COMLEX-USA Level 3 Examination
2026–2027 | Comprehensive Question
Practice Test with Answers & Rationales|
Free Pdf Access
1. A 68-year-old man presents to the emergency department with crushing
substernal chest pain for 45 minutes. ECG demonstrates ST-segment
elevation in leads V1–V4. What is the most appropriate next step?
A. Obtain stress testing
B. Begin proton pump inhibitor therapy
C. Activate emergent reperfusion therapy
D. Schedule outpatient cardiology follow-up
Correct Answer: C
Rationale: Anterior STEMI requires immediate reperfusion therapy to minimize
myocardial damage and improve survival.
2. A 72-year-old woman presents with acute left-sided weakness that began 90
minutes ago. Non-contrast CT shows no hemorrhage. What is the next best
step?
A. Aspirin only
B. Immediate thrombolytic evaluation
C. Discharge home
D. Observation for 24 hours
Correct Answer: B
Rationale: Patients presenting within the treatment window should be evaluated promptly
for reperfusion therapy.
,3. A hospitalized patient develops fever, hypotension, tachycardia, and
elevated serum lactate. What is the most appropriate initial management?
A. Delay treatment until cultures return
B. Broad-spectrum antibiotics and fluid resuscitation
C. Observation only
D. Oral hydration
Correct Answer: B
Rationale: Early antibiotics and aggressive fluid resuscitation are essential components of
sepsis management.
4. A 56-year-old woman presents with sudden severe headache described as
"the worst headache of my life." What diagnosis should be presumed until
excluded?
A. Migraine
B. Tension headache
C. Subarachnoid hemorrhage
D. Sinus headache
Correct Answer: C
Rationale: Thunderclap headache is highly concerning for subarachnoid hemorrhage.
5. A patient presents with acute chest pain radiating to the back and unequal
blood pressures between arms. What diagnosis is most likely?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Costochondritis
Correct Answer: C
Rationale: Unequal arm blood pressures and tearing chest pain strongly suggest aortic
dissection.
6. A diabetic patient presents with a foot ulcer probing to bone. What
diagnosis should be strongly suspected?
,A. Cellulitis
B. Osteomyelitis
C. Eczema
D. Peripheral neuropathy alone
Correct Answer: B
Rationale: A positive probe-to-bone test raises strong concern for osteomyelitis.
7. A patient develops acute respiratory distress, hypotension, and unilateral
absent breath sounds following trauma. What is the most likely diagnosis?
A. Pulmonary edema
B. Asthma exacerbation
C. Tension pneumothorax
D. Pleural effusion
Correct Answer: C
Rationale: Tension pneumothorax is a life-threatening emergency requiring immediate
decompression.
8. A patient with cirrhosis develops confusion and asterixis. What treatment is
most appropriate?
A. Insulin
B. Lactulose
C. Aspirin
D. Furosemide only
Correct Answer: B
Rationale: Lactulose reduces ammonia absorption and is first-line treatment for hepatic
encephalopathy.
9. A 30-year-old woman presents with fever, lower abdominal pain, and
cervical motion tenderness. What is the most likely diagnosis?
A. Appendicitis
B. Ovarian cyst
C. Pelvic inflammatory disease
D. Endometriosis
, Correct Answer: C
Rationale: Cervical motion tenderness is a hallmark of pelvic inflammatory disease.
10. A patient develops severe allergic reaction with wheezing, urticaria, and
hypotension. What is the immediate treatment?
A. Diphenhydramine only
B. Prednisone only
C. Epinephrine
D. Albuterol only
Correct Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylaxis.
11. A patient develops unilateral calf swelling three days after major surgery.
What is the most appropriate diagnostic study?
A. MRI
B. Venous duplex ultrasonography
C. Echocardiogram
D. Chest CT
Correct Answer: B
Rationale: Venous duplex ultrasonography is the preferred initial test for suspected DVT.
12. A patient presents with severe abdominal pain out of proportion to
examination findings. What diagnosis should be suspected?
A. Gastritis
B. Mesenteric ischemia
C. Cholecystitis
D. IBS
Correct Answer: B
Rationale: Pain out of proportion to physical findings is classic for mesenteric ischemia.
2026–2027 | Comprehensive Question
Practice Test with Answers & Rationales|
Free Pdf Access
1. A 68-year-old man presents to the emergency department with crushing
substernal chest pain for 45 minutes. ECG demonstrates ST-segment
elevation in leads V1–V4. What is the most appropriate next step?
A. Obtain stress testing
B. Begin proton pump inhibitor therapy
C. Activate emergent reperfusion therapy
D. Schedule outpatient cardiology follow-up
Correct Answer: C
Rationale: Anterior STEMI requires immediate reperfusion therapy to minimize
myocardial damage and improve survival.
2. A 72-year-old woman presents with acute left-sided weakness that began 90
minutes ago. Non-contrast CT shows no hemorrhage. What is the next best
step?
A. Aspirin only
B. Immediate thrombolytic evaluation
C. Discharge home
D. Observation for 24 hours
Correct Answer: B
Rationale: Patients presenting within the treatment window should be evaluated promptly
for reperfusion therapy.
,3. A hospitalized patient develops fever, hypotension, tachycardia, and
elevated serum lactate. What is the most appropriate initial management?
A. Delay treatment until cultures return
B. Broad-spectrum antibiotics and fluid resuscitation
C. Observation only
D. Oral hydration
Correct Answer: B
Rationale: Early antibiotics and aggressive fluid resuscitation are essential components of
sepsis management.
4. A 56-year-old woman presents with sudden severe headache described as
"the worst headache of my life." What diagnosis should be presumed until
excluded?
A. Migraine
B. Tension headache
C. Subarachnoid hemorrhage
D. Sinus headache
Correct Answer: C
Rationale: Thunderclap headache is highly concerning for subarachnoid hemorrhage.
5. A patient presents with acute chest pain radiating to the back and unequal
blood pressures between arms. What diagnosis is most likely?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Costochondritis
Correct Answer: C
Rationale: Unequal arm blood pressures and tearing chest pain strongly suggest aortic
dissection.
6. A diabetic patient presents with a foot ulcer probing to bone. What
diagnosis should be strongly suspected?
,A. Cellulitis
B. Osteomyelitis
C. Eczema
D. Peripheral neuropathy alone
Correct Answer: B
Rationale: A positive probe-to-bone test raises strong concern for osteomyelitis.
7. A patient develops acute respiratory distress, hypotension, and unilateral
absent breath sounds following trauma. What is the most likely diagnosis?
A. Pulmonary edema
B. Asthma exacerbation
C. Tension pneumothorax
D. Pleural effusion
Correct Answer: C
Rationale: Tension pneumothorax is a life-threatening emergency requiring immediate
decompression.
8. A patient with cirrhosis develops confusion and asterixis. What treatment is
most appropriate?
A. Insulin
B. Lactulose
C. Aspirin
D. Furosemide only
Correct Answer: B
Rationale: Lactulose reduces ammonia absorption and is first-line treatment for hepatic
encephalopathy.
9. A 30-year-old woman presents with fever, lower abdominal pain, and
cervical motion tenderness. What is the most likely diagnosis?
A. Appendicitis
B. Ovarian cyst
C. Pelvic inflammatory disease
D. Endometriosis
, Correct Answer: C
Rationale: Cervical motion tenderness is a hallmark of pelvic inflammatory disease.
10. A patient develops severe allergic reaction with wheezing, urticaria, and
hypotension. What is the immediate treatment?
A. Diphenhydramine only
B. Prednisone only
C. Epinephrine
D. Albuterol only
Correct Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylaxis.
11. A patient develops unilateral calf swelling three days after major surgery.
What is the most appropriate diagnostic study?
A. MRI
B. Venous duplex ultrasonography
C. Echocardiogram
D. Chest CT
Correct Answer: B
Rationale: Venous duplex ultrasonography is the preferred initial test for suspected DVT.
12. A patient presents with severe abdominal pain out of proportion to
examination findings. What diagnosis should be suspected?
A. Gastritis
B. Mesenteric ischemia
C. Cholecystitis
D. IBS
Correct Answer: B
Rationale: Pain out of proportion to physical findings is classic for mesenteric ischemia.
