COMLEX-USA Level 3 ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% VERIFIED SOLUTIONS
| UPDATED PER LATEST GUIDELINES |
GRADED A+
Section 1: Emergency Medicine & Acute Care
Question 1
A 65-year-old man with a history of hypertension and diabetes presents with 3 hours of
substernal chest pressure radiating to his left arm, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V1–V4. He is hemodynamically stable. Which of the following is the
most appropriate immediate management?
A) Aspirin, sublingual nitroglycerin, and emergent PCI
B) Aspirin and thrombolytic therapy
C) Aspirin, oxygen, and morphine
D) Immediate CABG
Answer: A) Aspirin, sublingual nitroglycerin, and emergent PCI
Rationale: This is an anteroseptal STEMI. Primary percutaneous coronary intervention is the
gold standard if available within 90 minutes. Aspirin and nitroglycerin are important initial steps
but not definitive; thrombolytics are used if PCI is unavailable.
Question 2
A 28-year-old woman presents with sudden-onset dyspnea, pleuritic chest pain, and
tachycardia. She recently completed a 14-hour international flight. Her SpO₂ is 89% on room air.
Which of the following is the most appropriate diagnostic test?
,A) D-dimer
B) CT pulmonary angiography
C) V/Q scan
D) Chest X-ray
Answer: B) CT pulmonary angiography
Rationale: This patient has a high pretest probability for pulmonary embolism (immobilization,
acute onset dyspnea, tachycardia, hypoxia). CT pulmonary angiography is the gold standard
diagnostic test and should be obtained without delay. A D-dimer is useful for low-risk patients.
Question 3
A 45-year-old man with a history of alcohol use disorder is brought to the ED with confusion,
ataxia, and ophthalmoplegia. He is disoriented to time and place. Which of the following is the
most appropriate immediate intervention?
A) IV dextrose 50%
B) IV thiamine 100 mg
C) IV lorazepam
D) CT scan of the head
Answer: B) IV thiamine 100 mg
Rationale: This is Wernicke's encephalopathy caused by thiamine deficiency. Thiamine must be
administered before or simultaneously with glucose to prevent precipitation of Wernicke-
Korsakoff syndrome. While a head CT may be needed, thiamine is the life-saving priority.
Question 4
A 72-year-old man with a history of smoking and hypertension presents with sudden-onset
severe "tearing" back pain. His blood pressure is 210/110 mmHg in the right arm and 180/100
mmHg in the left arm. Which of the following is the most appropriate next step?
A) IV labetalol and emergent CT angiography
B) Immediate surgical consultation only
C) CT angiography alone
D) IV antihypertensives and echocardiogram
Answer: A) IV labetalol and emergent CT angiography
,Rationale: This is a classic presentation of aortic dissection. CT angiography is the diagnostic
study of choice. Blood pressure must be controlled emergently with IV beta-blockers to reduce
aortic wall stress. Surgical consultation should follow imaging confirmation.
Question 5
A 32-year-old man with no significant medical history presents with acute-onset, severe
headache described as "the worst of his life." He is photophobic and nauseated. Neurological
exam is non-focal. Which of the following is the most appropriate initial imaging study?
A) Non-contrast CT head
B) CT angiography
C) MRI brain
D) Lumbar puncture
Answer: A) Non-contrast CT head
Rationale: This is a classic "thunderclap" headache concerning for subarachnoid hemorrhage.
Non-contrast CT is the first-line imaging study, with high sensitivity for acute SAH. A lumbar
puncture is indicated if the CT is negative but clinical suspicion remains high.
Question 6
A 55-year-old woman presents with 2 days of right lower quadrant abdominal pain. She has a
low-grade fever and nausea. On examination, she has rebound tenderness and guarding in the
right lower quadrant. Which of the following is the most appropriate initial step?
A) Abdominal CT with contrast
B) Complete blood count and urinalysis
C) Surgery consultation
D) Pelvic ultrasound
Answer: B) Complete blood count and urinalysis
Rationale: In a patient with suspected appendicitis, initial evaluation should include a CBC to
assess for leukocytosis and a urinalysis to rule out urinary tract pathology. While CT imaging
may be needed, basic laboratory studies are the appropriate first step.
Question 7
A 24-year-old male with no significant history presents with acute-onset, severe scrotal pain.
The left testicle is swollen and tender; cremasteric reflex is absent. Which of the following is the
, most appropriate management?
A) Scrotal ultrasound
B) Immediate urology consultation
C) Antibiotics and pain management
D) Doppler ultrasound
Answer: B) Immediate urology consultation
Rationale: This presentation is concerning for testicular torsion, a surgical emergency. The
absence of the cremasteric reflex is a classic sign. Immediate urology consultation for possible
surgical detorsion is required; imaging should not delay surgical evaluation when clinical
suspicion is high.
Question 8
A 65-year-old male with a history of BPH presents with acute inability to void and severe
suprapubic pain. He has a palpable distended bladder. Which of the following is the most
appropriate immediate management?
A) Alpha-blocker therapy
B) Foley catheter placement
C) Transurethral resection of the prostate
D) 5-alpha-reductase inhibitor
Answer: B) Foley catheter placement
Rationale: This is acute urinary retention, a medical emergency. Immediate decompression with
a Foley catheter is the priority to relieve patient distress and prevent complications such as
renal failure. Alpha-blockers and TURP are for subsequent management.
Question 9
A 58-year-old patient with cirrhosis and ascites is brought to the ED with fever, confusion, and
abdominal pain. Paracentesis reveals a polymorphonuclear leukocyte count of 500 cells/mm³.
Which of the following is the most appropriate treatment?
A) IV ceftriaxone and albumin
B) Oral fluoroquinolone
C) IV vancomycin and piperacillin-tazobactam
D) IV ceftriaxone alone
Answer: A) IV ceftriaxone and albumin
QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% VERIFIED SOLUTIONS
| UPDATED PER LATEST GUIDELINES |
GRADED A+
Section 1: Emergency Medicine & Acute Care
Question 1
A 65-year-old man with a history of hypertension and diabetes presents with 3 hours of
substernal chest pressure radiating to his left arm, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V1–V4. He is hemodynamically stable. Which of the following is the
most appropriate immediate management?
A) Aspirin, sublingual nitroglycerin, and emergent PCI
B) Aspirin and thrombolytic therapy
C) Aspirin, oxygen, and morphine
D) Immediate CABG
Answer: A) Aspirin, sublingual nitroglycerin, and emergent PCI
Rationale: This is an anteroseptal STEMI. Primary percutaneous coronary intervention is the
gold standard if available within 90 minutes. Aspirin and nitroglycerin are important initial steps
but not definitive; thrombolytics are used if PCI is unavailable.
Question 2
A 28-year-old woman presents with sudden-onset dyspnea, pleuritic chest pain, and
tachycardia. She recently completed a 14-hour international flight. Her SpO₂ is 89% on room air.
Which of the following is the most appropriate diagnostic test?
,A) D-dimer
B) CT pulmonary angiography
C) V/Q scan
D) Chest X-ray
Answer: B) CT pulmonary angiography
Rationale: This patient has a high pretest probability for pulmonary embolism (immobilization,
acute onset dyspnea, tachycardia, hypoxia). CT pulmonary angiography is the gold standard
diagnostic test and should be obtained without delay. A D-dimer is useful for low-risk patients.
Question 3
A 45-year-old man with a history of alcohol use disorder is brought to the ED with confusion,
ataxia, and ophthalmoplegia. He is disoriented to time and place. Which of the following is the
most appropriate immediate intervention?
A) IV dextrose 50%
B) IV thiamine 100 mg
C) IV lorazepam
D) CT scan of the head
Answer: B) IV thiamine 100 mg
Rationale: This is Wernicke's encephalopathy caused by thiamine deficiency. Thiamine must be
administered before or simultaneously with glucose to prevent precipitation of Wernicke-
Korsakoff syndrome. While a head CT may be needed, thiamine is the life-saving priority.
Question 4
A 72-year-old man with a history of smoking and hypertension presents with sudden-onset
severe "tearing" back pain. His blood pressure is 210/110 mmHg in the right arm and 180/100
mmHg in the left arm. Which of the following is the most appropriate next step?
A) IV labetalol and emergent CT angiography
B) Immediate surgical consultation only
C) CT angiography alone
D) IV antihypertensives and echocardiogram
Answer: A) IV labetalol and emergent CT angiography
,Rationale: This is a classic presentation of aortic dissection. CT angiography is the diagnostic
study of choice. Blood pressure must be controlled emergently with IV beta-blockers to reduce
aortic wall stress. Surgical consultation should follow imaging confirmation.
Question 5
A 32-year-old man with no significant medical history presents with acute-onset, severe
headache described as "the worst of his life." He is photophobic and nauseated. Neurological
exam is non-focal. Which of the following is the most appropriate initial imaging study?
A) Non-contrast CT head
B) CT angiography
C) MRI brain
D) Lumbar puncture
Answer: A) Non-contrast CT head
Rationale: This is a classic "thunderclap" headache concerning for subarachnoid hemorrhage.
Non-contrast CT is the first-line imaging study, with high sensitivity for acute SAH. A lumbar
puncture is indicated if the CT is negative but clinical suspicion remains high.
Question 6
A 55-year-old woman presents with 2 days of right lower quadrant abdominal pain. She has a
low-grade fever and nausea. On examination, she has rebound tenderness and guarding in the
right lower quadrant. Which of the following is the most appropriate initial step?
A) Abdominal CT with contrast
B) Complete blood count and urinalysis
C) Surgery consultation
D) Pelvic ultrasound
Answer: B) Complete blood count and urinalysis
Rationale: In a patient with suspected appendicitis, initial evaluation should include a CBC to
assess for leukocytosis and a urinalysis to rule out urinary tract pathology. While CT imaging
may be needed, basic laboratory studies are the appropriate first step.
Question 7
A 24-year-old male with no significant history presents with acute-onset, severe scrotal pain.
The left testicle is swollen and tender; cremasteric reflex is absent. Which of the following is the
, most appropriate management?
A) Scrotal ultrasound
B) Immediate urology consultation
C) Antibiotics and pain management
D) Doppler ultrasound
Answer: B) Immediate urology consultation
Rationale: This presentation is concerning for testicular torsion, a surgical emergency. The
absence of the cremasteric reflex is a classic sign. Immediate urology consultation for possible
surgical detorsion is required; imaging should not delay surgical evaluation when clinical
suspicion is high.
Question 8
A 65-year-old male with a history of BPH presents with acute inability to void and severe
suprapubic pain. He has a palpable distended bladder. Which of the following is the most
appropriate immediate management?
A) Alpha-blocker therapy
B) Foley catheter placement
C) Transurethral resection of the prostate
D) 5-alpha-reductase inhibitor
Answer: B) Foley catheter placement
Rationale: This is acute urinary retention, a medical emergency. Immediate decompression with
a Foley catheter is the priority to relieve patient distress and prevent complications such as
renal failure. Alpha-blockers and TURP are for subsequent management.
Question 9
A 58-year-old patient with cirrhosis and ascites is brought to the ED with fever, confusion, and
abdominal pain. Paracentesis reveals a polymorphonuclear leukocyte count of 500 cells/mm³.
Which of the following is the most appropriate treatment?
A) IV ceftriaxone and albumin
B) Oral fluoroquinolone
C) IV vancomycin and piperacillin-tazobactam
D) IV ceftriaxone alone
Answer: A) IV ceftriaxone and albumin
