely a:
A. Somatovisceral reflex
B. Viscerosomatic reflex from the lungs
C. Viscerosomatic reflex from the heart
D. Viscerosomatic reflex from the esophagus
E. Somatic dysfunction unrelated to visceral pathology
Correct Answer: B
Rationale: The sympathetic innervation to the lungs originates from T1–T4.
Viscerosomatic reflexes are a key OMM concept on COMLEX. Dysfunction in
these spinal segments may indicate lung pathology such as COPD, asthma, or
infection.
Question #7
Which of the following is a direct osteopathic manipulative technique?
A. Counterstrain
B. High-velocity, low-amplitude (HVLA)
C. Facilitated positional release
D. Myofascial release
E. Still technique
Correct Answer: B
Rationale: HVLA is a direct technique that engages the restrictive barrier
and applies a high-velocity, low-amplitude thrust. Counterstrain, facilitated
positional release, myofascial release, and Still technique are indirect
techniques. Direct techniques move the dysfunctional segment toward the
restrictive barrier; indirect techniques move away from the barrier.
