COMLEX LEVEL 2 (COMPREHENSIVE
OSTEOPATHIC MEDICAL LICENSING
EXAMINATION LEVEL 1) EXAM–
COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
1. A 55-year-old man with a 30-pack-year smoking
history presents with hemoptysis and unintentional
weight loss of 10 kg over 6 months. 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.
2. A 65-year-old woman with a history of hypertension
and type 2 diabetes presents with acute-onset,
,severe, tearing chest pain radiating to the back.
Blood pressure is 160/90 mmHg in the right arm and
100/70 mmHg in the left arm. Which of the following is
the most appropriate initial imaging study?
A) Chest X-ray
B) CT angiography of the chest
C) Transthoracic echocardiogram (TTE)
D) MRI of the chest
Correct answer: B
Rationale: CT angiography of the chest is the test of
choice for diagnosing aortic dissection.
3. A 28-year-old woman presents with episodic,
sharp, right upper quadrant pain lasting 2-4 hours,
occurring after fatty meals. Ultrasound shows
multiple gallstones. Which of the following is the most
appropriate management?
A) Ursodeoxycholic acid
B) Laparoscopic cholecystectomy
C) Endoscopic retrograde
cholangiopancreatography (ERCP)
D) Observation with dietary modification
Correct answer: B
,Rationale: Symptomatic cholelithiasis is managed
with laparoscopic cholecystectomy.
4. A 72-year-old man presents with painless jaundice,
dark urine, and clay-colored stools. CA 19-9 is
elevated. CT shows a mass in the head of the
pancreas. Which of the following is the most
appropriate next step?
A) Endoscopic ultrasound (EUS) with fine-needle
aspiration (FNA)
B) Exploratory laparotomy
C) CT-guided biopsy
D) MRI of the abdomen
Correct answer: A
Rationale: EUS with FNA is the preferred method for
tissue diagnosis of pancreatic mass.
5. A 45-year-old woman presents with fatigue,
arthralgias, and a malar rash. Laboratory studies
show ANA positive (1:640), anti-dsDNA positive, and
low C3 and C4. Which of the following is the most
appropriate initial treatment for active lupus
nephritis?
A) Hydroxychloroquine alone
, B) Prednisone alone
C) Mycophenolate mofetil plus prednisone
D) Azathioprine alone
Correct answer: C
Rationale: Active lupus nephritis is treated with
mycophenolate mofetil (or cyclophosphamide) plus
corticosteroids.
6. 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.
OSTEOPATHIC MEDICAL LICENSING
EXAMINATION LEVEL 1) EXAM–
COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
1. A 55-year-old man with a 30-pack-year smoking
history presents with hemoptysis and unintentional
weight loss of 10 kg over 6 months. 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.
2. A 65-year-old woman with a history of hypertension
and type 2 diabetes presents with acute-onset,
,severe, tearing chest pain radiating to the back.
Blood pressure is 160/90 mmHg in the right arm and
100/70 mmHg in the left arm. Which of the following is
the most appropriate initial imaging study?
A) Chest X-ray
B) CT angiography of the chest
C) Transthoracic echocardiogram (TTE)
D) MRI of the chest
Correct answer: B
Rationale: CT angiography of the chest is the test of
choice for diagnosing aortic dissection.
3. A 28-year-old woman presents with episodic,
sharp, right upper quadrant pain lasting 2-4 hours,
occurring after fatty meals. Ultrasound shows
multiple gallstones. Which of the following is the most
appropriate management?
A) Ursodeoxycholic acid
B) Laparoscopic cholecystectomy
C) Endoscopic retrograde
cholangiopancreatography (ERCP)
D) Observation with dietary modification
Correct answer: B
,Rationale: Symptomatic cholelithiasis is managed
with laparoscopic cholecystectomy.
4. A 72-year-old man presents with painless jaundice,
dark urine, and clay-colored stools. CA 19-9 is
elevated. CT shows a mass in the head of the
pancreas. Which of the following is the most
appropriate next step?
A) Endoscopic ultrasound (EUS) with fine-needle
aspiration (FNA)
B) Exploratory laparotomy
C) CT-guided biopsy
D) MRI of the abdomen
Correct answer: A
Rationale: EUS with FNA is the preferred method for
tissue diagnosis of pancreatic mass.
5. A 45-year-old woman presents with fatigue,
arthralgias, and a malar rash. Laboratory studies
show ANA positive (1:640), anti-dsDNA positive, and
low C3 and C4. Which of the following is the most
appropriate initial treatment for active lupus
nephritis?
A) Hydroxychloroquine alone
, B) Prednisone alone
C) Mycophenolate mofetil plus prednisone
D) Azathioprine alone
Correct answer: C
Rationale: Active lupus nephritis is treated with
mycophenolate mofetil (or cyclophosphamide) plus
corticosteroids.
6. 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.
