COMLEX-USA Level 2-CE Exam 2026: Comprehensive Clinical
Evaluation Practice Test — Internal Medicine, Surgery, Paediatrics,
Obstetrics & Gynaecology, Psychiatry, Emergency Medicine &
Osteopathic Principles — Multiple-Choice Questions with Answers &
Detailed Rationales
Practice Examination
Question 1
A 58-year-old male with a 40-pack-year smoking history presents with progressive dyspnea
on exertion and a chronic cough. Physical examination reveals barrel-shaped chest and
decreased breath sounds bilaterally. Spirometry demonstrates an FEV1/FVC ratio of 0.62.
Which of the following is the most likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease
C. Pulmonary fibrosis
D. Congestive heart failure
Correct Answer: B
Explanation:
COPD is characterized by irreversible airflow obstruction with FEV1/FVC ratio less than 0.70
in patients with significant smoking history and compatible symptoms.
Question 2
,A 34-year-old female presents with fatigue, weight gain, and cold intolerance. Laboratory
studies reveal elevated TSH and decreased free T4. Which of the following is the most
appropriate initial treatment?
A. Methimazole
B. Radioactive iodine ablation
C. Levothyroxine
D. Propranolol
Correct Answer: C
Explanation:
Primary hypothyroidism presents with elevated TSH and low free T4; levothyroxine is the
standard replacement therapy titrated to normalize TSH.
Question 3
A 72-year-old male presents with sudden onset of severe abdominal pain, hypotension, and
a pulsatile abdominal mass. Which of the following is the most immediate concern?
A. Acute pancreatitis
B. Ruptured abdominal aortic aneurysm
,C. Perforated peptic ulcer
D. Renal colic
Correct Answer: B
Explanation:
The triad of hypotension, abdominal pain, and pulsatile mass suggests ruptured AAA, a
surgical emergency requiring immediate intervention.
Question 4
A 6-month-old infant presents with a 3-day history of fever, irritability, and poor feeding.
Physical examination reveals bulging fontanelle and nuchal rigidity. Which of the following is
the most appropriate next step?
A. Oral amoxicillin and outpatient follow-up
B. Immediate lumbar puncture and IV antibiotics
C. CT head without contrast
D. Observation with antipyretics
Correct Answer: B
Explanation:
, Bacterial meningitis in infants requires emergent lumbar puncture for CSF analysis and
immediate empiric IV antibiotics to prevent morbidity.
Question 5
A 45-year-old female presents with episodic palpitations, diaphoresis, and headache. Plasma
metanephrines are elevated. Which of the following is the most likely diagnosis?
A. Pheochromocytoma
B. Carcinoid syndrome
C. Hyperthyroidism
D. Panic disorder
Correct Answer: A
Explanation:
Pheochromocytoma classically presents with paroxysmal hypertension, palpitations,
diaphoresis, and headache with elevated plasma metanephrines.
Question 6
A 28-year-old male presents with acute onset of unilateral scrotal pain and swelling that
began 2 hours ago. The cremasteric reflex is absent on the affected side. Which of the
following is the most appropriate next step?
Evaluation Practice Test — Internal Medicine, Surgery, Paediatrics,
Obstetrics & Gynaecology, Psychiatry, Emergency Medicine &
Osteopathic Principles — Multiple-Choice Questions with Answers &
Detailed Rationales
Practice Examination
Question 1
A 58-year-old male with a 40-pack-year smoking history presents with progressive dyspnea
on exertion and a chronic cough. Physical examination reveals barrel-shaped chest and
decreased breath sounds bilaterally. Spirometry demonstrates an FEV1/FVC ratio of 0.62.
Which of the following is the most likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease
C. Pulmonary fibrosis
D. Congestive heart failure
Correct Answer: B
Explanation:
COPD is characterized by irreversible airflow obstruction with FEV1/FVC ratio less than 0.70
in patients with significant smoking history and compatible symptoms.
Question 2
,A 34-year-old female presents with fatigue, weight gain, and cold intolerance. Laboratory
studies reveal elevated TSH and decreased free T4. Which of the following is the most
appropriate initial treatment?
A. Methimazole
B. Radioactive iodine ablation
C. Levothyroxine
D. Propranolol
Correct Answer: C
Explanation:
Primary hypothyroidism presents with elevated TSH and low free T4; levothyroxine is the
standard replacement therapy titrated to normalize TSH.
Question 3
A 72-year-old male presents with sudden onset of severe abdominal pain, hypotension, and
a pulsatile abdominal mass. Which of the following is the most immediate concern?
A. Acute pancreatitis
B. Ruptured abdominal aortic aneurysm
,C. Perforated peptic ulcer
D. Renal colic
Correct Answer: B
Explanation:
The triad of hypotension, abdominal pain, and pulsatile mass suggests ruptured AAA, a
surgical emergency requiring immediate intervention.
Question 4
A 6-month-old infant presents with a 3-day history of fever, irritability, and poor feeding.
Physical examination reveals bulging fontanelle and nuchal rigidity. Which of the following is
the most appropriate next step?
A. Oral amoxicillin and outpatient follow-up
B. Immediate lumbar puncture and IV antibiotics
C. CT head without contrast
D. Observation with antipyretics
Correct Answer: B
Explanation:
, Bacterial meningitis in infants requires emergent lumbar puncture for CSF analysis and
immediate empiric IV antibiotics to prevent morbidity.
Question 5
A 45-year-old female presents with episodic palpitations, diaphoresis, and headache. Plasma
metanephrines are elevated. Which of the following is the most likely diagnosis?
A. Pheochromocytoma
B. Carcinoid syndrome
C. Hyperthyroidism
D. Panic disorder
Correct Answer: A
Explanation:
Pheochromocytoma classically presents with paroxysmal hypertension, palpitations,
diaphoresis, and headache with elevated plasma metanephrines.
Question 6
A 28-year-old male presents with acute onset of unilateral scrotal pain and swelling that
began 2 hours ago. The cremasteric reflex is absent on the affected side. Which of the
following is the most appropriate next step?
