COMLEX LEVEL 1 TRUELEARN COMBANK
EXAMINATION TEST 2026 FULL QUESTIONS AND
CORRECT ANSWERS GRADED A+ - 250 Questions
This exam assesses mastery of osteopathic principles and practice, including somatic dysfunction diagnosis,
treatment modalities, and integration with clinical medicine at the COMLEX Level 1 standard. It contains 250
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 10 focused sections: Osteopathic Principles and Practice, Anatomy
and Embryology, Biochemistry and Genetics, Microbiology and Immunology, Pathology, Pharmacology,
Physiology, Behavioral Science and Biostatistics, Neurology and Special Senses, Musculoskeletal System and
Dermatology. Targeted learning outcomes include: Apply osteopathic principles to diagnose and manage somatic
dysfunction.; Select appropriate osteopathic manipulative treatment techniques based on tissue texture changes
and barrier concepts.; Integrate viscerosomatic and somatovisceral reflexes into clinical reasoning.. Every item
has been reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence
and self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 70%. Aligned with Meets COMLEX Level 1 blueprint requirements
and AACOM standards for osteopathic medical education. standards and reflects the question style commonly
seen on accredited program examinations. Students consistently achieving above the cut score on this bank have
Section 1: Osteopathic Principles and Practice (Questions 1-25)
1 A patient presents with restricted motion of the cervical spine in left rotation
and left sidebending, with the transverse processes more posterior on the left.
Which Fryette's principle best explains the coupled motion observed?
A) In neutral position, sidebending and rotation occur to opposite sides.
B) In non-neutral position, sidebending and rotation occur to the same side.
C) Motion is determined by the direction of the restrictive barrier.
D) Coupled motion is absent in the cervical spine.
Answer: B
Rationale: Fryette's second principle states that when the spine is in a
non-neutral (flexed or extended) position, sidebending and rotation occur to the
same side. The finding of restricted left rotation and left sidebending with
posterior left transverse processes indicates a non-neutral dysfunction, making
B correct. Option A describes neutral mechanics. Option C is a general
principle but not specific. Option D is false; cervical spine exhibits coupled
motion.
2 During evaluation of sacral motion, you find that the sacral base is deep on
the left and the inferior lateral angle is shallow on the left, with a positive
seated flexion test on the left. Which sacral somatic dysfunction is present?
,A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Left unilateral sacral flexion
D) Right unilateral sacral extension
Answer: A
Rationale: A deep sacral base on the left and shallow ILA on the left indicate a
left rotation of the sacrum relative to the ilia. The positive seated flexion test on
the left confirms the sacrum is rotated left. In a left-on-left torsion, the sacrum
rotates left relative to the ilia, and the oblique axis is left. Option B would have
opposite findings. Options C and D are unilateral sacral dysfunctions, which
present with a deep sulcus and posterior ILA on the same side, not the findings
described.
3 Which of the following osteopathic manipulative treatment techniques is
most appropriate for a patient with an acute lumbar strain presenting with
muscle spasm, pain, and restricted motion in all directions?
A) High-velocity low-amplitude thrust
B) Muscle energy technique
C) Counterstrain
D) Myofascial release
Answer: C
Rationale: Counterstrain is ideal for acute, painful conditions with muscle
spasm because it uses a position of comfort to reduce nociceptive input and
relax the muscle spindle. High-velocity low-amplitude (HVLA) thrust is
contraindicated in acute spasm due to risk of injury. Muscle energy and
myofascial release may be too aggressive for acute spasm, though they can be
used subacutely. Counterstrain provides gentle, immediate relief.
4 A patient with chronic low back pain has an innominate bone that is rotated
posteriorly on the left. Which of the following gait findings would you
expect to observe?
A) Left leg appears longer in supine, shorter in sitting
B) Right leg appears longer in supine, shorter in sitting
C) Left leg appears shorter in supine, longer in sitting
D) Equal leg lengths in both positions
Answer: A
,Rationale: A posteriorly rotated innominate causes the acetabulum to move
superiorly and posteriorly, making the leg appear longer in supine due to
forward rotation of the ilium relative to the femur. In sitting, the ischial
tuberosity is more posterior, making the leg appear shorter. Option B describes
an anteriorly rotated innominate. Option C is opposite. Option D is incorrect as
leg length changes are typical.
5 Which of the following statements accurately describes the relationship
between Chapman's reflexes and viscerosomatic reflexes?
A) Chapman's reflexes are anterior tender points that correspond to specific
visceral dysfunctions, while viscerosomatic reflexes are segmentally related
spinal tissue texture changes.
B) Chapman's reflexes are found only on the posterior thorax, whereas
viscerosomatic reflexes are located on the anterior abdomen.
C) Both Chapman's reflexes and viscerosomatic reflexes are mediated by the
sympathetic nervous system exclusively.
D) Chapman's reflexes are used for diagnosis only, while viscerosomatic
reflexes are used for treatment.
Answer: A
Rationale: Chapman's reflexes are anterior (and sometimes posterior) tender
points associated with visceral pathology, thought to be facilitated by
sympathetic overflow. Viscerosomatic reflexes are segmental changes in skin,
fascia, and muscle (e.g., hypertonicity, tenderness) at specific spinal levels
corresponding to affected organs. Option B is incorrect because Chapman's
points are primarily anterior. Option C is incorrect because parasympathetic
involvement is also possible. Option D is false; both are diagnostic and can
guide treatment.
6 In a patient with a diagnosis of fibromyalgia, which osteopathic manipulative
treatment approach is most evidence-based for pain reduction and improved
function?
A) High-velocity low-amplitude thrust to the thoracic spine
B) Cranial osteopathy with balanced membranous tension
C) Soft tissue techniques and myofascial release focusing on tender points
D) Articulatory techniques with repetitive motion
Answer: C
, Rationale: Evidence supports the use of soft tissue techniques and myofascial
release for fibromyalgia to reduce pain and improve range of motion by
addressing myofascial trigger points and muscle tension. HVLA thrust (A) may
exacerbate pain. Cranial osteopathy (B) lacks strong evidence for fibromyalgia.
Articulatory techniques (D) may be too aggressive. Option C is gentle and
directly addresses tender points, which are characteristic of fibromyalgia.
7 During an osteopathic structural examination, you note that the patient's right
shoulder is elevated, the right scapula is abducted and rotated downward, and
the cervical spine is sidebent to the left and rotated to the right. Which of the
following is the most likely underlying somatic dysfunction?
A) Left occipitoatlantal (OA) compression
B) Right occipitoatlantal (OA) compression
C) Left C1-C2 rotational dysfunction
D) Right C1-C2 rotational dysfunction
Answer: B
Rationale: Right OA compression typically presents with the occiput rotated
left and sidebent right relative to the atlas, leading to compensatory elevation
of the right shoulder and scapular changes as the body attempts to maintain
horizontal gaze. The cervical spine sidebent left and rotated right is a common
compensatory pattern. Option A would produce opposite findings. Options C
and D involve C1-C2, which primarily affects rotation, not scapular position.
8 Which of the following best describes the osteopathic concept of the 'somatic
component' of disease?
A) Somatic dysfunction is always the primary cause of disease.
B) Somatic dysfunction can contribute to or result from visceral disease, and
addressing it can improve overall health.
C) Somatic dysfunction is irrelevant to the diagnosis and treatment of visceral
disease.
D) Somatic dysfunction is a purely psychological phenomenon with no
physiological basis.
Answer: B
Rationale: The somatic component of disease refers to the concept that somatic
dysfunction (musculoskeletal changes) can both contribute to and be a
consequence of visceral disease. Osteopathic manipulative treatment can help
EXAMINATION TEST 2026 FULL QUESTIONS AND
CORRECT ANSWERS GRADED A+ - 250 Questions
This exam assesses mastery of osteopathic principles and practice, including somatic dysfunction diagnosis,
treatment modalities, and integration with clinical medicine at the COMLEX Level 1 standard. It contains 250
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 10 focused sections: Osteopathic Principles and Practice, Anatomy
and Embryology, Biochemistry and Genetics, Microbiology and Immunology, Pathology, Pharmacology,
Physiology, Behavioral Science and Biostatistics, Neurology and Special Senses, Musculoskeletal System and
Dermatology. Targeted learning outcomes include: Apply osteopathic principles to diagnose and manage somatic
dysfunction.; Select appropriate osteopathic manipulative treatment techniques based on tissue texture changes
and barrier concepts.; Integrate viscerosomatic and somatovisceral reflexes into clinical reasoning.. Every item
has been reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence
and self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 70%. Aligned with Meets COMLEX Level 1 blueprint requirements
and AACOM standards for osteopathic medical education. standards and reflects the question style commonly
seen on accredited program examinations. Students consistently achieving above the cut score on this bank have
Section 1: Osteopathic Principles and Practice (Questions 1-25)
1 A patient presents with restricted motion of the cervical spine in left rotation
and left sidebending, with the transverse processes more posterior on the left.
Which Fryette's principle best explains the coupled motion observed?
A) In neutral position, sidebending and rotation occur to opposite sides.
B) In non-neutral position, sidebending and rotation occur to the same side.
C) Motion is determined by the direction of the restrictive barrier.
D) Coupled motion is absent in the cervical spine.
Answer: B
Rationale: Fryette's second principle states that when the spine is in a
non-neutral (flexed or extended) position, sidebending and rotation occur to the
same side. The finding of restricted left rotation and left sidebending with
posterior left transverse processes indicates a non-neutral dysfunction, making
B correct. Option A describes neutral mechanics. Option C is a general
principle but not specific. Option D is false; cervical spine exhibits coupled
motion.
2 During evaluation of sacral motion, you find that the sacral base is deep on
the left and the inferior lateral angle is shallow on the left, with a positive
seated flexion test on the left. Which sacral somatic dysfunction is present?
,A) Left-on-left sacral torsion
B) Right-on-right sacral torsion
C) Left unilateral sacral flexion
D) Right unilateral sacral extension
Answer: A
Rationale: A deep sacral base on the left and shallow ILA on the left indicate a
left rotation of the sacrum relative to the ilia. The positive seated flexion test on
the left confirms the sacrum is rotated left. In a left-on-left torsion, the sacrum
rotates left relative to the ilia, and the oblique axis is left. Option B would have
opposite findings. Options C and D are unilateral sacral dysfunctions, which
present with a deep sulcus and posterior ILA on the same side, not the findings
described.
3 Which of the following osteopathic manipulative treatment techniques is
most appropriate for a patient with an acute lumbar strain presenting with
muscle spasm, pain, and restricted motion in all directions?
A) High-velocity low-amplitude thrust
B) Muscle energy technique
C) Counterstrain
D) Myofascial release
Answer: C
Rationale: Counterstrain is ideal for acute, painful conditions with muscle
spasm because it uses a position of comfort to reduce nociceptive input and
relax the muscle spindle. High-velocity low-amplitude (HVLA) thrust is
contraindicated in acute spasm due to risk of injury. Muscle energy and
myofascial release may be too aggressive for acute spasm, though they can be
used subacutely. Counterstrain provides gentle, immediate relief.
4 A patient with chronic low back pain has an innominate bone that is rotated
posteriorly on the left. Which of the following gait findings would you
expect to observe?
A) Left leg appears longer in supine, shorter in sitting
B) Right leg appears longer in supine, shorter in sitting
C) Left leg appears shorter in supine, longer in sitting
D) Equal leg lengths in both positions
Answer: A
,Rationale: A posteriorly rotated innominate causes the acetabulum to move
superiorly and posteriorly, making the leg appear longer in supine due to
forward rotation of the ilium relative to the femur. In sitting, the ischial
tuberosity is more posterior, making the leg appear shorter. Option B describes
an anteriorly rotated innominate. Option C is opposite. Option D is incorrect as
leg length changes are typical.
5 Which of the following statements accurately describes the relationship
between Chapman's reflexes and viscerosomatic reflexes?
A) Chapman's reflexes are anterior tender points that correspond to specific
visceral dysfunctions, while viscerosomatic reflexes are segmentally related
spinal tissue texture changes.
B) Chapman's reflexes are found only on the posterior thorax, whereas
viscerosomatic reflexes are located on the anterior abdomen.
C) Both Chapman's reflexes and viscerosomatic reflexes are mediated by the
sympathetic nervous system exclusively.
D) Chapman's reflexes are used for diagnosis only, while viscerosomatic
reflexes are used for treatment.
Answer: A
Rationale: Chapman's reflexes are anterior (and sometimes posterior) tender
points associated with visceral pathology, thought to be facilitated by
sympathetic overflow. Viscerosomatic reflexes are segmental changes in skin,
fascia, and muscle (e.g., hypertonicity, tenderness) at specific spinal levels
corresponding to affected organs. Option B is incorrect because Chapman's
points are primarily anterior. Option C is incorrect because parasympathetic
involvement is also possible. Option D is false; both are diagnostic and can
guide treatment.
6 In a patient with a diagnosis of fibromyalgia, which osteopathic manipulative
treatment approach is most evidence-based for pain reduction and improved
function?
A) High-velocity low-amplitude thrust to the thoracic spine
B) Cranial osteopathy with balanced membranous tension
C) Soft tissue techniques and myofascial release focusing on tender points
D) Articulatory techniques with repetitive motion
Answer: C
, Rationale: Evidence supports the use of soft tissue techniques and myofascial
release for fibromyalgia to reduce pain and improve range of motion by
addressing myofascial trigger points and muscle tension. HVLA thrust (A) may
exacerbate pain. Cranial osteopathy (B) lacks strong evidence for fibromyalgia.
Articulatory techniques (D) may be too aggressive. Option C is gentle and
directly addresses tender points, which are characteristic of fibromyalgia.
7 During an osteopathic structural examination, you note that the patient's right
shoulder is elevated, the right scapula is abducted and rotated downward, and
the cervical spine is sidebent to the left and rotated to the right. Which of the
following is the most likely underlying somatic dysfunction?
A) Left occipitoatlantal (OA) compression
B) Right occipitoatlantal (OA) compression
C) Left C1-C2 rotational dysfunction
D) Right C1-C2 rotational dysfunction
Answer: B
Rationale: Right OA compression typically presents with the occiput rotated
left and sidebent right relative to the atlas, leading to compensatory elevation
of the right shoulder and scapular changes as the body attempts to maintain
horizontal gaze. The cervical spine sidebent left and rotated right is a common
compensatory pattern. Option A would produce opposite findings. Options C
and D involve C1-C2, which primarily affects rotation, not scapular position.
8 Which of the following best describes the osteopathic concept of the 'somatic
component' of disease?
A) Somatic dysfunction is always the primary cause of disease.
B) Somatic dysfunction can contribute to or result from visceral disease, and
addressing it can improve overall health.
C) Somatic dysfunction is irrelevant to the diagnosis and treatment of visceral
disease.
D) Somatic dysfunction is a purely psychological phenomenon with no
physiological basis.
Answer: B
Rationale: The somatic component of disease refers to the concept that somatic
dysfunction (musculoskeletal changes) can both contribute to and be a
consequence of visceral disease. Osteopathic manipulative treatment can help
