Viscerosomatic reflexes (VSR’s) account for up to 20% of Osteopathic Manipulative Treatment questions for COMLEX examinations [1]. While VSR’s for the head and neck (T1-4), heart (T1-4), and respiratory tract (T2-7) may make intuitive sense for most DO students, the rest of the visceral organs and corresponding spinal level are easy to confuse. However, these points can be easily memorized with a little effort in order to boost COMLEX Level 1 scores.

Savarese’s OMT Review (“the green book”) provides a chart of all the relevant VSR’s that can be tested on the COMLEX (3rd edition, chapter 10), but there is a better way to ensure you are maximizing your OMT section points on test day: SLP SKU BLP.

What does SLP SKU BLP mean exactly? Besides the delirious ramblings of second-year deep in board preparation, SLP SKU BLP is a mnemonic I used to increase scores on the OMT portion of my COMLEX Level 1 exam. Each of the letters represents a visceral organ which is linked to spinal cord levels that innervate that viscera. The following table highlights the relationship between these organs and their spinal levels:

Abbreviation Upper Level Lower Level Visceral Organ
S 5 9 Stomach/foregut
L 6 9 Liver
P 5 11 Pancreas
S 9 11 Small intestine/midgut
K 10 11 Kidneys
U 10 2 Uterus
B 11 2 Bladder
L 11 2 Lower extremity/penis
P 12 2 Prostate/hindgut


In this table, VSR’s are thoracic levels except for the “2”s which are lumbar levels. For example, liver VSR’s will be T6-9 while prostate VSR’s are T12-L2. An easier way to remember this chart is [SLP SKU BLP] [5/6/5 9/10/10 11/11/12] [9/9/11 11/11/2 2/2/2]. The first bracket being abbreviations, the second bracket being upper levels, and the lower bracket being lower levels.

How can this table be used to boost COMLEX scores? Before my practice and real COMLEX Level 1 exam, I practiced writing down the table memory 10-15 times for a 2-3 days before the exam. The morning before my actual COMLEX Level 1, I went to a coffee shop and practiced writing the table again 5 times on a napkin (see said napkin here). Fairly confident I had memorized the table by this point, I went into the test and wrote out the table from memory on my scratch paper during my first question set. While this took 2-3 minutes away from my first set of questions, having the table right in front of me throughout the test proved invaluable as I could reference my scratch paper anytime a question with VSR’s appeared.

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Other high-yield VSR’s: head and neck T1-T4, heart T1-T5, respiratory tract T2-T7.

Hat tip to COMQUEST for the study tip that this memorization tool was developed from. For COMLEX Level 1 preparation, I highly recommend COMQUEST question bank as a supplemental bank for students to become familiar with COMLEX style questions.

What strategies do you use to learn viscerosomatics for the COMLEX? Let me know in the comments below.

[Featured image via flickr user Christopher]


  1. Savarese, Robert G., and John D. Capobianco. OMT Review: A Comprehensive Review in Osteopathic Medicine. 3rd ed. [Savarese], 2003. Print.