Preface

The purpose of this course is to prepare you to take and successfully pass the Comlex Level 3 examination for osteopathic students. This is a national examination, required as part as three separate exams, for entry into an accredited allopathic or osteopathic residency program after graduation from an osteopathic college. The goal is to allow the generalist in osteopathy to demonstrate their skills in patient assessment and management of patients based on what they have learned in osteopathic curricula and clinical rotations.

There are different domains on the examination that cover the areas of osteopathy, including OMT, health and wellness, human development and sexuality, neurology and mental health, endocrinology and metabolism, gastroenterology, pulmonology, cardiology and hematologic conditions, the musculoskeletal system, the genitourinary and renal system, and disorders of the integumentary system. Through the learned material and sample questions, your knowledge in these areas will be refreshed and your test-taking skills will be honed.

Prior to studying the material, we will talk about the examination itself and what it entails so you can be better prepared for the rigors of taking it. While taking this examination generally means you have already passed the Comlex Level 1 and Comlex Level 2 examination, this Comlex Level 3 examination has a slightly different focus and examination formats that will test your knowledge and skills in a unique way.

Chapter one in the course introduces osteopathic principles and practice, reminding you of the things you have learned about the direct and indirect techniques used in osteopathic clinical medicine. We will talk about the viscerosomatic reflex, Chapman reflex points, and Jones CS tender points and will review the different types of osteopathic manual treatment and musculoskeletal testing. The goal is to review the foundations of osteopathy as it is used in clinical situations.

The focus of chapter two is the various somatic dysfunctions that exist in the spine, including how these are best diagnosed and how they are managed through OMT.

Somatic dysfunctions of the cranium and spine manifest in several different ways so it takes skilled diagnostic skills and an understanding of the way these structures function under physiological conditions. The management is individualized to the specific somatic dysfunction, the details of which are covered in this chapter.

Chapter three in the course focuses on the fact that osteopathic principles and practice do not simply apply to the musculoskeletal system. Somatic dysfunctions exist in each of the body systems, some of which are explainable by the various viscerosomatic reflexes. Disorders related to the head and neck, heart, lungs, gastrointestinal tract, genitourinary system, pediatrics, obstetrics, and the hospitalized patient are covered as part of this chapter.

In chapter four, we talk about the different osteopathic treatments and techniques you will likely use in everyday practice. These are things learned at the bedside and in clinical rotations but may help jar your memory when you take the examination, especially as questions are asked about specific positioning recommendations and treatment options you will recommend as part of your clinical decision-making questions on the test. Things like cranial treatment, cervical treatment, management of all spinal OMT, extremity-related treatments, and therapies directed at the body as a whole will be explained in the chapter.

Chapter five in the course includes many aspects of the osteopathic physician’s role in community health, wellness issues, and end of life care. Many issues you will be asked to manage are not individual patient healthcare issues but are actually public health issues you may become involved in. A great deal of what you will do in the field of community health and wellness is education about disease risk factors, disease prevention, and health promotion. The Comlex-USA Level 3 examination will ask you about these issues and those things you as a practicing generalist should be able to identify and manage.

Chapter six covers the numerous issues dealing with normal and abnormal human development, including developmental delays in children, normal and abnormal sexual development, reproductive issues like contraceptive techniques, infertility, sexual dysfunction, normal obstetrical care, the care of high-risk pregnancies, pregnancy loss, labor and delivery, and congenital or acquired diseases of newborns. These issues

involve the care of men, women, neonates, and children as they apply to their development, sexuality, and reproductive issues and are important aspects of the primary care of patients of all ages.

The two main topics in chapter seven in the course are endocrine system disorders and issues related to metabolism. Metabolic issues can cause issues regarding a person’s height or weight, although there are endocrine problems that can affect height, which will be discussed. The two most common endocrine diseases seen in primary care are thyroid disorders and diabetes mellitus—both of which require both short-term and long-term management. In this chapter, we will also talk about hormonal evaluation of patients as they relate to the common and less common endocrine disorder you might encounter.

Chapter eight combines issues related to both the neurological system and psychiatry. The different psychiatric disorders frequently encountered in generalist practices include mood disorders, anxiety disorders, substance abuse disorders, schizophrenia, and adjustment disorders. Neurological diseases that are commonly seen and discussed in the chapter include the management of headaches, seizures, traumatic brain injuries, weakness, paralysis, and sleep disorders. These can be interrelated with similar symptoms that can often be evaluated and managed by the generalist in family medicine.

Chapter nine in the course mainly deals with the different musculoskeletal system complaints you will encounter as part of a generalist practice and talks about the allopathic approaches to musculoskeletal complaints. In the first part of the course, musculoskeletal issues from an osteopathic perspective will be discussed. You should also keep in mind, however, how these are evaluated and treated from an allopathic perspective so you can see where osteopathic principles and allopathic medicine can work together to help individuals with a variety of musculoskeletal disorders.

Chapter ten discusses the major presentations you will encounter related to the kidneys, other aspects of the genitourinary system in men and women, and the breasts. These include things like changes in the amount of urination, dysuria, hematuria, and urethral discharge as well as diseases of the penis, testes, and scrotum in men. Among women,

common symptoms discussed in the chapter include those related to pelvic floor relaxation, vaginal discharge, vaginal bleeding, pelvic pain, and breast symptoms.

The focus of chapter eleven in the course is gastrointestinal and nutritional health, which are interrelated topics. Patients can present with a variety of GI related symptoms, such as reflux, abdominal pain, jaundice, nausea and vomiting, GI bleeding, disorders of stool frequency, and anorectal disorders. The chapter also talks about the manifestations of the different types of common gastrointestinal cancers. Disorders related to the teeth and mouth are covered as well as swallowing difficulties. Finally, the chapter talks about the manifestations and treatment of hernias of the inguinal area and the abdominal wall.

Chapter twelve places a focus on disorders of the circulatory system and hematologic system, including their presentation. Patients can present with chest pain, palpitations, edema, dyspnea or orthopnea, as well as symptoms suggestive of chest trauma. Hematologic diseases can involve disorders of excessive bleeding, excessive clotting, or lymphadenopathy, which are also discussed as part of this chapter. Most of the treatment of these diseases depend on a solid understanding of how these are treated allopathically.

Chapter thirteen in the course covers patient presentations related to ENT diseases and respiratory illnesses. Common complaints you will encounter include things like cough, nasal congestion, dyspnea, ear pain, ear discharge, and sore throat. Related signs you might uncover include pallor and cyanosis, which are also discussed in this chapter. Head and neck as well as lung cancer is covered so you know how to recognize these things and how to participate in their treatment.

The focus of chapter fourteen is the recognition, workup, and management of skinrelated diseases. This includes disorders related to the hair and scalp, nail disorders, skin ulcerations, rashes, and pigment diseases. Common skin complaints are also covered, such as pruritis and urticaria, which can also be a part of angioedema. Burn management, would care, and the management of bites, skins, and infestations are all a part of this chapter.