COMPREHENSIVE OSTEOPATHIC
MEDICAL LICENSING EXAMINATION OF
THE UNITED STATES LEVEL 2 COGNITIVE
EVALUATION PRACTICE EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
1. A 65-year-old man presents with crushing chest pain radiating to the left
arm. ECG shows ST elevation in leads II, III, and aVF. What is the most likely
diagnosis?
A. Stable angina
B. NSTEMI
C. Inferior STEMI
D. Pericarditis
Answer: C. Inferior STEMI
Rationale: ST elevations in leads II, III, and aVF correspond to the inferior wall of
the heart, typically supplied by the right coronary artery. This pattern indicates
an acute transmural myocardial infarction (STEMI), requiring urgent reperfusion
therapy.
2. A 25-year-old woman presents with dysuria and frequency. Urinalysis shows
leukocyte esterase and nitrites. What is the most likely organism?
, A. Staphylococcus saprophyticus
B. Escherichia coli
C. Enterococcus
D. Klebsiella
Answer: B. Escherichia coli
Rationale: E. coli is the most common cause of uncomplicated urinary tract
infections. The presence of nitrites suggests a gram-negative organism capable
of reducing nitrates, which is characteristic of E. coli.
3. A patient with asthma presents with worsening shortness of breath. Which
medication is first-line for acute exacerbation?
A. Inhaled corticosteroids
B. Long-acting beta agonist
C. Short-acting beta agonist
D. Leukotriene antagonist
Answer: C. Short-acting beta agonist
Rationale: Short-acting beta-agonists (e.g., albuterol) provide rapid
bronchodilation and are the first-line treatment for acute asthma exacerbations.
Other medications are used for long-term control.
4. A 70-year-old smoker presents with hematuria. What is the most likely
diagnosis?
A. Renal stone
B. Bladder cancer
C. UTI
D. Glomerulonephritis
Answer: B. Bladder cancer
Rationale: Painless hematuria in an older smoker strongly suggests bladder
cancer. Smoking is the most significant risk factor due to carcinogenic exposure
affecting the urothelium.
, 5. A child presents with a barking cough and inspiratory stridor. What is the
most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
Answer: B. Croup
Rationale: Croup (laryngotracheobronchitis) presents with a characteristic
barking cough and inspiratory stridor, usually caused by parainfluenza virus. It
typically affects young children.
6. A patient with diabetes presents with polyuria and polydipsia. Blood
glucose is 400 mg/dL. What is the likely condition?
A. Hypoglycemia
B. DKA
C. HHS
D. Insulinoma
Answer: C. HHS
Rationale: Hyperosmolar hyperglycemic state (HHS) is characterized by very high
glucose levels (>600 mg/dL often) without significant ketoacidosis. It is more
common in type 2 diabetes and presents with dehydration and altered mental
status.
7. A patient presents with fever, neck stiffness, and altered mental status.
What is the next step?
A. MRI
B. Antibiotics immediately
C. LP first
D. CT scan
, Answer: B. Antibiotics immediately
Rationale: Suspected bacterial meningitis requires immediate empiric antibiotic
therapy to reduce mortality. Imaging or lumbar puncture should not delay
treatment in unstable patients.
8. A 55-year-old man has elevated PSA. What is the next step?
A. Repeat PSA
B. Prostate biopsy
C. MRI
D. Watchful waiting
Answer: B. Prostate biopsy
Rationale: Elevated PSA suggests possible prostate cancer. A biopsy is required
for definitive diagnosis. Repeating PSA may be considered in borderline cases,
but persistent elevation warrants biopsy.
9. A patient presents with sudden severe headache described as “worst of
life.” What is the likely diagnosis?
A. Migraine
B. Tension headache
C. Subarachnoid hemorrhage
D. Cluster headache
Answer: C. Subarachnoid hemorrhage
Rationale: A sudden, severe “thunderclap” headache is classic for subarachnoid
hemorrhage, often due to a ruptured aneurysm. Immediate CT scan is required.
10.A newborn presents with a machine-like murmur. What is the diagnosis?
A. ASD
B. VSD
MEDICAL LICENSING EXAMINATION OF
THE UNITED STATES LEVEL 2 COGNITIVE
EVALUATION PRACTICE EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
1. A 65-year-old man presents with crushing chest pain radiating to the left
arm. ECG shows ST elevation in leads II, III, and aVF. What is the most likely
diagnosis?
A. Stable angina
B. NSTEMI
C. Inferior STEMI
D. Pericarditis
Answer: C. Inferior STEMI
Rationale: ST elevations in leads II, III, and aVF correspond to the inferior wall of
the heart, typically supplied by the right coronary artery. This pattern indicates
an acute transmural myocardial infarction (STEMI), requiring urgent reperfusion
therapy.
2. A 25-year-old woman presents with dysuria and frequency. Urinalysis shows
leukocyte esterase and nitrites. What is the most likely organism?
, A. Staphylococcus saprophyticus
B. Escherichia coli
C. Enterococcus
D. Klebsiella
Answer: B. Escherichia coli
Rationale: E. coli is the most common cause of uncomplicated urinary tract
infections. The presence of nitrites suggests a gram-negative organism capable
of reducing nitrates, which is characteristic of E. coli.
3. A patient with asthma presents with worsening shortness of breath. Which
medication is first-line for acute exacerbation?
A. Inhaled corticosteroids
B. Long-acting beta agonist
C. Short-acting beta agonist
D. Leukotriene antagonist
Answer: C. Short-acting beta agonist
Rationale: Short-acting beta-agonists (e.g., albuterol) provide rapid
bronchodilation and are the first-line treatment for acute asthma exacerbations.
Other medications are used for long-term control.
4. A 70-year-old smoker presents with hematuria. What is the most likely
diagnosis?
A. Renal stone
B. Bladder cancer
C. UTI
D. Glomerulonephritis
Answer: B. Bladder cancer
Rationale: Painless hematuria in an older smoker strongly suggests bladder
cancer. Smoking is the most significant risk factor due to carcinogenic exposure
affecting the urothelium.
, 5. A child presents with a barking cough and inspiratory stridor. What is the
most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
Answer: B. Croup
Rationale: Croup (laryngotracheobronchitis) presents with a characteristic
barking cough and inspiratory stridor, usually caused by parainfluenza virus. It
typically affects young children.
6. A patient with diabetes presents with polyuria and polydipsia. Blood
glucose is 400 mg/dL. What is the likely condition?
A. Hypoglycemia
B. DKA
C. HHS
D. Insulinoma
Answer: C. HHS
Rationale: Hyperosmolar hyperglycemic state (HHS) is characterized by very high
glucose levels (>600 mg/dL often) without significant ketoacidosis. It is more
common in type 2 diabetes and presents with dehydration and altered mental
status.
7. A patient presents with fever, neck stiffness, and altered mental status.
What is the next step?
A. MRI
B. Antibiotics immediately
C. LP first
D. CT scan
, Answer: B. Antibiotics immediately
Rationale: Suspected bacterial meningitis requires immediate empiric antibiotic
therapy to reduce mortality. Imaging or lumbar puncture should not delay
treatment in unstable patients.
8. A 55-year-old man has elevated PSA. What is the next step?
A. Repeat PSA
B. Prostate biopsy
C. MRI
D. Watchful waiting
Answer: B. Prostate biopsy
Rationale: Elevated PSA suggests possible prostate cancer. A biopsy is required
for definitive diagnosis. Repeating PSA may be considered in borderline cases,
but persistent elevation warrants biopsy.
9. A patient presents with sudden severe headache described as “worst of
life.” What is the likely diagnosis?
A. Migraine
B. Tension headache
C. Subarachnoid hemorrhage
D. Cluster headache
Answer: C. Subarachnoid hemorrhage
Rationale: A sudden, severe “thunderclap” headache is classic for subarachnoid
hemorrhage, often due to a ruptured aneurysm. Immediate CT scan is required.
10.A newborn presents with a machine-like murmur. What is the diagnosis?
A. ASD
B. VSD
