COMLEX-USA Level 1 Licensure Exam V2 COMLEX-
USA Level 1 Licensure Exam V2
1. A 45-year-old male presents with chronic epigastric pain that improves after eating.
Physical examination reveals a tissue texture abnormality at the level of T5-T9 on the right.
Which of the following is the most likely location for a Chapman point associated with this
patient’s condition?
A. Right 6th intercostal space
B. Right 5th intercostal space
C. Left 5th intercostal space
D. Left 6th intercostal space
Correct Answer: A
Explanation: The patient’s symptoms are suggestive of a duodenal ulcer, as the pain
improves with food. The anterior Chapman point for the duodenum is located in the right
6th intercostal space. Recognizing viscerosomatic reflexes and Chapman points is essential
for diagnosing visceral pathology through the musculoskeletal system in osteopathic
clinical practice.
,2. A 24-year-old female presents with a 2-day history of dysuria and increased urinary
frequency. A physical exam reveals suprapubic tenderness but no costovertebral angle
tenderness. Which of the following segments would you expect to find a viscerosomatic
reflex for this patient’s condition?
A. T10-T11
B. T12-L2
C. T11-L1
D. S2-S4
Correct Answer: B
Explanation: This patient likely has cystitis, which involves the bladder. The sympathetic
viscerosomatic reflex for the bladder is T12-L2. Understanding the specific spinal levels
associated with sympathetic innervation allows the osteopathic physician to identify and
treat related somatic dysfunctions efficiently.
3. A 62-year-old female with a history of hypertension presents for a routine check-up.
Osteopathic examination reveals a sacral base that is anterior on the right and a deep sulcus
on the left. The spring test is negative. Which of the following is the most likely sacral
diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Right-on-left backward torsion
,D. Left-on-right backward torsion
Correct Answer: A
Explanation: A negative spring test indicates a forward torsion. In a left-on-left forward
torsion, the sacral base is deep on the left (anterior) and the inferior lateral angle is
posterior on the right. This requires integration of the Fryette laws as they apply to the
relationship between L5 and the sacrum to confirm the diagnosis.
4. A 30-year-old male presents with a persistent cough and night sweats. A chest X-ray shows
a cavitary lesion in the right upper lobe. Sputum cultures are pending. Which of the following
is the primary mechanism of the host defense against this organism?
A. Antibody-mediated opsonization
B. Macrophage activation by Th1 cells
C. CD8+ T-cell mediated lysis
D. Neutrophil-mediated phagocytosis
Correct Answer: B
Explanation: The presentation is highly suspicious for Mycobacterium tuberculosis. The
immune response to TB involves Th1 cells secreting interferon-gamma to activate
macrophages, which then attempt to contain the infection within granulomas. This cell-
mediated immunity is crucial for controlling intracellular pathogens and is a high-yield
topic for boards.
, 5. A 19-year-old college student is brought to the emergency department with a high fever,
headache, and stiff neck. Physical exam shows a petechial rash on the lower extremities.
Which of the following is the most common long-term complication of this condition?
A. Chronic arthritis
B. Hearing loss
C. Permanent paralysis
D. Visual impairment
Correct Answer: B
Explanation: The patient has bacterial meningitis, likely caused by Neisseria meningitidis
given the petechial rash. Sensorineural hearing loss is the most common neurologic
complication following bacterial meningitis in survivors. Prompt recognition and treatment
with antibiotics are vital to reduce the risk of long-term morbidity and mortality.
6. A 55-year-old male presents with worsening shortness of breath and a productive cough.
He has a 40 pack-year smoking history. Pulmonary function testing reveals a decreased
FEV1/FVC ratio and an increased total lung capacity. Which of the following is the most likely
diagnosis?
A. Asthma
B. Chronic Bronchitis
C. Pulmonary Fibrosis
D. Emphysema
USA Level 1 Licensure Exam V2
1. A 45-year-old male presents with chronic epigastric pain that improves after eating.
Physical examination reveals a tissue texture abnormality at the level of T5-T9 on the right.
Which of the following is the most likely location for a Chapman point associated with this
patient’s condition?
A. Right 6th intercostal space
B. Right 5th intercostal space
C. Left 5th intercostal space
D. Left 6th intercostal space
Correct Answer: A
Explanation: The patient’s symptoms are suggestive of a duodenal ulcer, as the pain
improves with food. The anterior Chapman point for the duodenum is located in the right
6th intercostal space. Recognizing viscerosomatic reflexes and Chapman points is essential
for diagnosing visceral pathology through the musculoskeletal system in osteopathic
clinical practice.
,2. A 24-year-old female presents with a 2-day history of dysuria and increased urinary
frequency. A physical exam reveals suprapubic tenderness but no costovertebral angle
tenderness. Which of the following segments would you expect to find a viscerosomatic
reflex for this patient’s condition?
A. T10-T11
B. T12-L2
C. T11-L1
D. S2-S4
Correct Answer: B
Explanation: This patient likely has cystitis, which involves the bladder. The sympathetic
viscerosomatic reflex for the bladder is T12-L2. Understanding the specific spinal levels
associated with sympathetic innervation allows the osteopathic physician to identify and
treat related somatic dysfunctions efficiently.
3. A 62-year-old female with a history of hypertension presents for a routine check-up.
Osteopathic examination reveals a sacral base that is anterior on the right and a deep sulcus
on the left. The spring test is negative. Which of the following is the most likely sacral
diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Right-on-left backward torsion
,D. Left-on-right backward torsion
Correct Answer: A
Explanation: A negative spring test indicates a forward torsion. In a left-on-left forward
torsion, the sacral base is deep on the left (anterior) and the inferior lateral angle is
posterior on the right. This requires integration of the Fryette laws as they apply to the
relationship between L5 and the sacrum to confirm the diagnosis.
4. A 30-year-old male presents with a persistent cough and night sweats. A chest X-ray shows
a cavitary lesion in the right upper lobe. Sputum cultures are pending. Which of the following
is the primary mechanism of the host defense against this organism?
A. Antibody-mediated opsonization
B. Macrophage activation by Th1 cells
C. CD8+ T-cell mediated lysis
D. Neutrophil-mediated phagocytosis
Correct Answer: B
Explanation: The presentation is highly suspicious for Mycobacterium tuberculosis. The
immune response to TB involves Th1 cells secreting interferon-gamma to activate
macrophages, which then attempt to contain the infection within granulomas. This cell-
mediated immunity is crucial for controlling intracellular pathogens and is a high-yield
topic for boards.
, 5. A 19-year-old college student is brought to the emergency department with a high fever,
headache, and stiff neck. Physical exam shows a petechial rash on the lower extremities.
Which of the following is the most common long-term complication of this condition?
A. Chronic arthritis
B. Hearing loss
C. Permanent paralysis
D. Visual impairment
Correct Answer: B
Explanation: The patient has bacterial meningitis, likely caused by Neisseria meningitidis
given the petechial rash. Sensorineural hearing loss is the most common neurologic
complication following bacterial meningitis in survivors. Prompt recognition and treatment
with antibiotics are vital to reduce the risk of long-term morbidity and mortality.
6. A 55-year-old male presents with worsening shortness of breath and a productive cough.
He has a 40 pack-year smoking history. Pulmonary function testing reveals a decreased
FEV1/FVC ratio and an increased total lung capacity. Which of the following is the most likely
diagnosis?
A. Asthma
B. Chronic Bronchitis
C. Pulmonary Fibrosis
D. Emphysema
