COMLEX Level 2–style 200 practise
Questions with Answers & Rationales
Original COMLEX Level 2–style practice questions designed to strengthen clinical reasoning, diagnostic skills, and exam
readiness across medicine, surgery, pediatrics, OB/GYN, OMM, ethics, and biostatistics with detailed answers and
explanations.
Question 1
A 64-year-old man with hypertension develops sudden severe tearing chest pain radiating to the
back. Blood pressure is 185/100 mm Hg in the right arm and 155/90 mm Hg in the left arm. Chest
radiograph shows a widened mediastinum. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Acute pericarditis
E. Esophageal rupture
Answer: C. Aortic dissection
Explanation: Abrupt tearing chest pain, blood pressure differential between arms, and widened
mediastinum are classic findings of acute aortic dissection. Initial management includes IV beta-
blockade followed by definitive imaging and surgical consultation for Type A dissections.
Question 2
A 72-year-old woman presents with sudden painless loss of vision in her right eye that began 30
minutes ago. Funduscopic examination reveals a pale retina with a cherry-red spot at the macula.
A. Acute angle-closure glaucoma
B. Central retinal artery occlusion
C. Retinal detachment
D. Vitreous hemorrhage
Answer: B. Central retinal artery occlusion
Explanation: Sudden painless monocular vision loss with a cherry-red spot is classic for central
retinal artery occlusion. This is an ophthalmic emergency requiring immediate ophthalmology
consultation.
Question 3
A 24-year-old woman presents with dysuria and urinary frequency. Urinalysis is positive for leukocyte
esterase and nitrites. She has no fever or flank pain.
,A. Ciprofloxacin
B. Nitrofurantoin
C. Vancomycin
D. Ceftriaxone
Answer: B. Nitrofurantoin
Explanation: Nitrofurantoin is a first-line treatment for uncomplicated cystitis in nonpregnant adults
when pyelonephritis is not suspected.
Question 4
A 65-year-old man with atrial fibrillation suddenly develops left-sided weakness and facial droop. CT
of the head shows no hemorrhage. Symptoms began 90 minutes ago.
A. Aspirin only
B. Intravenous thrombolysis if eligible
C. Immediate carotid endarterectomy
D. Observation
Answer: B. Intravenous thrombolysis if eligible
Explanation: Patients with acute ischemic stroke presenting within the treatment window and
meeting eligibility criteria should receive intravenous thrombolytic therapy.
Question 5
A 58-year-old man has crushing substernal chest pain for 45 minutes. ECG shows ST-segment
elevation in leads II, III, and aVF.
A. Stable angina
B. NSTEMI
C. Inferior STEMI
D. Pericarditis
Answer: C. Inferior STEMI
Explanation: ST-segment elevation in leads II, III, and aVF localizes an inferior wall myocardial
infarction, typically involving the right coronary artery.
Question 6
A newborn develops jaundice within 12 hours of birth. Direct antiglobulin (Coombs) test is positive.
A. Physiologic jaundice
,B. Breast milk jaundice
C. Hemolytic disease of the newborn
D. Gilbert syndrome
Answer: C. Hemolytic disease of the newborn
Explanation: Jaundice within the first 24 hours suggests pathologic hyperbilirubinemia, often due to
immune-mediated hemolysis.
Question 7
A 35-year-old woman has episodes of palpitations, sweating, headaches, and hypertension. Plasma
metanephrines are elevated.
A. Hyperthyroidism
B. Pheochromocytoma
C. Panic disorder
D. Cushing syndrome
Answer: B. Pheochromocytoma
Explanation: Episodic headaches, diaphoresis, palpitations, and elevated metanephrines are
characteristic of pheochromocytoma.
Question 8
A patient develops fever, cough, and rusty sputum. Chest radiograph demonstrates right lower lobe
consolidation.
A. Viral bronchitis
B. Community-acquired pneumonia
C. Pulmonary embolism
D. COPD exacerbation
Answer: B. Community-acquired pneumonia
Explanation: Lobar consolidation with fever and productive cough is consistent with bacterial
community-acquired pneumonia.
Question 9
A 10-year-old boy presents with polyuria, weight loss, and abdominal pain. Glucose is 450 mg/dL,
bicarbonate is 12 mEq/L, and ketones are present.
A. Hyperosmolar hyperglycemic state
, B. Diabetic ketoacidosis
C. Acute pancreatitis
D. Diabetes insipidus
Answer: B. Diabetic ketoacidosis
Explanation: Hyperglycemia, ketosis, and metabolic acidosis are diagnostic of diabetic ketoacidosis.
Question 10
A 70-year-old man presents with progressive resting tremor, bradykinesia, cogwheel rigidity, and
shuffling gait.
A. Essential tremor
B. Parkinson disease
C. Huntington disease
D. Cerebellar stroke
Answer: B. Parkinson disease
Explanation: Resting tremor, rigidity, bradykinesia, and postural instability are classic features of
Parkinson disease.
Question 11
A 28-year-old woman presents with lower abdominal pain, cervical motion tenderness, and fever.
Pregnancy test is negative.
A. Ovarian torsion
B. Pelvic inflammatory disease
C. Endometriosis
D. Appendicitis
Answer: B. Pelvic inflammatory disease
Explanation: Cervical motion tenderness, fever, and pelvic pain are characteristic of pelvic
inflammatory disease and warrant empiric antibiotic therapy.
Question 12
A 67-year-old man with a 40-pack-year smoking history presents with hematuria without pain.
Physical examination is unremarkable.
A. Urinary tract infection
B. Bladder cancer
C. Nephrolithiasis
Questions with Answers & Rationales
Original COMLEX Level 2–style practice questions designed to strengthen clinical reasoning, diagnostic skills, and exam
readiness across medicine, surgery, pediatrics, OB/GYN, OMM, ethics, and biostatistics with detailed answers and
explanations.
Question 1
A 64-year-old man with hypertension develops sudden severe tearing chest pain radiating to the
back. Blood pressure is 185/100 mm Hg in the right arm and 155/90 mm Hg in the left arm. Chest
radiograph shows a widened mediastinum. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Acute pericarditis
E. Esophageal rupture
Answer: C. Aortic dissection
Explanation: Abrupt tearing chest pain, blood pressure differential between arms, and widened
mediastinum are classic findings of acute aortic dissection. Initial management includes IV beta-
blockade followed by definitive imaging and surgical consultation for Type A dissections.
Question 2
A 72-year-old woman presents with sudden painless loss of vision in her right eye that began 30
minutes ago. Funduscopic examination reveals a pale retina with a cherry-red spot at the macula.
A. Acute angle-closure glaucoma
B. Central retinal artery occlusion
C. Retinal detachment
D. Vitreous hemorrhage
Answer: B. Central retinal artery occlusion
Explanation: Sudden painless monocular vision loss with a cherry-red spot is classic for central
retinal artery occlusion. This is an ophthalmic emergency requiring immediate ophthalmology
consultation.
Question 3
A 24-year-old woman presents with dysuria and urinary frequency. Urinalysis is positive for leukocyte
esterase and nitrites. She has no fever or flank pain.
,A. Ciprofloxacin
B. Nitrofurantoin
C. Vancomycin
D. Ceftriaxone
Answer: B. Nitrofurantoin
Explanation: Nitrofurantoin is a first-line treatment for uncomplicated cystitis in nonpregnant adults
when pyelonephritis is not suspected.
Question 4
A 65-year-old man with atrial fibrillation suddenly develops left-sided weakness and facial droop. CT
of the head shows no hemorrhage. Symptoms began 90 minutes ago.
A. Aspirin only
B. Intravenous thrombolysis if eligible
C. Immediate carotid endarterectomy
D. Observation
Answer: B. Intravenous thrombolysis if eligible
Explanation: Patients with acute ischemic stroke presenting within the treatment window and
meeting eligibility criteria should receive intravenous thrombolytic therapy.
Question 5
A 58-year-old man has crushing substernal chest pain for 45 minutes. ECG shows ST-segment
elevation in leads II, III, and aVF.
A. Stable angina
B. NSTEMI
C. Inferior STEMI
D. Pericarditis
Answer: C. Inferior STEMI
Explanation: ST-segment elevation in leads II, III, and aVF localizes an inferior wall myocardial
infarction, typically involving the right coronary artery.
Question 6
A newborn develops jaundice within 12 hours of birth. Direct antiglobulin (Coombs) test is positive.
A. Physiologic jaundice
,B. Breast milk jaundice
C. Hemolytic disease of the newborn
D. Gilbert syndrome
Answer: C. Hemolytic disease of the newborn
Explanation: Jaundice within the first 24 hours suggests pathologic hyperbilirubinemia, often due to
immune-mediated hemolysis.
Question 7
A 35-year-old woman has episodes of palpitations, sweating, headaches, and hypertension. Plasma
metanephrines are elevated.
A. Hyperthyroidism
B. Pheochromocytoma
C. Panic disorder
D. Cushing syndrome
Answer: B. Pheochromocytoma
Explanation: Episodic headaches, diaphoresis, palpitations, and elevated metanephrines are
characteristic of pheochromocytoma.
Question 8
A patient develops fever, cough, and rusty sputum. Chest radiograph demonstrates right lower lobe
consolidation.
A. Viral bronchitis
B. Community-acquired pneumonia
C. Pulmonary embolism
D. COPD exacerbation
Answer: B. Community-acquired pneumonia
Explanation: Lobar consolidation with fever and productive cough is consistent with bacterial
community-acquired pneumonia.
Question 9
A 10-year-old boy presents with polyuria, weight loss, and abdominal pain. Glucose is 450 mg/dL,
bicarbonate is 12 mEq/L, and ketones are present.
A. Hyperosmolar hyperglycemic state
, B. Diabetic ketoacidosis
C. Acute pancreatitis
D. Diabetes insipidus
Answer: B. Diabetic ketoacidosis
Explanation: Hyperglycemia, ketosis, and metabolic acidosis are diagnostic of diabetic ketoacidosis.
Question 10
A 70-year-old man presents with progressive resting tremor, bradykinesia, cogwheel rigidity, and
shuffling gait.
A. Essential tremor
B. Parkinson disease
C. Huntington disease
D. Cerebellar stroke
Answer: B. Parkinson disease
Explanation: Resting tremor, rigidity, bradykinesia, and postural instability are classic features of
Parkinson disease.
Question 11
A 28-year-old woman presents with lower abdominal pain, cervical motion tenderness, and fever.
Pregnancy test is negative.
A. Ovarian torsion
B. Pelvic inflammatory disease
C. Endometriosis
D. Appendicitis
Answer: B. Pelvic inflammatory disease
Explanation: Cervical motion tenderness, fever, and pelvic pain are characteristic of pelvic
inflammatory disease and warrant empiric antibiotic therapy.
Question 12
A 67-year-old man with a 40-pack-year smoking history presents with hematuria without pain.
Physical examination is unremarkable.
A. Urinary tract infection
B. Bladder cancer
C. Nephrolithiasis
