COMLEX LEVEL 1 EXAM LATEST 2026 UPDATE 100
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A 25-year-old man presents with fever, productive cough, and pleuritic chest pain.
Physical examination reveals decreased rib motion on the right during inhalation.
Which rib motion dysfunction is most likely present?
A. Right rib inhalation dysfunction
B. Right rib exhalation dysfunction
C. Left rib inhalation dysfunction
D. Bilateral rib inhalation dysfunction
Answer: B. Right rib exhalation dysfunction
Rationale: Decreased motion during inhalation indicates the rib is “stuck down,”
consistent with an exhalation dysfunction.
Question 2
Which embryologic structure gives rise to the adrenal medulla?
A. Mesoderm
B. Endoderm
C. Neural crest cells
D. Ectoderm
Answer: C. Neural crest cells
Rationale: The adrenal medulla originates from neural crest cells, which also give
rise to components of the sympathetic nervous system.
,Question 3
A patient with peptic ulcer disease experiences referred pain to the mid-epigastric
region. This corresponds to which spinal level?
A. T1–T4
B. T5–T9
C. T10–T11
D. L1–L2
Answer: B. T5–T9
Rationale: The stomach receives sympathetic innervation from T5–T9, commonly
associated with epigastric referred pain.
Question 4
A 60-year-old man presents with resting tremor, rigidity, and bradykinesia.
Degeneration of which neurotransmitter system is responsible?
A. Serotonin
B. Dopamine
C. Acetylcholine
D. GABA
Answer: B. Dopamine
Rationale: Parkinson disease results from degeneration of dopaminergic neurons
in the substantia nigra pars compacta.
Question 5
Which osteopathic technique involves positioning a joint into a position of ease
and holding it until a release is felt?
,A. Muscle energy
B. Counterstrain
C. High-velocity low-amplitude
D. Myofascial release
Answer: B. Counterstrain
Rationale: Counterstrain involves passive positioning into maximal comfort to
reduce proprioceptive activity and relieve tenderness.
Question 6
A patient presents with hypercalcemia, nephrolithiasis, and bone pain. Which
condition is most likely?
A. Secondary hyperparathyroidism
B. Primary hyperparathyroidism
C. Hypoparathyroidism
D. Vitamin D deficiency
Answer: B. Primary hyperparathyroidism
Rationale: Primary hyperparathyroidism causes elevated calcium levels, leading to
“stones, bones, groans, and psychiatric overtones.”
Question 7
Which rib is considered atypical?
A. Rib 3
B. Rib 6
C. Rib 1
D. Rib 8
Answer: C. Rib 1
Rationale: Ribs 1, 2, 10, 11, and 12 are atypical due to unique anatomical features.
, Question 8
A patient develops hemolytic anemia after taking sulfa drugs. Which enzyme
deficiency is most likely responsible?
A. Pyruvate kinase
B. Glucose-6-phosphate dehydrogenase
C. Hexokinase
D. Lactate dehydrogenase
Answer: B. Glucose-6-phosphate dehydrogenase
Rationale: G6PD deficiency leads to oxidative damage to red blood cells following
exposure to certain drugs or infections.
Question 9
Facilitated segments in osteopathic medicine are best described as:
A. Hypoactive spinal segments
B. Segments with increased sympathetic activity
C. Segments with decreased sensitivity
D. Areas of decreased tissue texture changes
Answer: B. Segments with increased sympathetic activity
Rationale: Facilitated segments exhibit heightened responsiveness due to
increased sympathetic tone and lowered activation thresholds.
Question 10
Which immunoglobulin is most abundant in mucosal secretions?
A. IgG
B. IgM
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A 25-year-old man presents with fever, productive cough, and pleuritic chest pain.
Physical examination reveals decreased rib motion on the right during inhalation.
Which rib motion dysfunction is most likely present?
A. Right rib inhalation dysfunction
B. Right rib exhalation dysfunction
C. Left rib inhalation dysfunction
D. Bilateral rib inhalation dysfunction
Answer: B. Right rib exhalation dysfunction
Rationale: Decreased motion during inhalation indicates the rib is “stuck down,”
consistent with an exhalation dysfunction.
Question 2
Which embryologic structure gives rise to the adrenal medulla?
A. Mesoderm
B. Endoderm
C. Neural crest cells
D. Ectoderm
Answer: C. Neural crest cells
Rationale: The adrenal medulla originates from neural crest cells, which also give
rise to components of the sympathetic nervous system.
,Question 3
A patient with peptic ulcer disease experiences referred pain to the mid-epigastric
region. This corresponds to which spinal level?
A. T1–T4
B. T5–T9
C. T10–T11
D. L1–L2
Answer: B. T5–T9
Rationale: The stomach receives sympathetic innervation from T5–T9, commonly
associated with epigastric referred pain.
Question 4
A 60-year-old man presents with resting tremor, rigidity, and bradykinesia.
Degeneration of which neurotransmitter system is responsible?
A. Serotonin
B. Dopamine
C. Acetylcholine
D. GABA
Answer: B. Dopamine
Rationale: Parkinson disease results from degeneration of dopaminergic neurons
in the substantia nigra pars compacta.
Question 5
Which osteopathic technique involves positioning a joint into a position of ease
and holding it until a release is felt?
,A. Muscle energy
B. Counterstrain
C. High-velocity low-amplitude
D. Myofascial release
Answer: B. Counterstrain
Rationale: Counterstrain involves passive positioning into maximal comfort to
reduce proprioceptive activity and relieve tenderness.
Question 6
A patient presents with hypercalcemia, nephrolithiasis, and bone pain. Which
condition is most likely?
A. Secondary hyperparathyroidism
B. Primary hyperparathyroidism
C. Hypoparathyroidism
D. Vitamin D deficiency
Answer: B. Primary hyperparathyroidism
Rationale: Primary hyperparathyroidism causes elevated calcium levels, leading to
“stones, bones, groans, and psychiatric overtones.”
Question 7
Which rib is considered atypical?
A. Rib 3
B. Rib 6
C. Rib 1
D. Rib 8
Answer: C. Rib 1
Rationale: Ribs 1, 2, 10, 11, and 12 are atypical due to unique anatomical features.
, Question 8
A patient develops hemolytic anemia after taking sulfa drugs. Which enzyme
deficiency is most likely responsible?
A. Pyruvate kinase
B. Glucose-6-phosphate dehydrogenase
C. Hexokinase
D. Lactate dehydrogenase
Answer: B. Glucose-6-phosphate dehydrogenase
Rationale: G6PD deficiency leads to oxidative damage to red blood cells following
exposure to certain drugs or infections.
Question 9
Facilitated segments in osteopathic medicine are best described as:
A. Hypoactive spinal segments
B. Segments with increased sympathetic activity
C. Segments with decreased sensitivity
D. Areas of decreased tissue texture changes
Answer: B. Segments with increased sympathetic activity
Rationale: Facilitated segments exhibit heightened responsiveness due to
increased sympathetic tone and lowered activation thresholds.
Question 10
Which immunoglobulin is most abundant in mucosal secretions?
A. IgG
B. IgM
