COMLEX LEVEL 2 PRACTICE EXAM
(CLINICAL KNOWLEDGE + CLINICAL SKILLS)
Format: MCQ | Correct Answers Bolded | Rationales Included
Question 1:
A 25-year-old female presents with right lower quadrant pain for 12 hours,
nausea, and low-grade fever. McBurney's point is tender. Which is the most
appropriate next step?
A. Pelvic ultrasound
B. CT abdomen and pelvis with contrast
C. Laparoscopy
D. Colonoscopy
Rationale: CT with contrast is the gold standard for diagnosing appendicitis in
nonpregnant adults. Pelvic ultrasound is preferred in pregnant patients.
Question 2:
A 55-year-old male with poorly controlled diabetes presents with foot pain,
erythema, and a foul-smelling discharge. X-ray shows gas in soft tissues. What is
the next best step?
,A. IV antibiotics alone
B. Surgical debridement and IV antibiotics
C. Hyperbaric oxygen therapy
D. Oral clindamycin
Rationale: Gas gangrene (clostridial myonecrosis) requires emergent surgical
debridement in addition to broad-spectrum IV antibiotics.
Question 3:
During an osteopathic structural exam, a patient has a left transverse process at
T4 that is posterior and asymmetrical with worse asymmetry on extension.
Diagnosis?
A. T4 ERS left
B. T4 FRS left
C. T4 ERS right
D. T4 FRS right
Rationale: Findings suggest flexed, rotated, and sidebent left. Posterior transverse
process indicates rotation.
Question 4:
A 45-year-old man has crushing chest pain radiating to his left arm. EKG shows ST
elevations in leads II, III, and aVF. What's the culprit artery?
A. LAD
B. Circumflex
, C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior wall MI involves leads II, III, and aVF, which are typically
supplied by the right coronary artery (RCA).
Question 5:
Which osteopathic technique is contraindicated in an acutely hospitalized patient
with rib fracture and shallow breathing?
A. Rib raising
B. High-velocity low-amplitude (HVLA)
C. Muscle energy
D. Myofascial release
Rationale: HVLA is contraindicated in rib fractures due to risk of worsening injury.
Other techniques are gentler and appropriate.
Question 6:
A 30-year-old woman presents with bilateral wrist pain, morning stiffness >1
hour, and joint swelling. What is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Rheumatoid arthritis
D. Pseudogout
(CLINICAL KNOWLEDGE + CLINICAL SKILLS)
Format: MCQ | Correct Answers Bolded | Rationales Included
Question 1:
A 25-year-old female presents with right lower quadrant pain for 12 hours,
nausea, and low-grade fever. McBurney's point is tender. Which is the most
appropriate next step?
A. Pelvic ultrasound
B. CT abdomen and pelvis with contrast
C. Laparoscopy
D. Colonoscopy
Rationale: CT with contrast is the gold standard for diagnosing appendicitis in
nonpregnant adults. Pelvic ultrasound is preferred in pregnant patients.
Question 2:
A 55-year-old male with poorly controlled diabetes presents with foot pain,
erythema, and a foul-smelling discharge. X-ray shows gas in soft tissues. What is
the next best step?
,A. IV antibiotics alone
B. Surgical debridement and IV antibiotics
C. Hyperbaric oxygen therapy
D. Oral clindamycin
Rationale: Gas gangrene (clostridial myonecrosis) requires emergent surgical
debridement in addition to broad-spectrum IV antibiotics.
Question 3:
During an osteopathic structural exam, a patient has a left transverse process at
T4 that is posterior and asymmetrical with worse asymmetry on extension.
Diagnosis?
A. T4 ERS left
B. T4 FRS left
C. T4 ERS right
D. T4 FRS right
Rationale: Findings suggest flexed, rotated, and sidebent left. Posterior transverse
process indicates rotation.
Question 4:
A 45-year-old man has crushing chest pain radiating to his left arm. EKG shows ST
elevations in leads II, III, and aVF. What's the culprit artery?
A. LAD
B. Circumflex
, C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior wall MI involves leads II, III, and aVF, which are typically
supplied by the right coronary artery (RCA).
Question 5:
Which osteopathic technique is contraindicated in an acutely hospitalized patient
with rib fracture and shallow breathing?
A. Rib raising
B. High-velocity low-amplitude (HVLA)
C. Muscle energy
D. Myofascial release
Rationale: HVLA is contraindicated in rib fractures due to risk of worsening injury.
Other techniques are gentler and appropriate.
Question 6:
A 30-year-old woman presents with bilateral wrist pain, morning stiffness >1
hour, and joint swelling. What is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Rheumatoid arthritis
D. Pseudogout
