COMLEX-USA LEVEL 2-CE STYLE EXAM TEST
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | INSTANT DOWNLOAD PDF
Practice Questions (COMLEX-USA Level 2-CE)
1. A 25-year-old woman presents with acute right lower quadrant pain,
fever, and leukocytosis. Physical exam reveals rebound tenderness at
McBurney’s point. What is the most likely diagnosis?
A) Ovarian torsion
B) Ectopic pregnancy
C) Acute appendicitis
D) Pelvic inflammatory disease
Rationale: The classic presentation of RLQ pain, fever, leukocytosis, and
rebound tenderness indicates acute appendicitis.
2. A 67-year-old man with a history of hypertension presents with sudden-
onset tearing chest pain radiating to the back. Blood pressure is higher in
the right arm than the left. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Rationale: Tearing chest pain with unequal arm BPs strongly suggests an
aortic dissection.
3. A 32-year-old woman at 10 weeks gestation presents with vaginal
bleeding and cramping. On ultrasound, products of conception are seen
within the cervical canal. What is the diagnosis?
A) Threatened abortion
B) Complete abortion
,C) Incomplete abortion
D) Missed abortion
Rationale: Products of conception in the cervix with ongoing bleeding
and cramping indicate incomplete abortion.
4. A 5-year-old boy has a barking cough, inspiratory stridor, and
hoarseness. Symptoms worsen at night. What is the most likely diagnosis?
A) Epiglottitis
B) Croup (laryngotracheobronchitis)
C) Bacterial tracheitis
D) Foreign body aspiration
Rationale: Classic “seal-like” barking cough and inspiratory stridor in a
young child indicates viral croup.
5. A 23-year-old man is in a motor vehicle crash. He presents with
shortness of breath, hypotension, jugular venous distension, and absent
breath sounds on the right. What is the best immediate step?
A) Obtain a chest X-ray
B) Needle decompression of the right chest
C) Intubation
D) Pericardiocentesis
Rationale: This is a tension pneumothorax, and immediate needle
decompression is required before imaging.
6. A 55-year-old man presents with fatigue and pallor. CBC shows
microcytic anemia. Colonoscopy reveals a mass in the ascending colon.
What is the most likely underlying cause of anemia?
A) Vitamin B12 deficiency
B) Iron deficiency due to chronic blood loss
C) Aplastic anemia
D) Anemia of chronic disease
Rationale: Right-sided colon cancers often cause occult bleeding, leading
to iron deficiency anemia.
, 7. A 45-year-old woman has progressive fatigue and pruritus. Labs show
elevated alkaline phosphatase, positive antimitochondrial antibodies, and
evidence of cholestasis. What is the most likely diagnosis?
A) Primary sclerosing cholangitis
B) Primary biliary cholangitis
C) Autoimmune hepatitis
D) Gallstones
Rationale: Middle-aged woman, AMA+, and cholestasis is classic for
primary biliary cholangitis.
8. A 70-year-old man presents with progressive resting tremor,
bradykinesia, and cogwheel rigidity. Which neurotransmitter is most
deficient?
A) Acetylcholine
B) Serotonin
C) Dopamine
D) Norepinephrine
Rationale: Parkinson’s disease results from loss of dopaminergic neurons
in the substantia nigra.
9. A 16-year-old girl presents with polyuria, polydipsia, weight loss, and
fruity-smelling breath. Labs reveal hyperglycemia, metabolic acidosis,
and ketonuria. What is the best initial treatment?
A) Oral hypoglycemic agents
B) Bicarbonate therapy
C) IV insulin and fluids
D) Long-acting insulin only
Rationale: Diabetic ketoacidosis requires aggressive IV fluids and insulin
therapy.
10. A 22-year-old man presents with urethral discharge and dysuria.
Gram stain shows gram-negative diplococci. What is the most appropriate
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | INSTANT DOWNLOAD PDF
Practice Questions (COMLEX-USA Level 2-CE)
1. A 25-year-old woman presents with acute right lower quadrant pain,
fever, and leukocytosis. Physical exam reveals rebound tenderness at
McBurney’s point. What is the most likely diagnosis?
A) Ovarian torsion
B) Ectopic pregnancy
C) Acute appendicitis
D) Pelvic inflammatory disease
Rationale: The classic presentation of RLQ pain, fever, leukocytosis, and
rebound tenderness indicates acute appendicitis.
2. A 67-year-old man with a history of hypertension presents with sudden-
onset tearing chest pain radiating to the back. Blood pressure is higher in
the right arm than the left. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Rationale: Tearing chest pain with unequal arm BPs strongly suggests an
aortic dissection.
3. A 32-year-old woman at 10 weeks gestation presents with vaginal
bleeding and cramping. On ultrasound, products of conception are seen
within the cervical canal. What is the diagnosis?
A) Threatened abortion
B) Complete abortion
,C) Incomplete abortion
D) Missed abortion
Rationale: Products of conception in the cervix with ongoing bleeding
and cramping indicate incomplete abortion.
4. A 5-year-old boy has a barking cough, inspiratory stridor, and
hoarseness. Symptoms worsen at night. What is the most likely diagnosis?
A) Epiglottitis
B) Croup (laryngotracheobronchitis)
C) Bacterial tracheitis
D) Foreign body aspiration
Rationale: Classic “seal-like” barking cough and inspiratory stridor in a
young child indicates viral croup.
5. A 23-year-old man is in a motor vehicle crash. He presents with
shortness of breath, hypotension, jugular venous distension, and absent
breath sounds on the right. What is the best immediate step?
A) Obtain a chest X-ray
B) Needle decompression of the right chest
C) Intubation
D) Pericardiocentesis
Rationale: This is a tension pneumothorax, and immediate needle
decompression is required before imaging.
6. A 55-year-old man presents with fatigue and pallor. CBC shows
microcytic anemia. Colonoscopy reveals a mass in the ascending colon.
What is the most likely underlying cause of anemia?
A) Vitamin B12 deficiency
B) Iron deficiency due to chronic blood loss
C) Aplastic anemia
D) Anemia of chronic disease
Rationale: Right-sided colon cancers often cause occult bleeding, leading
to iron deficiency anemia.
, 7. A 45-year-old woman has progressive fatigue and pruritus. Labs show
elevated alkaline phosphatase, positive antimitochondrial antibodies, and
evidence of cholestasis. What is the most likely diagnosis?
A) Primary sclerosing cholangitis
B) Primary biliary cholangitis
C) Autoimmune hepatitis
D) Gallstones
Rationale: Middle-aged woman, AMA+, and cholestasis is classic for
primary biliary cholangitis.
8. A 70-year-old man presents with progressive resting tremor,
bradykinesia, and cogwheel rigidity. Which neurotransmitter is most
deficient?
A) Acetylcholine
B) Serotonin
C) Dopamine
D) Norepinephrine
Rationale: Parkinson’s disease results from loss of dopaminergic neurons
in the substantia nigra.
9. A 16-year-old girl presents with polyuria, polydipsia, weight loss, and
fruity-smelling breath. Labs reveal hyperglycemia, metabolic acidosis,
and ketonuria. What is the best initial treatment?
A) Oral hypoglycemic agents
B) Bicarbonate therapy
C) IV insulin and fluids
D) Long-acting insulin only
Rationale: Diabetic ketoacidosis requires aggressive IV fluids and insulin
therapy.
10. A 22-year-old man presents with urethral discharge and dysuria.
Gram stain shows gram-negative diplococci. What is the most appropriate
