COMSAE 112 Exam 2026 – NEWEST Questions with
Answers & Explanations (COMLEX-USA Level 2-CE
Prep) Instant Download Pdf
Questions 1–30: Internal Medicine & Clinical Reasoning
1. A 58-year-old man with hypertension and type 2 diabetes presents with sudden
onset of severe, tearing chest pain radiating to the back. Which diagnosis is most
likely?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Tearing pain to the back with risk factors strongly suggests aortic dissection.
2. A 45-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Laboratory studies show elevated TSH and low free T4. Which condition
best explains these findings?
A. Subacute thyroiditis
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hyperthyroidism
Elevated TSH with low T4 indicates primary thyroid failure.
3. A 62-year-old man with a history of smoking presents with progressive dyspnea,
chronic cough, and barrel chest. Pulmonary function tests show increased total lung
capacity. Which diagnosis is most consistent?
A. Asthma
B. Emphysema (COPD)
C. Interstitial lung disease
D. Bronchiectasis
,Hyperinflation and smoking history fit emphysema.
4. A 70-year-old woman presents with confusion, polyuria, and constipation.
Laboratory results show hypercalcemia and elevated parathyroid hormone. Which
diagnosis is most likely?
A. Malignancy-associated hypercalcemia
B. Primary hyperparathyroidism
C. Vitamin D intoxication
D. Sarcoidosis
High calcium with inappropriately high PTH indicates primary hyperparathyroidism.
5. A 55-year-old man presents with epigastric pain that improves with meals and
occasional night pain relieved by eating. Which diagnosis is most likely?
A. Gastric ulcer
B. Duodenal ulcer
C. Gastric cancer
D. Chronic pancreatitis
Pain relieved by food is classic for duodenal ulcer.
6. A 30-year-old woman presents with symmetric polyarthritis of the small joints of
her hands and morning stiffness lasting more than one hour. Which diagnosis is
most likely?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Gout
D. Psoriatic arthritis
Symmetric small-joint involvement with prolonged morning stiffness suggests RA.
7. A 65-year-old man presents with progressive memory loss, difficulty managing
finances, and getting lost in familiar places. Which diagnosis is most likely?
,A. Normal aging
B. Alzheimer disease
C. Delirium
D. Depression
Gradual cognitive decline affecting daily function is typical of Alzheimer’s.
8. A 40-year-old woman presents with heat intolerance, weight loss, tremor, and
exophthalmos. TSH is suppressed and free T4 is elevated. Which diagnosis is most
likely?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Hyperthyroidism with eye findings strongly suggests Graves disease.
9. A 50-year-old man presents with hematemesis and melena. He has a history of
heavy alcohol use and stigmata of chronic liver disease. Which source of bleeding is
most likely?
A. Hemorrhoids
B. Esophageal varices
C. Duodenal ulcer
D. Diverticulosis
In a cirrhotic patient, variceal bleeding is a major concern.
10. A 25-year-old woman presents with fever, sore throat, posterior cervical
lymphadenopathy, and fatigue. Monospot test is positive. Which organism is most
likely responsible?
A. Group A Streptococcus
B. Epstein–Barr virus
C. Cytomegalovirus
D. HIV
, Classic infectious mononucleosis presentation with positive monospot.
11. A 60-year-old man presents with weight loss, jaundice, and a palpable, nontender
gallbladder. Which diagnosis is most likely?
A. Acute cholecystitis
B. Pancreatic head cancer
C. Hepatitis A
D. Gallstone ileus
Courvoisier sign (painless jaundice + palpable gallbladder) suggests pancreatic cancer.
12. A 35-year-old man presents with recurrent episodes of severe vertigo, tinnitus,
and fluctuating hearing loss in one ear. Which diagnosis is most likely?
A. Vestibular neuritis
B. Meniere disease
C. Acoustic neuroma
D. Benign paroxysmal positional vertigo
Episodic vertigo with auditory symptoms fits Meniere disease.
13. A 45-year-old woman presents with fatigue, pruritus, and elevated alkaline
phosphatase. Antimitochondrial antibody test is positive. Which diagnosis is most
likely?
A. Hepatitis C
B. Primary biliary cholangitis
C. Hemochromatosis
D. Wilson disease
AMA positivity with cholestatic labs in a middle-aged woman suggests PBC.
14. A 70-year-old man presents with new-onset atrial fibrillation, is hemodynamically
stable, and has a CHA₂DS₂-VASc score of 4. Which strategy best reduces his stroke
risk?
Answers & Explanations (COMLEX-USA Level 2-CE
Prep) Instant Download Pdf
Questions 1–30: Internal Medicine & Clinical Reasoning
1. A 58-year-old man with hypertension and type 2 diabetes presents with sudden
onset of severe, tearing chest pain radiating to the back. Which diagnosis is most
likely?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Tearing pain to the back with risk factors strongly suggests aortic dissection.
2. A 45-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Laboratory studies show elevated TSH and low free T4. Which condition
best explains these findings?
A. Subacute thyroiditis
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hyperthyroidism
Elevated TSH with low T4 indicates primary thyroid failure.
3. A 62-year-old man with a history of smoking presents with progressive dyspnea,
chronic cough, and barrel chest. Pulmonary function tests show increased total lung
capacity. Which diagnosis is most consistent?
A. Asthma
B. Emphysema (COPD)
C. Interstitial lung disease
D. Bronchiectasis
,Hyperinflation and smoking history fit emphysema.
4. A 70-year-old woman presents with confusion, polyuria, and constipation.
Laboratory results show hypercalcemia and elevated parathyroid hormone. Which
diagnosis is most likely?
A. Malignancy-associated hypercalcemia
B. Primary hyperparathyroidism
C. Vitamin D intoxication
D. Sarcoidosis
High calcium with inappropriately high PTH indicates primary hyperparathyroidism.
5. A 55-year-old man presents with epigastric pain that improves with meals and
occasional night pain relieved by eating. Which diagnosis is most likely?
A. Gastric ulcer
B. Duodenal ulcer
C. Gastric cancer
D. Chronic pancreatitis
Pain relieved by food is classic for duodenal ulcer.
6. A 30-year-old woman presents with symmetric polyarthritis of the small joints of
her hands and morning stiffness lasting more than one hour. Which diagnosis is
most likely?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Gout
D. Psoriatic arthritis
Symmetric small-joint involvement with prolonged morning stiffness suggests RA.
7. A 65-year-old man presents with progressive memory loss, difficulty managing
finances, and getting lost in familiar places. Which diagnosis is most likely?
,A. Normal aging
B. Alzheimer disease
C. Delirium
D. Depression
Gradual cognitive decline affecting daily function is typical of Alzheimer’s.
8. A 40-year-old woman presents with heat intolerance, weight loss, tremor, and
exophthalmos. TSH is suppressed and free T4 is elevated. Which diagnosis is most
likely?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Hyperthyroidism with eye findings strongly suggests Graves disease.
9. A 50-year-old man presents with hematemesis and melena. He has a history of
heavy alcohol use and stigmata of chronic liver disease. Which source of bleeding is
most likely?
A. Hemorrhoids
B. Esophageal varices
C. Duodenal ulcer
D. Diverticulosis
In a cirrhotic patient, variceal bleeding is a major concern.
10. A 25-year-old woman presents with fever, sore throat, posterior cervical
lymphadenopathy, and fatigue. Monospot test is positive. Which organism is most
likely responsible?
A. Group A Streptococcus
B. Epstein–Barr virus
C. Cytomegalovirus
D. HIV
, Classic infectious mononucleosis presentation with positive monospot.
11. A 60-year-old man presents with weight loss, jaundice, and a palpable, nontender
gallbladder. Which diagnosis is most likely?
A. Acute cholecystitis
B. Pancreatic head cancer
C. Hepatitis A
D. Gallstone ileus
Courvoisier sign (painless jaundice + palpable gallbladder) suggests pancreatic cancer.
12. A 35-year-old man presents with recurrent episodes of severe vertigo, tinnitus,
and fluctuating hearing loss in one ear. Which diagnosis is most likely?
A. Vestibular neuritis
B. Meniere disease
C. Acoustic neuroma
D. Benign paroxysmal positional vertigo
Episodic vertigo with auditory symptoms fits Meniere disease.
13. A 45-year-old woman presents with fatigue, pruritus, and elevated alkaline
phosphatase. Antimitochondrial antibody test is positive. Which diagnosis is most
likely?
A. Hepatitis C
B. Primary biliary cholangitis
C. Hemochromatosis
D. Wilson disease
AMA positivity with cholestatic labs in a middle-aged woman suggests PBC.
14. A 70-year-old man presents with new-onset atrial fibrillation, is hemodynamically
stable, and has a CHA₂DS₂-VASc score of 4. Which strategy best reduces his stroke
risk?
