Free COMLEX Level 3 Questions

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Our SmartBank is not a typical qbank. Our questions contain thorough answers and explanations to help improve your understanding of the material. We explain the correct answer, as well as why the others options were incorrect. They are designed to help prepare you for the COMLEX Level 3 exam and for your career.

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Your Free COMLEX Level 3 Question

A 66-year-old male electrician presents to the office with a 10-year history of neck pain. He describes a focal, achy pain toward the top of his neck that is worse with flexion. He admits to occasional headaches but denies any weakness or radiating pain. His past medical history is significant for hypertension. The patient’s vital signs are stable, and his neurological examination is unremarkable. Osteopathic structural examination reveals that his OA joint is restricted in translation to the left and becomes more restricted in a flexed position. The correct diagnosis for this somatic dysfunction is:

• A. extended, sidebent left, rotated left
• B. extended, sidebent left, rotated right
• C. extended, sidebent right, rotated right
• D. flexed, sidebent left, rotated right
• E. neutral, sidebent left, rotated right

The Answer and Explanation

Did you get it right? The correct answer is: B

This patient presents with neck pain and was found to have a restriction at the occipito-atlanto (OA) articulation that is worse in flexion and left-sided translation. Sidebending and rotation at the OA occur on opposite sides, coupled with either flexion or extension. In osteopathic manipulative medicine, this somatic dysfunction is correctly diagnosed as extended, sidebent left, rotated right. The OA articulation consists of the 2 occipital condyles with the superior articular facets of the atlas (C1). The primary motion of the OA joint is flexion and extension. Sidebending and rotation of the OA joint always occur in opposite directions, which shows type I-like mechanics but is not truly type I since Fryette laws do not apply to the cervical spine.

Translation to one side induces sidebending to the opposite side. In this case, the OA is restricted in translation to the left, indicating that the OA is resisting sidebending to the right; therefore, the position of ease is sidebending left. Remember that somatic dysfunctions are named for the freedom of motion. Since sidebending and rotation always occur in opposite directions at the OA joint, with sidebending to the left, the OA will be rotated to the right.

Finally, the restriction becomes worse in flexion, which indicates a position of ease in extension. Putting it all together, the somatic dysfunction is correctly diagnosed as extended, sidebent left, rotated right. 

The figure below depicts the sidebending motion.

Wrong Answer Explanations

Answer A:  Labeling the diagnosis as extended, sidebent left, rotated left is only partially correct. It is correct to label this somatic dysfunction as extended since it becomes worse in flexion, and extension is the position of ease. It is also correct to say that the OA joint is sidebent left. Since the OA joint is restricted in translation to the left, the freedom of motion is translation to the right. Translation to 1 side induces sidebending to the opposite side. Thus, right translation induces left-side bending. However, diagnosing the OA joint as being rotated left is incorrect. The OA joint follows type I-like mechanics: sidebending and rotation occur to opposite sides. Therefore, if the OA joint is sidebent left, it must be rotated right.

Answer C: Labeling the diagnosis as extended, sidebent right, rotated right is only partially correct. It is correct to label this somatic dysfunction as extended since it becomes worse in flexion, and extension is the position of ease. The OA, however, is not sidebent right. The patient’s OA joint is restricted in translation to the left, meaning the freedom of motion is translation to the right. Translation to 1 side induces sidebending to the opposite side. Thus, if the OA translates to the right, it will sidebend to the left. Since sidebending and rotation occur to opposite sides, the OA joint will be rotated to the right.

Answer D: Labeling the diagnosis as flexed, sidebent left, rotated right is only partially correct. This somatic dysfunction is correctly diagnosed as sidebent left, rotated right, as the OA joint follows type I-like mechanics, with rotation and sidebending always occurring in opposite directions. It is incorrect to state that the OA joint is flexed. Remember, somatic dysfunctions are named for the freedom of motion. The restriction of the OA joint becomes worse in flexion; thus, the position of ease must be extension.

Answer E: Labeling the diagnosis as neutral, sidebent left, rotated right is only partially correct. This somatic dysfunction is correctly diagnosed as sidebent left, rotated right, as the OA joint follows type I-like mechanics, with rotation and sidebending always occurring in opposite directions. However, this is not a neutral dysfunction because the patient’s OA joint became more restricted in a flexed position. The position of ease, therefore, is extension. Remember, this is type I-like; Fryette’s laws are not actually being followed in the cervical spine. Therefore, it is okay that a single segment that is extended is sidebent and rotated to opposite sides (as this seems to be a mix of Laws I and II).

Bottom Line: The occipito-atlanto joint follows type I-like mechanics, with sidebending and rotation occurring to opposite sides, coupled with either flexion or extension.

COMBANK Insight: Fryette laws describe the typical pattern of motion of vertebrae within the spine. Law I states that in a neutral position, sidebending and rotation will occur to opposite sides. This law typically applies to a group of vertebrae. Law II, which usually applies to a single vertebral segment, states that in a non-neutral position (either flexion or extension), rotation and sidebending will occur to the same side. Fryette laws I and II apply only to the thoracic and lumbar vertebrae, not the cervical vertebrae.

For more information, see:

• Savarese RG, Adesina AT, Capobianco J, Reed G. OMT Review: A Comprehensive Review in Osteopathic Medicine. 4th ed. OMT Publishing; 2020:chapters 1, 2.
• DiGiovanna EL, Amen CJ, Burns DK, eds. An Osteopathic Approach to Diagnosis and Treatment. 4th ed. Wolters Kluwer; 2020:chapter 4.

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