COMLEX LEVEL 3 EXAM –
COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
1. A 55-year-old man with a history of hypertension
and type 2 diabetes presents to the emergency
department with acute-onset, crushing substernal
chest pain radiating to the left arm. ECG shows ST-
segment elevation in leads V1-V4. Which of the
following is the most appropriate immediate
reperfusion strategy if the patient presents to a
percutaneous coronary intervention (PCI)-capable
hospital within 90 minutes of symptom onset?
A) Primary PCI
B) Thrombolytics (tPA)
C) Aspirin and nitroglycerin alone
D) Emergent coronary artery bypass grafting (CABG)
Correct answer: A
Rationale: Primary PCI is the preferred reperfusion
strategy for STEMI if it can be performed within 90
minutes of first medical contact.
,2. A 28-year-old woman presents with a 2-week
history of fever, sore throat, and lymphadenopathy.
Monospot test is positive. She is diagnosed with
infectious mononucleosis. Which of the following is
the most important advice regarding physical
activity?
A) Avoid contact sports for 4-6 weeks due to risk of
splenic rupture
B) Resume full activity immediately
C) Avoid all exercise for 3 months
D) Only avoid swimming
Correct answer: A
Rationale: Splenomegaly occurs in infectious
mononucleosis; contact sports should be avoided for
4-6 weeks to prevent splenic rupture.
3. A 32-year-old pregnant woman at 28 weeks
gestation presents with headache, blurred vision,
and epigastric pain. Blood pressure is 170/110
mmHg. Urinalysis shows 3+ protein. Which of the
following is the most appropriate next step?
A) Oral labetalol and outpatient follow-up
B) Intravenous magnesium sulfate and emergent
delivery
,C) Intravenous hydralazine and expectant
management
D) Bed rest and blood pressure monitoring
Correct answer: B
Rationale: Severe preeclampsia at ≥28 weeks with
end-organ symptoms requires magnesium sulfate for
seizure prophylaxis and emergent delivery.
4. A 60-year-old man with a 30-pack-year smoking
history presents with hemoptysis and unintentional
weight loss. Chest X-ray shows a right hilar mass.
Which of the following is the most appropriate next
step?
A) CT-guided biopsy of the mass
B) Bronchoscopy with biopsy
C) PET-CT
D) Observation with repeat chest X-ray in 3 months
Correct answer: B
Rationale: Bronchoscopy with biopsy is indicated for
a central (hilar) mass to obtain tissue diagnosis for
suspected lung cancer.
5. A 45-year-old man with a history of alcohol use
disorder presents with acute-onset, severe
, epigastric pain radiating to the back, nausea, and
vomiting. Serum lipase is 1200 U/L (normal <60).
Which of the following is the most appropriate initial
fluid resuscitation?
A) Lactated Ringer's solution
B) 0.9% normal saline
C) 5% dextrose in water
D) Albumin
Correct answer: A
Rationale: Lactated Ringer's is preferred over normal
saline for fluid resuscitation in acute pancreatitis
(reduces risk of hyperchloremic metabolic acidosis).
6. A 70-year-old man presents with a painless,
pulsatile abdominal mass. Ultrasound shows an
abdominal aortic aneurysm measuring 5.5 cm. He is
asymptomatic. Which of the following is the most
appropriate management?
A) Immediate endovascular repair
B) Ultrasound surveillance every 6 months
C) Open surgical repair
D) Antiplatelet therapy alone
Correct answer: A
COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
1. A 55-year-old man with a history of hypertension
and type 2 diabetes presents to the emergency
department with acute-onset, crushing substernal
chest pain radiating to the left arm. ECG shows ST-
segment elevation in leads V1-V4. Which of the
following is the most appropriate immediate
reperfusion strategy if the patient presents to a
percutaneous coronary intervention (PCI)-capable
hospital within 90 minutes of symptom onset?
A) Primary PCI
B) Thrombolytics (tPA)
C) Aspirin and nitroglycerin alone
D) Emergent coronary artery bypass grafting (CABG)
Correct answer: A
Rationale: Primary PCI is the preferred reperfusion
strategy for STEMI if it can be performed within 90
minutes of first medical contact.
,2. A 28-year-old woman presents with a 2-week
history of fever, sore throat, and lymphadenopathy.
Monospot test is positive. She is diagnosed with
infectious mononucleosis. Which of the following is
the most important advice regarding physical
activity?
A) Avoid contact sports for 4-6 weeks due to risk of
splenic rupture
B) Resume full activity immediately
C) Avoid all exercise for 3 months
D) Only avoid swimming
Correct answer: A
Rationale: Splenomegaly occurs in infectious
mononucleosis; contact sports should be avoided for
4-6 weeks to prevent splenic rupture.
3. A 32-year-old pregnant woman at 28 weeks
gestation presents with headache, blurred vision,
and epigastric pain. Blood pressure is 170/110
mmHg. Urinalysis shows 3+ protein. Which of the
following is the most appropriate next step?
A) Oral labetalol and outpatient follow-up
B) Intravenous magnesium sulfate and emergent
delivery
,C) Intravenous hydralazine and expectant
management
D) Bed rest and blood pressure monitoring
Correct answer: B
Rationale: Severe preeclampsia at ≥28 weeks with
end-organ symptoms requires magnesium sulfate for
seizure prophylaxis and emergent delivery.
4. A 60-year-old man with a 30-pack-year smoking
history presents with hemoptysis and unintentional
weight loss. Chest X-ray shows a right hilar mass.
Which of the following is the most appropriate next
step?
A) CT-guided biopsy of the mass
B) Bronchoscopy with biopsy
C) PET-CT
D) Observation with repeat chest X-ray in 3 months
Correct answer: B
Rationale: Bronchoscopy with biopsy is indicated for
a central (hilar) mass to obtain tissue diagnosis for
suspected lung cancer.
5. A 45-year-old man with a history of alcohol use
disorder presents with acute-onset, severe
, epigastric pain radiating to the back, nausea, and
vomiting. Serum lipase is 1200 U/L (normal <60).
Which of the following is the most appropriate initial
fluid resuscitation?
A) Lactated Ringer's solution
B) 0.9% normal saline
C) 5% dextrose in water
D) Albumin
Correct answer: A
Rationale: Lactated Ringer's is preferred over normal
saline for fluid resuscitation in acute pancreatitis
(reduces risk of hyperchloremic metabolic acidosis).
6. A 70-year-old man presents with a painless,
pulsatile abdominal mass. Ultrasound shows an
abdominal aortic aneurysm measuring 5.5 cm. He is
asymptomatic. Which of the following is the most
appropriate management?
A) Immediate endovascular repair
B) Ultrasound surveillance every 6 months
C) Open surgical repair
D) Antiplatelet therapy alone
Correct answer: A
