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COMLEX Level 2-CE Form 110 Exam ACTUAL EXAM
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
COMLEX Level 2-CE Form 110 Practice Exam
COMLEX Level 2-CE (Form 110) exam, covering high-yield clinical presentations across internal
medicine, surgery, pediatrics, OB/GYN, psychiatry, and osteopathic principles.
1. A 56-year-old man presents with substernal chest pain that began 1 hour ago while he was mowing
the lawn. The pain is pressure-like and radiates to the left arm. ECG shows ST elevation in leads II, III,
and aVF. What is the next best step in management?
A) Give sublingual nitroglycerin
B) Administer aspirin and activate the cardiac catheterization lab
C) Start IV heparin only
D) Order a chest X-ray
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior STEMI. Reperfusion therapy (PCI if
available) is required. Aspirin reduces mortality. While nitroglycerin and heparin may be used as
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supportive measures, they are not definitive. Chest X-ray is not appropriate at this initial stage when the
ECG is diagnostic .
2. A 25-year-old woman presents with fever, dysuria, and flank pain. Urinalysis shows white blood cell
(WBC) casts. What is the best treatment?
A) Oral nitrofurantoin
B) IV ceftriaxone
C) Oral ciprofloxacin
D) IV vancomycin
Answer: B
Rationale: WBC casts indicate pyelonephritis (upper urinary tract infection). In a patient with systemic
symptoms such as fever, inpatient IV therapy (e.g., ceftriaxone) is indicated. Nitrofurantoin is used for
simple cystitis but does not achieve adequate renal tissue levels for pyelonephritis. Oral fluoroquinolones
may be used for mild pyelonephritis but are not recommended for initial inpatient management .
3. A 60-year-old man with chronic alcohol use presents with confusion, ataxia, and ophthalmoplegia.
Which vitamin deficiency is most likely?
A) Vitamin B1 (thiamine)
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B) Vitamin B6 (pyridoxine)
C) Vitamin B12 (cobalamin)
D) Vitamin C
Answer: A
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia is characteristic of Wernicke
encephalopathy, which is caused by thiamine (vitamin B1) deficiency, commonly seen in patients with
chronic alcohol use .
4. A 32-year-old woman presents with fatigue, weight gain, constipation, and dry skin. Laboratory
studies show an elevated TSH. What is the best treatment?
A) Methimazole
B) Levothyroxine
C) Radioactive iodine
D) Propranolol
Answer: B
Rationale: The patient has primary hypothyroidism (symptoms suggestive of hypothyroidism with
elevated TSH). Levothyroxine is the standard treatment. Methimazole and radioactive iodine are used for
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hyperthyroidism. Propranolol is used for symptomatic management of hyperthyroidism (e.g., tremor,
tachycardia) but does not treat the underlying disorder .
5. A 19-year-old male presents after a motorcycle accident. He is hypotensive, has distended neck veins,
and tracheal deviation to the left. What is the best initial management?
A) Endotracheal intubation
B) Needle thoracostomy (decompression)
C) Chest tube placement
D) IV fluids
Answer: B
Rationale: The presentation is classic for tension pneumothorax (hypotension, distended neck veins, and
tracheal deviation away from the affected side). Immediate decompression with a large-bore needle
(needle thoracostomy) is required, followed by chest tube placement. Endotracheal intubation may
worsen the condition in tension pneumothorax. IV fluids are supportive but not definitive .
6. A 72-year-old man has a resting tremor, bradykinesia, and cogwheel rigidity. What is the most
appropriate initial therapy?
A) Levodopa-carbidopa
COMLEX Level 2-CE Form 110 Exam ACTUAL EXAM
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
COMLEX Level 2-CE Form 110 Practice Exam
COMLEX Level 2-CE (Form 110) exam, covering high-yield clinical presentations across internal
medicine, surgery, pediatrics, OB/GYN, psychiatry, and osteopathic principles.
1. A 56-year-old man presents with substernal chest pain that began 1 hour ago while he was mowing
the lawn. The pain is pressure-like and radiates to the left arm. ECG shows ST elevation in leads II, III,
and aVF. What is the next best step in management?
A) Give sublingual nitroglycerin
B) Administer aspirin and activate the cardiac catheterization lab
C) Start IV heparin only
D) Order a chest X-ray
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior STEMI. Reperfusion therapy (PCI if
available) is required. Aspirin reduces mortality. While nitroglycerin and heparin may be used as
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supportive measures, they are not definitive. Chest X-ray is not appropriate at this initial stage when the
ECG is diagnostic .
2. A 25-year-old woman presents with fever, dysuria, and flank pain. Urinalysis shows white blood cell
(WBC) casts. What is the best treatment?
A) Oral nitrofurantoin
B) IV ceftriaxone
C) Oral ciprofloxacin
D) IV vancomycin
Answer: B
Rationale: WBC casts indicate pyelonephritis (upper urinary tract infection). In a patient with systemic
symptoms such as fever, inpatient IV therapy (e.g., ceftriaxone) is indicated. Nitrofurantoin is used for
simple cystitis but does not achieve adequate renal tissue levels for pyelonephritis. Oral fluoroquinolones
may be used for mild pyelonephritis but are not recommended for initial inpatient management .
3. A 60-year-old man with chronic alcohol use presents with confusion, ataxia, and ophthalmoplegia.
Which vitamin deficiency is most likely?
A) Vitamin B1 (thiamine)
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B) Vitamin B6 (pyridoxine)
C) Vitamin B12 (cobalamin)
D) Vitamin C
Answer: A
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia is characteristic of Wernicke
encephalopathy, which is caused by thiamine (vitamin B1) deficiency, commonly seen in patients with
chronic alcohol use .
4. A 32-year-old woman presents with fatigue, weight gain, constipation, and dry skin. Laboratory
studies show an elevated TSH. What is the best treatment?
A) Methimazole
B) Levothyroxine
C) Radioactive iodine
D) Propranolol
Answer: B
Rationale: The patient has primary hypothyroidism (symptoms suggestive of hypothyroidism with
elevated TSH). Levothyroxine is the standard treatment. Methimazole and radioactive iodine are used for
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hyperthyroidism. Propranolol is used for symptomatic management of hyperthyroidism (e.g., tremor,
tachycardia) but does not treat the underlying disorder .
5. A 19-year-old male presents after a motorcycle accident. He is hypotensive, has distended neck veins,
and tracheal deviation to the left. What is the best initial management?
A) Endotracheal intubation
B) Needle thoracostomy (decompression)
C) Chest tube placement
D) IV fluids
Answer: B
Rationale: The presentation is classic for tension pneumothorax (hypotension, distended neck veins, and
tracheal deviation away from the affected side). Immediate decompression with a large-bore needle
(needle thoracostomy) is required, followed by chest tube placement. Endotracheal intubation may
worsen the condition in tension pneumothorax. IV fluids are supportive but not definitive .
6. A 72-year-old man has a resting tremor, bradykinesia, and cogwheel rigidity. What is the most
appropriate initial therapy?
A) Levodopa-carbidopa
