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Exam Review

Key Facts: COMLEX Level 1 Exam

352

Total Questions

NBOME 2026

92%

First-Time Pass Rate

NBOME 2024

Total Testing Time

NBOME

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.

Sample COMLEX Level 1 Practice Questions

Try these sample questions to review concepts for the COMLEX Level 1 exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 240+ question experience with AI tutoring.

1Which osteopathic principle states that structure and function are reciprocally interrelated?

A.The body is capable of self-regulation and self-healing

B.Structure and function are reciprocally interrelated

C.The body possesses an inherent ability to heal itself

D.Rational treatment is based upon these principles

Explanation: The second osteopathic principle states that structure and function are reciprocally interrelated. This means that changes in anatomical structure will affect function, and alterations in function can eventually affect structure. This principle guides osteopathic physicians in their diagnostic and therapeutic approach.

2During OMT for a patient with a flexed, rotated, and side-bent thoracic vertebra, which muscle energy technique position is correct?

A.Extend, rotate toward, and side-bend toward the restriction

B.Flex, rotate away from, and side-bend away from the restriction

C.Flex, rotate toward, and side-bend toward the restriction

D.Extend, rotate away from, and side-bend toward the restriction

Explanation: In muscle energy technique for a Type II somatic dysfunction (a single flexed, rotated, and side-bent thoracic vertebra), the patient is positioned into the restrictive barrier (flexion, rotation toward, and side-bending toward) to engage the restricted tissues. The patient then contracts the appropriate muscles against a counterforce.

3What is the primary purpose of rib raising technique in osteopathic manipulative medicine?

A.To decrease sympathetic tone and improve lymphatic drainage

B.To increase parasympathetic tone to the lungs

C.To mobilize the costovertebral joints directly

D.To treat primary respiratory dysfunction

Explanation: Rib raising technique primarily works by decreasing sympathetic tone through manipulation of the costotransverse articulations. This also improves thoracic lymphatic drainage, which can be beneficial in patients with pulmonary conditions, upper respiratory infections, or conditions involving lymphatic congestion.

4A patient has tenderness at the anterior Chapman reflex point in the left 5th intercostal space near the sternocostal junction. Which organ is most likely associated with this finding?

A.Stomach

B.Liver

C.Kidney

D.Small intestine

Explanation: Anterior Chapman points for the stomach are located in the left 5th intercostal space (acidity) and left 6th intercostal space (peristalsis) near the sternocostal junction. Posterior stomach points are found at the left T5-T7 intertransverse spaces. The liver is on the right 5th intercostal space.

5In cranial osteopathy, which cranial strain pattern is characterized by one sphenobasilar synchondrosis (SBS) superior and the other inferior?

A.Torsion

B.Side-bending rotation

C.Vertical strain

D.Lateral strain

Explanation: Vertical strain patterns occur when one side of the SBS moves superior and the other inferior, creating a vertical shearing force. In superior vertical strain, the basilar portion moves superior; in inferior vertical strain, it moves inferior. This differs from torsion (opposite rotation), side-bending rotation (coupled movements), and lateral strain (side-to-side translation).

6Which layer of fascia is directly manipulated during the fascial release technique known as "unwinding"?

A.Superficial fascia only

B.Deep fascia only

C.All fascial layers following the path of least resistance

D.Periosteal fascia only

Explanation: Fascial unwinding is a technique that engages all layers of fascia following the path of least resistance. The practitioner follows the tissue in the direction it naturally releases, allowing the body to "unwind" accumulated strain patterns. This technique respects the interconnected nature of fascial tissue throughout the body.

7A 45-year-old man presents with low back pain that radiates down the posterior thigh to the lateral foot. Straight leg raise test is positive at 30 degrees. Which nerve root is most likely affected?

A.L3

B.L4

C.L5

D.S1

Explanation: S1 radiculopathy typically presents with pain radiating down the posterior thigh and lateral foot. The straight leg raise test that is positive at less than 40 degrees strongly suggests nerve root compression. L4 would affect the anterior thigh and medial leg, while L5 would affect the lateral leg and great toe.

8Which muscle is the primary hip flexor and is often tight in patients with anterior pelvic tilt?

A.Rectus femoris

B.Iliopsoas

C.Sartorius

D.Tensor fasciae latae

Explanation: The iliopsoas (comprising psoas major and iliacus) is the primary hip flexor. When chronically tight, it pulls the lumbar spine into hyperlordosis and the pelvis into anterior tilt. This common postural dysfunction can contribute to low back pain and altered biomechanics.

9A patient presents with pain over the lateral epicondyle of the humerus that worsens with resisted wrist extension. What is the most likely diagnosis?

A.Medial epicondylitis

B.Lateral epicondylitis

C.Olecranon bursitis

D.Radial tunnel syndrome

Explanation: Lateral epicondylitis (tennis elbow) is characterized by pain over the lateral epicondyle, tenderness to palpation, and pain with resisted wrist extension or passive wrist flexion. It involves the common extensor origin, particularly the extensor carpi radialis brevis.

10In the diagnosis of rotator cuff tears, which physical examination finding has the highest specificity?

A.Positive painful arc test

B.Weakness with external rotation

C.Positive drop arm test

D.Pain with impingement testing

Explanation: The drop arm test (inability to slowly lower the arm from 90 degrees abduction) has high specificity for a full-thickness rotator cuff tear, particularly involving the supraspinatus. While other tests may suggest impingement or tendinopathy, the drop arm test specifically indicates structural failure of the rotator cuff.

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.

Exam sponsor: NBOME (National Board of Osteopathic Medical Examiners). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

352 questions

Time Limit

8 hours (7 blocks)

Passing Score

Pass/Fail

Exam / Certification Fees

$675

Exam sponsor website

Reported exam pass rate: 92%. first-time pass rate for US osteopathic medical students (2024) This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

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

Endocrine & Metabolism

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

Genitourinary & Renal

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

Human Development & Reproduction

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

Patient Care & Competencies

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

Practice-Based Learning

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

Interpersonal Communication

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

Professionalism

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

Systems-Based Practice

Healthcare delivery, resource allocation, interprofessional teams, population health

Preparing for 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 / certification fees: $675 Official sources

Using Our Practice Resources

Work through all 240 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

COMLEX Level 1: Suggested Study Strategy

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.