1
COMLEX-USA Comprehensive
Practice Examination V2.0: 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 integrated osteopathic principles, clinical
reasoning, and basic science correlations
Exam Format: Single-best-answer multiple-choice questions aligned with NBOME
COMLEX-USA blueprint
, 2
Osteopathic Emphasis: Integration of OMM/OMT, viscerosomatic reflexes, Chapman
points, cranial osteopathy, and osteopathic principles throughout all systems
SECTION 1: OSTEOPATHIC PRINCIPLES, PRACTICE, AND
MANIPULATIVE TREATMENT (OMM/OPP)
Question 1
A 42-year-old female presents with chronic right-sided headache and dizziness. On
cranial osteopathic examination, you find the sphenobasilar synchondrosis (SBS) is
restricted with the sphenoid rotated to the right and the occiput rotated to the left
around an anterior-posterior axis. What is the most appropriate cranial strain pattern
diagnosis?
A) Vertical strain
B) Lateral strain
C) Torsion strain
D) Sidebending rotation strain
E) Compression strain
- detailed answer 100% correct :-C) Torsion strain
Rationale: Torsion strain occurs when the sphenoid and occiput rotate in opposite
directions around an anterior-posterior axis. In this case, the sphenoid rotates right and
occiput rotates left. Vertical strain involves both bones moving superiorly or inferiorly.
Lateral strain involves both bones rotating in the same direction around a vertical axis.
Sidebending rotation strain involves sidebending and opposite rotation. Compression
strain involves both bones moving toward each other. The diagnosis is confirmed by the
opposite rotational pattern described.
, 3
Question 2
A 55-year-old male with chronic low back pain presents for osteopathic evaluation.
Standing flexion test reveals that the left PSIS moves superiorly and medially. The right
sacral base is anterior, and the left sacral base is posterior. Which sacral dysfunction is
most consistent with these findings?
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral extension
D) Right unilateral sacral flexion
E) Bilateral sacral extension
- detailed answer 100% correct :-B) 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. Left on left
torsion would present with the left PSIS moving superiorly and the left base anterior.
The description clearly matches right on right torsion with the anterior base on the right
and PSIS motion on the right.
Question 3
A 32-year-old female with chronic sinusitis and recurrent ear infections is being treated
with osteopathic manipulative treatment. Which lymphatic technique specifically targets
lymphatic drainage from the head and neck region by utilizing gentle traction and
rotation?
, 4
A) Spencer technique
B) Galbreath technique
C) Pedal pump
D) Doming of the diaphragm
E) Thoracic inlet release
- detailed answer 100% correct :-B) Galbreath technique
Rationale: The Galbreath technique specifically facilitates lymphatic drainage from the
head and neck region through gentle traction and rotation of the head and cervical
spine. Spencer technique addresses shoulder pathology. Pedal pump promotes lower
extremity lymphatic return. Doming of the diaphragm facilitates abdominal and thoracic
lymphatic flow. Thoracic inlet release addresses upper extremity and thoracic lymphatic
drainage. The technique is particularly effective for patients with chronic sinusitis and
otitis media.
Question 4
A 38-year-old male presents with chronic right upper quadrant abdominal pain. On
osteopathic examination, you identify a tender point located at the tip of the right 11th
rib. According to Chapman's reflex system, this point is associated with dysfunction of
which organ?
A) Liver
B) Gallbladder
C) Right kidney
D) Appendix
E) Stomach
- detailed answer 100% correct :-D) Appendix
COMLEX-USA Comprehensive
Practice Examination V2.0: 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 integrated osteopathic principles, clinical
reasoning, and basic science correlations
Exam Format: Single-best-answer multiple-choice questions aligned with NBOME
COMLEX-USA blueprint
, 2
Osteopathic Emphasis: Integration of OMM/OMT, viscerosomatic reflexes, Chapman
points, cranial osteopathy, and osteopathic principles throughout all systems
SECTION 1: OSTEOPATHIC PRINCIPLES, PRACTICE, AND
MANIPULATIVE TREATMENT (OMM/OPP)
Question 1
A 42-year-old female presents with chronic right-sided headache and dizziness. On
cranial osteopathic examination, you find the sphenobasilar synchondrosis (SBS) is
restricted with the sphenoid rotated to the right and the occiput rotated to the left
around an anterior-posterior axis. What is the most appropriate cranial strain pattern
diagnosis?
A) Vertical strain
B) Lateral strain
C) Torsion strain
D) Sidebending rotation strain
E) Compression strain
- detailed answer 100% correct :-C) Torsion strain
Rationale: Torsion strain occurs when the sphenoid and occiput rotate in opposite
directions around an anterior-posterior axis. In this case, the sphenoid rotates right and
occiput rotates left. Vertical strain involves both bones moving superiorly or inferiorly.
Lateral strain involves both bones rotating in the same direction around a vertical axis.
Sidebending rotation strain involves sidebending and opposite rotation. Compression
strain involves both bones moving toward each other. The diagnosis is confirmed by the
opposite rotational pattern described.
, 3
Question 2
A 55-year-old male with chronic low back pain presents for osteopathic evaluation.
Standing flexion test reveals that the left PSIS moves superiorly and medially. The right
sacral base is anterior, and the left sacral base is posterior. Which sacral dysfunction is
most consistent with these findings?
A) Left on left sacral torsion
B) Right on right sacral torsion
C) Left unilateral sacral extension
D) Right unilateral sacral flexion
E) Bilateral sacral extension
- detailed answer 100% correct :-B) 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. Left on left
torsion would present with the left PSIS moving superiorly and the left base anterior.
The description clearly matches right on right torsion with the anterior base on the right
and PSIS motion on the right.
Question 3
A 32-year-old female with chronic sinusitis and recurrent ear infections is being treated
with osteopathic manipulative treatment. Which lymphatic technique specifically targets
lymphatic drainage from the head and neck region by utilizing gentle traction and
rotation?
, 4
A) Spencer technique
B) Galbreath technique
C) Pedal pump
D) Doming of the diaphragm
E) Thoracic inlet release
- detailed answer 100% correct :-B) Galbreath technique
Rationale: The Galbreath technique specifically facilitates lymphatic drainage from the
head and neck region through gentle traction and rotation of the head and cervical
spine. Spencer technique addresses shoulder pathology. Pedal pump promotes lower
extremity lymphatic return. Doming of the diaphragm facilitates abdominal and thoracic
lymphatic flow. Thoracic inlet release addresses upper extremity and thoracic lymphatic
drainage. The technique is particularly effective for patients with chronic sinusitis and
otitis media.
Question 4
A 38-year-old male presents with chronic right upper quadrant abdominal pain. On
osteopathic examination, you identify a tender point located at the tip of the right 11th
rib. According to Chapman's reflex system, this point is associated with dysfunction of
which organ?
A) Liver
B) Gallbladder
C) Right kidney
D) Appendix
E) Stomach
- detailed answer 100% correct :-D) Appendix
