COMLEX LEVEL 1 BOARD EXAM PREP 2026–
2027 The Ultimate Comprehensive Osteopathic
Medical Licensing Examination Study Guide Practice
Questions Featuring OMT, Basic Sciences, Clinical
Medicine & Exam Success Strategies Aligned with the
Latest NBOME COMLEX-USA Level 1 Blueprint
(320-Question Format Effective May 2026)
1. A 28-year-old male presents with low back pain after moving furniture.
Examination reveals a right posterior innominate rotation. Standing flexion
test is positive on the right. Seated flexion test is positive on the left. What is
the most likely somatic dysfunction?
• A) Right on right sacral torsion
• B) Left on left sacral torsion
• C) Right unilateral sacral flexion
• D) Bilateral sacral extension
• E) Left unilateral sacral extension
2. Which of the following best describes the primary goal of osteopathic
manipulative treatment (OMT)?
• A) Replace pharmacologic therapy
• B) Restore normal structure and function
• C) Cure infectious disease
• D) Strengthen muscle mass
• E) Eliminate all pain
3. A patient presents with a "rib hump" on forward bending, right thoracic
asymmetry, and a left lateral translation of the trunk. Using Fryette's Type I
,(group) law, at the apex of the curve in the thoracic spine, what is the expected
position of the vertebrae?
• A) Neutral, rotated to the left, sidebent to the right
• B) Neutral, rotated to the right, sidebent to the left
• C) Non-neutral, rotated to the left, sidebent to the left
• D) Non-neutral, rotated to the right, sidebent to the right
• E) Neutral, rotated to the left, sidebent to the left
4. Which osteopathic principle emphasizes the interrelationship of structure
and function?
• A) The body is a unit
• B) The body possesses self-healing mechanisms
• C) Structure and function are reciprocally interrelated
• D) Rational treatment is based on these principles
• E) The body is capable of self-regulation
5. A patient presents with a tender point 2 cm lateral to the L3 spinous
process, exacerbated by lumbar extension. Which OMT technique is most
appropriate?
• A) Muscle energy
• B) Counterstrain
• C) High-velocity low-amplitude (HVLA)
• D) Myofascial release
• E) Lymphatic pump
6. Which is a characteristic of Fryette's Type II somatic dysfunction?
• A) Occurs only in the thoracic spine
• B) Involves a single vertebra
• C) Exhibits neutral mechanics
• D) Always involves multiple vertebrae
, • E) Sidebending and rotation occur to opposite sides
7. A patient with chronic low back pain has a right posterior innominate
rotation. Which muscle is likely shortened?
• A) Left quadratus lumborum
• B) Right hamstrings
• C) Right iliopsoas
• D) Left gluteus maximus
• E) Right piriformis
8. During an osteopathic structural exam, you find a T4 spinous process
deviated left, with right rotation restriction. Fryette's Type II mechanics
apply. Which statement is true?
• A) Sidebending and rotation occur to opposite sides
• B) Neutral mechanics apply
• C) Rotation and sidebending occur to same side
• D) Only rotation is restricted
• E) The segment is in neutral position
9. A patient with asthma has tenderness at the 2nd intercostal space, right
parasternal region. This is a Chapman's reflex for which organ?
• A) Kidney
• B) Lung
• C) Stomach
• D) Gallbladder
• E) Liver
10. In counterstrain, you find a tender point at the anterior medial knee.
Which muscle is likely the primary dysfunction?
• A) Vastus lateralis
• B) Sartorius
, • C) Rectus femoris
• D) Gracilis
• E) Semitendinosus
11. A patient has a right forward sacral torsion. Which of the following is
correct regarding the L5 rotation?
• A) L5 rotates right
• B) L5 rotates left
• C) L5 is neutral
• D) L5 rotates posterior
• E) L5 rotates anterior
12. During a cranial exam, you feel a "wax paper" crunching sensation. This
indicates:
• A) Normal flexion phase
• B) Cranial strain pattern
• C) Normal extension phase
• D) Suture diastasis
• E) Meningeal tension
13. Which muscle energy technique (MET) is used for a right anterior
innominate dysfunction?
• A) Patient contracts right hamstrings against resistance
• B) Patient contracts right hip flexors against resistance
• C) Patient contracts left gluteus maximus
• D) Patient relaxes completely
• E) Patient contracts right gluteus maximus
14. A patient with tension headache has suboccipital tenderness. Which
cranial bone is likely restricted?
• A) Frontal
2027 The Ultimate Comprehensive Osteopathic
Medical Licensing Examination Study Guide Practice
Questions Featuring OMT, Basic Sciences, Clinical
Medicine & Exam Success Strategies Aligned with the
Latest NBOME COMLEX-USA Level 1 Blueprint
(320-Question Format Effective May 2026)
1. A 28-year-old male presents with low back pain after moving furniture.
Examination reveals a right posterior innominate rotation. Standing flexion
test is positive on the right. Seated flexion test is positive on the left. What is
the most likely somatic dysfunction?
• A) Right on right sacral torsion
• B) Left on left sacral torsion
• C) Right unilateral sacral flexion
• D) Bilateral sacral extension
• E) Left unilateral sacral extension
2. Which of the following best describes the primary goal of osteopathic
manipulative treatment (OMT)?
• A) Replace pharmacologic therapy
• B) Restore normal structure and function
• C) Cure infectious disease
• D) Strengthen muscle mass
• E) Eliminate all pain
3. A patient presents with a "rib hump" on forward bending, right thoracic
asymmetry, and a left lateral translation of the trunk. Using Fryette's Type I
,(group) law, at the apex of the curve in the thoracic spine, what is the expected
position of the vertebrae?
• A) Neutral, rotated to the left, sidebent to the right
• B) Neutral, rotated to the right, sidebent to the left
• C) Non-neutral, rotated to the left, sidebent to the left
• D) Non-neutral, rotated to the right, sidebent to the right
• E) Neutral, rotated to the left, sidebent to the left
4. Which osteopathic principle emphasizes the interrelationship of structure
and function?
• A) The body is a unit
• B) The body possesses self-healing mechanisms
• C) Structure and function are reciprocally interrelated
• D) Rational treatment is based on these principles
• E) The body is capable of self-regulation
5. A patient presents with a tender point 2 cm lateral to the L3 spinous
process, exacerbated by lumbar extension. Which OMT technique is most
appropriate?
• A) Muscle energy
• B) Counterstrain
• C) High-velocity low-amplitude (HVLA)
• D) Myofascial release
• E) Lymphatic pump
6. Which is a characteristic of Fryette's Type II somatic dysfunction?
• A) Occurs only in the thoracic spine
• B) Involves a single vertebra
• C) Exhibits neutral mechanics
• D) Always involves multiple vertebrae
, • E) Sidebending and rotation occur to opposite sides
7. A patient with chronic low back pain has a right posterior innominate
rotation. Which muscle is likely shortened?
• A) Left quadratus lumborum
• B) Right hamstrings
• C) Right iliopsoas
• D) Left gluteus maximus
• E) Right piriformis
8. During an osteopathic structural exam, you find a T4 spinous process
deviated left, with right rotation restriction. Fryette's Type II mechanics
apply. Which statement is true?
• A) Sidebending and rotation occur to opposite sides
• B) Neutral mechanics apply
• C) Rotation and sidebending occur to same side
• D) Only rotation is restricted
• E) The segment is in neutral position
9. A patient with asthma has tenderness at the 2nd intercostal space, right
parasternal region. This is a Chapman's reflex for which organ?
• A) Kidney
• B) Lung
• C) Stomach
• D) Gallbladder
• E) Liver
10. In counterstrain, you find a tender point at the anterior medial knee.
Which muscle is likely the primary dysfunction?
• A) Vastus lateralis
• B) Sartorius
, • C) Rectus femoris
• D) Gracilis
• E) Semitendinosus
11. A patient has a right forward sacral torsion. Which of the following is
correct regarding the L5 rotation?
• A) L5 rotates right
• B) L5 rotates left
• C) L5 is neutral
• D) L5 rotates posterior
• E) L5 rotates anterior
12. During a cranial exam, you feel a "wax paper" crunching sensation. This
indicates:
• A) Normal flexion phase
• B) Cranial strain pattern
• C) Normal extension phase
• D) Suture diastasis
• E) Meningeal tension
13. Which muscle energy technique (MET) is used for a right anterior
innominate dysfunction?
• A) Patient contracts right hamstrings against resistance
• B) Patient contracts right hip flexors against resistance
• C) Patient contracts left gluteus maximus
• D) Patient relaxes completely
• E) Patient contracts right gluteus maximus
14. A patient with tension headache has suboccipital tenderness. Which
cranial bone is likely restricted?
• A) Frontal
