COMLEX Level 2-CE (Form 120)
Practice 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 45-year-old man presents with sudden-onset chest pain radiating to his back. Blood
pressure is 180/110 mmHg in the right arm and 160/100 mmHg in the left arm. What
is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
Rationale: The asymmetric blood pressures and severe chest pain radiating to the back
suggest an aortic dissection. Immediate imaging with CT angiography or TEE is warranted.
2. A 32-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs
show elevated TSH and low free T4. What is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Subacute thyroiditis
D. Graves’ disease
B. Hypothyroidism
Rationale: Elevated TSH with low free T4 is consistent with primary hypothyroidism.
3. A 68-year-old man with COPD presents with worsening shortness of breath. He is
cyanotic with clubbing of fingers. ABG shows pH 7.32, PaCO2 60 mmHg, PaO2 55
mmHg. What is the primary acid-base disturbance?
, A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
B. Respiratory acidosis
Rationale: Elevated PaCO2 and low pH indicate primary respiratory acidosis, often seen in
chronic COPD exacerbations.
4. A 25-year-old male presents with knee pain after playing basketball. X-ray shows a
small avulsion fracture at the tibial tuberosity. What is the likely diagnosis?
A. Osgood-Schlatter disease
B. Patellar tendon rupture
C. Meniscal tear
D. Osteochondritis dissecans
A. Osgood-Schlatter disease
Rationale: Avulsion fracture at the tibial tuberosity in adolescents/young adults after
activity is characteristic of Osgood-Schlatter disease.
5. A 60-year-old man presents with painless hematuria. Ultrasound shows a mass in the
bladder. What is the most likely diagnosis?
A. Bladder cancer
B. Urinary tract infection
C. Kidney stone
D. Benign prostatic hyperplasia
A. Bladder cancer
Rationale: Painless hematuria in older adults is most commonly due to bladder cancer;
imaging and cystoscopy are indicated.
6. A 50-year-old woman presents with fever, fatigue, and a butterfly-shaped rash on her
face. Labs show positive ANA and anti-dsDNA. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Dermatomyositis
D. Psoriasis
B. Systemic lupus erythematosus
Rationale: Malar rash and positive ANA/anti-dsDNA are hallmark features of SLE.
7. A 22-year-old college student presents with acute confusion, fever, and a purpuric
rash. Lumbar puncture shows gram-negative diplococci. What is the most
appropriate treatment?
A. Oral amoxicillin
, B. IV ceftriaxone
C. Oral azithromycin
D. IV vancomycin
B. IV ceftriaxone
Rationale: Neisseria meningitidis causes meningococcemia/meningitis; IV ceftriaxone is
first-line therapy.
8. A 40-year-old man presents with severe epigastric pain radiating to the back. Serum
lipase is elevated. What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Gastritis
B. Acute pancreatitis
Rationale: Epigastric pain radiating to the back with elevated serum lipase is classic for
acute pancreatitis.
9. A 28-year-old woman presents with dyspnea and wheezing. Symptoms are worse at
night and after exercise. What is the most appropriate long-term therapy?
A. Short-acting beta-agonist PRN
B. Inhaled corticosteroid
C. Oral antibiotics
D. Leukotriene receptor antagonist only
B. Inhaled corticosteroid
Rationale: Long-term control of persistent asthma is achieved with inhaled corticosteroids;
short-acting beta-agonists are for acute relief.
10. A 65-year-old man presents with progressive difficulty swallowing solids, halitosis,
and regurgitation of undigested food. What is the most likely diagnosis?
A. Esophageal cancer
B. Achalasia
C. Gastroesophageal reflux disease
D. Zenker’s diverticulum
D. Zenker’s diverticulum
Rationale: Dysphagia to solids, regurgitation of undigested food, and halitosis suggest
Zenker’s diverticulum; confirmed by barium swallow.
11. A 55-year-old man presents with new-onset severe headache and jaw claudication.
ESR is elevated. What is the most likely diagnosis?
A. Migraine
B. Temporal arteritis
Practice 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 45-year-old man presents with sudden-onset chest pain radiating to his back. Blood
pressure is 180/110 mmHg in the right arm and 160/100 mmHg in the left arm. What
is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
Rationale: The asymmetric blood pressures and severe chest pain radiating to the back
suggest an aortic dissection. Immediate imaging with CT angiography or TEE is warranted.
2. A 32-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs
show elevated TSH and low free T4. What is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Subacute thyroiditis
D. Graves’ disease
B. Hypothyroidism
Rationale: Elevated TSH with low free T4 is consistent with primary hypothyroidism.
3. A 68-year-old man with COPD presents with worsening shortness of breath. He is
cyanotic with clubbing of fingers. ABG shows pH 7.32, PaCO2 60 mmHg, PaO2 55
mmHg. What is the primary acid-base disturbance?
, A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
B. Respiratory acidosis
Rationale: Elevated PaCO2 and low pH indicate primary respiratory acidosis, often seen in
chronic COPD exacerbations.
4. A 25-year-old male presents with knee pain after playing basketball. X-ray shows a
small avulsion fracture at the tibial tuberosity. What is the likely diagnosis?
A. Osgood-Schlatter disease
B. Patellar tendon rupture
C. Meniscal tear
D. Osteochondritis dissecans
A. Osgood-Schlatter disease
Rationale: Avulsion fracture at the tibial tuberosity in adolescents/young adults after
activity is characteristic of Osgood-Schlatter disease.
5. A 60-year-old man presents with painless hematuria. Ultrasound shows a mass in the
bladder. What is the most likely diagnosis?
A. Bladder cancer
B. Urinary tract infection
C. Kidney stone
D. Benign prostatic hyperplasia
A. Bladder cancer
Rationale: Painless hematuria in older adults is most commonly due to bladder cancer;
imaging and cystoscopy are indicated.
6. A 50-year-old woman presents with fever, fatigue, and a butterfly-shaped rash on her
face. Labs show positive ANA and anti-dsDNA. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Dermatomyositis
D. Psoriasis
B. Systemic lupus erythematosus
Rationale: Malar rash and positive ANA/anti-dsDNA are hallmark features of SLE.
7. A 22-year-old college student presents with acute confusion, fever, and a purpuric
rash. Lumbar puncture shows gram-negative diplococci. What is the most
appropriate treatment?
A. Oral amoxicillin
, B. IV ceftriaxone
C. Oral azithromycin
D. IV vancomycin
B. IV ceftriaxone
Rationale: Neisseria meningitidis causes meningococcemia/meningitis; IV ceftriaxone is
first-line therapy.
8. A 40-year-old man presents with severe epigastric pain radiating to the back. Serum
lipase is elevated. What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Gastritis
B. Acute pancreatitis
Rationale: Epigastric pain radiating to the back with elevated serum lipase is classic for
acute pancreatitis.
9. A 28-year-old woman presents with dyspnea and wheezing. Symptoms are worse at
night and after exercise. What is the most appropriate long-term therapy?
A. Short-acting beta-agonist PRN
B. Inhaled corticosteroid
C. Oral antibiotics
D. Leukotriene receptor antagonist only
B. Inhaled corticosteroid
Rationale: Long-term control of persistent asthma is achieved with inhaled corticosteroids;
short-acting beta-agonists are for acute relief.
10. A 65-year-old man presents with progressive difficulty swallowing solids, halitosis,
and regurgitation of undigested food. What is the most likely diagnosis?
A. Esophageal cancer
B. Achalasia
C. Gastroesophageal reflux disease
D. Zenker’s diverticulum
D. Zenker’s diverticulum
Rationale: Dysphagia to solids, regurgitation of undigested food, and halitosis suggest
Zenker’s diverticulum; confirmed by barium swallow.
11. A 55-year-old man presents with new-onset severe headache and jaw claudication.
ESR is elevated. What is the most likely diagnosis?
A. Migraine
B. Temporal arteritis
