COMLEX-USA Level 2-CE practice exam
Questions With Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 56-year-old man presents with sudden chest pain radiating to
his left arm. ECG shows ST-segment elevations in leads II, III, and
aVF. What is the most appropriate immediate management?
A. Oral aspirin
B. Immediate percutaneous coronary intervention (PCI)
C. Oral beta-blocker
D. Intravenous nitroglycerin
Rationale: Immediate PCI is the treatment of choice for acute ST-
elevation myocardial infarction (STEMI) to restore coronary blood
flow.
2. A 22-year-old woman presents with fever, sore throat, and
posterior cervical lymphadenopathy. Monospot test is positive.
Which of the following is most appropriate?
A. Amoxicillin
B. Supportive care
C. Ciprofloxacin
D. Corticosteroids
Rationale: Infectious mononucleosis is viral; treatment is supportive.
Antibiotics like amoxicillin can cause rash.
, 3. A patient with type 1 diabetes presents with polyuria, polydipsia,
and fruity breath. Blood glucose is 540 mg/dL. What is the next
step?
A. Oral hypoglycemics
B. Intravenous fluids and insulin
C. Subcutaneous insulin only
D. Observation
Rationale: This is diabetic ketoacidosis (DKA); treatment includes IV
fluids, insulin, and electrolyte management.
4. A 45-year-old male has right upper quadrant pain and jaundice.
Ultrasound shows gallstones with common bile duct dilation. Most
likely diagnosis?
A. Acute cholecystitis
B. Choledocholithiasis
C. Hepatitis A
D. Pancreatitis
Rationale: CBD dilation with gallstones suggests choledocholithiasis,
often requiring ERCP.
5. A 30-year-old woman presents with chronic fatigue, hair loss, and
cold intolerance. Labs show TSH 8.5 mIU/L, free T4 low. Next best
step?
A. Ultrasound thyroid
B. Start levothyroxine therapy
C. Methimazole
D. Radioactive iodine therapy
Rationale: Primary hypothyroidism indicated by elevated TSH and low
free T4; treatment is levothyroxine.
, 6. A 60-year-old smoker has hematuria and flank pain. Imaging
shows a mass in the right kidney. Most likely diagnosis?
A. Renal cyst
B. Renal cell carcinoma
C. Nephrolithiasis
D. Pyelonephritis
Rationale: Painless hematuria in a smoker with renal mass is classic
for renal cell carcinoma.
7. A 72-year-old man presents with sudden right-sided weakness and
slurred speech. CT shows no hemorrhage. Best next step?
A. Aspirin only
B. Tissue plasminogen activator (tPA) if within window
C. Observation
D. Statin therapy
Rationale: Acute ischemic stroke without hemorrhage may benefit
from tPA if within 3–4.5 hours of symptom onset.
8. A 24-year-old man has painful swelling of the right big toe. Serum
uric acid is elevated. Most appropriate treatment?
A. Acetaminophen
B. NSAIDs
C. Corticosteroids
D. Allopurinol
Rationale: Acute gout attack is treated with NSAIDs; allopurinol is for
chronic management.
9. A 35-year-old woman presents with shortness of breath and
hemoptysis. CT angiogram shows a filling defect in the pulmonary
, artery. Next best step?
A. Start anticoagulation
B. Thrombolysis
C. Observation
D. Bronchoscopy
Rationale: Pulmonary embolism requires immediate anticoagulation
unless contraindicated.
10. A 50-year-old man has progressive fatigue and pallor. Labs:
Hb 8.0 g/dL, MCV 72 fL. Most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folate deficiency
D. Hemolytic anemia
Rationale: Microcytic anemia is most commonly caused by iron
deficiency.
11. A 28-year-old woman presents with heat intolerance, weight
loss, and palpitations. Exam reveals exophthalmos. Labs: TSH low,
free T4 high. Best treatment?
A. Levothyroxine
B. Methimazole
C. Radioactive iodine
D. Propranolol only
Rationale: Hyperthyroidism (Graves’ disease) is treated medically with
antithyroid drugs like methimazole.
Questions With Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 56-year-old man presents with sudden chest pain radiating to
his left arm. ECG shows ST-segment elevations in leads II, III, and
aVF. What is the most appropriate immediate management?
A. Oral aspirin
B. Immediate percutaneous coronary intervention (PCI)
C. Oral beta-blocker
D. Intravenous nitroglycerin
Rationale: Immediate PCI is the treatment of choice for acute ST-
elevation myocardial infarction (STEMI) to restore coronary blood
flow.
2. A 22-year-old woman presents with fever, sore throat, and
posterior cervical lymphadenopathy. Monospot test is positive.
Which of the following is most appropriate?
A. Amoxicillin
B. Supportive care
C. Ciprofloxacin
D. Corticosteroids
Rationale: Infectious mononucleosis is viral; treatment is supportive.
Antibiotics like amoxicillin can cause rash.
, 3. A patient with type 1 diabetes presents with polyuria, polydipsia,
and fruity breath. Blood glucose is 540 mg/dL. What is the next
step?
A. Oral hypoglycemics
B. Intravenous fluids and insulin
C. Subcutaneous insulin only
D. Observation
Rationale: This is diabetic ketoacidosis (DKA); treatment includes IV
fluids, insulin, and electrolyte management.
4. A 45-year-old male has right upper quadrant pain and jaundice.
Ultrasound shows gallstones with common bile duct dilation. Most
likely diagnosis?
A. Acute cholecystitis
B. Choledocholithiasis
C. Hepatitis A
D. Pancreatitis
Rationale: CBD dilation with gallstones suggests choledocholithiasis,
often requiring ERCP.
5. A 30-year-old woman presents with chronic fatigue, hair loss, and
cold intolerance. Labs show TSH 8.5 mIU/L, free T4 low. Next best
step?
A. Ultrasound thyroid
B. Start levothyroxine therapy
C. Methimazole
D. Radioactive iodine therapy
Rationale: Primary hypothyroidism indicated by elevated TSH and low
free T4; treatment is levothyroxine.
, 6. A 60-year-old smoker has hematuria and flank pain. Imaging
shows a mass in the right kidney. Most likely diagnosis?
A. Renal cyst
B. Renal cell carcinoma
C. Nephrolithiasis
D. Pyelonephritis
Rationale: Painless hematuria in a smoker with renal mass is classic
for renal cell carcinoma.
7. A 72-year-old man presents with sudden right-sided weakness and
slurred speech. CT shows no hemorrhage. Best next step?
A. Aspirin only
B. Tissue plasminogen activator (tPA) if within window
C. Observation
D. Statin therapy
Rationale: Acute ischemic stroke without hemorrhage may benefit
from tPA if within 3–4.5 hours of symptom onset.
8. A 24-year-old man has painful swelling of the right big toe. Serum
uric acid is elevated. Most appropriate treatment?
A. Acetaminophen
B. NSAIDs
C. Corticosteroids
D. Allopurinol
Rationale: Acute gout attack is treated with NSAIDs; allopurinol is for
chronic management.
9. A 35-year-old woman presents with shortness of breath and
hemoptysis. CT angiogram shows a filling defect in the pulmonary
, artery. Next best step?
A. Start anticoagulation
B. Thrombolysis
C. Observation
D. Bronchoscopy
Rationale: Pulmonary embolism requires immediate anticoagulation
unless contraindicated.
10. A 50-year-old man has progressive fatigue and pallor. Labs:
Hb 8.0 g/dL, MCV 72 fL. Most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folate deficiency
D. Hemolytic anemia
Rationale: Microcytic anemia is most commonly caused by iron
deficiency.
11. A 28-year-old woman presents with heat intolerance, weight
loss, and palpitations. Exam reveals exophthalmos. Labs: TSH low,
free T4 high. Best treatment?
A. Levothyroxine
B. Methimazole
C. Radioactive iodine
D. Propranolol only
Rationale: Hyperthyroidism (Graves’ disease) is treated medically with
antithyroid drugs like methimazole.
