COMLEX Level 2 Master Set-Questions with 100%
Correct Answers
Patient presents with multiple episodes of hematemesis, obtunded and vominting bright red
blood with multiple emergency department visits for alcohol intoxication or withdrawal.
Upper endoscopy is likely to show what?
Dilated Distal esophageal veins (Esophageal Varices) caused by increased portal venous
pressure secondary to cirrhosis or other liver disease. Upper Endo is gold standard for
diagnosis.
Pnuemopericardium presentation
Shortness of breath and chest pain that increases with inspiration. Crunching sound may be
ausculated, CXR with show radiolucent air between heart and pericardial sac
Patient with weakness, proximal muscle pain and dark urine for 3 days with history of HTN,
HLD, T2DM and BPH on atorvastatin, metformin, lisinopril and tamsulosis. Started new med
10 days ago and thens ymptoms started. Serum K+ 5.6, CK 1250, what med exacerbated this
condition.
B. Gemfibrozil
- Statins are most common tested cause of med induced rhabdo. The risk increased with
concurrent use of fibrates, niacin or cytochrome p450-3A4 inhibitors.
- Incorrect answeres were ezetimibe, glyburide, HCTZ, pioglitazone.
Commonly tested biases
21 y.o obese female (young woman) with recurrent headaches worse on awakening and
blurry vision. Vomited several times in the past week and has bilateral papilledema. Most
likely diagnosis?
Pseudotumor cerebri (aka idiopathic intracranial hypertension). Classically diagnosed in
overweight women of childbearing age with similar symptoms. Can sometimes have abducens
nerve palsy leading to diplopia. Can be precipitated by isotretinoin or tetracyclines. DIAGNOSIS:
,non-contrast CT of head to rule out mass followed by LP showing elevated opening pressure.
Treated with carbonic anhydrase inhibitor acetazolamide.
66 y.o male with history of SBO presents to ER with abd distension. Gained 20 lbs over a
couple months. Last few days, diffuse abd pain, nausea, multiple episodes of non-bilious,
non-bloddy emesis. Temp of 101.1, HR 103. Distended abd, diffuse tenderness, multiple
telangiectasias, paracentesis performed what are the expected findings?
Ascitic fluid with elevated absolute neutrophil count and positive culture indicating
Spontaneous bacterial periotonitis. Fever, tachy, diffuse abd pain, ascites. Most commonly
caused by Gm(-) orgs like E.Coli or Klebsiella.
Facilitated Positional Release
indirect and passive treatment
passively move patient into the way they want to go, add an activating force (compression),
passively move patient further into the way they want to move, passively return patient to
normal, recheck
30 y.o male PMH of hyperparathyroidism and parathyroidectomy presents for eval for
galactorrhea. Mild gynecomastia on exam with milk expression, TSH normal, Prolactin 202
ng/mL. MRI confirms prolactinoma. Given his history, he is most at risk for developing which
condition?
History consistent with MEN1 (pituitary adenoma, hyperparathyroidism, pancreatic tumor).
Most common pancreatic tumor associated with MEN1 is a gastrinoma which causes excessive
uncontrolled gastrin stimulation leading to Peptic Ulcer Disease.
80 y.o male brought to the ED after hip fracture due to fall in home. History of osteoporosis
and mild balance impairment. Most appropriate measure to prevent future falls in this
patient?
Supervised exercise training program emphasizing strength and balance to prevent future falls.
, 10 month old female with 2 days of persistent diarrhea. Noted to be progressively more
lethargic over the last 12 hours and won't eat or drink. Temp 101.7, HR 170, BP 75/50, Na+
160, K+ 4.2, Cl- 108, HCO3- 10. Iv access obtained, most appropriate next step?
IV bolus of 0.9% saline
58 y.o male with elevated troponins, ekg changes and 2/6 systolic ejection murmur
undergoes the appropriate diagnostic procedure. What complication is he most at risk for
after the procedure?
Contrast Nephropathy caused by cardiac catheterization. 5% of patients experience this
complication after the procedure with greatest risk in those with moderate to severe renal
insufficiency or poorly controlled diabetes.
27 y.o male presents for OMT for insuries sustained during a MVC. On structural exam, the
frontal and temporal bones favor external rotation. What finding would most likely be seen
during this phase of craniosacral motion?
Sacral Counternutation
- During craniosacral flexion, the midline bones move into flexion paired bones move into
external rotation. This causes cephalad movement of the dura mater which causes the sacral
base to move into extension or counternutation.
Osteopathic exam reveals hypertonicity of paraspinal muscles T2 to T5 bilaterally. T3 is
neutral, side-bent right, rotated left. You decide to perform short lever HVLA. What is the
correct treatment setup for this?
Thenar eminence on the patients left transvers process of T3, side bend to the left, rotate to
the right. (Thenar eminence place on the side of the rotation in the dysfunction)
16 y.o male brought to ED after falling to the floor after finding out he got a perfect score on
his chemistry exam. There was no dizziness, LOC, twitching, shaking, tongue biting, confusion
before or after. 3 similar episodes but otherwise feels well besides being tired. EEG, Echo
Correct Answers
Patient presents with multiple episodes of hematemesis, obtunded and vominting bright red
blood with multiple emergency department visits for alcohol intoxication or withdrawal.
Upper endoscopy is likely to show what?
Dilated Distal esophageal veins (Esophageal Varices) caused by increased portal venous
pressure secondary to cirrhosis or other liver disease. Upper Endo is gold standard for
diagnosis.
Pnuemopericardium presentation
Shortness of breath and chest pain that increases with inspiration. Crunching sound may be
ausculated, CXR with show radiolucent air between heart and pericardial sac
Patient with weakness, proximal muscle pain and dark urine for 3 days with history of HTN,
HLD, T2DM and BPH on atorvastatin, metformin, lisinopril and tamsulosis. Started new med
10 days ago and thens ymptoms started. Serum K+ 5.6, CK 1250, what med exacerbated this
condition.
B. Gemfibrozil
- Statins are most common tested cause of med induced rhabdo. The risk increased with
concurrent use of fibrates, niacin or cytochrome p450-3A4 inhibitors.
- Incorrect answeres were ezetimibe, glyburide, HCTZ, pioglitazone.
Commonly tested biases
21 y.o obese female (young woman) with recurrent headaches worse on awakening and
blurry vision. Vomited several times in the past week and has bilateral papilledema. Most
likely diagnosis?
Pseudotumor cerebri (aka idiopathic intracranial hypertension). Classically diagnosed in
overweight women of childbearing age with similar symptoms. Can sometimes have abducens
nerve palsy leading to diplopia. Can be precipitated by isotretinoin or tetracyclines. DIAGNOSIS:
,non-contrast CT of head to rule out mass followed by LP showing elevated opening pressure.
Treated with carbonic anhydrase inhibitor acetazolamide.
66 y.o male with history of SBO presents to ER with abd distension. Gained 20 lbs over a
couple months. Last few days, diffuse abd pain, nausea, multiple episodes of non-bilious,
non-bloddy emesis. Temp of 101.1, HR 103. Distended abd, diffuse tenderness, multiple
telangiectasias, paracentesis performed what are the expected findings?
Ascitic fluid with elevated absolute neutrophil count and positive culture indicating
Spontaneous bacterial periotonitis. Fever, tachy, diffuse abd pain, ascites. Most commonly
caused by Gm(-) orgs like E.Coli or Klebsiella.
Facilitated Positional Release
indirect and passive treatment
passively move patient into the way they want to go, add an activating force (compression),
passively move patient further into the way they want to move, passively return patient to
normal, recheck
30 y.o male PMH of hyperparathyroidism and parathyroidectomy presents for eval for
galactorrhea. Mild gynecomastia on exam with milk expression, TSH normal, Prolactin 202
ng/mL. MRI confirms prolactinoma. Given his history, he is most at risk for developing which
condition?
History consistent with MEN1 (pituitary adenoma, hyperparathyroidism, pancreatic tumor).
Most common pancreatic tumor associated with MEN1 is a gastrinoma which causes excessive
uncontrolled gastrin stimulation leading to Peptic Ulcer Disease.
80 y.o male brought to the ED after hip fracture due to fall in home. History of osteoporosis
and mild balance impairment. Most appropriate measure to prevent future falls in this
patient?
Supervised exercise training program emphasizing strength and balance to prevent future falls.
, 10 month old female with 2 days of persistent diarrhea. Noted to be progressively more
lethargic over the last 12 hours and won't eat or drink. Temp 101.7, HR 170, BP 75/50, Na+
160, K+ 4.2, Cl- 108, HCO3- 10. Iv access obtained, most appropriate next step?
IV bolus of 0.9% saline
58 y.o male with elevated troponins, ekg changes and 2/6 systolic ejection murmur
undergoes the appropriate diagnostic procedure. What complication is he most at risk for
after the procedure?
Contrast Nephropathy caused by cardiac catheterization. 5% of patients experience this
complication after the procedure with greatest risk in those with moderate to severe renal
insufficiency or poorly controlled diabetes.
27 y.o male presents for OMT for insuries sustained during a MVC. On structural exam, the
frontal and temporal bones favor external rotation. What finding would most likely be seen
during this phase of craniosacral motion?
Sacral Counternutation
- During craniosacral flexion, the midline bones move into flexion paired bones move into
external rotation. This causes cephalad movement of the dura mater which causes the sacral
base to move into extension or counternutation.
Osteopathic exam reveals hypertonicity of paraspinal muscles T2 to T5 bilaterally. T3 is
neutral, side-bent right, rotated left. You decide to perform short lever HVLA. What is the
correct treatment setup for this?
Thenar eminence on the patients left transvers process of T3, side bend to the left, rotate to
the right. (Thenar eminence place on the side of the rotation in the dysfunction)
16 y.o male brought to ED after falling to the floor after finding out he got a perfect score on
his chemistry exam. There was no dizziness, LOC, twitching, shaking, tongue biting, confusion
before or after. 3 similar episodes but otherwise feels well besides being tired. EEG, Echo
