COMLEX Level 1 Board Review Questions and Practice Tests

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“BoardVitals offers well-written practice questions with highly detailed explanations that help students review for Step 1. Even going over wrong answers helps students learn high-yield associations so that they know what key information to look for on the real exam and won’t get questions like those wrong in the future. BoardVitals offers both a tutor/review mode and a timed test mode to give students flexibility in practicing for the exam. BoardVitals makes it easy to study at your own pace. ”

Jess U.
Medical Student

gold key Key Board Review Features


COMLEX Level 1 Board Review Topics Covered:

  • Pharmacology
  • Immune System
  • Biochemistry and Molecular Biology
  • Biology of Cells
  • Human Development and Genetics
  • Multisystem Processes (Nutrition, Physiology, Fluids, Metabolic)
  • Microbial Biology and Infection
  • Hematopoietic and Lymphoreticular Systems
  • Central and Peripheral Nervous Systems
  • Musculoskeletal System
  • Respiratory System
  • Renal/Urinary System
  • Endocrine System
  • Genitourinary System and Human Sexuality
  • Digestion and Metabolism
  • Circulation and Cardiovascular System
  • Skin, Hair and Nails
  • Biostatistics & Epidemiology
  • Cognition, Behavior, Substance Abuse, and Pain
  • Pathology
  • Osteopathic Manipulative Treatment
  • Health Care Delivery Issues

Information about the COMLEX Level 1

As outlined by the NBOME, the COMLEX Level 1 is a problem-based and symptom-based assessment, administered in a timed environment.

Passing this exam means the candidates has demonstrated competence in the foundational biomedical sciences and osteopathic principles as required to solve clinical problems in the supervised clinical practice setting and to prepare for lifelong learning.

What topics are covered on the COMLEX Level 1?

According to the COMLEX-USA Examination Blueprint, the exam covers the following topics:

Dimension 1: Patient Presentation

  • Population Health Concepts and Patients with Presentations Related to Health Promotion, Chronic Disease Management, and Human Development 8 - 16%
  • Patients With Presentations Related to Digestion and Metabolism 4 - 10%
  • Patients With Presentations Related to Cognition, Behavior, Sensory & Central Nervous Systems, Substance Abuse, and Visceral and Sensory Pain 28 - 38%
  • Patients With Presentations Related to the Musculoskeletal System, including Somatic Pain 6 - 12%
  • Patients With Presentations Related to the Genitourinary System and Human Sexuality 3 - 8%
  • Patients With Presentations Related to Circulation and the Respiratory System 8 - 16%
  • Patients With Presentations Related to Thermoregulation 2 - 6%
  • Patients With Presentations Related to Trauma, Masses, Edema, Discharge, and the Skin, Hair and Nails 8 - 16%
  • Patients With Presentations Related to Pregnancy, the Peripartum, and the Neonatal Period 3 - 8%

Dimension 2: Physician Tasks

  • Health Promotion & Disease Prevention 1 - 5%
  • History & Physical Examination 5 - 15%
  • Diagnostic Technologies 1 - 5%
  • Management 2 - 7%
  • Scientific Understanding of Health & Disease Mechanisms 70 - 85%
  • Health Care Delivery Issues 1 - 3%

How long is the COMLEX Level 1?

The COMLEX Level 1 is a one-day exam delivered in two 4-hour sessions, containing a total of 400 test questions predominantly in single best answer, multiple choice or extended matching item formats, with some novel test items involving audio-visual components designed to assess an expanded physician competency subset.

Examples of question formats can be found under Practice Examinations.

COMLEX Tips and Tricks

Level 1 is typically given to 2nd year Osteopathic Medical Students. While each exam has slight variations, we have heard that Neuro and Psychiatric Pharm are heavily tested. OMM questions tend to be on the easier side. Several students that we have talked to struggled with the ‘data gathering’ section… this probably is one area where rote memorization is advised.

It’s important to understand that COMLEX is not a combination of USMLE and OMT – the scoring is completely different and the questions are a little more ‘murky’ than the more straightforward approach of the USMLE exams. Your study time should be focused on working through these types of questions instead of just memorizing facts. You should be using practice questions to drive the study focus, and always study the answer options as well. (We’ve spent a significant amount of time writing out explanations for incorrect answers for a reason – it really helps!)

All in all, BoardVitals is a pretty challenging question bank. Students that score over 50% on our COMLEX question bank tend to do very well on the real exam. We’ve focused on really teaching the key concepts. Just make sure to flag problematic questions that you can go back to the week before the exam. Good luck!