COMLEX-USA EXAMS – PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains:
Osteopathic Manipulative Medicine (OMM) & Neuromusculoskeletal Medicine
Medical Knowledge & Foundational Biomedical Sciences
Patient Care & Procedural Skills
Interpersonal & Communication Skills
Professionalism & Medical Ethics
Practice-Based Learning & Improvement
Systems-Based Practice & Healthcare Delivery Systems
Introduction:
The purpose of this comprehensive assessment is to evaluate the clinical competence, foundational knowledge, and
ethical decision-making required for safe and effective osteopathic medical practice. This examination assesses
essential skills across foundational biomedical sciences, patient care, and osteopathic principles. Utilizing a multiple-
choice and scenario-based structure, the questions emphasize real-world application, diagnostic reasoning, and
evidence-based clinical management. Candidates are expected to integrate medical knowledge with osteopathic
tenets to address diverse patient presentations, regulatory compliance, and professional ethics. Success on this
examination demonstrates readiness for advanced clinical training and independent practice.
SECTION ONE: QUESTIONS 1–100
1. A 45-year-old male presents with a 2-week history of low back pain after lifting heavy boxes. Physical
examination reveals a tissue texture abnormality characterized by boggy, warm, and moist skin in the lumbar
, region. Range of motion is restricted, and there is exquisitely tender paraspinal muscle spasm. Structural exam
reveals that L3 is rotated right and sidebent right, and this asymmetry worsens when the spine is extended. What
is the most likely somatic dysfunction present at L3?
A. L3 Neutral, Rotated Right, Sidebent Left
B. L3 Flexed, Rotated Left, Sidebent Left
C. L3 Extended, Rotated Right, Sidebent Right
D. L3 Flexed, Rotated Right, Sidebent Right
🟢 C. L3 Extended, Rotated Right, Sidebent Right
🔴 RATIONALE: According to Fryette's principles of thoracic and lumbar spinal motion, Type II dysfunctions involve a
single vertebral segment, occur in a non-neutral (flexed or extended) state, and rotation and sidebending occur to the
same side. Because the asymmetry worsens in extension, it is easier in flexion, meaning it is a flexed dysfunction.
Wait, if it worsens in extension, the dysfunction is a flexion dysfunction (it likes flexion, hates extension). Let's re-verify:
if it worsens when extended, it is a Flexed, Rotated Right, Sidebent Right dysfunction because the dysfunction is
named for its position of ease. Let's correct the option choice to ensure accuracy: A flexed dysfunction worsens in
extension. Therefore, if L3 is rotated right and sidebent right, and worsens in extension, its ease is in flexion. The
correct diagnosis is L3 Flexed, Rotated Right, Sidebent Right. Let's mark D as correct.
🟢 D. L3 Flexed, Rotated Right, Sidebent Right
🔴 RATIONALE: Type II somatic dysfunctions occur at a single vertebral segment, demonstrate sidebending and
rotation to the same side, and become more apparent in either flexion or extension. Because the asymmetry worsens
during spinal extension, the vertebral segment prefers flexion (its position of ease), making it a flexed dysfunction.
2. A 62-year-old female with a history of chronic obstructive pulmonary disease (COPD) presents with an acute
exacerbation. She reports worsening shortness of breath and productive cough. Physical examination reveals
hyperresonance to percussion, prolonged expiratory phase, and bilateral wheezing. An osteopathic structural
examination is performed to assess autonomic tone. At which of the following spinal levels would you expect to
find somatic dysfunction associated with sympathetic viscerosomatic reflexes for the lungs?
A. T1–T4
B. T2–T7
,C. T5–T9
D. T10–T11
🟢 B. T2–T7
🔴 RATIONALE: The sympathetic innervation to the lungs and visceral pleura originates from the T2 to T7 spinal cord
segments. Viscerosomatic reflexes resulting from acute pulmonary pathology like a COPD exacerbation typically
manifest as tissue texture abnormalities and restricted motion within these segments.
3. A 28-year-old female presents to the clinic complaining of severe, throbbing unilateral headaches accompanied
by nausea and photophobia. She notes that the headaches typically last for 24 hours and are preceded by visual
scintillating scotomas. A structural examination reveals a cranial somatic dysfunction characterized by a superior
sphenobasilar synchondrosis (SBS) strain. Which of the following describes the position of the sphenoid and
occiput during a superior SBS strain?
A. The sphenoid base moves superiorly relative to the occipital base
B. The sphenoid base moves inferiorly relative to the occipital base
C. The sphenoid and occiput rotate in opposite directions about a vertical axis
D. The sphenoid and occiput rotate in the same direction about a vertical axis
🟢 A. The sphenoid base moves superiorly relative to the occipital base
🔴 RATIONALE: A superior SBS strain is a non-physiological cranial strain named for the position of the base of the
sphenoid relative to the base of the occiput. In a superior strain, the sphenoid base moves superiorly relative to the
occipital base, which rotates the sphenoid anteriorly and limits normal cranial flexion-extension mechanics.
4. A 35-year-old construction worker presents with sharp pain in his right shoulder when lifting his arm overhead. On
physical examination, there is maximal tenderness elicited at the anterior aspect of the shoulder within the
intertubercular groove. Active abduction of the shoulder is painful between 60 and 120 degrees. Yergason’s test
is positive. Which of the following muscles is most likely involved in this patient's presentation?
A. Supraspinatus
B. Infraspinatus
, C. Biceps brachii, long head
D. Subscapularis
🟢 C. Biceps brachii, long head
🔴 RATIONALE: Tenderness located directly within the intertubercular (bicipital) groove along with a positive
Yergason's test indicates bicipital tenosynovitis or tendinopathy affecting the long head of the biceps brachii muscle,
which commonly coexists with rotator cuff pathology or impingement syndrome.
5. A 54-year-old male with a history of poorly controlled hypertension presents to the emergency department
complaining of sudden-onset, tearing chest pain that radiates to his back between his scapulae. His blood
pressure is 190/110 mmHg in the right arm and 160/95 mmHg in the left arm. A chest X-ray shows mediastinal
widening. What is the most appropriate next step in the immediate management of this patient?
A. Intravenous administration of beta-blockers
B. Immediate administration of tPA (tissue plasminogen activator)
C. Sublingual nitroglycerin administration
D. Urgent cardiac catheterization
🟢 A. Intravenous administration of beta-blockers
🔴 RATIONALE: The clinical triad of tearing chest pain radiating to the back, asymmetric blood pressures between
arms, and a widened mediastinum is highly specific for an acute aortic dissection. Immediate management focuses on
reducing aortic wall stress by lowering heart rate and blood pressure using intravenous beta-blockers (e.g., esmolol or
labetalol) before vasodilators are added.
6. A 19-year-old college student is brought to the health clinic by her roommate due to altered mental status, high
fever, and severe headache. On examination, the patient is lethargic, has a temperature of 39.2°C (102.6°F), and
demonstrates resistance and pain when her neck is passively flexed. Petechial lesions are noted on her lower
extremities. Lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis shows elevated neutrophils,
low glucose, and high protein. Which of the following is the most likely causative organism?
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains:
Osteopathic Manipulative Medicine (OMM) & Neuromusculoskeletal Medicine
Medical Knowledge & Foundational Biomedical Sciences
Patient Care & Procedural Skills
Interpersonal & Communication Skills
Professionalism & Medical Ethics
Practice-Based Learning & Improvement
Systems-Based Practice & Healthcare Delivery Systems
Introduction:
The purpose of this comprehensive assessment is to evaluate the clinical competence, foundational knowledge, and
ethical decision-making required for safe and effective osteopathic medical practice. This examination assesses
essential skills across foundational biomedical sciences, patient care, and osteopathic principles. Utilizing a multiple-
choice and scenario-based structure, the questions emphasize real-world application, diagnostic reasoning, and
evidence-based clinical management. Candidates are expected to integrate medical knowledge with osteopathic
tenets to address diverse patient presentations, regulatory compliance, and professional ethics. Success on this
examination demonstrates readiness for advanced clinical training and independent practice.
SECTION ONE: QUESTIONS 1–100
1. A 45-year-old male presents with a 2-week history of low back pain after lifting heavy boxes. Physical
examination reveals a tissue texture abnormality characterized by boggy, warm, and moist skin in the lumbar
, region. Range of motion is restricted, and there is exquisitely tender paraspinal muscle spasm. Structural exam
reveals that L3 is rotated right and sidebent right, and this asymmetry worsens when the spine is extended. What
is the most likely somatic dysfunction present at L3?
A. L3 Neutral, Rotated Right, Sidebent Left
B. L3 Flexed, Rotated Left, Sidebent Left
C. L3 Extended, Rotated Right, Sidebent Right
D. L3 Flexed, Rotated Right, Sidebent Right
🟢 C. L3 Extended, Rotated Right, Sidebent Right
🔴 RATIONALE: According to Fryette's principles of thoracic and lumbar spinal motion, Type II dysfunctions involve a
single vertebral segment, occur in a non-neutral (flexed or extended) state, and rotation and sidebending occur to the
same side. Because the asymmetry worsens in extension, it is easier in flexion, meaning it is a flexed dysfunction.
Wait, if it worsens in extension, the dysfunction is a flexion dysfunction (it likes flexion, hates extension). Let's re-verify:
if it worsens when extended, it is a Flexed, Rotated Right, Sidebent Right dysfunction because the dysfunction is
named for its position of ease. Let's correct the option choice to ensure accuracy: A flexed dysfunction worsens in
extension. Therefore, if L3 is rotated right and sidebent right, and worsens in extension, its ease is in flexion. The
correct diagnosis is L3 Flexed, Rotated Right, Sidebent Right. Let's mark D as correct.
🟢 D. L3 Flexed, Rotated Right, Sidebent Right
🔴 RATIONALE: Type II somatic dysfunctions occur at a single vertebral segment, demonstrate sidebending and
rotation to the same side, and become more apparent in either flexion or extension. Because the asymmetry worsens
during spinal extension, the vertebral segment prefers flexion (its position of ease), making it a flexed dysfunction.
2. A 62-year-old female with a history of chronic obstructive pulmonary disease (COPD) presents with an acute
exacerbation. She reports worsening shortness of breath and productive cough. Physical examination reveals
hyperresonance to percussion, prolonged expiratory phase, and bilateral wheezing. An osteopathic structural
examination is performed to assess autonomic tone. At which of the following spinal levels would you expect to
find somatic dysfunction associated with sympathetic viscerosomatic reflexes for the lungs?
A. T1–T4
B. T2–T7
,C. T5–T9
D. T10–T11
🟢 B. T2–T7
🔴 RATIONALE: The sympathetic innervation to the lungs and visceral pleura originates from the T2 to T7 spinal cord
segments. Viscerosomatic reflexes resulting from acute pulmonary pathology like a COPD exacerbation typically
manifest as tissue texture abnormalities and restricted motion within these segments.
3. A 28-year-old female presents to the clinic complaining of severe, throbbing unilateral headaches accompanied
by nausea and photophobia. She notes that the headaches typically last for 24 hours and are preceded by visual
scintillating scotomas. A structural examination reveals a cranial somatic dysfunction characterized by a superior
sphenobasilar synchondrosis (SBS) strain. Which of the following describes the position of the sphenoid and
occiput during a superior SBS strain?
A. The sphenoid base moves superiorly relative to the occipital base
B. The sphenoid base moves inferiorly relative to the occipital base
C. The sphenoid and occiput rotate in opposite directions about a vertical axis
D. The sphenoid and occiput rotate in the same direction about a vertical axis
🟢 A. The sphenoid base moves superiorly relative to the occipital base
🔴 RATIONALE: A superior SBS strain is a non-physiological cranial strain named for the position of the base of the
sphenoid relative to the base of the occiput. In a superior strain, the sphenoid base moves superiorly relative to the
occipital base, which rotates the sphenoid anteriorly and limits normal cranial flexion-extension mechanics.
4. A 35-year-old construction worker presents with sharp pain in his right shoulder when lifting his arm overhead. On
physical examination, there is maximal tenderness elicited at the anterior aspect of the shoulder within the
intertubercular groove. Active abduction of the shoulder is painful between 60 and 120 degrees. Yergason’s test
is positive. Which of the following muscles is most likely involved in this patient's presentation?
A. Supraspinatus
B. Infraspinatus
, C. Biceps brachii, long head
D. Subscapularis
🟢 C. Biceps brachii, long head
🔴 RATIONALE: Tenderness located directly within the intertubercular (bicipital) groove along with a positive
Yergason's test indicates bicipital tenosynovitis or tendinopathy affecting the long head of the biceps brachii muscle,
which commonly coexists with rotator cuff pathology or impingement syndrome.
5. A 54-year-old male with a history of poorly controlled hypertension presents to the emergency department
complaining of sudden-onset, tearing chest pain that radiates to his back between his scapulae. His blood
pressure is 190/110 mmHg in the right arm and 160/95 mmHg in the left arm. A chest X-ray shows mediastinal
widening. What is the most appropriate next step in the immediate management of this patient?
A. Intravenous administration of beta-blockers
B. Immediate administration of tPA (tissue plasminogen activator)
C. Sublingual nitroglycerin administration
D. Urgent cardiac catheterization
🟢 A. Intravenous administration of beta-blockers
🔴 RATIONALE: The clinical triad of tearing chest pain radiating to the back, asymmetric blood pressures between
arms, and a widened mediastinum is highly specific for an acute aortic dissection. Immediate management focuses on
reducing aortic wall stress by lowering heart rate and blood pressure using intravenous beta-blockers (e.g., esmolol or
labetalol) before vasodilators are added.
6. A 19-year-old college student is brought to the health clinic by her roommate due to altered mental status, high
fever, and severe headache. On examination, the patient is lethargic, has a temperature of 39.2°C (102.6°F), and
demonstrates resistance and pain when her neck is passively flexed. Petechial lesions are noted on her lower
extremities. Lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis shows elevated neutrophils,
low glucose, and high protein. Which of the following is the most likely causative organism?
