COMLEX-USA Level 1 Licensure Exam V1 COMLEX-
USA Level 1 Licensure Exam V1
1. A 45-year-old male presents with acute onset of right upper quadrant pain that radiates to
his right scapula. Physical examination reveals tenderness at the right 6th intercostal space
along the mid-clavicular line. Which of the following viscerosomatic reflex levels is most likely
associated with this patient’s condition?
A. T2-T4
B. T5-T9
C. T10-T11
D. T12-L2
Correct Answer: B
Explanation: The patient’s presentation is consistent with acute cholecystitis, and the
anterior Chapman point for the gallbladder is located in the right 6th intercostal space.
Viscerosomatic reflexes for the gallbladder and upper gastrointestinal tract (stomach, liver,
gallbladder, pancreas, and duodenum) are primarily mediated through the T5-T9 spinal
levels via the greater splanchnic nerve. Recognizing these reflex patterns is critical for
OMM diagnosis and helps differentiate visceral pathology from primary musculoskeletal
dysfunction.
,2. A 24-year-old female presents with a sore throat, fever, and cervical lymphadenopathy. A
rapid strep test is negative. Physical exam reveals splenomegaly. If an osteopathic exam were
performed, where would you most likely find the posterior Chapman point associated with
the spleen?
A. Right 7th intercostal space near the costochondral junction
B. Left T7 transverse process
C. Left 7th intercostal space near the costochondral junction
D. Right T7 transverse process
Correct Answer: B
Explanation: This patient likely has infectious mononucleosis, involving the spleen. The
posterior Chapman point for the spleen is located on the left side at the level of the T7
transverse process. Understanding Chapman points is essential for localized visceral
assessment in the osteopathic physical exam. Candidates must distinguish between
anterior points (used for screening) and posterior points (used for confirmation).
3. A 32-year-old male presents with low back pain. Osteopathic examination reveals a sacral
base that is anterior on the left and a positive seated flexion test on the right. The deep
sulcus is on the left, and the posterior ILA is on the right. The sphinx test is negative
(improves with extension). What is the most likely diagnosis?
A. Left on Left forward torsion
B. Right on Left backward torsion
,C. Left on Right backward torsion
D. Right on Right forward torsion
Correct Answer: D
Explanation: A positive seated flexion test on the right indicates the side of the
dysfunction. Since the sphinx test is negative (improves with extension), it indicates a
forward torsion. In a forward torsion, the axis is the same as the rotation (e.g., Right on
Right). For a Right on Right torsion, the sacral base is deep on the left (anterior) and the
ILA is posterior on the right, which matches the clinical findings.
4. A 60-year-old female with a history of chronic obstructive pulmonary disease (COPD)
presents with an exacerbation. Which of the following osteopathic techniques would be most
appropriate to assist in the mobilization of secretions and improve lymphatic drainage?
A. HVLA of the thoracic spine
B. Rib raising
C. Pedal pump
D. Cranial rhythmic impulse enhancement
Correct Answer: B
Explanation: Rib raising is a balanced tension technique that helps to normalize
sympathetic tone (T1-T6 for the lungs) and improve thoracic excursion, which indirectly
aids lymphatic flow. While lymphatic pumps like the pedal pump are useful, rib raising is
specifically targeted at the sympathetic innervation of the respiratory system in COPD
, patients. Understanding the autonomic influences on the respiratory system is a core
component of the COMLEX-USA blueprint.
5. A 28-year-old postpartum female presents with wrist pain on the radial side. She notes
pain when lifting her newborn. Positive Finkelstein test is noted. Which tendon is most likely
involved in this condition?
A. Abductor pollicis longus
B. Extensor carpi radialis brevis
C. Flexor carpi radialis
D. Extensor digitorum communis
Correct Answer: A
Explanation: De Quervain’s tenosynovitis involves the first dorsal compartment of the
wrist, which contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
tendons. A positive Finkelstein test confirms this diagnosis, commonly seen in new
mothers due to repetitive thumb abduction and ulnar deviation. Mastery of
musculoskeletal anatomy and clinical tests is essential for the Level 1 exam.
6. A 19-year-old college student presents with a headache and stiff neck. Lumbar puncture
reveals increased opening pressure, decreased glucose, and increased protein. Gram stain
shows Gram-negative diplococci. Which of the following is the most likely causative agent?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
USA Level 1 Licensure Exam V1
1. A 45-year-old male presents with acute onset of right upper quadrant pain that radiates to
his right scapula. Physical examination reveals tenderness at the right 6th intercostal space
along the mid-clavicular line. Which of the following viscerosomatic reflex levels is most likely
associated with this patient’s condition?
A. T2-T4
B. T5-T9
C. T10-T11
D. T12-L2
Correct Answer: B
Explanation: The patient’s presentation is consistent with acute cholecystitis, and the
anterior Chapman point for the gallbladder is located in the right 6th intercostal space.
Viscerosomatic reflexes for the gallbladder and upper gastrointestinal tract (stomach, liver,
gallbladder, pancreas, and duodenum) are primarily mediated through the T5-T9 spinal
levels via the greater splanchnic nerve. Recognizing these reflex patterns is critical for
OMM diagnosis and helps differentiate visceral pathology from primary musculoskeletal
dysfunction.
,2. A 24-year-old female presents with a sore throat, fever, and cervical lymphadenopathy. A
rapid strep test is negative. Physical exam reveals splenomegaly. If an osteopathic exam were
performed, where would you most likely find the posterior Chapman point associated with
the spleen?
A. Right 7th intercostal space near the costochondral junction
B. Left T7 transverse process
C. Left 7th intercostal space near the costochondral junction
D. Right T7 transverse process
Correct Answer: B
Explanation: This patient likely has infectious mononucleosis, involving the spleen. The
posterior Chapman point for the spleen is located on the left side at the level of the T7
transverse process. Understanding Chapman points is essential for localized visceral
assessment in the osteopathic physical exam. Candidates must distinguish between
anterior points (used for screening) and posterior points (used for confirmation).
3. A 32-year-old male presents with low back pain. Osteopathic examination reveals a sacral
base that is anterior on the left and a positive seated flexion test on the right. The deep
sulcus is on the left, and the posterior ILA is on the right. The sphinx test is negative
(improves with extension). What is the most likely diagnosis?
A. Left on Left forward torsion
B. Right on Left backward torsion
,C. Left on Right backward torsion
D. Right on Right forward torsion
Correct Answer: D
Explanation: A positive seated flexion test on the right indicates the side of the
dysfunction. Since the sphinx test is negative (improves with extension), it indicates a
forward torsion. In a forward torsion, the axis is the same as the rotation (e.g., Right on
Right). For a Right on Right torsion, the sacral base is deep on the left (anterior) and the
ILA is posterior on the right, which matches the clinical findings.
4. A 60-year-old female with a history of chronic obstructive pulmonary disease (COPD)
presents with an exacerbation. Which of the following osteopathic techniques would be most
appropriate to assist in the mobilization of secretions and improve lymphatic drainage?
A. HVLA of the thoracic spine
B. Rib raising
C. Pedal pump
D. Cranial rhythmic impulse enhancement
Correct Answer: B
Explanation: Rib raising is a balanced tension technique that helps to normalize
sympathetic tone (T1-T6 for the lungs) and improve thoracic excursion, which indirectly
aids lymphatic flow. While lymphatic pumps like the pedal pump are useful, rib raising is
specifically targeted at the sympathetic innervation of the respiratory system in COPD
, patients. Understanding the autonomic influences on the respiratory system is a core
component of the COMLEX-USA blueprint.
5. A 28-year-old postpartum female presents with wrist pain on the radial side. She notes
pain when lifting her newborn. Positive Finkelstein test is noted. Which tendon is most likely
involved in this condition?
A. Abductor pollicis longus
B. Extensor carpi radialis brevis
C. Flexor carpi radialis
D. Extensor digitorum communis
Correct Answer: A
Explanation: De Quervain’s tenosynovitis involves the first dorsal compartment of the
wrist, which contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
tendons. A positive Finkelstein test confirms this diagnosis, commonly seen in new
mothers due to repetitive thumb abduction and ulnar deviation. Mastery of
musculoskeletal anatomy and clinical tests is essential for the Level 1 exam.
6. A 19-year-old college student presents with a headache and stiff neck. Lumbar puncture
reveals increased opening pressure, decreased glucose, and increased protein. Gram stain
shows Gram-negative diplococci. Which of the following is the most likely causative agent?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
