COMLEX Level 3 practice (Form 125)
Exam With Actual 120 Questions &
Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
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1. A 55-year-old male presents with sudden onset chest pain radiating to his back.
Blood pressure is 180/100 mmHg, heart rate 110 bpm. Which is the most likely
diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
Rationale: Sudden tearing chest pain radiating to the back with hypertension and unequal
pulses suggests acute aortic dissection.
2. A 32-year-old woman presents with fatigue, cold intolerance, and constipation. Lab
results show TSH 8.5 μIU/mL (high), free T4 low. What is the most appropriate initial
therapy?
A. Methimazole
B. Levothyroxine
C. Propylthiouracil
D. Radioactive iodine
B. Levothyroxine
Rationale: Primary hypothyroidism is treated with thyroid hormone replacement, typically
levothyroxine.
, 3. A 65-year-old male with COPD presents with worsening dyspnea and productive
cough. His PaO2 is 55 mmHg. Which is the most appropriate next step?
A. Start low-flow oxygen
B. Start high-dose steroids
C. Immediate intubation
D. Prescribe inhaled beta-agonist only
A. Start low-flow oxygen
Rationale: COPD exacerbation with hypoxemia requires controlled oxygen therapy,
avoiding over-oxygenation.
4. A 28-year-old female presents with fever, sore throat, and cervical lymphadenopathy.
Rapid strep test is positive. What is the first-line treatment?
A. Azithromycin
B. Penicillin V
C. Amoxicillin-clavulanate
D. Ciprofloxacin
B. Penicillin V
Rationale: Streptococcal pharyngitis is treated with penicillin or amoxicillin; macrolides are
reserved for penicillin-allergic patients.
5. A 60-year-old male has painless hematuria. What is the most likely diagnosis?
A. Urinary tract infection
B. Bladder cancer
C. Kidney stones
D. Benign prostatic hyperplasia
B. Bladder cancer
Rationale: Painless gross hematuria in an older adult is concerning for urothelial
carcinoma.
6. A 7-year-old presents with fever, sore throat, and a sandpaper-like rash. What is the
causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Coxsackievirus
B. Streptococcus pyogenes
Rationale: Scarlet fever is caused by Group A Streptococcus, presenting with pharyngitis
and characteristic rash.
7. A 50-year-old female with a history of chronic hepatitis B presents with fatigue.
Ultrasound shows a liver mass. AFP is elevated. Most likely diagnosis?
, A. Hepatocellular carcinoma
B. Metastatic colon cancer
C. Hemangioma
D. Cirrhosis
A. Hepatocellular carcinoma
Rationale: Chronic hepatitis B increases risk of HCC; liver mass with elevated AFP is highly
suggestive.
8. A 72-year-old male presents with tremor at rest, bradykinesia, and rigidity. What is
the first-line therapy?
A. Levodopa-carbidopa
B. Donepezil
C. Propranolol
D. Baclofen
A. Levodopa-carbidopa
Rationale: Parkinson disease is primarily treated with dopamine replacement; levodopa-
carbidopa is first-line.
9. A 65-year-old male presents with sudden vision loss in one eye. Fundoscopy shows a
pale retina with a cherry-red spot. Most likely diagnosis?
A. Central retinal artery occlusion
B. Retinal detachment
C. Acute glaucoma
D. Optic neuritis
A. Central retinal artery occlusion
Rationale: Acute, painless monocular vision loss with cherry-red spot indicates central
retinal artery occlusion.
10. A 35-year-old female presents with fatigue and generalized pruritus. Labs show
elevated alkaline phosphatase and positive antimitochondrial antibodies. Most likely
diagnosis?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune hepatitis
D. Hepatitis C
A. Primary biliary cholangitis
Rationale: Middle-aged women with fatigue, pruritus, and AMA positivity are classic for
PBC.
11. A 24-year-old male presents with severe right lower quadrant pain, nausea, and
fever. What is the most appropriate initial test?
Exam With Actual 120 Questions &
Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
1. A 55-year-old male presents with sudden onset chest pain radiating to his back.
Blood pressure is 180/100 mmHg, heart rate 110 bpm. Which is the most likely
diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
Rationale: Sudden tearing chest pain radiating to the back with hypertension and unequal
pulses suggests acute aortic dissection.
2. A 32-year-old woman presents with fatigue, cold intolerance, and constipation. Lab
results show TSH 8.5 μIU/mL (high), free T4 low. What is the most appropriate initial
therapy?
A. Methimazole
B. Levothyroxine
C. Propylthiouracil
D. Radioactive iodine
B. Levothyroxine
Rationale: Primary hypothyroidism is treated with thyroid hormone replacement, typically
levothyroxine.
, 3. A 65-year-old male with COPD presents with worsening dyspnea and productive
cough. His PaO2 is 55 mmHg. Which is the most appropriate next step?
A. Start low-flow oxygen
B. Start high-dose steroids
C. Immediate intubation
D. Prescribe inhaled beta-agonist only
A. Start low-flow oxygen
Rationale: COPD exacerbation with hypoxemia requires controlled oxygen therapy,
avoiding over-oxygenation.
4. A 28-year-old female presents with fever, sore throat, and cervical lymphadenopathy.
Rapid strep test is positive. What is the first-line treatment?
A. Azithromycin
B. Penicillin V
C. Amoxicillin-clavulanate
D. Ciprofloxacin
B. Penicillin V
Rationale: Streptococcal pharyngitis is treated with penicillin or amoxicillin; macrolides are
reserved for penicillin-allergic patients.
5. A 60-year-old male has painless hematuria. What is the most likely diagnosis?
A. Urinary tract infection
B. Bladder cancer
C. Kidney stones
D. Benign prostatic hyperplasia
B. Bladder cancer
Rationale: Painless gross hematuria in an older adult is concerning for urothelial
carcinoma.
6. A 7-year-old presents with fever, sore throat, and a sandpaper-like rash. What is the
causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Coxsackievirus
B. Streptococcus pyogenes
Rationale: Scarlet fever is caused by Group A Streptococcus, presenting with pharyngitis
and characteristic rash.
7. A 50-year-old female with a history of chronic hepatitis B presents with fatigue.
Ultrasound shows a liver mass. AFP is elevated. Most likely diagnosis?
, A. Hepatocellular carcinoma
B. Metastatic colon cancer
C. Hemangioma
D. Cirrhosis
A. Hepatocellular carcinoma
Rationale: Chronic hepatitis B increases risk of HCC; liver mass with elevated AFP is highly
suggestive.
8. A 72-year-old male presents with tremor at rest, bradykinesia, and rigidity. What is
the first-line therapy?
A. Levodopa-carbidopa
B. Donepezil
C. Propranolol
D. Baclofen
A. Levodopa-carbidopa
Rationale: Parkinson disease is primarily treated with dopamine replacement; levodopa-
carbidopa is first-line.
9. A 65-year-old male presents with sudden vision loss in one eye. Fundoscopy shows a
pale retina with a cherry-red spot. Most likely diagnosis?
A. Central retinal artery occlusion
B. Retinal detachment
C. Acute glaucoma
D. Optic neuritis
A. Central retinal artery occlusion
Rationale: Acute, painless monocular vision loss with cherry-red spot indicates central
retinal artery occlusion.
10. A 35-year-old female presents with fatigue and generalized pruritus. Labs show
elevated alkaline phosphatase and positive antimitochondrial antibodies. Most likely
diagnosis?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune hepatitis
D. Hepatitis C
A. Primary biliary cholangitis
Rationale: Middle-aged women with fatigue, pruritus, and AMA positivity are classic for
PBC.
11. A 24-year-old male presents with severe right lower quadrant pain, nausea, and
fever. What is the most appropriate initial test?
