COMLEX-USA Comprehensive Practice
Examination: 150 High-Yield Multiple-
Choice Questions with Detailed Rationales
for Osteopathic Medical Licensure
Preparation a well detailed practice exam
2025/2026 graded A+ well written !!!
Target Audience: Osteopathic medical students preparing for COMLEX-USA Levels 1, 2-CE, and 3
Difficulty Level: Advanced/Hard with mixed conceptual, application-based, and clinical scenario
questions
Exam Format: Single-best-answer multiple-choice questions aligned with NBOME COMLEX-USA
blueprint
Osteopathic Emphasis: Integration of osteopathic principles, OMM/OMT, viscerosomatic
reflexes, Chapman points, and structure-function relationships throughout all questions
SECTION 1: OSTEOPATHIC PRINCIPLES, PRACTICE, AND MANIPULATIVE TREATMENT
(OMM/OPP)
Question 1
A 45-year-old male presents with chronic low back pain. On osteopathic structural examination,
you note that when the patient is in a seated position and flexes forward, the right PSIS moves
,superiorly and medially relative to the left. The right sacral base is anterior, and the left sacral
base is posterior. What is the most likely sacral dysfunction diagnosis?
A) Right on right sacral torsion
B) Left on left sacral torsion
C) Right unilateral sacral flexion
D) Left unilateral sacral flexion
E) Bilateral sacral extension
Correct Answer: A) Right on right sacral torsion
Rationale: In right on right sacral torsion, the right sacral base is anterior (deep) and the left
sacral base is posterior (superficial). On forward flexion, the right PSIS moves superiorly and
medially. The sacrum rotates around a right oblique axis. This is a common COMLEX high-yield
topic. Left on left torsion would present with opposite findings (left base anterior). Unilateral
sacral dysfunctions involve flexion or extension of one side without the rotational component
described here.
Question 2
A 32-year-old female with a history of recurrent otitis media as a child now presents with
chronic sinus congestion and headaches. Osteopathic manipulative treatment is being
considered. Which lymphatic technique would be most appropriate to facilitate drainage of the
head and neck region?
A) Thoracic inlet release
B) Doming of the diaphragm
C) Galbreath technique
D) Pedal pump
E) Spencer technique
Correct Answer: C) Galbreath technique
Rationale: The Galbreath technique is specifically designed to facilitate lymphatic drainage from
the head and neck region. It involves gentle traction and rotation of the head and cervical spine
to promote movement of lymphatic fluid. Thoracic inlet release addresses upper extremity and
thoracic lymphatic drainage. Doming of the diaphragm facilitates abdominal and thoracic
lymphatic flow. Pedal pump promotes lower extremity lymphatic return. Spencer technique is
used for shoulder pathology.
,Question 3
A 28-year-old female presents with right upper quadrant abdominal pain that has been present
for several months. On physical examination, you identify a tender point located at the tip of
the right 12th rib. According to Chapman's reflex system, this point is most likely associated with
dysfunction of which organ?
A) Liver
B) Gallbladder
C) Right kidney
D) Appendix
E) Stomach
Correct Answer: B) Gallbladder
Rationale: The Chapman point for the gallbladder is located at the tip of the right 12th rib.
Chapman points are visceral reflex points located in the deep fascia and periosteum that
become tender with dysfunction of the corresponding viscera. The liver's Chapman point is at
the right 5th-6th intercostal space. The right kidney point is at the right 12th rib but more
posteriorly. The appendix point is at the tip of the right 11th rib. The stomach point is at the left
6th-7th intercostal space.
Question 4
During a structural examination, you identify a somatic dysfunction of the thoracic spine where
the vertebrae are rotated and sidebent to the same side. Fryette's principles describe this as
which type of dysfunction?
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Neutral dysfunction
E) Non-neutral dysfunction
Correct Answer: A) Type I dysfunction
Rationale: Fryette's Type I dysfunction describes a group of vertebrae (typically 3 or more) that
are rotated and sidebent to the same side in the neutral position. Type II dysfunction describes
a single vertebral segment that is rotated and sidebent to opposite sides in a non-neutral (flexed
or extended) position. Type III dysfunction occurs in the transitional areas (C7, T12, L5) where
motion is altered. Neutral and non-neutral describe the position of the spine, not the type of
dysfunction.
, Question 5
A 55-year-old male with a history of COPD presents with increased dyspnea and productive
cough. On osteopathic examination, you note restricted motion of the ribs. Which rib
dysfunction pattern is most commonly associated with decreased inspiratory capacity?
A) Rib inhalation dysfunction
B) Rib exhalation dysfunction
C) Pump handle dysfunction
D) Bucket handle dysfunction
E) Caliper dysfunction
Correct Answer: B) Rib exhalation dysfunction
Rationale: Rib exhalation dysfunction occurs when the rib is stuck in an exhalation (depressed)
position, limiting the ability to expand the rib cage during inspiration. This directly decreases
inspiratory capacity. Rib inhalation dysfunction limits exhalation. Pump handle dysfunction
affects upper ribs (1-5) and their anterior-superior motion. Bucket handle dysfunction affects
lower ribs (6-10) and their lateral motion. Caliper dysfunction affects ribs 11-12.
Question 6
A 40-year-old female presents with chronic headache and neck pain. Cranial osteopathic
examination reveals restriction of the sphenobasilar synchondrosis (SBS) with the basilar
portion of the occiput rotated to the right and the sphenoid rotated to the left. This describes
which cranial strain pattern?
A) Vertical strain
B) Lateral strain
C) Torsion strain
D) Sidebending rotation strain
E) Compression strain
Correct Answer: C) Torsion strain
Rationale: Torsion strain of the SBS occurs when the sphenoid and occiput rotate in opposite
directions around an anterior-posterior axis. In this case, the occiput rotates to the right and the
sphenoid rotates to the left. Vertical strain involves both bones moving in the same direction
superiorly or inferiorly. Lateral strain involves both bones moving in the same direction laterally.
Sidebending rotation involves sidebending of both bones in the same direction. Compression
strain involves both bones moving toward each other.
Examination: 150 High-Yield Multiple-
Choice Questions with Detailed Rationales
for Osteopathic Medical Licensure
Preparation a well detailed practice exam
2025/2026 graded A+ well written !!!
Target Audience: Osteopathic medical students preparing for COMLEX-USA Levels 1, 2-CE, and 3
Difficulty Level: Advanced/Hard with mixed conceptual, application-based, and clinical scenario
questions
Exam Format: Single-best-answer multiple-choice questions aligned with NBOME COMLEX-USA
blueprint
Osteopathic Emphasis: Integration of osteopathic principles, OMM/OMT, viscerosomatic
reflexes, Chapman points, and structure-function relationships throughout all questions
SECTION 1: OSTEOPATHIC PRINCIPLES, PRACTICE, AND MANIPULATIVE TREATMENT
(OMM/OPP)
Question 1
A 45-year-old male presents with chronic low back pain. On osteopathic structural examination,
you note that when the patient is in a seated position and flexes forward, the right PSIS moves
,superiorly and medially relative to the left. The right sacral base is anterior, and the left sacral
base is posterior. What is the most likely sacral dysfunction diagnosis?
A) Right on right sacral torsion
B) Left on left sacral torsion
C) Right unilateral sacral flexion
D) Left unilateral sacral flexion
E) Bilateral sacral extension
Correct Answer: A) Right on right sacral torsion
Rationale: In right on right sacral torsion, the right sacral base is anterior (deep) and the left
sacral base is posterior (superficial). On forward flexion, the right PSIS moves superiorly and
medially. The sacrum rotates around a right oblique axis. This is a common COMLEX high-yield
topic. Left on left torsion would present with opposite findings (left base anterior). Unilateral
sacral dysfunctions involve flexion or extension of one side without the rotational component
described here.
Question 2
A 32-year-old female with a history of recurrent otitis media as a child now presents with
chronic sinus congestion and headaches. Osteopathic manipulative treatment is being
considered. Which lymphatic technique would be most appropriate to facilitate drainage of the
head and neck region?
A) Thoracic inlet release
B) Doming of the diaphragm
C) Galbreath technique
D) Pedal pump
E) Spencer technique
Correct Answer: C) Galbreath technique
Rationale: The Galbreath technique is specifically designed to facilitate lymphatic drainage from
the head and neck region. It involves gentle traction and rotation of the head and cervical spine
to promote movement of lymphatic fluid. Thoracic inlet release addresses upper extremity and
thoracic lymphatic drainage. Doming of the diaphragm facilitates abdominal and thoracic
lymphatic flow. Pedal pump promotes lower extremity lymphatic return. Spencer technique is
used for shoulder pathology.
,Question 3
A 28-year-old female presents with right upper quadrant abdominal pain that has been present
for several months. On physical examination, you identify a tender point located at the tip of
the right 12th rib. According to Chapman's reflex system, this point is most likely associated with
dysfunction of which organ?
A) Liver
B) Gallbladder
C) Right kidney
D) Appendix
E) Stomach
Correct Answer: B) Gallbladder
Rationale: The Chapman point for the gallbladder is located at the tip of the right 12th rib.
Chapman points are visceral reflex points located in the deep fascia and periosteum that
become tender with dysfunction of the corresponding viscera. The liver's Chapman point is at
the right 5th-6th intercostal space. The right kidney point is at the right 12th rib but more
posteriorly. The appendix point is at the tip of the right 11th rib. The stomach point is at the left
6th-7th intercostal space.
Question 4
During a structural examination, you identify a somatic dysfunction of the thoracic spine where
the vertebrae are rotated and sidebent to the same side. Fryette's principles describe this as
which type of dysfunction?
A) Type I dysfunction
B) Type II dysfunction
C) Type III dysfunction
D) Neutral dysfunction
E) Non-neutral dysfunction
Correct Answer: A) Type I dysfunction
Rationale: Fryette's Type I dysfunction describes a group of vertebrae (typically 3 or more) that
are rotated and sidebent to the same side in the neutral position. Type II dysfunction describes
a single vertebral segment that is rotated and sidebent to opposite sides in a non-neutral (flexed
or extended) position. Type III dysfunction occurs in the transitional areas (C7, T12, L5) where
motion is altered. Neutral and non-neutral describe the position of the spine, not the type of
dysfunction.
, Question 5
A 55-year-old male with a history of COPD presents with increased dyspnea and productive
cough. On osteopathic examination, you note restricted motion of the ribs. Which rib
dysfunction pattern is most commonly associated with decreased inspiratory capacity?
A) Rib inhalation dysfunction
B) Rib exhalation dysfunction
C) Pump handle dysfunction
D) Bucket handle dysfunction
E) Caliper dysfunction
Correct Answer: B) Rib exhalation dysfunction
Rationale: Rib exhalation dysfunction occurs when the rib is stuck in an exhalation (depressed)
position, limiting the ability to expand the rib cage during inspiration. This directly decreases
inspiratory capacity. Rib inhalation dysfunction limits exhalation. Pump handle dysfunction
affects upper ribs (1-5) and their anterior-superior motion. Bucket handle dysfunction affects
lower ribs (6-10) and their lateral motion. Caliper dysfunction affects ribs 11-12.
Question 6
A 40-year-old female presents with chronic headache and neck pain. Cranial osteopathic
examination reveals restriction of the sphenobasilar synchondrosis (SBS) with the basilar
portion of the occiput rotated to the right and the sphenoid rotated to the left. This describes
which cranial strain pattern?
A) Vertical strain
B) Lateral strain
C) Torsion strain
D) Sidebending rotation strain
E) Compression strain
Correct Answer: C) Torsion strain
Rationale: Torsion strain of the SBS occurs when the sphenoid and occiput rotate in opposite
directions around an anterior-posterior axis. In this case, the occiput rotates to the right and the
sphenoid rotates to the left. Vertical strain involves both bones moving in the same direction
superiorly or inferiorly. Lateral strain involves both bones moving in the same direction laterally.
Sidebending rotation involves sidebending of both bones in the same direction. Compression
strain involves both bones moving toward each other.
