COMLEX-USA Level 1 Exam 2026: Comprehensive Osteopathic
Medical Licensing Practice Test — Anatomy, Physiology,
Biochemistry, Microbiology, Pharmacology, Pathology & Osteopathic
Principles — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Section 1: Osteopathic Principles & Practice (OPP/OMT)
1. A 45-year-old male presents with low back pain. On examination, the physician notes that
L3 rotates right and sidebends left, with the dysfunction present in both flexion and
extension. According to Fryette's laws, which type of somatic dysfunction is this?
A. Type I somatic dysfunction
B. Type II somatic dysfunction
C. Combined somatic dysfunction
D. Non-neutral somatic dysfunction
Correct Answer: A
Explanation: Type I dysfunction occurs at neutral (present in flexion and extension), with
rotation and sidebending to opposite sides. This is a group dysfunction.
2. A 32-year-old female presents with chronic headaches. Cranial examination reveals the
sphenobasilar synchondrosis (SBS) is restricted in extension. Which motion is impaired?
A. The sphenoid and occiput moving toward each other anteriorly
B. The sphenoid and occiput moving away from each other posteriorly
C. Rotation of the sphenoid around an anteroposterior axis
D. Lateral flexion of the sphenoid relative to the occiput
,Correct Answer: A
Explanation: SBS flexion dysfunction is when the sphenoid and occiput fail to move toward
each other anteriorly, which is the flexion phase.
3. During a structural examination, a Chapman's reflex point is identified at the second
intercostal space on the left, approximately two inches from the sternum. Which organ is
associated with this reflex point?
A. Liver
B. Heart
C. Gallbladder
D. Stomach
Correct Answer: B
Explanation: The Chapman's reflex point for the heart is located at the second and third
intercostal spaces on the left, near the sternum.
4. A 55-year-old male presents with right upper quadrant pain. A Chapman's reflex point is
found at the fifth intercostal space on the right, two inches from the sternum. Which organ
is most likely involved?
A. Liver
B. Pancreas
C. Gallbladder
D. Stomach
Correct Answer: C
,Explanation: The gallbladder's Chapman's reflex point is at the fifth intercostal space on the
right, near the sternum.
5. A patient presents with chronic constipation. A Chapman's reflex point is identified at the
inferior angle of the scapula on the left. This finding suggests dysfunction of which organ?
A. Spleen
B. Kidney
C. Colon
D. Bladder
Correct Answer: C
Explanation: The Chapman's reflex point for the colon is located at the inferior angle of the
scapula, with the left side associated with the descending colon.
6. In muscle energy technique (MET), the patient performs an isometric contraction at what
percentage of maximal effort?
A. 100%
B. 20%
C. 50%
D. 75%
Correct Answer: B
Explanation: MET uses a submaximal isometric contraction of approximately 20% of maximal
effort to engage neuromuscular reflexes without fatigue.
, 7. A 28-year-old male presents with right sacral torsion on a left axis. Which diagnosis is
correct?
A. Left-on-right sacral torsion
B. Right-on-left sacral torsion
C. Bilateral sacral torsion
D. Sacral extension dysfunction
Correct Answer: B
Explanation: Right-on-left sacral torsion means the sacrum rotates right around a left oblique
axis.
8. A patient has a right anterior innominate rotation. Which landmark finding is expected?
A. Right PSIS is more prominent posteriorly
B. Right iliac crest is inferior
C. Right PSIS is superior
D. Right iliac crest is superior
Correct Answer: D
Explanation: An anterior innominate rotation results in the ipsilateral iliac crest being
superior relative to the sacrum.
9. During cranial examination, a torsion pattern is identified. What characterizes this strain
pattern?
Medical Licensing Practice Test — Anatomy, Physiology,
Biochemistry, Microbiology, Pharmacology, Pathology & Osteopathic
Principles — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Section 1: Osteopathic Principles & Practice (OPP/OMT)
1. A 45-year-old male presents with low back pain. On examination, the physician notes that
L3 rotates right and sidebends left, with the dysfunction present in both flexion and
extension. According to Fryette's laws, which type of somatic dysfunction is this?
A. Type I somatic dysfunction
B. Type II somatic dysfunction
C. Combined somatic dysfunction
D. Non-neutral somatic dysfunction
Correct Answer: A
Explanation: Type I dysfunction occurs at neutral (present in flexion and extension), with
rotation and sidebending to opposite sides. This is a group dysfunction.
2. A 32-year-old female presents with chronic headaches. Cranial examination reveals the
sphenobasilar synchondrosis (SBS) is restricted in extension. Which motion is impaired?
A. The sphenoid and occiput moving toward each other anteriorly
B. The sphenoid and occiput moving away from each other posteriorly
C. Rotation of the sphenoid around an anteroposterior axis
D. Lateral flexion of the sphenoid relative to the occiput
,Correct Answer: A
Explanation: SBS flexion dysfunction is when the sphenoid and occiput fail to move toward
each other anteriorly, which is the flexion phase.
3. During a structural examination, a Chapman's reflex point is identified at the second
intercostal space on the left, approximately two inches from the sternum. Which organ is
associated with this reflex point?
A. Liver
B. Heart
C. Gallbladder
D. Stomach
Correct Answer: B
Explanation: The Chapman's reflex point for the heart is located at the second and third
intercostal spaces on the left, near the sternum.
4. A 55-year-old male presents with right upper quadrant pain. A Chapman's reflex point is
found at the fifth intercostal space on the right, two inches from the sternum. Which organ
is most likely involved?
A. Liver
B. Pancreas
C. Gallbladder
D. Stomach
Correct Answer: C
,Explanation: The gallbladder's Chapman's reflex point is at the fifth intercostal space on the
right, near the sternum.
5. A patient presents with chronic constipation. A Chapman's reflex point is identified at the
inferior angle of the scapula on the left. This finding suggests dysfunction of which organ?
A. Spleen
B. Kidney
C. Colon
D. Bladder
Correct Answer: C
Explanation: The Chapman's reflex point for the colon is located at the inferior angle of the
scapula, with the left side associated with the descending colon.
6. In muscle energy technique (MET), the patient performs an isometric contraction at what
percentage of maximal effort?
A. 100%
B. 20%
C. 50%
D. 75%
Correct Answer: B
Explanation: MET uses a submaximal isometric contraction of approximately 20% of maximal
effort to engage neuromuscular reflexes without fatigue.
, 7. A 28-year-old male presents with right sacral torsion on a left axis. Which diagnosis is
correct?
A. Left-on-right sacral torsion
B. Right-on-left sacral torsion
C. Bilateral sacral torsion
D. Sacral extension dysfunction
Correct Answer: B
Explanation: Right-on-left sacral torsion means the sacrum rotates right around a left oblique
axis.
8. A patient has a right anterior innominate rotation. Which landmark finding is expected?
A. Right PSIS is more prominent posteriorly
B. Right iliac crest is inferior
C. Right PSIS is superior
D. Right iliac crest is superior
Correct Answer: D
Explanation: An anterior innominate rotation results in the ipsilateral iliac crest being
superior relative to the sacrum.
9. During cranial examination, a torsion pattern is identified. What characterizes this strain
pattern?
