What are the only two OMM question formats on COMLEX?

According to the National Board of Osteopathic Medical Examiners’s (NBOME) blueprint for COMLEX, it is estimated that Osteopathic principles comprises about 15-30% of the exam, depending on which form you are given. Now, as anyone who has taken COMLEX will tell you, 30% of the exam is not actually pure OMM questions, this percentage takes into account two types of questions that test osteopathic principles, the pure OMM questions and the integrated OMM questions.

Pure Osteopathic Principles / OMM Questions

Pure OMM questions are what most students think about when they imagine being tested on osteopathic principles. These questions will only evaluate your understanding of osteopathic practice without incorporating other areas of traditional or general medicine. If you have subscribed to our osteopathic medicine video course and followed along each video by completing the associated worksheets and anki deck then these questions will be very simple and easy for you to answer as almost every pure OMM concept is covered amongst these resources. Now let’s take a look at an example of a pure OMM question:

“A man presents to the clinic for evaluation of lower back pain. On examination you note that C7 is flexed, sidebent right, rotated left. What would be the appropriate positioning for this patient when treating him with muscle energy?”

As you can see this question is solely evaluating your understanding of osteopathic treatment techniques and not the broader concept of back pain or other areas of general medicine.

Integrated Osteopathic Principles / OMM Questions

The second type of OMM question you will encounter on your COMLEX exams is the integrated OMM question format. These questions tend to be more challenging and incorporate both osteopathic principles and general medicine. This question format also tends to have very lengthy stems, most of which information is not needed to answer the question, which is why we would suggest you determine if you can answer the question by just reading the last 1-2 sentences of the stem to save you time. Then if you have time at the end of the block you can go back to these length questions and review the entire stem and determine if your answer is still correct. A typical integrated OMM question will look something like this:

“A man presents to the clinic for evaluation of lower back pain. He states that the pain first started after a seven hour long car ride he had for his daughter’s college graduation ceremony. The pain radiates to the back of his leg and is dull in nature. He has had a similar episode several months earlier after a long flight to the Bahamas for vacation. On examination you note that C7 is flexed, sidebent right, rotated left. There is a positive straight leg raise test. A Chapman’s point in noted in the right sixth intercostal space. He denies any other complaints of pain. Which of the following is the most likely cause of this patient’s back pain?”

A.     Herniated disc

B.     Sciatic nerve irritation

C.     Gallstones

D.    Vertebral compression fracture

E.     Somatic symptom disorder

In the scenario above the most likely answer is B, commonly known as sciatica. Note that the stem is much longer than the pure OMM question stem and requires knowledge of both OMM and general medicine. While knowing the chapman’s point that correlates with the 6th intercostal space on the right is not technically required to answer this question it is helpful and could be a clue. A chapman’s point in this area correlates to the liver and gallbladder which could be a possible item on the differential diagnosis had the stem not said he has no other complaints.

Now let’s look at one final case:

“A man presents to the clinic for evaluation of swelling and shortness of breath. He states his symptoms have gradually developed over the course of a year and appear to be slowly progressing. On exam you note that the patient has pitting edema of the lower extremities bilaterally and a mild, yet noticeable cough at rest. His abdomen is mildly enlarged but the exam is limited due to enlarged body habitus. Osteopathic exam reveals C7 is flexed, sidebent right, rotated left and a Chapman’s point is noted at the 2nd intercostal space. Which of the following is the most likely cause of this patient’s symptoms?”

A.     Cirrhosis

B.     Heart Failure

C.     Gallstones

D.    Pneumonia

E.     Sinusitis

The best answer, for this somewhat vague question, is B, heart failure. While we admit this question is vague and arguably incomplete these are the types of questions the COMLEX uses to determine if you can incorporate general medicine concepts with osteopathic medicine concepts. After reviewing the stem there are 2 viable questions that you should be deciding between and those are answer choices A & B. Cirrhosis and heart failure tend to share many common symptoms due to fluid overload as we see in this patient. In real practice it would be almost impossible to diagnose this patient without more history (i.e. alcohol intake history, signs of jaundice, prior medical history, IV drug use, current medication list, and so on…) or labs. This is where understanding the osteopathic findings can serve as a tie breaker between two possible answer choices. A Chapman’s point at the second intercostal space correlates to the area for the heart, which now gives us another reason to choose heart failure as our answer.

Now as a former student and current teacher I do not like asking these questions any more than you like answering them, but unfortunately this is the vague format that COMLEX examiners use on COMLEX and therefore a format you need to be able to decipher. Use all of the clues available to you, and when in doubt go with your first instinct as it is usually the right answer. Best of luck and happy studying!

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