COMLEX-USA Level 3 Licensure Exam V1 COMLEX-
USA Level 3 Licensure Exam V1 COMLEX-USA Level
3 Licensure Exam V1
1. A 65-year-old male with a history of chronic heart failure presents with increasing
shortness of breath and peripheral edema. Physical exam reveals jugular venous distention
and an S3 gallop. Which of the following is the most appropriate initial management step?
A. Oral Lisinopril
B. Intravenous Digoxin
C. Oral Metoprolol Succinate
D. Intravenous Furosemide
Correct Answer: D
Explanation: The core concept is managing acute decompensated heart failure with
volume overload. Intravenous loop diuretics are the first-line intervention to reduce
preload and improve pulmonary symptoms quickly. A common clinical pitfall is initiating
or increasing beta-blockers during an acute flare, which can further decrease cardiac
output in the short term.
2. A 28-year-old female presents with lower back pain. Physical examination shows a positive
seated flexion test on the left, a deep sacral sulcus on the right, and a posterior inferior
lateral angle (ILA) on the left. What is the most likely sacral diagnosis?
A. Left-on-left forward torsion
,B. Right-on-right forward torsion
C. Right-on-left backward torsion
D. Left-on-right backward torsion
Correct Answer: C
Explanation: Sacral torsions are diagnosed by findings of the seated flexion test and
palpation of the sulci and ILAs. A positive seated flexion on the left with a deep right sulcus
and posterior left ILA indicates a right-on-left backward torsion. Understanding the
relationship between L5 and the sacrum is crucial for COMLEX, where L5 typically rotates
opposite to the sacrum in torsions.
3. A 32-year-old pregnant woman at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache. Which of the
following is the most appropriate next step in her management?
A. Oral Nifedipine and discharge
B. Bed rest and repeat labs in one week
C. Expectant management until 37 weeks
D. Magnesium sulfate and delivery
Correct Answer: D
Explanation: This patient presents with preeclampsia with severe features, necessitating
seizure prophylaxis and stabilization followed by delivery. Magnesium sulfate is the gold
,standard for preventing eclampsia in these patients. Delaying delivery in the setting of
severe features like headache or visual changes increases the risk of maternal and fetal
morbidity.
4. A 4-year-old child is brought to the emergency department with a barking cough and
inspiratory stridor that improves when the child is taken into the cold night air. What is the
most appropriate treatment?
A. Nebulized Albuterol
B. Oral Dexamethasone
C. Intravenous Ceftriaxone
D. Inhaled Ribavirin
Correct Answer: B
Explanation: The diagnosis is laryngotracheobronchitis (Croup), typically caused by
parainfluenza virus. Corticosteroids like dexamethasone reduce airway edema and have
been shown to decrease the need for hospitalization. Pitfalls include confusing croup with
epiglottitis, which presents with higher fever, drooling, and a toxic appearance.
, 5. A 78-year-old patient with terminal pancreatic cancer is no longer able to make decisions.
He has no advance directive, but his daughter, who is the designated durable power of
attorney for healthcare, requests that he be kept comfortable and not be intubated. The
patient’s son disagrees and wants full measures. What is the most appropriate legal course of
action?
A. Follow the son’s wishes
B. Follow the daughter’s wishes
C. Consult the hospital ethics committee for a vote
D. Perform full resuscitation until a court order is obtained
Correct Answer: B
Explanation: In medical ethics, the designated durable power of attorney (DPOA) for
healthcare holds the highest legal authority for decision-making when the patient lacks
capacity. The DPOA’s decisions take precedence over other family members, including
other children. A common pitfall is assuming all immediate family members have equal say
when a formal legal surrogate has been appointed.
6. A 24-year-old male presents with right lower quadrant abdominal pain, nausea, and a low-
grade fever. On physical exam, pain is elicited in the right lower quadrant when the patient’s
right hip is passively extended. This finding is known as:
A. Rovsing sign
B. Murphy sign
USA Level 3 Licensure Exam V1 COMLEX-USA Level
3 Licensure Exam V1
1. A 65-year-old male with a history of chronic heart failure presents with increasing
shortness of breath and peripheral edema. Physical exam reveals jugular venous distention
and an S3 gallop. Which of the following is the most appropriate initial management step?
A. Oral Lisinopril
B. Intravenous Digoxin
C. Oral Metoprolol Succinate
D. Intravenous Furosemide
Correct Answer: D
Explanation: The core concept is managing acute decompensated heart failure with
volume overload. Intravenous loop diuretics are the first-line intervention to reduce
preload and improve pulmonary symptoms quickly. A common clinical pitfall is initiating
or increasing beta-blockers during an acute flare, which can further decrease cardiac
output in the short term.
2. A 28-year-old female presents with lower back pain. Physical examination shows a positive
seated flexion test on the left, a deep sacral sulcus on the right, and a posterior inferior
lateral angle (ILA) on the left. What is the most likely sacral diagnosis?
A. Left-on-left forward torsion
,B. Right-on-right forward torsion
C. Right-on-left backward torsion
D. Left-on-right backward torsion
Correct Answer: C
Explanation: Sacral torsions are diagnosed by findings of the seated flexion test and
palpation of the sulci and ILAs. A positive seated flexion on the left with a deep right sulcus
and posterior left ILA indicates a right-on-left backward torsion. Understanding the
relationship between L5 and the sacrum is crucial for COMLEX, where L5 typically rotates
opposite to the sacrum in torsions.
3. A 32-year-old pregnant woman at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache. Which of the
following is the most appropriate next step in her management?
A. Oral Nifedipine and discharge
B. Bed rest and repeat labs in one week
C. Expectant management until 37 weeks
D. Magnesium sulfate and delivery
Correct Answer: D
Explanation: This patient presents with preeclampsia with severe features, necessitating
seizure prophylaxis and stabilization followed by delivery. Magnesium sulfate is the gold
,standard for preventing eclampsia in these patients. Delaying delivery in the setting of
severe features like headache or visual changes increases the risk of maternal and fetal
morbidity.
4. A 4-year-old child is brought to the emergency department with a barking cough and
inspiratory stridor that improves when the child is taken into the cold night air. What is the
most appropriate treatment?
A. Nebulized Albuterol
B. Oral Dexamethasone
C. Intravenous Ceftriaxone
D. Inhaled Ribavirin
Correct Answer: B
Explanation: The diagnosis is laryngotracheobronchitis (Croup), typically caused by
parainfluenza virus. Corticosteroids like dexamethasone reduce airway edema and have
been shown to decrease the need for hospitalization. Pitfalls include confusing croup with
epiglottitis, which presents with higher fever, drooling, and a toxic appearance.
, 5. A 78-year-old patient with terminal pancreatic cancer is no longer able to make decisions.
He has no advance directive, but his daughter, who is the designated durable power of
attorney for healthcare, requests that he be kept comfortable and not be intubated. The
patient’s son disagrees and wants full measures. What is the most appropriate legal course of
action?
A. Follow the son’s wishes
B. Follow the daughter’s wishes
C. Consult the hospital ethics committee for a vote
D. Perform full resuscitation until a court order is obtained
Correct Answer: B
Explanation: In medical ethics, the designated durable power of attorney (DPOA) for
healthcare holds the highest legal authority for decision-making when the patient lacks
capacity. The DPOA’s decisions take precedence over other family members, including
other children. A common pitfall is assuming all immediate family members have equal say
when a formal legal surrogate has been appointed.
6. A 24-year-old male presents with right lower quadrant abdominal pain, nausea, and a low-
grade fever. On physical exam, pain is elicited in the right lower quadrant when the patient’s
right hip is passively extended. This finding is known as:
A. Rovsing sign
B. Murphy sign
