COMLEX LEVEL 2- CE EXAM WITH VERIFIED
QUESTIONS AND ANSWERS|| GUARANTEED
PASS|| ALREADY GRADED A+
CARDIOVASCULAR SYSTEM
1. A 68-year-old male with hypertension and hyperlipidemia presents with
substernal chest pressure that began 2 hours ago while shoveling snow. The
pain radiates to his left arm and jaw. He is diaphoretic and nauseous. ECG
reveals ST-segment elevation in leads V1–V4. What is the MOST
appropriate next step?
A. Administer aspirin and sublingual nitroglycerin
B. Obtain cardiac troponin levels
C. Perform a chest X-ray
D. Administer morphine sulfate
Answer: A. This is an acute anterior STEMI (ST elevation in V1–V4).
Immediate reperfusion therapy is priority. Aspirin (324 mg chewed) reduces
mortality, and nitroglycerin relieves ischemic pain and reduces preload.
Troponin should not delay reperfusion.
2. A 64-year-old man presents with crushing substernal chest pain for 45
minutes. ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Inferior wall MI (leads II, III, aVF) is most commonly caused by
right coronary artery occlusion.
,3. A 55-year-old female with HFrEF on lisinopril, carvedilol, and
furosemide presents with worsening dyspnea, orthopnea, and 3+ pitting
edema. Which medication is MOST appropriate to add to reduce
mortality?
A. Spironolactone
B. Digoxin
C. Hydralazine and isosorbide dinitrate
D. Diltiazem
Answer: A. Spironolactone (aldosterone antagonist) is indicated in HFrEF
(NYHA III–IV) already on ACE inhibitors and beta-blockers to reduce
mortality.
4. A 67-year-old man with hypertension presents with sudden-onset tearing
chest pain radiating to the back. Blood pressure is higher in the right arm
than the left. What is the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B. Tearing chest pain with unequal arm BPs strongly suggests aortic
dissection.
5. A 72-year-old man with a history of atrial fibrillation presents with
sudden-onset left leg pain, pallor, and pulselessness. What is the most likely
diagnosis?
A. Deep vein thrombosis
B. Arterial embolism
C. Varicose veins
D. Venous insufficiency
Answer: B. Acute arterial occlusion in a patient with atrial fibrillation suggests
embolic source.
6. Which ECG finding is most characteristic of pericarditis?
A. ST-segment elevation in all leads
, B. ST-segment depression in V1–V4
C. Diffuse PR depression and diffuse ST elevation
D. Q waves in inferior leads
Answer: C. Diffuse PR depression and diffuse ST elevation are classic for
pericarditis.
7. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which
anticoagulation strategy is most appropriate?
A. Aspirin only
B. Warfarin or DOAC
C. No anticoagulation
D. Dual antiplatelet therapy
Answer: B. CHA₂DS₂-VASc ≥2 in males or ≥3 in females warrants oral
anticoagulation.
8. A 45-year-old obese woman presents with acute-onset chest pain that is
pleuritic and positional. She has a low-grade fever. ECG shows diffuse ST
elevations. What is the most likely diagnosis?
A. Acute coronary syndrome
B. Pericarditis
C. Pulmonary embolism
D. Aortic dissection
Answer: B. Pleuritic, positional chest pain with diffuse ST elevations suggests
pericarditis.
9. Which medication is first-line for rate control in atrial fibrillation with
heart failure?
A. Metoprolol
B. Diltiazem
C. Digoxin
D. Amiodarone
Answer: C. Digoxin is preferred for rate control in AF with HFrEF.
, 10. A 60-year-old male presents with syncope during exercise. On
auscultation, a harsh crescendo-decrescendo systolic murmur is heard at
the right upper sternal border that radiates to the carotids. What is the
most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Pulmonic stenosis
Answer: A. Classic AS murmur with syncope on exertion.
11. A patient with acute decompensated heart failure presents with
dyspnea, rales, and JVD. Which medication is most appropriate for acute
symptom relief?
A. IV furosemide
B. Oral lisinopril
C. Metoprolol
D. Spironolactone
Answer: A. IV loop diuretics are first-line for acute decompensated HF.
12. A 50-year-old with hypertension presents with a blood pressure of
180/110 mmHg, headache, and blurred vision. Fundoscopy reveals
papilledema. What is the most appropriate next step?
A. Oral antihypertensive and outpatient follow-up
B. IV antihypertensive therapy
C. Observation and repeat BP in 1 hour
D. CT head
Answer: B. Hypertensive emergency with end-organ damage requires IV
antihypertensive therapy.
13. A 70-year-old woman with chronic HF presents with progressive
dyspnea. Echocardiogram reveals an ejection fraction of 25%. Which beta-
blocker is most strongly recommended for mortality benefit?
A. Metoprolol succinate
B. Atenolol
QUESTIONS AND ANSWERS|| GUARANTEED
PASS|| ALREADY GRADED A+
CARDIOVASCULAR SYSTEM
1. A 68-year-old male with hypertension and hyperlipidemia presents with
substernal chest pressure that began 2 hours ago while shoveling snow. The
pain radiates to his left arm and jaw. He is diaphoretic and nauseous. ECG
reveals ST-segment elevation in leads V1–V4. What is the MOST
appropriate next step?
A. Administer aspirin and sublingual nitroglycerin
B. Obtain cardiac troponin levels
C. Perform a chest X-ray
D. Administer morphine sulfate
Answer: A. This is an acute anterior STEMI (ST elevation in V1–V4).
Immediate reperfusion therapy is priority. Aspirin (324 mg chewed) reduces
mortality, and nitroglycerin relieves ischemic pain and reduces preload.
Troponin should not delay reperfusion.
2. A 64-year-old man presents with crushing substernal chest pain for 45
minutes. ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Inferior wall MI (leads II, III, aVF) is most commonly caused by
right coronary artery occlusion.
,3. A 55-year-old female with HFrEF on lisinopril, carvedilol, and
furosemide presents with worsening dyspnea, orthopnea, and 3+ pitting
edema. Which medication is MOST appropriate to add to reduce
mortality?
A. Spironolactone
B. Digoxin
C. Hydralazine and isosorbide dinitrate
D. Diltiazem
Answer: A. Spironolactone (aldosterone antagonist) is indicated in HFrEF
(NYHA III–IV) already on ACE inhibitors and beta-blockers to reduce
mortality.
4. A 67-year-old man with hypertension presents with sudden-onset tearing
chest pain radiating to the back. Blood pressure is higher in the right arm
than the left. What is the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B. Tearing chest pain with unequal arm BPs strongly suggests aortic
dissection.
5. A 72-year-old man with a history of atrial fibrillation presents with
sudden-onset left leg pain, pallor, and pulselessness. What is the most likely
diagnosis?
A. Deep vein thrombosis
B. Arterial embolism
C. Varicose veins
D. Venous insufficiency
Answer: B. Acute arterial occlusion in a patient with atrial fibrillation suggests
embolic source.
6. Which ECG finding is most characteristic of pericarditis?
A. ST-segment elevation in all leads
, B. ST-segment depression in V1–V4
C. Diffuse PR depression and diffuse ST elevation
D. Q waves in inferior leads
Answer: C. Diffuse PR depression and diffuse ST elevation are classic for
pericarditis.
7. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which
anticoagulation strategy is most appropriate?
A. Aspirin only
B. Warfarin or DOAC
C. No anticoagulation
D. Dual antiplatelet therapy
Answer: B. CHA₂DS₂-VASc ≥2 in males or ≥3 in females warrants oral
anticoagulation.
8. A 45-year-old obese woman presents with acute-onset chest pain that is
pleuritic and positional. She has a low-grade fever. ECG shows diffuse ST
elevations. What is the most likely diagnosis?
A. Acute coronary syndrome
B. Pericarditis
C. Pulmonary embolism
D. Aortic dissection
Answer: B. Pleuritic, positional chest pain with diffuse ST elevations suggests
pericarditis.
9. Which medication is first-line for rate control in atrial fibrillation with
heart failure?
A. Metoprolol
B. Diltiazem
C. Digoxin
D. Amiodarone
Answer: C. Digoxin is preferred for rate control in AF with HFrEF.
, 10. A 60-year-old male presents with syncope during exercise. On
auscultation, a harsh crescendo-decrescendo systolic murmur is heard at
the right upper sternal border that radiates to the carotids. What is the
most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Pulmonic stenosis
Answer: A. Classic AS murmur with syncope on exertion.
11. A patient with acute decompensated heart failure presents with
dyspnea, rales, and JVD. Which medication is most appropriate for acute
symptom relief?
A. IV furosemide
B. Oral lisinopril
C. Metoprolol
D. Spironolactone
Answer: A. IV loop diuretics are first-line for acute decompensated HF.
12. A 50-year-old with hypertension presents with a blood pressure of
180/110 mmHg, headache, and blurred vision. Fundoscopy reveals
papilledema. What is the most appropriate next step?
A. Oral antihypertensive and outpatient follow-up
B. IV antihypertensive therapy
C. Observation and repeat BP in 1 hour
D. CT head
Answer: B. Hypertensive emergency with end-organ damage requires IV
antihypertensive therapy.
13. A 70-year-old woman with chronic HF presents with progressive
dyspnea. Echocardiogram reveals an ejection fraction of 25%. Which beta-
blocker is most strongly recommended for mortality benefit?
A. Metoprolol succinate
B. Atenolol
