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COMLEX Level 1 – Saverese-Style OMM ACTUAL Exam (2025
Edition) 100 High-Yield Osteopathic Manipulative Medicine
Questions with Answers and Rationales Modeled after Saverese OMT
Review Concepts | Updated for COMLEX-USA Level 1 (2025
Format)
Major Content Areas
Somatic Dysfunction Diagnosis: TART findings, segmental motion, Fryette’s Laws
OMT Modalities: HVLA, Muscle Energy (MET), Counterstrain, FPR, BLT, Myofascial
Release
Cranial Osteopathy: Strain patterns, SBS motions, cranial nerve associations
Viscerosomatic & Chapman's Reflexes: Autonomic mapping, key reflex points
Lymphatic & Respiratory Techniques: Thoracic inlet release, pump techniques,
diaphragmatic motion
Autonomics & Osteopathic Reflexes: Sympathetic/parasympathetic levels and effects
Postural & Biomechanical Screening: Gait analysis, sacral torsions, innominate
dysfunctions
Integration with Clinical Systems: Cardio-respiratory, GI, GU, musculoskeletal cases
1. A patient presents with acute low back pain after lifting. On exam the L5 transverse
process is posterior and superior on the right; sacral sulcus on the right is shallow, and the
right PSIS is inferior. Which sacral somatic dysfunction is most consistent?
A. Right unilateral sacral flexion
B. Right unilateral sacral extension
C. Left unilateral sacral flexion
D. Left unilateral sacral extension
Rationale: Unilateral sacral flexion presents with a shallow sulcus and inferior PSIS on
the affected side; the sacral base moves anterior (flexion) on that side.
2. A patient has tissue texture changes, asymmetry, restriction of motion, and tenderness at
T3. Which mnemonic summarizes these findings?
A. SOAP
B. TART
C. PACE
D. ABCD
Rationale: TART = Tissue texture change, Asymmetry, Restriction of motion,
Tenderness — OMM diagnostic criteria for somatic dysfunction.
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3. According to Fryette’s Type II mechanics, in a single vertebral segment that is rotated
right and sidebent right, which statement is true regarding motion coupling?
A. In neutral, rotation and sidebending are to opposite sides.
B. In non-neutral (flexed/extended) mechanics, rotation and sidebending occur to
the same side.
C. Type II is only seen in the thoracolumbar junction.
D. Rotation and sidebending are independent in Type II.
Rationale: Fryette’s Type II (non-neutral) mechanics: rotation and sidebending are
coupled to the same side in a single vertebral segment.
4. A 6-month-old presents with plagiocephaly and a preference to turn head to the right.
Which diagnosis and initial OMM approach are most appropriate?
A. Left cranial torsion; treat with HVLA
B. Right sternocleidomastoid-related positional preference (torticollis); conservative
stretching and positioning plus cranial strain evaluation
C. Bilateral temporomandibular dysfunction; mandibular adjustment
D. Trigeminal neuralgia; referral to neurosurgery
Rationale: Infant positional torticollis due to SCM shortening causes head-turn
preference; first-line: conservative stretching, repositioning, and evaluate cranial base.
5. Which technique is best for treating an acutely tender, hypertonic trapezius muscle with a
reproducible tender point?
A. HVLA thrust to C5
B. Counterstrain targeted to the trapezius tender point
C. High-velocity rotation of the skull
D. Prolonged static stretching only
Rationale: Counterstrain places the muscle in a position of ease to reduce tender point
pain and reset proprioception—appropriate for acute tender points.
6. A patient’s thoracic spine is found flexed, rotated left, sidebent left at T6 (F Rl Sl).
According to muscle energy, what is the correct patient positioning for direct muscle
energy to improve rotation?
A. Move the segment further into the restriction (i.e., further flex, rotate left,
sidebend left) and have patient attempt to rotate right against resistance.
B. Move to neutral and have patient rotate left.
C. Extend and rotate right only.
D. Use HVLA thrust toward left rotation.
Rationale: In direct MET, the operator positions toward the barrier (into the dysfunction)
and patient exerts an isometric contraction away from the restriction.
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7. A patient has increased sympathetic tone presenting as palmar sweating and tachycardia.
Which spinal levels are most associated with sympathetic outflow to the heart?
A. C1–C3
B. T1–T4 (upper thoracic)
C. L1–L2
D. S2–S4
Rationale: Cardiac sympathetic innervation arises mainly from T1–T4; dysfunction there
can affect heart rate and autonomic balance.
8. Which description best fits an anatomic Chapman reflex point?
A. A diffuse, poorly localized pain within a muscle belly
B. A discrete, small, tender nodule in deep fascia or periosteum that may reflect
visceral dysfunction
C. A vascular bruit over the abdomen
D. A trigger for autonomic hyperreflexia
Rationale: Chapman's points are palpable nodules (gangliform contractions) that
correlate with visceral dysfunction and are used diagnostically/therapeutically.
9. A patient with asthma has increased rib cage fixation at the upper ribs and decreased
anterior chest excursion. Which techniques target improving rib excursion and lymphatic
flow?
A. HVLA to the lumbar spine
B. Rib muscle energy and balanced ligamentous tension (BLT) or myofascial release
for the thorax, plus lymphatic pump techniques
C. Pelvic diaphragm release only
D. Cranial vault molding
Rationale: Thoracic/rib techniques restore motion to improve ventilation and lymphatic
pumps enhance lymphatic flow—useful in pulmonary conditions.
10. In cranial osteopathy, the SBS (sphenobasilar synchondrosis) rotates such that during
cranial flexion the base moves:
A. Posterior and superior
B. Anterior and inferior (caudad)
C. Lateral only
D. No movement occurs
Rationale: During cranial flexion, the SBS moves anterior and inferior; vault widens
transversely and becomes shorter AP.
COMLEX Level 1 – Saverese-Style OMM ACTUAL Exam (2025
Edition) 100 High-Yield Osteopathic Manipulative Medicine
Questions with Answers and Rationales Modeled after Saverese OMT
Review Concepts | Updated for COMLEX-USA Level 1 (2025
Format)
Major Content Areas
Somatic Dysfunction Diagnosis: TART findings, segmental motion, Fryette’s Laws
OMT Modalities: HVLA, Muscle Energy (MET), Counterstrain, FPR, BLT, Myofascial
Release
Cranial Osteopathy: Strain patterns, SBS motions, cranial nerve associations
Viscerosomatic & Chapman's Reflexes: Autonomic mapping, key reflex points
Lymphatic & Respiratory Techniques: Thoracic inlet release, pump techniques,
diaphragmatic motion
Autonomics & Osteopathic Reflexes: Sympathetic/parasympathetic levels and effects
Postural & Biomechanical Screening: Gait analysis, sacral torsions, innominate
dysfunctions
Integration with Clinical Systems: Cardio-respiratory, GI, GU, musculoskeletal cases
1. A patient presents with acute low back pain after lifting. On exam the L5 transverse
process is posterior and superior on the right; sacral sulcus on the right is shallow, and the
right PSIS is inferior. Which sacral somatic dysfunction is most consistent?
A. Right unilateral sacral flexion
B. Right unilateral sacral extension
C. Left unilateral sacral flexion
D. Left unilateral sacral extension
Rationale: Unilateral sacral flexion presents with a shallow sulcus and inferior PSIS on
the affected side; the sacral base moves anterior (flexion) on that side.
2. A patient has tissue texture changes, asymmetry, restriction of motion, and tenderness at
T3. Which mnemonic summarizes these findings?
A. SOAP
B. TART
C. PACE
D. ABCD
Rationale: TART = Tissue texture change, Asymmetry, Restriction of motion,
Tenderness — OMM diagnostic criteria for somatic dysfunction.
,2|Page
3. According to Fryette’s Type II mechanics, in a single vertebral segment that is rotated
right and sidebent right, which statement is true regarding motion coupling?
A. In neutral, rotation and sidebending are to opposite sides.
B. In non-neutral (flexed/extended) mechanics, rotation and sidebending occur to
the same side.
C. Type II is only seen in the thoracolumbar junction.
D. Rotation and sidebending are independent in Type II.
Rationale: Fryette’s Type II (non-neutral) mechanics: rotation and sidebending are
coupled to the same side in a single vertebral segment.
4. A 6-month-old presents with plagiocephaly and a preference to turn head to the right.
Which diagnosis and initial OMM approach are most appropriate?
A. Left cranial torsion; treat with HVLA
B. Right sternocleidomastoid-related positional preference (torticollis); conservative
stretching and positioning plus cranial strain evaluation
C. Bilateral temporomandibular dysfunction; mandibular adjustment
D. Trigeminal neuralgia; referral to neurosurgery
Rationale: Infant positional torticollis due to SCM shortening causes head-turn
preference; first-line: conservative stretching, repositioning, and evaluate cranial base.
5. Which technique is best for treating an acutely tender, hypertonic trapezius muscle with a
reproducible tender point?
A. HVLA thrust to C5
B. Counterstrain targeted to the trapezius tender point
C. High-velocity rotation of the skull
D. Prolonged static stretching only
Rationale: Counterstrain places the muscle in a position of ease to reduce tender point
pain and reset proprioception—appropriate for acute tender points.
6. A patient’s thoracic spine is found flexed, rotated left, sidebent left at T6 (F Rl Sl).
According to muscle energy, what is the correct patient positioning for direct muscle
energy to improve rotation?
A. Move the segment further into the restriction (i.e., further flex, rotate left,
sidebend left) and have patient attempt to rotate right against resistance.
B. Move to neutral and have patient rotate left.
C. Extend and rotate right only.
D. Use HVLA thrust toward left rotation.
Rationale: In direct MET, the operator positions toward the barrier (into the dysfunction)
and patient exerts an isometric contraction away from the restriction.
, 3|Page
7. A patient has increased sympathetic tone presenting as palmar sweating and tachycardia.
Which spinal levels are most associated with sympathetic outflow to the heart?
A. C1–C3
B. T1–T4 (upper thoracic)
C. L1–L2
D. S2–S4
Rationale: Cardiac sympathetic innervation arises mainly from T1–T4; dysfunction there
can affect heart rate and autonomic balance.
8. Which description best fits an anatomic Chapman reflex point?
A. A diffuse, poorly localized pain within a muscle belly
B. A discrete, small, tender nodule in deep fascia or periosteum that may reflect
visceral dysfunction
C. A vascular bruit over the abdomen
D. A trigger for autonomic hyperreflexia
Rationale: Chapman's points are palpable nodules (gangliform contractions) that
correlate with visceral dysfunction and are used diagnostically/therapeutically.
9. A patient with asthma has increased rib cage fixation at the upper ribs and decreased
anterior chest excursion. Which techniques target improving rib excursion and lymphatic
flow?
A. HVLA to the lumbar spine
B. Rib muscle energy and balanced ligamentous tension (BLT) or myofascial release
for the thorax, plus lymphatic pump techniques
C. Pelvic diaphragm release only
D. Cranial vault molding
Rationale: Thoracic/rib techniques restore motion to improve ventilation and lymphatic
pumps enhance lymphatic flow—useful in pulmonary conditions.
10. In cranial osteopathy, the SBS (sphenobasilar synchondrosis) rotates such that during
cranial flexion the base moves:
A. Posterior and superior
B. Anterior and inferior (caudad)
C. Lateral only
D. No movement occurs
Rationale: During cranial flexion, the SBS moves anterior and inferior; vault widens
transversely and becomes shorter AP.
