Page 1 of 147
COMLEX Level 1 (Form 110) Exam ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT ANSWERS LATEST UPDATE THIS
YEAR
Summarized Exam Coverage – COMLEX Level 1 (Form 110)
Exam Structure: he content is divided into physician tasks (60%), osteopathic principles (10%), and basic
science disciplines (30%) .
Osteopathic Principles & Practice (10%)
• Somatic dysfunction (TART: tenderness, asymmetry, range of motion, tissue texture changes)
• Chapman’s reflexes (anterior/posterior, e.g., parasympathetic vs. sympathetic)
• Fryette’s principles (Type I / Type II mechanics)
• Myofascial release, muscle energy, counterstrain, high-velocity/low-amplitude (HVLA)
• Viscerosomatic and somatovisceral reflexes
Basic Sciences (30%)
• Anatomy (neuroanatomy, cardiopulmonary, GI, MSK)
• Biochemistry (enzyme kinetics, metabolism, genetics)
• Microbiology (bacterial classification, viral replication, fungal infections)
• Immunology (humoral/cell-mediated immunity, complement, cytokines)
• Pathology (neoplasia, inflammation, cell injury)
• Pharmacology (drug mechanisms, side effects, interactions)
• General principles of pharmacodynamics/pharmacokinetics
Physician Tasks (60%)
• Clinical presentation (symptom to diagnosis)
• Diagnostic imaging and laboratory studies
• Differential diagnosis
• Pharmacotherapeutics
• Disease prevention and health maintenance
Select High-Yield Topics Tested on Form 110
• Dysrhythmias (ECGs: atrial fib, SVT, V-tach)
• Valvular heart disease (aortic stenosis, mitral regurgitation)
• Shock types (distributive, cardiogenic, hypovolemic)
• Cranial nerves and brainstem lesions
• Diabetes mellitus (Type 1 vs. Type 2, DKA management)
• Bacterial toxins (tetanospasmin, botulinum toxin, exotoxins)
• Osteopathic manipulation for rib dysfunction, sacral torsion, and cervical somatic dysfunction
• Chapman’s reflex locations (e.g., anterior/mid-clavicular for sinusitis, inferior angle of scapula
for pleurisy)
• Fryette’s principles for spinal motion (neutral vs. non-neutral mechanics)
.
, Page 2 of 147
1. A 45-year-old man with a history of alcohol use disorder presents with hematemesis, jaundice, and
confusion. Laboratory studies show elevated ammonia, AST, ALT, and bilirubin. Which cell type is
directly responsible for the metabolism of ammonia that is impaired in this condition?
A) Hepatocytes in the periportal zone
B) Kupffer cells
C) Stellate (Ito) cells
D) Cholangiocytes
Answer: A – Periportal hepatocytes contain glutamine synthetase and the urea cycle enzymes that
metabolize ammonia. Advanced cirrhosis disrupts these cells, leading to hyperammonemia.
2. A 6-year-old boy presents with acute onset of stridor, drooling, and a “hot potato” voice. He is sitting
upright and leaning forward. What is the most appropriate next step in management?
A) Visual inspection of the oropharynx using a tongue depressor
B) Lateral neck X-ray
C) Immediate administration of intramuscular ceftriaxone
D) Prepare for emergency airway management and do not agitate the child
, Page 3 of 147
Answer: D – The presentation is highly concerning for epiglottitis (usually H. influenzae type B).
Manipulation of the airway (e.g., tongue depressor) can precipitate complete obstruction. Airway
security is the priority.
3. A 32-year-old woman presents with episodic palpitations, sweating, headache, and hypertension. A
24-hour urine test shows elevated levels of normetanephrine and metanephrine. Which imaging study is
most appropriate to localize the source of these findings?
A) CT of the chest, abdomen, and pelvis with intravenous contrast
B) MRI of the brain with gadolinium
C) Ultrasound of the neck
D) Octreotide scan
Answer: A – Elevated metanephrines/normetanephrines indicate a pheochromocytoma. CT of the
abdomen (adrenal region) is the first-line imaging modality to locate the tumor.
4. A 22-year-old woman with systemic lupus erythematosus presents with pleuritic chest pain, shortness
of breath, and a friction rub on auscultation. She is diagnosed with pericarditis. Which osteopathic
manipulative treatment (OMT) technique is contraindicated in the presence of a friction rub?
A) Rib raising
, Page 4 of 147
B) Thoracic inlet myofascial release
C) High-velocity/low-amplitude (HVLA) thrust to the thoracic spine
D) Suboccipital decompression
Answer: C – Acute pericarditis is an inflammatory condition with a friction rub. HVLA thrust is
contraindicated in acute inflammatory conditions due to risk of exacerbating inflammation and pain.
5. A 58-year-old man presents with a 2-month history of fatigue, unintentional weight loss, and a new
diagnosis of normocytic anemia. Physical examination reveals splenomegaly and a platelet count of
850,000/μL. Which laboratory finding is most specific for the underlying disorder?
A) Positive direct Coombs test
B) JAK2 V617F mutation
C) Elevated serum ferritin
D) Positive anti-nuclear antibody (ANA)
Answer: B – The triad of splenomegaly, normocytic anemia, and thrombocytosis suggests
myeloproliferative disorder. JAK2 V617F mutation is present in ~95% of polycythemia vera and many
cases of essential thrombocythemia and primary myelofibrosis.
COMLEX Level 1 (Form 110) Exam ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT ANSWERS LATEST UPDATE THIS
YEAR
Summarized Exam Coverage – COMLEX Level 1 (Form 110)
Exam Structure: he content is divided into physician tasks (60%), osteopathic principles (10%), and basic
science disciplines (30%) .
Osteopathic Principles & Practice (10%)
• Somatic dysfunction (TART: tenderness, asymmetry, range of motion, tissue texture changes)
• Chapman’s reflexes (anterior/posterior, e.g., parasympathetic vs. sympathetic)
• Fryette’s principles (Type I / Type II mechanics)
• Myofascial release, muscle energy, counterstrain, high-velocity/low-amplitude (HVLA)
• Viscerosomatic and somatovisceral reflexes
Basic Sciences (30%)
• Anatomy (neuroanatomy, cardiopulmonary, GI, MSK)
• Biochemistry (enzyme kinetics, metabolism, genetics)
• Microbiology (bacterial classification, viral replication, fungal infections)
• Immunology (humoral/cell-mediated immunity, complement, cytokines)
• Pathology (neoplasia, inflammation, cell injury)
• Pharmacology (drug mechanisms, side effects, interactions)
• General principles of pharmacodynamics/pharmacokinetics
Physician Tasks (60%)
• Clinical presentation (symptom to diagnosis)
• Diagnostic imaging and laboratory studies
• Differential diagnosis
• Pharmacotherapeutics
• Disease prevention and health maintenance
Select High-Yield Topics Tested on Form 110
• Dysrhythmias (ECGs: atrial fib, SVT, V-tach)
• Valvular heart disease (aortic stenosis, mitral regurgitation)
• Shock types (distributive, cardiogenic, hypovolemic)
• Cranial nerves and brainstem lesions
• Diabetes mellitus (Type 1 vs. Type 2, DKA management)
• Bacterial toxins (tetanospasmin, botulinum toxin, exotoxins)
• Osteopathic manipulation for rib dysfunction, sacral torsion, and cervical somatic dysfunction
• Chapman’s reflex locations (e.g., anterior/mid-clavicular for sinusitis, inferior angle of scapula
for pleurisy)
• Fryette’s principles for spinal motion (neutral vs. non-neutral mechanics)
.
, Page 2 of 147
1. A 45-year-old man with a history of alcohol use disorder presents with hematemesis, jaundice, and
confusion. Laboratory studies show elevated ammonia, AST, ALT, and bilirubin. Which cell type is
directly responsible for the metabolism of ammonia that is impaired in this condition?
A) Hepatocytes in the periportal zone
B) Kupffer cells
C) Stellate (Ito) cells
D) Cholangiocytes
Answer: A – Periportal hepatocytes contain glutamine synthetase and the urea cycle enzymes that
metabolize ammonia. Advanced cirrhosis disrupts these cells, leading to hyperammonemia.
2. A 6-year-old boy presents with acute onset of stridor, drooling, and a “hot potato” voice. He is sitting
upright and leaning forward. What is the most appropriate next step in management?
A) Visual inspection of the oropharynx using a tongue depressor
B) Lateral neck X-ray
C) Immediate administration of intramuscular ceftriaxone
D) Prepare for emergency airway management and do not agitate the child
, Page 3 of 147
Answer: D – The presentation is highly concerning for epiglottitis (usually H. influenzae type B).
Manipulation of the airway (e.g., tongue depressor) can precipitate complete obstruction. Airway
security is the priority.
3. A 32-year-old woman presents with episodic palpitations, sweating, headache, and hypertension. A
24-hour urine test shows elevated levels of normetanephrine and metanephrine. Which imaging study is
most appropriate to localize the source of these findings?
A) CT of the chest, abdomen, and pelvis with intravenous contrast
B) MRI of the brain with gadolinium
C) Ultrasound of the neck
D) Octreotide scan
Answer: A – Elevated metanephrines/normetanephrines indicate a pheochromocytoma. CT of the
abdomen (adrenal region) is the first-line imaging modality to locate the tumor.
4. A 22-year-old woman with systemic lupus erythematosus presents with pleuritic chest pain, shortness
of breath, and a friction rub on auscultation. She is diagnosed with pericarditis. Which osteopathic
manipulative treatment (OMT) technique is contraindicated in the presence of a friction rub?
A) Rib raising
, Page 4 of 147
B) Thoracic inlet myofascial release
C) High-velocity/low-amplitude (HVLA) thrust to the thoracic spine
D) Suboccipital decompression
Answer: C – Acute pericarditis is an inflammatory condition with a friction rub. HVLA thrust is
contraindicated in acute inflammatory conditions due to risk of exacerbating inflammation and pain.
5. A 58-year-old man presents with a 2-month history of fatigue, unintentional weight loss, and a new
diagnosis of normocytic anemia. Physical examination reveals splenomegaly and a platelet count of
850,000/μL. Which laboratory finding is most specific for the underlying disorder?
A) Positive direct Coombs test
B) JAK2 V617F mutation
C) Elevated serum ferritin
D) Positive anti-nuclear antibody (ANA)
Answer: B – The triad of splenomegaly, normocytic anemia, and thrombocytosis suggests
myeloproliferative disorder. JAK2 V617F mutation is present in ~95% of polycythemia vera and many
cases of essential thrombocythemia and primary myelofibrosis.
