COMLEX-USA Level 2-CE Exam 2026: Clinical Evaluation Practice
Test — Internal Medicine, Surgery, Paediatrics, OB/GYN, Psychiatry,
Emergency Medicine & Osteopathic Clinical Practice — 190
Multiple-Choice Questions with Answers & Detailed Rationales
Question 1
A 58-year-old man presents with sudden-onset severe chest pain radiating to his back. He
has a history of hypertension. Blood pressure is 180/100 mmHg in the right arm and 140/80
mmHg in the left arm. Chest X-ray shows a widened mediastinum. What is the most likely
diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Explanation: Sudden severe chest pain radiating to the back with interarm blood pressure
differential and widened mediastinum is classic for aortic dissection. Immediate CT
angiography is indicated.
Question 2
A 24-year-old woman presents with a 2-week history of malaise, fever, and a new murmur.
Blood cultures grow Streptococcus viridans. Which valve is most commonly affected in
subacute bacterial endocarditis?
A. Aortic valve
,B. Mitral valve
C. Tricuspid valve
D. Pulmonary valve
Correct Answer: B
Explanation: Subacute bacterial endocarditis most commonly affects the mitral valve,
especially in patients with underlying valvular disease. Streptococcus viridans is the classic
organism.
Question 3
A 4-year-old boy is brought to the clinic with a 3-day history of fever, sore throat, and a
sandpaper-like rash. Examination reveals strawberry tongue and palatal petechiae. What is
the most appropriate treatment?
A. Amoxicillin
B. Penicillin G
C. Azithromycin
D. Supportive care only
Correct Answer: B
Explanation: Scarlet fever caused by group A Streptococcus is treated with penicillin G to
prevent rheumatic fever. Amoxicillin is an alternative but penicillin is first-line.
Question 4
,A 65-year-old woman with a history of COPD presents with increased dyspnea and purulent
sputum. She has a temperature of 38.5°C and oxygen saturation of 88% on room air. What is
the most appropriate initial management?
A. Oral azithromycin
B. Inhaled bronchodilators and oral corticosteroids
C. Supplemental oxygen and antibiotics
D. Immediate intubation
Correct Answer: C
Explanation: Acute exacerbation of COPD with hypoxemia requires supplemental oxygen to
target SpO2 88-92% and antibiotics for purulent sputum. Non-invasive ventilation may be
considered.
Question 5
A 32-year-old man presents with a painless penile ulcer with a clean base and indurated
edges. He reports recent unprotected intercourse. What is the most likely diagnosis?
A. Herpes simplex virus
B. Syphilis
C. Chancroid
D. Lymphogranuloma venereum
Correct Answer: B
Explanation: Primary syphilis presents as a painless, indurated chancre with a clean base.
Darkfield microscopy or serology confirms the diagnosis. Treatment is benzathine penicillin
G.
, Question 6
A 70-year-old woman presents with sudden painless vision loss in her right eye. Fundoscopy
reveals a cherry-red spot at the macula. What is the most likely diagnosis?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Vitreous hemorrhage
D. Retinal detachment
Correct Answer: B
Explanation: Central retinal artery occlusion presents with sudden painless vision loss and a
cherry-red spot at the macula due to ischemia of the retinal layers. It is an ophthalmologic
emergency.
Question 7
A 28-year-old woman at 34 weeks gestation presents with severe headache and visual
disturbances. Blood pressure is 170/110 mmHg. Urinalysis shows proteinuria. What is the
most appropriate management?
A. Oral labetalol
B. Intravenous magnesium sulfate and delivery
C. Bed rest and monitoring
D. Oral nifedipine
Correct Answer: B
Test — Internal Medicine, Surgery, Paediatrics, OB/GYN, Psychiatry,
Emergency Medicine & Osteopathic Clinical Practice — 190
Multiple-Choice Questions with Answers & Detailed Rationales
Question 1
A 58-year-old man presents with sudden-onset severe chest pain radiating to his back. He
has a history of hypertension. Blood pressure is 180/100 mmHg in the right arm and 140/80
mmHg in the left arm. Chest X-ray shows a widened mediastinum. What is the most likely
diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Explanation: Sudden severe chest pain radiating to the back with interarm blood pressure
differential and widened mediastinum is classic for aortic dissection. Immediate CT
angiography is indicated.
Question 2
A 24-year-old woman presents with a 2-week history of malaise, fever, and a new murmur.
Blood cultures grow Streptococcus viridans. Which valve is most commonly affected in
subacute bacterial endocarditis?
A. Aortic valve
,B. Mitral valve
C. Tricuspid valve
D. Pulmonary valve
Correct Answer: B
Explanation: Subacute bacterial endocarditis most commonly affects the mitral valve,
especially in patients with underlying valvular disease. Streptococcus viridans is the classic
organism.
Question 3
A 4-year-old boy is brought to the clinic with a 3-day history of fever, sore throat, and a
sandpaper-like rash. Examination reveals strawberry tongue and palatal petechiae. What is
the most appropriate treatment?
A. Amoxicillin
B. Penicillin G
C. Azithromycin
D. Supportive care only
Correct Answer: B
Explanation: Scarlet fever caused by group A Streptococcus is treated with penicillin G to
prevent rheumatic fever. Amoxicillin is an alternative but penicillin is first-line.
Question 4
,A 65-year-old woman with a history of COPD presents with increased dyspnea and purulent
sputum. She has a temperature of 38.5°C and oxygen saturation of 88% on room air. What is
the most appropriate initial management?
A. Oral azithromycin
B. Inhaled bronchodilators and oral corticosteroids
C. Supplemental oxygen and antibiotics
D. Immediate intubation
Correct Answer: C
Explanation: Acute exacerbation of COPD with hypoxemia requires supplemental oxygen to
target SpO2 88-92% and antibiotics for purulent sputum. Non-invasive ventilation may be
considered.
Question 5
A 32-year-old man presents with a painless penile ulcer with a clean base and indurated
edges. He reports recent unprotected intercourse. What is the most likely diagnosis?
A. Herpes simplex virus
B. Syphilis
C. Chancroid
D. Lymphogranuloma venereum
Correct Answer: B
Explanation: Primary syphilis presents as a painless, indurated chancre with a clean base.
Darkfield microscopy or serology confirms the diagnosis. Treatment is benzathine penicillin
G.
, Question 6
A 70-year-old woman presents with sudden painless vision loss in her right eye. Fundoscopy
reveals a cherry-red spot at the macula. What is the most likely diagnosis?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Vitreous hemorrhage
D. Retinal detachment
Correct Answer: B
Explanation: Central retinal artery occlusion presents with sudden painless vision loss and a
cherry-red spot at the macula due to ischemia of the retinal layers. It is an ophthalmologic
emergency.
Question 7
A 28-year-old woman at 34 weeks gestation presents with severe headache and visual
disturbances. Blood pressure is 170/110 mmHg. Urinalysis shows proteinuria. What is the
most appropriate management?
A. Oral labetalol
B. Intravenous magnesium sulfate and delivery
C. Bed rest and monitoring
D. Oral nifedipine
Correct Answer: B
