COMSAE/ COMLEX-USA Level 1 & 2
Verified Multiple Choice and Conceptual Actual Emended
Exam Questions With Reviewed 100% Correct Detailed
Answers
Guaranteed Pass!!Current Update
1. In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also
occur with overdosing of the cholinergic medications used to treat
myasthenia. What symptom helps differentiate a myasthenic crisis from a
cholinergic crisis?
A) Hyperreflexia
B) Muscle fasciculations
C) Diplopia
D) Bradycardia
Answer: B
2. A 74-year-old man presents after his wife witnessed him grab his head in
pain and fall to the floor. He has not regained consciousness. His current
blood pressure is 150/96 mm Hg, and his heart rate is 65 bpm. Emergent
head CT shows a subarachnoid hemorrhage. What is the best treatment to
prevent cerebral vasospasm?
A) Nimodipine
B) Mannitol
C) Labetalol
D) Phenytoin
Answer: A
3. A 75-year-old man is involved in a motor vehicle accident and strikes his
forehead on the windshield. He complains of neck pain and severe burning
in his shoulders and arms. His physical examination reveals weakness of his
upper extremities. What type of spinal cord injury does this patient have?
, A) Brown-Séquard syndrome
B) Central cord syndrome
C) Anterior cord syndrome
D) Posterior cord syndrome
Answer: B
4. A 37-year-old man fell from a ladder and hit the right side of his head. He
lost consciousness briefly, recovered, and then developed worsening
headache and hemiparesis. CT reveals a lens-shaped hyperdensity under
the right temporal bone. What is the most likely diagnosis?
A) Subdural hematoma
B) Subarachnoid hemorrhage
C) Epidural hematoma
D) Intracerebral hemorrhage
Answer: C
5. A 1-year-old boy presents with increasing lethargy. He is barely responsive,
and his parents deny trauma. What is the most common cause of
nontraumatic altered levels of consciousness in this age group?
A) Seizure
B) Metabolic disorder
C) Infection
D) Intracranial tumor
Answer: C
6. A 44-year-old man notices eyelid drooping, weakness in jaw and limbs, and
difficulty swallowing. Symptoms worsen with activity. A Tensilon test is
positive. What is the underlying pathology?
A) Antibodies to muscle-specific kinase
B) Antibodies to acetylcholine receptor
C) Antibodies to voltage-gated calcium channels
D) Antibodies to presynaptic receptors
Answer: B
,7. A 31-year-old woman presents with purpural rash, fever, chills, nausea, and
thrombocytopenia. She works as a nurse. Gram-negative diplococci are
found in blood cultures. What is the most appropriate therapy?
A) IV steroids
B) Broad-spectrum antibiotics
C) Antiviral therapy
D) Platelet transfusion
Answer: B
8. A 54-year-old HIV-positive man presents with generalized seizure and
cortical ring-enhancing lesions on brain MRI. He has not been on
antiretrovirals. What is the most likely cause?
A) Toxoplasma encephalitis
B) CMV encephalitis
C) Primary CNS lymphoma
D) Cryptococcal meningitis
Answer: A
9. A 24-year-old man presents to the emergency department with fever,
photophobia, and nuchal rigidity. Kernig and Brudzinski signs are positive.
Lumbar puncture reveals elevated opening pressure, low glucose, and
elevated protein. What is the most likely diagnosis?
A) Viral meningitis
B) Bacterial meningitis
C) Subarachnoid hemorrhage
D) Multiple sclerosis
Answer: B
10.A 42-year-old woman has bilateral lower extremity weakness, areflexia, and
ascending paralysis after a gastrointestinal illness. Nerve conduction studies
show slowed conduction velocity. What is the diagnosis?
A) Multiple sclerosis
B) Amyotrophic lateral sclerosis
C) Guillain-Barré syndrome
D) Myasthenia gravis
Answer: C
11.A patient presents with a thunderclap headache and brief loss of
consciousness. Noncontrast CT of the head is negative. What is the next best
, step?
A) Start migraine therapy
B) Order lumbar puncture
C) Begin anticoagulation
D) Repeat CT with contrast
Answer: B
12.A 66-year-old man has progressive weakness and fasciculations in all four
limbs. Sensation remains intact. EMG confirms widespread denervation.
What is the most likely diagnosis?
A) Guillain-Barré syndrome
B) ALS
C) Myasthenia gravis
D) Peripheral neuropathy
Answer: B
13.A 17-year-old is brought in after a motorcycle crash. He is alert but has no
sensation or motor function below T6. MRI confirms a complete spinal cord
transection. What is the most immediate concern in the first 24 hours?
A) Hypovolemic shock
B) Autonomic dysreflexia
C) Spinal shock
D) Deep vein thrombosis
Answer: C
14.A 27-year-old woman presents with double vision, slurred speech, and right
leg numbness that developed over several days. MRI of the brain shows
periventricular white matter lesions. What is the diagnosis?
A) Amyotrophic lateral sclerosis
B) Guillain-Barré syndrome
C) Multiple sclerosis
D) Stroke
Answer: C
15.A 62-year-old man presents with weakness, double vision, and difficulty
swallowing. Symptoms began with paresthesias in the feet and progressed
upward. He now has bilateral loss of deep tendon reflexes. What CSF
finding confirms the suspected diagnosis?
A) Low glucose
B) Pleocytosis
C) Elevated protein with normal WBC count
D) Increased opening pressure
Answer: C
Verified Multiple Choice and Conceptual Actual Emended
Exam Questions With Reviewed 100% Correct Detailed
Answers
Guaranteed Pass!!Current Update
1. In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also
occur with overdosing of the cholinergic medications used to treat
myasthenia. What symptom helps differentiate a myasthenic crisis from a
cholinergic crisis?
A) Hyperreflexia
B) Muscle fasciculations
C) Diplopia
D) Bradycardia
Answer: B
2. A 74-year-old man presents after his wife witnessed him grab his head in
pain and fall to the floor. He has not regained consciousness. His current
blood pressure is 150/96 mm Hg, and his heart rate is 65 bpm. Emergent
head CT shows a subarachnoid hemorrhage. What is the best treatment to
prevent cerebral vasospasm?
A) Nimodipine
B) Mannitol
C) Labetalol
D) Phenytoin
Answer: A
3. A 75-year-old man is involved in a motor vehicle accident and strikes his
forehead on the windshield. He complains of neck pain and severe burning
in his shoulders and arms. His physical examination reveals weakness of his
upper extremities. What type of spinal cord injury does this patient have?
, A) Brown-Séquard syndrome
B) Central cord syndrome
C) Anterior cord syndrome
D) Posterior cord syndrome
Answer: B
4. A 37-year-old man fell from a ladder and hit the right side of his head. He
lost consciousness briefly, recovered, and then developed worsening
headache and hemiparesis. CT reveals a lens-shaped hyperdensity under
the right temporal bone. What is the most likely diagnosis?
A) Subdural hematoma
B) Subarachnoid hemorrhage
C) Epidural hematoma
D) Intracerebral hemorrhage
Answer: C
5. A 1-year-old boy presents with increasing lethargy. He is barely responsive,
and his parents deny trauma. What is the most common cause of
nontraumatic altered levels of consciousness in this age group?
A) Seizure
B) Metabolic disorder
C) Infection
D) Intracranial tumor
Answer: C
6. A 44-year-old man notices eyelid drooping, weakness in jaw and limbs, and
difficulty swallowing. Symptoms worsen with activity. A Tensilon test is
positive. What is the underlying pathology?
A) Antibodies to muscle-specific kinase
B) Antibodies to acetylcholine receptor
C) Antibodies to voltage-gated calcium channels
D) Antibodies to presynaptic receptors
Answer: B
,7. A 31-year-old woman presents with purpural rash, fever, chills, nausea, and
thrombocytopenia. She works as a nurse. Gram-negative diplococci are
found in blood cultures. What is the most appropriate therapy?
A) IV steroids
B) Broad-spectrum antibiotics
C) Antiviral therapy
D) Platelet transfusion
Answer: B
8. A 54-year-old HIV-positive man presents with generalized seizure and
cortical ring-enhancing lesions on brain MRI. He has not been on
antiretrovirals. What is the most likely cause?
A) Toxoplasma encephalitis
B) CMV encephalitis
C) Primary CNS lymphoma
D) Cryptococcal meningitis
Answer: A
9. A 24-year-old man presents to the emergency department with fever,
photophobia, and nuchal rigidity. Kernig and Brudzinski signs are positive.
Lumbar puncture reveals elevated opening pressure, low glucose, and
elevated protein. What is the most likely diagnosis?
A) Viral meningitis
B) Bacterial meningitis
C) Subarachnoid hemorrhage
D) Multiple sclerosis
Answer: B
10.A 42-year-old woman has bilateral lower extremity weakness, areflexia, and
ascending paralysis after a gastrointestinal illness. Nerve conduction studies
show slowed conduction velocity. What is the diagnosis?
A) Multiple sclerosis
B) Amyotrophic lateral sclerosis
C) Guillain-Barré syndrome
D) Myasthenia gravis
Answer: C
11.A patient presents with a thunderclap headache and brief loss of
consciousness. Noncontrast CT of the head is negative. What is the next best
, step?
A) Start migraine therapy
B) Order lumbar puncture
C) Begin anticoagulation
D) Repeat CT with contrast
Answer: B
12.A 66-year-old man has progressive weakness and fasciculations in all four
limbs. Sensation remains intact. EMG confirms widespread denervation.
What is the most likely diagnosis?
A) Guillain-Barré syndrome
B) ALS
C) Myasthenia gravis
D) Peripheral neuropathy
Answer: B
13.A 17-year-old is brought in after a motorcycle crash. He is alert but has no
sensation or motor function below T6. MRI confirms a complete spinal cord
transection. What is the most immediate concern in the first 24 hours?
A) Hypovolemic shock
B) Autonomic dysreflexia
C) Spinal shock
D) Deep vein thrombosis
Answer: C
14.A 27-year-old woman presents with double vision, slurred speech, and right
leg numbness that developed over several days. MRI of the brain shows
periventricular white matter lesions. What is the diagnosis?
A) Amyotrophic lateral sclerosis
B) Guillain-Barré syndrome
C) Multiple sclerosis
D) Stroke
Answer: C
15.A 62-year-old man presents with weakness, double vision, and difficulty
swallowing. Symptoms began with paresthesias in the feet and progressed
upward. He now has bilateral loss of deep tendon reflexes. What CSF
finding confirms the suspected diagnosis?
A) Low glucose
B) Pleocytosis
C) Elevated protein with normal WBC count
D) Increased opening pressure
Answer: C
