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COMLEX-USA Level Level 2-CE (Cognitive
Evaluation) EXAM ACTUAL QUESTIONS AND
ANSWERS LATEST UPDATE THIS YEAR
COMLEX-USA Level 2-CE (Cognitive Evaluation) exam, presented in random order. The questions cover
the core clinical domains: Internal Medicine, Pediatrics, Obstetrics & Gynecology, Surgery, Psychiatry,
Emergency Medicine, Osteopathic Principles & Practice (OPP), and Medical Ethics/Jurisprudence
Question 1
A 45-year-old male presents with acute-onset right lower quadrant pain, nausea, and fever. Laboratory
tests show leukocytosis. On examination, there is tenderness at McBurney’s point. What is the most
appropriate next step?
A) Abdominal CT scan
B) Diagnostic laparoscopy
C) Surgical consultation
D) Empiric antibiotics and observation
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Correct Answer: C
Rationale: Surgical consultation is indicated for suspected appendicitis; CT may be obtained but should
not delay surgical evaluation.
Question 2
A 62-year-old female with a history of hypertension presents with acute shortness of breath and
hypoxia. ECG shows sinus tachycardia with S1Q3T3 pattern. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Pericarditis
D) Decompensated heart failure
Correct Answer: B
Rationale: The S1Q3T3 pattern is classic for acute cor pulmonale from pulmonary embolism.
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Question 3
A 28-year-old G1P0 at 36 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals
placenta previa. What is the most appropriate management?
A) Digital cervical examination
B) Emergency cesarean section
C) Hospital admission for observation
D) Outpatient follow-up with pelvic rest
Correct Answer: C
Rationale: Placenta previa after 36 weeks requires hospital admission for monitoring and planned
delivery; digital exam is contraindicated.
Question 4
A 70-year-old male presents with a several-month history of worsening tremor at rest, rigidity, and
bradykinesia. What is the most appropriate initial pharmacotherapy?
A) Levodopa-carbidopa
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B) Benztropine
C) Amantadine
D) Selegiline
Correct Answer: A
Rationale: Levodopa-carbidopa remains the most effective symptomatic treatment for Parkinson’s
disease, especially in older patients.
Question 5
A 32-year-old female presents with episodic palpitations, anxiety, and diaphoresis. Her blood pressure is
160/90 mm Hg and heart rate 110 bpm during an episode. Urinary metanephrines are elevated. Where
is the most likely location of the tumor?
A) Thyroid
B) Adrenal medulla
C) Pancreas
D) Lung
COMLEX-USA Level Level 2-CE (Cognitive
Evaluation) EXAM ACTUAL QUESTIONS AND
ANSWERS LATEST UPDATE THIS YEAR
COMLEX-USA Level 2-CE (Cognitive Evaluation) exam, presented in random order. The questions cover
the core clinical domains: Internal Medicine, Pediatrics, Obstetrics & Gynecology, Surgery, Psychiatry,
Emergency Medicine, Osteopathic Principles & Practice (OPP), and Medical Ethics/Jurisprudence
Question 1
A 45-year-old male presents with acute-onset right lower quadrant pain, nausea, and fever. Laboratory
tests show leukocytosis. On examination, there is tenderness at McBurney’s point. What is the most
appropriate next step?
A) Abdominal CT scan
B) Diagnostic laparoscopy
C) Surgical consultation
D) Empiric antibiotics and observation
, Page 2 of 184
Correct Answer: C
Rationale: Surgical consultation is indicated for suspected appendicitis; CT may be obtained but should
not delay surgical evaluation.
Question 2
A 62-year-old female with a history of hypertension presents with acute shortness of breath and
hypoxia. ECG shows sinus tachycardia with S1Q3T3 pattern. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Pericarditis
D) Decompensated heart failure
Correct Answer: B
Rationale: The S1Q3T3 pattern is classic for acute cor pulmonale from pulmonary embolism.
, Page 3 of 184
Question 3
A 28-year-old G1P0 at 36 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals
placenta previa. What is the most appropriate management?
A) Digital cervical examination
B) Emergency cesarean section
C) Hospital admission for observation
D) Outpatient follow-up with pelvic rest
Correct Answer: C
Rationale: Placenta previa after 36 weeks requires hospital admission for monitoring and planned
delivery; digital exam is contraindicated.
Question 4
A 70-year-old male presents with a several-month history of worsening tremor at rest, rigidity, and
bradykinesia. What is the most appropriate initial pharmacotherapy?
A) Levodopa-carbidopa
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B) Benztropine
C) Amantadine
D) Selegiline
Correct Answer: A
Rationale: Levodopa-carbidopa remains the most effective symptomatic treatment for Parkinson’s
disease, especially in older patients.
Question 5
A 32-year-old female presents with episodic palpitations, anxiety, and diaphoresis. Her blood pressure is
160/90 mm Hg and heart rate 110 bpm during an episode. Urinary metanephrines are elevated. Where
is the most likely location of the tumor?
A) Thyroid
B) Adrenal medulla
C) Pancreas
D) Lung
