COMSAE Phase 2 Form 116 Exam Questions and Answers
2026 |Actual COMLEX Level 2 Practice Questions with
Detailed Rationales | Comprehensive Board Review Study
Guide| pdf
Overview & Coverage
Prepare confidently for your COMSAE Phase 2 Form 116 and COMLEX Level 2 board exams with this
comprehensive question practice exam designed to reinforce high-yield clinical concepts and board-style
reasoning. Each multiple-choice question includes the correct answer and a clear explanation to
strengthen diagnostic skills, clinical decision-making, and exam readiness.
This study guide covers the most frequently tested topics, including Internal Medicine, Cardiology,
Pulmonology, Gastroenterology, Endocrinology, Nephrology, Neurology, Infectious Diseases,
Hematology, Oncology, Rheumatology, Emergency Medicine, General Surgery, Orthopedics,
Obstetrics & Gynecology, Pediatrics, Psychiatry, Preventive Medicine, Medical Ethics, Patient
Safety, and high-yield COMLEX Level 2 clinical scenarios. Ideal for final exam review, self-assessment,
remediation, and board preparation, this resource helps students build confidence before test day.
1. A 68-year-old man presents to the emergency department with crushing substernal
chest pain that began 45 minutes ago while shoveling snow. The pain radiates to his
left shoulder and jaw and is associated with diaphoresis and nausea. An
electrocardiogram demonstrates ST-segment elevations in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. First diagonal artery
Answer: C. Right coronary artery
Explanation: ST-segment elevation in leads II, III, and aVF indicates an inferior
myocardial infarction. In most patients, this is caused by occlusion of the right coronary
artery, which supplies the inferior wall of the left ventricle.
,2. A 24-year-old woman presents with fever, dysuria, urinary frequency, and right-
sided flank pain. Physical examination reveals right costovertebral angle tenderness.
Urinalysis shows numerous white blood cells, positive leukocyte esterase, positive
nitrites, and white blood cell casts. Which diagnosis is most likely?
A. Acute cystitis
B. Nephrolithiasis
C. Acute pyelonephritis
D. Interstitial cystitis
Answer: C. Acute pyelonephritis
Explanation: Fever, flank pain, costovertebral angle tenderness, and white blood cell
casts strongly suggest acute pyelonephritis involving the renal parenchyma.
3. A 72-year-old woman suddenly develops right facial droop, right arm weakness,
and difficulty speaking. Symptoms began 40 minutes ago. A noncontrast head CT
shows no intracranial hemorrhage. Which intervention is most appropriate if no
contraindications exist?
A. Aspirin only
B. Immediate carotid endarterectomy
C. Heparin infusion
D. Intravenous thrombolytic therapy
Answer: D. Intravenous thrombolytic therapy
Explanation: Patients with acute ischemic stroke presenting within the appropriate
treatment window and without contraindications should be evaluated promptly for
intravenous thrombolytic therapy.
4. A 59-year-old man with long-standing hypertension presents with progressive
shortness of breath and bilateral lower-extremity edema. Echocardiography
demonstrates a reduced ejection fraction of 30%. Which medication has been shown
to improve survival in patients with heart failure with reduced ejection fraction?
A. Digoxin alone
B. Furosemide alone
,C. An angiotensin-converting enzyme (ACE) inhibitor
D. Hydrochlorothiazide alone
Answer: C. An angiotensin-converting enzyme (ACE) inhibitor
Explanation: ACE inhibitors reduce mortality and hospitalizations in patients with heart
failure with reduced ejection fraction by decreasing afterload and limiting adverse cardiac
remodeling.
5. A 6-year-old child presents with fever, sore throat, muffled voice, drooling, and
difficulty swallowing. The child prefers to sit leaning forward and appears anxious.
Which diagnosis should be considered first?
A. Viral pharyngitis
B. Croup
C. Peritonsillar abscess
D. Epiglottitis
Answer: D. Epiglottitis
Explanation: Fever, drooling, muffled voice, and the tripod position are classic findings
of epiglottitis. Airway management is the highest priority.
6. A 54-year-old woman presents with sudden onset of severe epigastric pain
radiating to her back. Laboratory studies reveal markedly elevated serum lipase.
Which diagnosis is most likely?
A. Acute cholecystitis
B. Perforated peptic ulcer
C. Acute pancreatitis
D. Acute appendicitis
Answer: C. Acute pancreatitis
Explanation: Severe epigastric pain radiating to the back accompanied by a markedly
elevated lipase level is highly suggestive of acute pancreatitis.
, 7. A 32-year-old woman at 34 weeks' gestation presents with blood pressure of
170/112 mmHg, severe headache, visual disturbances, and proteinuria. Which
diagnosis is most likely?
A. Chronic hypertension
B. Gestational hypertension
C. Eclampsia
D. Severe preeclampsia
Answer: D. Severe preeclampsia
Explanation: Severe hypertension after 20 weeks of pregnancy with proteinuria and
signs of end-organ involvement is consistent with severe preeclampsia.
8. A 67-year-old smoker reports painless hematuria for two weeks. Which diagnosis
should be considered until proven otherwise?
A. Urinary tract infection
B. Benign prostatic hyperplasia
C. Nephrolithiasis
D. Bladder cancer
Answer: D. Bladder cancer
Explanation: Painless gross hematuria in an older smoker is highly concerning for
bladder cancer and requires prompt evaluation.
9. A 25-year-old man presents with fever, headache, neck stiffness, and photophobia.
Cerebrospinal fluid analysis demonstrates elevated opening pressure, neutrophilic
predominance, low glucose, and elevated protein. Which diagnosis is most likely?
A. Viral meningitis
B. Fungal meningitis
C. Tuberculous meningitis
D. Acute bacterial meningitis
Answer: D. Acute bacterial meningitis
2026 |Actual COMLEX Level 2 Practice Questions with
Detailed Rationales | Comprehensive Board Review Study
Guide| pdf
Overview & Coverage
Prepare confidently for your COMSAE Phase 2 Form 116 and COMLEX Level 2 board exams with this
comprehensive question practice exam designed to reinforce high-yield clinical concepts and board-style
reasoning. Each multiple-choice question includes the correct answer and a clear explanation to
strengthen diagnostic skills, clinical decision-making, and exam readiness.
This study guide covers the most frequently tested topics, including Internal Medicine, Cardiology,
Pulmonology, Gastroenterology, Endocrinology, Nephrology, Neurology, Infectious Diseases,
Hematology, Oncology, Rheumatology, Emergency Medicine, General Surgery, Orthopedics,
Obstetrics & Gynecology, Pediatrics, Psychiatry, Preventive Medicine, Medical Ethics, Patient
Safety, and high-yield COMLEX Level 2 clinical scenarios. Ideal for final exam review, self-assessment,
remediation, and board preparation, this resource helps students build confidence before test day.
1. A 68-year-old man presents to the emergency department with crushing substernal
chest pain that began 45 minutes ago while shoveling snow. The pain radiates to his
left shoulder and jaw and is associated with diaphoresis and nausea. An
electrocardiogram demonstrates ST-segment elevations in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. First diagonal artery
Answer: C. Right coronary artery
Explanation: ST-segment elevation in leads II, III, and aVF indicates an inferior
myocardial infarction. In most patients, this is caused by occlusion of the right coronary
artery, which supplies the inferior wall of the left ventricle.
,2. A 24-year-old woman presents with fever, dysuria, urinary frequency, and right-
sided flank pain. Physical examination reveals right costovertebral angle tenderness.
Urinalysis shows numerous white blood cells, positive leukocyte esterase, positive
nitrites, and white blood cell casts. Which diagnosis is most likely?
A. Acute cystitis
B. Nephrolithiasis
C. Acute pyelonephritis
D. Interstitial cystitis
Answer: C. Acute pyelonephritis
Explanation: Fever, flank pain, costovertebral angle tenderness, and white blood cell
casts strongly suggest acute pyelonephritis involving the renal parenchyma.
3. A 72-year-old woman suddenly develops right facial droop, right arm weakness,
and difficulty speaking. Symptoms began 40 minutes ago. A noncontrast head CT
shows no intracranial hemorrhage. Which intervention is most appropriate if no
contraindications exist?
A. Aspirin only
B. Immediate carotid endarterectomy
C. Heparin infusion
D. Intravenous thrombolytic therapy
Answer: D. Intravenous thrombolytic therapy
Explanation: Patients with acute ischemic stroke presenting within the appropriate
treatment window and without contraindications should be evaluated promptly for
intravenous thrombolytic therapy.
4. A 59-year-old man with long-standing hypertension presents with progressive
shortness of breath and bilateral lower-extremity edema. Echocardiography
demonstrates a reduced ejection fraction of 30%. Which medication has been shown
to improve survival in patients with heart failure with reduced ejection fraction?
A. Digoxin alone
B. Furosemide alone
,C. An angiotensin-converting enzyme (ACE) inhibitor
D. Hydrochlorothiazide alone
Answer: C. An angiotensin-converting enzyme (ACE) inhibitor
Explanation: ACE inhibitors reduce mortality and hospitalizations in patients with heart
failure with reduced ejection fraction by decreasing afterload and limiting adverse cardiac
remodeling.
5. A 6-year-old child presents with fever, sore throat, muffled voice, drooling, and
difficulty swallowing. The child prefers to sit leaning forward and appears anxious.
Which diagnosis should be considered first?
A. Viral pharyngitis
B. Croup
C. Peritonsillar abscess
D. Epiglottitis
Answer: D. Epiglottitis
Explanation: Fever, drooling, muffled voice, and the tripod position are classic findings
of epiglottitis. Airway management is the highest priority.
6. A 54-year-old woman presents with sudden onset of severe epigastric pain
radiating to her back. Laboratory studies reveal markedly elevated serum lipase.
Which diagnosis is most likely?
A. Acute cholecystitis
B. Perforated peptic ulcer
C. Acute pancreatitis
D. Acute appendicitis
Answer: C. Acute pancreatitis
Explanation: Severe epigastric pain radiating to the back accompanied by a markedly
elevated lipase level is highly suggestive of acute pancreatitis.
, 7. A 32-year-old woman at 34 weeks' gestation presents with blood pressure of
170/112 mmHg, severe headache, visual disturbances, and proteinuria. Which
diagnosis is most likely?
A. Chronic hypertension
B. Gestational hypertension
C. Eclampsia
D. Severe preeclampsia
Answer: D. Severe preeclampsia
Explanation: Severe hypertension after 20 weeks of pregnancy with proteinuria and
signs of end-organ involvement is consistent with severe preeclampsia.
8. A 67-year-old smoker reports painless hematuria for two weeks. Which diagnosis
should be considered until proven otherwise?
A. Urinary tract infection
B. Benign prostatic hyperplasia
C. Nephrolithiasis
D. Bladder cancer
Answer: D. Bladder cancer
Explanation: Painless gross hematuria in an older smoker is highly concerning for
bladder cancer and requires prompt evaluation.
9. A 25-year-old man presents with fever, headache, neck stiffness, and photophobia.
Cerebrospinal fluid analysis demonstrates elevated opening pressure, neutrophilic
predominance, low glucose, and elevated protein. Which diagnosis is most likely?
A. Viral meningitis
B. Fungal meningitis
C. Tuberculous meningitis
D. Acute bacterial meningitis
Answer: D. Acute bacterial meningitis
