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200+ Free COMLEX Level 1 Practice Questions

Pass your Comprehensive Osteopathic Medical Licensing Examination Level 1 exam on the first try — instant access, no signup required.

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92% Pass Rate
200+ Questions
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Questions by Category

Comlex-Omt-Principles24 questions
Comlex-Musculoskeletal23 questions
Comlex-Cardiovascular-Hematologic18 questions
Comlex-Nervous-Mental-Health18 questions
Comlex-Gi-Nutritional17 questions
Comlex-Community-Health17 questions
Comlex-Respiratory13 questions
Comlex-Endocrine-Metabolism12 questions
Comlex-Application-Knowledge12 questions
Comlex-Integumentary10 questions
Comlex-Genitourinary-Renal9 questions
Comlex-Human-Development-Reproduction7 questions
Comlex-Professionalism6 questions
Comlex-Patient-Care5 questions
Comlex-Practice-Based-Learning3 questions
Comlex-Communication3 questions
Comlex-Systems-Based-Practice3 questions
2026 Statistics

Key Facts: COMLEX Level 1 Exam

352

Total Questions

NBOME 2026

92%

First-Time Pass Rate

NBOME 2024

8h

Total Testing Time

NBOME

7

Question Blocks

NBOME

~$675

Exam Fee

NBOME 2026

12%

OMT Content

NBOME Blueprint

COMLEX Level 1 is a Pass/Fail exam consisting of 352 questions over 8 hours. It differs from USMLE Step 1 by integrating osteopathic manipulative treatment (OMT) principles throughout all clinical content areas. First-time pass rates for US osteopathic medical students average 92%. The exam emphasizes clinical vignettes requiring application of basic science knowledge with an osteopathic perspective, including somatic dysfunction diagnosis and OMT treatment selection.

About the COMLEX Level 1 Exam

COMLEX Level 1 is the first of three osteopathic medical licensing examinations required for DO licensure. The exam uniquely integrates osteopathic principles and manipulative treatment (OMT) with foundational biomedical and clinical sciences across two dimensions: Dimension 1 covers OMT Principles (12%), Patient Care (6%), Application of Knowledge (60%), Practice-Based Learning (4%), Communication (3%), Professionalism (3%), and Systems-Based Practice (2%). Dimension 2 covers clinical presentations across all organ systems with emphasis on the osteopathic approach to patient care.

Questions

352 scored questions

Time Limit

8 hours (7 blocks)

Passing Score

Pass/Fail

Exam Fee

$675 (NBOME (National Board of Osteopathic Medical Examiners))

COMLEX Level 1 Exam Content Outline

12%

OMT Principles

Osteopathic philosophy, somatic dysfunction diagnosis, muscle energy, HVLA, counterstrain, cranial osteopathy, Chapman points, myofascial release, lymphatic techniques

13%

Musculoskeletal & Integumentary

Bone and joint disorders, connective tissue diseases, dermatology, wound healing, trauma with integrated OMT approach

12%

Community Health & Wellness

Preventive medicine, public health, epidemiology, social determinants of health, patient safety, healthcare systems

10%

Nervous System & Mental Health

Neuroscience, neurological disorders, psychiatric conditions, OMT for headaches, autonomic nervous system integration

10%

Gastrointestinal & Nutritional

Digestive physiology, liver and pancreatic function, GI pathology, nutrition, metabolic disorders

10%

Cardiovascular & Hematologic

Cardiac physiology, electrophysiology, heart disease, vascular pathology, hematopoiesis, coagulation disorders

10%

Respiratory System

Pulmonary physiology and pathology, respiratory infections, obstructive and restrictive diseases

5%

Endocrine & Metabolism

Hormone regulation, endocrine physiology and pathology, diabetes, thyroid disorders

5%

Genitourinary & Renal

Renal function, electrolyte disorders, acid-base balance, GU pathology, pregnancy-related conditions

5%

Human Development & Reproduction

Embryology, growth and development, male and female reproductive systems, pregnancy and childbirth

6%

Patient Care & Competencies

Patient-centered care, history and physical exam, clinical reasoning, evidence-based medicine

4%

Practice-Based Learning

Quality improvement, research methods, lifelong learning, self-assessment

3%

Interpersonal Communication

Doctor-patient relationship, communication skills, cultural competence, health literacy

3%

Professionalism

Medical ethics, professional behavior, legal issues, boundaries, wellness

2%

Systems-Based Practice

Healthcare delivery, resource allocation, interprofessional teams, population health

How to Pass the COMLEX Level 1 Exam

What You Need to Know

  • Passing score: Pass/Fail
  • Exam length: 352 questions
  • Time limit: 8 hours (7 blocks)
  • Exam fee: $675

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

COMLEX Level 1 Study Tips from Top Performers

1Master OMT fundamentals - viscerosomatic reflexes, Chapman points, and technique indications are high-yield
2Learn to identify somatic dysfunction patterns from clinical presentations
3Practice clinical vignettes that integrate OMT with standard medical management
4Focus on musculoskeletal anatomy - essential for both OMT and clinical reasoning
5Understand autonomic nervous system innervation patterns for viscerosomatic diagnosis
6Review cranial osteopathy basics - strain patterns, CRI, and common dysfunctions
7Use spaced repetition for OMT technique steps and contraindications

Frequently Asked Questions

How is COMLEX Level 1 different from USMLE Step 1?

COMLEX Level 1 uniquely integrates osteopathic manipulative treatment (OMT) principles throughout all clinical content areas. About 12% of the exam specifically covers OMT techniques including muscle energy, HVLA, counterstrain, cranial osteopathy, and viscerosomatic relationships. The exam also emphasizes osteopathic philosophy and the holistic approach to patient care that distinguishes DO training from MD training.

What is the COMLEX Level 1 pass rate?

First-time pass rates for US osteopathic medical students are approximately 92% (2024 data). The exam transitioned to Pass/Fail scoring in 2022, similar to USMLE Step 1. Pass rates may vary by osteopathic medical school and student preparation.

How many questions are on COMLEX Level 1?

The exam contains 352 multiple-choice questions divided into 7 blocks. Each block contains approximately 50 questions with a time limit per block. Total testing time is 8 hours including breaks.

What OMT topics are tested on COMLEX Level 1?

OMT content includes: muscle energy technique, high-velocity low-amplitude (HVLA), counterstrain, cranial osteopathy, Chapman points (viscerosomatic reflexes), myofascial release, lymphatic pump techniques, rib raising, balanced ligamentous tension, and osteopathic philosophy principles. Questions often require identifying somatic dysfunction patterns and selecting appropriate OMT techniques.

Do I need to take both COMLEX Level 1 and USMLE Step 1?

Historically, many osteopathic students took both exams for residency applications. However, since both exams transitioned to Pass/Fail scoring in 2022, the rationale for dual-testing has diminished. Many DO students now take only COMLEX Level 1, though some competitive specialties may still prefer or require USMLE scores. Check specific residency program requirements.

What is the best way to study for COMLEX Level 1?

Use COMLEX-specific question banks (e.g., TrueLearn COMLEX, UWorld with OMT focus) alongside standard USMLE resources. Master OMT principles including viscerosomatic relationships, Chapman points, and technique selection. Study in timed blocks to simulate exam conditions. Focus on integrated organ system review with osteopathic perspective.