COMLEX-USA Level 3 Licensure Exam V3 COMLEX-
USA Level 3 Licensure Exam V3 COMLEX-USA Level
3 Licensure Exam V3
1. A 68-year-old male with a history of hypertension and Type 2 Diabetes presents for a
follow-up. His blood pressure is 152/94 mmHg despite taking lisinopril 20 mg daily. Physical
examination reveals a soft systolic murmur and trace pedal edema. Laboratory results show a
serum creatinine of 1.4 mg/dL and a potassium of 4.2 mEq/L. According to current guidelines,
what is the most appropriate next step in managing his hypertension?
A. Increase lisinopril to 40 mg daily
B. Add chlorthalidone 12.5 mg daily
C. Discontinue lisinopril and start losartan 50 mg daily
D. Add amlodipine 5 mg daily
Correct Answer: D
Explanation: The patient’s blood pressure remains above the target of 130/80 mmHg for
patients with diabetes and chronic kidney disease. Amlodipine, a dihydropyridine calcium
channel blocker, is an excellent second agent that works synergistically with ACE inhibitors
while avoiding the electrolyte disturbances sometimes seen with high-dose diuretics. While
increasing the ACE inhibitor is an option, the addition of a second class of antihypertensive
often provides superior blood pressure reduction and cardiovascular protection.
,2. A 45-year-old female presents with acute onset of right upper quadrant pain that radiates
to her right shoulder blade. She reports nausea and one episode of vomiting. On
examination, there is significant tenderness in the right upper quadrant, and inspiration is
inhibited when the physician palpates deeply under the right costal margin. Her temperature
is 101.2°F (38.4°C). Which of the following is the most likely osteopathic finding associated
with this clinical condition?
A. T5-T9 paraspinal hypertonicity on the right
B. T2-T4 paraspinal hypertonicity on the left
C. T10-T11 paraspinal hypertonicity on the right
D. T12-L2 paraspinal hypertonicity on the left
Correct Answer: A
Explanation: The clinical scenario describes acute cholecystitis, supported by Murphy’s
sign and systemic symptoms. Viscerosomatic reflexes for the gallbladder and liver are
typically found in the T5-T9 region on the right side. Recognizing these dermatomal and
myotomal patterns is crucial for osteopathic physicians to correlate systemic pathology
with musculoskeletal findings.
3. A 32-year-old pregnant female at 34 weeks gestation presents to the emergency
department with a sudden onset of severe abdominal pain and dark vaginal bleeding. She has
no history of trauma but admits to tobacco use. Her blood pressure is 160/110 mmHg. The
fetal heart rate monitor shows late decelerations. What is the most likely diagnosis?
A. Abruptio placentae
,B. Placenta previa
C. Uterine rupture
D. Vasa previa
Correct Answer: A
Explanation: Abruptio placentae presents with painful vaginal bleeding and uterine
tenderness, often associated with hypertension and smoking. Unlike placenta previa, which
is painless, abruption can lead to significant fetal distress as evidenced by late
decelerations. Immediate management involves stabilization and often emergent delivery
depending on fetal and maternal status.
4. A 55-year-old male presents for a routine check-up. He has a 30-pack-year smoking history
and quit 5 years ago. He has no symptoms of cough or shortness of breath. According to the
U.S. Preventive Services Task Force (USPSTF), which screening test is indicated for this
patient?
A. Annual chest X-ray
B. Sputum cytology every 6 months
C. Annual low-dose computed tomography (LDCT)
D. No screening is indicated at this time
Correct Answer: C
, Explanation: The USPSTF recommends annual screening for lung cancer with low-dose CT
in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently
smoke or have quit within the past 15 years. This patient meets the criteria based on age
and smoking history. Early detection via LDCT has been shown to significantly reduce lung
cancer mortality in high-risk populations.
5. A 24-year-old male athlete presents with localized pain in his left groin that worsens with
activity. Examination reveals tenderness over the pubic symphysis and adductor muscles.
OMT examination shows the left pubic bone is inferior compared to the right. Which muscle
should be engaged to correct this dysfunction using muscle energy?
A. Right hamstrings
B. Left rectus abdominis
C. Left adductor longus
D. Right piriformis
Correct Answer: B
Explanation: An inferior pubic shear is corrected by engaging the muscles that pull the
pubic bone superiorly, which primarily include the rectus abdominis. In muscle energy
treatment, the patient would be asked to perform a contraction that engages the abdominal
muscles against resistance. Precise diagnosis of pelvic shears is essential for effectively
resolving groin pain in active individuals.
USA Level 3 Licensure Exam V3 COMLEX-USA Level
3 Licensure Exam V3
1. A 68-year-old male with a history of hypertension and Type 2 Diabetes presents for a
follow-up. His blood pressure is 152/94 mmHg despite taking lisinopril 20 mg daily. Physical
examination reveals a soft systolic murmur and trace pedal edema. Laboratory results show a
serum creatinine of 1.4 mg/dL and a potassium of 4.2 mEq/L. According to current guidelines,
what is the most appropriate next step in managing his hypertension?
A. Increase lisinopril to 40 mg daily
B. Add chlorthalidone 12.5 mg daily
C. Discontinue lisinopril and start losartan 50 mg daily
D. Add amlodipine 5 mg daily
Correct Answer: D
Explanation: The patient’s blood pressure remains above the target of 130/80 mmHg for
patients with diabetes and chronic kidney disease. Amlodipine, a dihydropyridine calcium
channel blocker, is an excellent second agent that works synergistically with ACE inhibitors
while avoiding the electrolyte disturbances sometimes seen with high-dose diuretics. While
increasing the ACE inhibitor is an option, the addition of a second class of antihypertensive
often provides superior blood pressure reduction and cardiovascular protection.
,2. A 45-year-old female presents with acute onset of right upper quadrant pain that radiates
to her right shoulder blade. She reports nausea and one episode of vomiting. On
examination, there is significant tenderness in the right upper quadrant, and inspiration is
inhibited when the physician palpates deeply under the right costal margin. Her temperature
is 101.2°F (38.4°C). Which of the following is the most likely osteopathic finding associated
with this clinical condition?
A. T5-T9 paraspinal hypertonicity on the right
B. T2-T4 paraspinal hypertonicity on the left
C. T10-T11 paraspinal hypertonicity on the right
D. T12-L2 paraspinal hypertonicity on the left
Correct Answer: A
Explanation: The clinical scenario describes acute cholecystitis, supported by Murphy’s
sign and systemic symptoms. Viscerosomatic reflexes for the gallbladder and liver are
typically found in the T5-T9 region on the right side. Recognizing these dermatomal and
myotomal patterns is crucial for osteopathic physicians to correlate systemic pathology
with musculoskeletal findings.
3. A 32-year-old pregnant female at 34 weeks gestation presents to the emergency
department with a sudden onset of severe abdominal pain and dark vaginal bleeding. She has
no history of trauma but admits to tobacco use. Her blood pressure is 160/110 mmHg. The
fetal heart rate monitor shows late decelerations. What is the most likely diagnosis?
A. Abruptio placentae
,B. Placenta previa
C. Uterine rupture
D. Vasa previa
Correct Answer: A
Explanation: Abruptio placentae presents with painful vaginal bleeding and uterine
tenderness, often associated with hypertension and smoking. Unlike placenta previa, which
is painless, abruption can lead to significant fetal distress as evidenced by late
decelerations. Immediate management involves stabilization and often emergent delivery
depending on fetal and maternal status.
4. A 55-year-old male presents for a routine check-up. He has a 30-pack-year smoking history
and quit 5 years ago. He has no symptoms of cough or shortness of breath. According to the
U.S. Preventive Services Task Force (USPSTF), which screening test is indicated for this
patient?
A. Annual chest X-ray
B. Sputum cytology every 6 months
C. Annual low-dose computed tomography (LDCT)
D. No screening is indicated at this time
Correct Answer: C
, Explanation: The USPSTF recommends annual screening for lung cancer with low-dose CT
in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently
smoke or have quit within the past 15 years. This patient meets the criteria based on age
and smoking history. Early detection via LDCT has been shown to significantly reduce lung
cancer mortality in high-risk populations.
5. A 24-year-old male athlete presents with localized pain in his left groin that worsens with
activity. Examination reveals tenderness over the pubic symphysis and adductor muscles.
OMT examination shows the left pubic bone is inferior compared to the right. Which muscle
should be engaged to correct this dysfunction using muscle energy?
A. Right hamstrings
B. Left rectus abdominis
C. Left adductor longus
D. Right piriformis
Correct Answer: B
Explanation: An inferior pubic shear is corrected by engaging the muscles that pull the
pubic bone superiorly, which primarily include the rectus abdominis. In muscle energy
treatment, the patient would be asked to perform a contraction that engages the abdominal
muscles against resistance. Precise diagnosis of pelvic shears is essential for effectively
resolving groin pain in active individuals.
