COMLEX-USA Cognitive Evaluation Practice
Exam Questions With Correct Answers
(Verified Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 54-year-old man presents with chest pain radiating to the left
arm and diaphoresis. ECG shows ST elevation in leads II, III, and
aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Rationale: Inferior wall myocardial infarction is indicated by ST
elevations in leads II, III, and aVF. The right coronary artery most
commonly supplies the inferior portion of the heart, making it the
likely site of occlusion.
2. A 25-year-old woman presents with heat intolerance, weight loss,
and exophthalmos. Labs show decreased TSH and elevated T3/T4.
, What is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Rationale: Graves disease is an autoimmune condition characterized
by TSH receptor-stimulating antibodies leading to hyperthyroidism
and ophthalmopathy.
3. A 60-year-old man with chronic smoking history develops
hematuria. Cytology shows malignant cells with “coffee bean”
nuclei. What is the most likely diagnosis?
A. Renal cell carcinoma
B. Prostate adenocarcinoma
C. Transitional cell carcinoma
D. Wilms tumor
Rationale: Transitional cell carcinoma of the bladder is strongly
associated with smoking and presents with hematuria and
characteristic nuclear morphology.
, 4. A child presents with a “slapped cheek” rash and mild anemia.
What is the causative agent?
A. Epstein-Barr virus
B. Parvovirus B19
C. Measles virus
D. Rubella virus
Rationale: Parvovirus B19 causes erythema infectiosum and can
suppress erythroid precursors leading to anemia.
5. A patient with chronic alcoholism presents with confusion, ataxia,
and ophthalmoplegia. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Thiamine (B1)
C. Niacin (B3)
D. Pyridoxine (B6)
Rationale: Thiamine deficiency leads to Wernicke encephalopathy,
classically seen in alcoholics.
6. A 45-year-old woman has fatigue, cold intolerance, and
myxedema. Which lab finding is expected?
, A. Increased T3 and T4
B. Increased TSH, decreased T4
C. Decreased TSH, increased T4
D. Normal TSH, increased T4
Rationale: Primary hypothyroidism results in elevated TSH due to loss
of negative feedback.
7. A newborn has projectile vomiting and a palpable “olive-like”
abdominal mass. Diagnosis?
A. Intussusception
B. Pyloric stenosis
C. Hirschsprung disease
D. Malrotation
Rationale: Hypertrophic pyloric stenosis presents with projectile non-
bilious vomiting and a palpable pyloric “olive.”
8. A patient presents with resting tremor, bradykinesia, and rigidity.
Which structure is primarily affected?
A. Cerebellum
B. Substantia nigra
Exam Questions With Correct Answers
(Verified Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 54-year-old man presents with chest pain radiating to the left
arm and diaphoresis. ECG shows ST elevation in leads II, III, and
aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Posterior descending artery
Rationale: Inferior wall myocardial infarction is indicated by ST
elevations in leads II, III, and aVF. The right coronary artery most
commonly supplies the inferior portion of the heart, making it the
likely site of occlusion.
2. A 25-year-old woman presents with heat intolerance, weight loss,
and exophthalmos. Labs show decreased TSH and elevated T3/T4.
, What is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Rationale: Graves disease is an autoimmune condition characterized
by TSH receptor-stimulating antibodies leading to hyperthyroidism
and ophthalmopathy.
3. A 60-year-old man with chronic smoking history develops
hematuria. Cytology shows malignant cells with “coffee bean”
nuclei. What is the most likely diagnosis?
A. Renal cell carcinoma
B. Prostate adenocarcinoma
C. Transitional cell carcinoma
D. Wilms tumor
Rationale: Transitional cell carcinoma of the bladder is strongly
associated with smoking and presents with hematuria and
characteristic nuclear morphology.
, 4. A child presents with a “slapped cheek” rash and mild anemia.
What is the causative agent?
A. Epstein-Barr virus
B. Parvovirus B19
C. Measles virus
D. Rubella virus
Rationale: Parvovirus B19 causes erythema infectiosum and can
suppress erythroid precursors leading to anemia.
5. A patient with chronic alcoholism presents with confusion, ataxia,
and ophthalmoplegia. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Thiamine (B1)
C. Niacin (B3)
D. Pyridoxine (B6)
Rationale: Thiamine deficiency leads to Wernicke encephalopathy,
classically seen in alcoholics.
6. A 45-year-old woman has fatigue, cold intolerance, and
myxedema. Which lab finding is expected?
, A. Increased T3 and T4
B. Increased TSH, decreased T4
C. Decreased TSH, increased T4
D. Normal TSH, increased T4
Rationale: Primary hypothyroidism results in elevated TSH due to loss
of negative feedback.
7. A newborn has projectile vomiting and a palpable “olive-like”
abdominal mass. Diagnosis?
A. Intussusception
B. Pyloric stenosis
C. Hirschsprung disease
D. Malrotation
Rationale: Hypertrophic pyloric stenosis presents with projectile non-
bilious vomiting and a palpable pyloric “olive.”
8. A patient presents with resting tremor, bradykinesia, and rigidity.
Which structure is primarily affected?
A. Cerebellum
B. Substantia nigra
