COMLEX Level 2-CE 2026 Practice Exam | Clinical
Medicine Questions with Verified Answers &
Rationales
Welcome to this comprehensive COMLEX Level 2-CE practice exam. This resource contains 200 exam-style
clinical medicine questions covering the full scope of osteopathic board preparation. Each question mirrors
the format and difficulty of the COMLEX, with mixed subjects and integrated clinical scenarios. Every answer
includes a clear rationale. Use this exam to assess your readiness and build test-taking stamina.
Key Topics Covered
1. Cardiovascular & Pulmonary – Heart failure, arrhythmias, COPD, asthma, PE, hypertension
2. Gastrointestinal & Renal – GI bleeding, hepatitis, nephrolithiasis, acute kidney injury
3. Neurology & Psychiatry – Stroke, seizures, dementia, depression, bipolar, anxiety
4. Musculoskeletal & OMM – Fractures, arthritis, somatic dysfunction, HVLA, counterstrain
5. Infectious Disease & Immunology – Pneumonia, sepsis, HIV, autoimmune disorders
6. Endocrine & Metabolic – Diabetes, thyroid disorders, adrenal insufficiency
7. OB/GYN & Pediatrics – Pregnancy complications, newborn care, childhood illnesses
8. Osteopathic Principles & Practice – Chapman’s reflexes, tender points, viscerosomatic reflexes
Questions 1–200
1. A 55-year-old male with a 30-pack-year smoking history presents with progressive dyspnea,
chronic cough, and barrel chest. Which pulmonary function test finding is most consistent with
COPD?
A) Reduced FEV1/FVC ratio (<0.70)
B) Normal FEV1 with reduced FVC
C) Increased FEV1/FVC ratio
D) Reduced total lung capacity
Answer A: Reduced FEV1/FVC ratio (<0.70)
Rationale: COPD causes irreversible airflow obstruction, defined by post-bronchodilator FEV1/FVC <0.70.
Total lung capacity is normal or increased (hyperinflation). Asthma shows reversibility.
,2. A 28-year-old female presents with episodic palpitations, sweating, and headache. Her blood
pressure is 180/110 mmHg during an episode. Which laboratory test is most helpful in diagnosis?
A) Plasma metanephrines
B) Serum cortisol
C) Thyroid stimulating hormone
D) Renin and aldosterone
Answer A: Plasma metanephrines
Rationale: Paroxysmal hypertension with palpitations and headache suggests pheochromocytoma;
metanephrines are first-line. Cortisol for Cushing’s; renin/aldosterone for primary hyperaldosteronism.
Confirm with imaging (CT/MIBG).
3. A 45-year-old male with HIV (CD4 count 120) presents with fever, dry cough, and hypoxemia. Chest
X-ray shows bilateral interstitial infiltrates. Which organism is most likely?
A) Pneumocystis jirovecii
B) Mycobacterium tuberculosis
C) Streptococcus pneumoniae
D) Histoplasma capsulatum
Answer A: Pneumocystis jirovecii
Rationale: PJP occurs with CD4 <200; presents with progressive dyspnea, dry cough, and bilateral infiltrates.
TB is more focal; Streptococcus is lobar. Prophylaxis with TMP-SMX is indicated.
4. A 68-year-old female on warfarin for atrial fibrillation presents with acute-onset severe headache,
nausea, and right-sided weakness. INR is 4.2. Non-contrast head CT shows a left parietal lobe
hemorrhage. Which intervention is most urgent?
A) Administer vitamin K 10 mg IV and prothrombin complex concentrate (PCC)
B) Give fresh frozen plasma only
C) Start a heparin drip
D) Administer tissue plasminogen activator
Answer A: Administer vitamin K 10 mg IV and prothrombin complex concentrate (PCC)
Rationale: Warfarin-related intracranial hemorrhage requires rapid reversal with PCC (or FFP) plus IV
vitamin K. PCC is faster than FFP; tPA is contraindicated. Blood pressure control is also critical.
,5. A 32-year-old pregnant woman at 28 weeks gestation presents with new-onset hypertension (BP
150/95 mmHg) and proteinuria (2+ on dipstick). She denies headache or visual changes. Which
diagnosis is most appropriate?
A) Gestational hypertension
B) Preeclampsia without severe features
C) Chronic hypertension
D) HELLP syndrome
Answer B: Preeclampsia without severe features
Rationale: New hypertension after 20 weeks with proteinuria defines preeclampsia; no severe features (BP
<160/110, normal labs). HELLP requires thrombocytopenia and liver enzyme elevation. Gestational
hypertension lacks proteinuria.
6. A 62-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is responsible?
A) Thiamine (B1)
B) Vitamin B12
C) Niacin
D) Vitamin E
Answer A: Thiamine (B1)
Rationale: Wernicke’s encephalopathy (confusion, ataxia, ophthalmoplegia) is due to thiamine deficiency.
Give IV thiamine before glucose to prevent exacerbation. If untreated, progresses to Korsakoff psychosis.
7. A 25-year-old male presents with low back pain that worsens with rest and improves with
exercise. He also has morning stiffness lasting 2 hours. Which finding on physical exam is most
specific?
A) Decreased lumbar lordosis
B) Positive Schober test
C) Pain with lateral bending
D) Tenderness over the sacroiliac joints
Answer B: Positive Schober test
Rationale: Schober test measures lumbar flexion; reduced expansion indicates axial spondyloarthritis (e.g.,
ankylosing spondylitis). Sacroiliac tenderness is common but less specific. HLA-B27 is supportive.
, 8. A 50-year-old female with systemic lupus erythematosus (SLE) presents with acute kidney injury,
hypertension, and hematuria. Renal biopsy shows diffuse proliferative glomerulonephritis (class IV).
Which initial therapy is indicated?
A) High-dose corticosteroids plus cyclophosphamide or mycophenolate
B) Hydroxychloroquine alone
C) Azathioprine monotherapy
D) Rituximab as first-line
Answer A: High-dose corticosteroids plus cyclophosphamide or mycophenolate
Rationale: Class IV lupus nephritis requires aggressive immunosuppression; cyclophosphamide or MMF
with steroids is standard. Hydroxychloroquine is background therapy. Rituximab is second-line.
9. A 34-year-old male presents with acute, severe, tearing chest pain radiating to the back. Blood
pressure is 160/100 mmHg in the right arm and 110/70 mmHg in the left arm. Which imaging study
is most appropriate?
A) CT angiography of the chest
B) Transthoracic echocardiogram
C) Chest X-ray
D) Ventilation-perfusion scan
Answer A: CT angiography of the chest
Rationale: Acute aortic dissection with unequal arm pressures is best diagnosed by CT angiography. TEE is
alternative but CT is faster and widely available. Chest X-ray is insensitive.
10. A 72-year-old male with Parkinson’s disease presents with worsening rigidity and bradykinesia.
He has been on carbidopa-levodopa for 5 years and now experiences “off” periods before his next
dose. Which medication can be added to reduce “off” time?
A) Entacapone
B) Benztropine
C) Selegiline
D) Amantadine
Answer A: Entacapone
Rationale: Entacapone (COMT inhibitor) prolongs levodopa half-life, reducing motor fluctuations. Selegiline
(MAO-B inhibitor) is used early; amantadine for dyskinesias. Benztropine for tremor.
Medicine Questions with Verified Answers &
Rationales
Welcome to this comprehensive COMLEX Level 2-CE practice exam. This resource contains 200 exam-style
clinical medicine questions covering the full scope of osteopathic board preparation. Each question mirrors
the format and difficulty of the COMLEX, with mixed subjects and integrated clinical scenarios. Every answer
includes a clear rationale. Use this exam to assess your readiness and build test-taking stamina.
Key Topics Covered
1. Cardiovascular & Pulmonary – Heart failure, arrhythmias, COPD, asthma, PE, hypertension
2. Gastrointestinal & Renal – GI bleeding, hepatitis, nephrolithiasis, acute kidney injury
3. Neurology & Psychiatry – Stroke, seizures, dementia, depression, bipolar, anxiety
4. Musculoskeletal & OMM – Fractures, arthritis, somatic dysfunction, HVLA, counterstrain
5. Infectious Disease & Immunology – Pneumonia, sepsis, HIV, autoimmune disorders
6. Endocrine & Metabolic – Diabetes, thyroid disorders, adrenal insufficiency
7. OB/GYN & Pediatrics – Pregnancy complications, newborn care, childhood illnesses
8. Osteopathic Principles & Practice – Chapman’s reflexes, tender points, viscerosomatic reflexes
Questions 1–200
1. A 55-year-old male with a 30-pack-year smoking history presents with progressive dyspnea,
chronic cough, and barrel chest. Which pulmonary function test finding is most consistent with
COPD?
A) Reduced FEV1/FVC ratio (<0.70)
B) Normal FEV1 with reduced FVC
C) Increased FEV1/FVC ratio
D) Reduced total lung capacity
Answer A: Reduced FEV1/FVC ratio (<0.70)
Rationale: COPD causes irreversible airflow obstruction, defined by post-bronchodilator FEV1/FVC <0.70.
Total lung capacity is normal or increased (hyperinflation). Asthma shows reversibility.
,2. A 28-year-old female presents with episodic palpitations, sweating, and headache. Her blood
pressure is 180/110 mmHg during an episode. Which laboratory test is most helpful in diagnosis?
A) Plasma metanephrines
B) Serum cortisol
C) Thyroid stimulating hormone
D) Renin and aldosterone
Answer A: Plasma metanephrines
Rationale: Paroxysmal hypertension with palpitations and headache suggests pheochromocytoma;
metanephrines are first-line. Cortisol for Cushing’s; renin/aldosterone for primary hyperaldosteronism.
Confirm with imaging (CT/MIBG).
3. A 45-year-old male with HIV (CD4 count 120) presents with fever, dry cough, and hypoxemia. Chest
X-ray shows bilateral interstitial infiltrates. Which organism is most likely?
A) Pneumocystis jirovecii
B) Mycobacterium tuberculosis
C) Streptococcus pneumoniae
D) Histoplasma capsulatum
Answer A: Pneumocystis jirovecii
Rationale: PJP occurs with CD4 <200; presents with progressive dyspnea, dry cough, and bilateral infiltrates.
TB is more focal; Streptococcus is lobar. Prophylaxis with TMP-SMX is indicated.
4. A 68-year-old female on warfarin for atrial fibrillation presents with acute-onset severe headache,
nausea, and right-sided weakness. INR is 4.2. Non-contrast head CT shows a left parietal lobe
hemorrhage. Which intervention is most urgent?
A) Administer vitamin K 10 mg IV and prothrombin complex concentrate (PCC)
B) Give fresh frozen plasma only
C) Start a heparin drip
D) Administer tissue plasminogen activator
Answer A: Administer vitamin K 10 mg IV and prothrombin complex concentrate (PCC)
Rationale: Warfarin-related intracranial hemorrhage requires rapid reversal with PCC (or FFP) plus IV
vitamin K. PCC is faster than FFP; tPA is contraindicated. Blood pressure control is also critical.
,5. A 32-year-old pregnant woman at 28 weeks gestation presents with new-onset hypertension (BP
150/95 mmHg) and proteinuria (2+ on dipstick). She denies headache or visual changes. Which
diagnosis is most appropriate?
A) Gestational hypertension
B) Preeclampsia without severe features
C) Chronic hypertension
D) HELLP syndrome
Answer B: Preeclampsia without severe features
Rationale: New hypertension after 20 weeks with proteinuria defines preeclampsia; no severe features (BP
<160/110, normal labs). HELLP requires thrombocytopenia and liver enzyme elevation. Gestational
hypertension lacks proteinuria.
6. A 62-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is responsible?
A) Thiamine (B1)
B) Vitamin B12
C) Niacin
D) Vitamin E
Answer A: Thiamine (B1)
Rationale: Wernicke’s encephalopathy (confusion, ataxia, ophthalmoplegia) is due to thiamine deficiency.
Give IV thiamine before glucose to prevent exacerbation. If untreated, progresses to Korsakoff psychosis.
7. A 25-year-old male presents with low back pain that worsens with rest and improves with
exercise. He also has morning stiffness lasting 2 hours. Which finding on physical exam is most
specific?
A) Decreased lumbar lordosis
B) Positive Schober test
C) Pain with lateral bending
D) Tenderness over the sacroiliac joints
Answer B: Positive Schober test
Rationale: Schober test measures lumbar flexion; reduced expansion indicates axial spondyloarthritis (e.g.,
ankylosing spondylitis). Sacroiliac tenderness is common but less specific. HLA-B27 is supportive.
, 8. A 50-year-old female with systemic lupus erythematosus (SLE) presents with acute kidney injury,
hypertension, and hematuria. Renal biopsy shows diffuse proliferative glomerulonephritis (class IV).
Which initial therapy is indicated?
A) High-dose corticosteroids plus cyclophosphamide or mycophenolate
B) Hydroxychloroquine alone
C) Azathioprine monotherapy
D) Rituximab as first-line
Answer A: High-dose corticosteroids plus cyclophosphamide or mycophenolate
Rationale: Class IV lupus nephritis requires aggressive immunosuppression; cyclophosphamide or MMF
with steroids is standard. Hydroxychloroquine is background therapy. Rituximab is second-line.
9. A 34-year-old male presents with acute, severe, tearing chest pain radiating to the back. Blood
pressure is 160/100 mmHg in the right arm and 110/70 mmHg in the left arm. Which imaging study
is most appropriate?
A) CT angiography of the chest
B) Transthoracic echocardiogram
C) Chest X-ray
D) Ventilation-perfusion scan
Answer A: CT angiography of the chest
Rationale: Acute aortic dissection with unequal arm pressures is best diagnosed by CT angiography. TEE is
alternative but CT is faster and widely available. Chest X-ray is insensitive.
10. A 72-year-old male with Parkinson’s disease presents with worsening rigidity and bradykinesia.
He has been on carbidopa-levodopa for 5 years and now experiences “off” periods before his next
dose. Which medication can be added to reduce “off” time?
A) Entacapone
B) Benztropine
C) Selegiline
D) Amantadine
Answer A: Entacapone
Rationale: Entacapone (COMT inhibitor) prolongs levodopa half-life, reducing motor fluctuations. Selegiline
(MAO-B inhibitor) is used early; amantadine for dyskinesias. Benztropine for tremor.
