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COMLEX-USA Question of the Month

Here are some sample COMLEX-USA questions.

A 65-year-old male presents to the office with the complaint of double vision. He reports that the double vision seems to become more prominent when he reads the newspaper at night and is less of a problem in the early morning. He also reports that his speech becomes difficult to understand in the evening. All of these symptoms have been present for 3 or 4 months and fluctuate in severity. Physical examination reveals ptosis of the right eye, and the patient seems to grimace when he smiles. What is the most likely diagnosis?
A. arsenic poisoning
B. hemispheric brain tumor
C. myasthenia gravis
D. peripheral neuropathy
E. Pick disease

A new integrative medicine clinic offers nutritional and thermography tests that may be clinically valuable to several of your patients. For each test that you order, the clinic offers to send you a $10 referral fee per patient. The integrative medicine clinic would also give you 10% of the sale price for any nutritional products that your patients purchase through them. You decline the offer because it is in violation of the
A. False Claims Act (FCA)
B. Health Insurance Portability and Accountability Act (HIPAA)
C. Program Fraud Civil Remedies Act (PFCRA)
D. Racketeer Influenced and Corrupt Organizations Act (RICO)
E. Stark Law

A 25-year-old female presents to the office with a 4-week history of numbness and paresthesia over a large, oval-shaped area on the lateral aspect of her left thigh. The symptoms began after she tripped down the stairs and fell on her left side. Physical examination reveals normal motor findings and decreased sensation to light touch that is localized to the left lateral thigh. Lower extremity deep tendon reflexes are +2/4 bilaterally. Hypertonicity of which of the following muscles is the most likely cause of this patient’s condition?
A. left iliopsoas
B. left piriformis
C. left vastus lateralis
D. right iliacus
E. right quadratus lumborum

A 24-year-old female presents to the office with a 1-week history of bloody diarrhea. She reports no weight loss. Her temperature is 37.1°C (98.8°F). Physical examination reveals increased muscle tension in the paravertebral tissue at T10-L2 on the left. Colonoscopy reveals superficial ulcers diffusely distributed in the rectum and distal colon. A biopsy of rectal tissue reveals chronic inflammation in the mucosa and cryptic abscesses. What is the most likely diagnosis?
A. celiac sprue
B. Crohn disease
C. ischemic bowel disease
D. ulcerative colitis
E. Whipple disease

An 85-year-old female is brought to the office by her daughter, who has been concerned about her mother’s confusion and poor memory over the past 3 years. She was especially concerned when the patient recently became lost while taking a walk. On questioning, the patient stares off into the distance and is reluctant to answer questions, but she does complain of insomnia and depression. Past medical history reveals hypothyroidism diagnosed 30 years ago, which is managed with levothyroxine. Vital signs reveal a blood pressure of 110/60 mmHg and a heart rate of 60/min. Her thyroid-stimulating hormone level is 2.5 mcIU/mL (reference range: 0.4-4.2 mcIU/mL). An MRI of the brain reveals medial temporal lobe atrophy. Which of the following is most likely present in this patient’s brain?
A. aggregated prions
B. aggregates of α-synuclein
C. deposits of amyloid-β peptide
D. phosphorylated glial fibrillary acidic protein
E. phosphorylated huntingtin protein

A 44-year-old male presents to the office for a follow-up evaluation 6 weeks after a motor vehicle collision in which he sustained fractures of ribs 4-9 on the right. The ribs have since healed, but he reports that he has persistent shortness of breath. On examination, ribs 4-9 on the right move poorly with inhalation but descend well with exhalation. In order to appropriately treat this somatic dysfunction with muscle energy, the patient should contract which of the following muscles against the physician’s counterforce?
A. anterior scalene
B. iliocostalis
C. latissimus dorsi
D. pectoralis minor
E. serratus posterior superior

A 19-year-old female is admitted to the hospital for evaluation of fever and left-sided flank pain. She reports that she began to experience nausea, fever, chills, and progressive urinary incontinence 5 days ago. She is sexually active. Her temperature is 38.8°C (101.8°F). Urinalysis results are positive for leukocyte esterase and blood (reference range for both: negative). Microscopy of urine cultures grown on blood agar reveals gram-positive cocci. The most likely etiologic agent is
A. Escherichia coli
B. Proteus mirabilis
C. Staphylococcus aureus
D. Staphylococcus epidermidis
E. Staphylococcus saprophyticus

A 35-year-old male presents to the office as a new patient with a 9-month history of diffuse muscle achiness. He also complains of fatigue and muscle weakness, and he is frustrated that he did not receive a diagnosis from his previous physician. Past medical history is unremarkable. He does not use any medications or supplements. Physical examination reveals widespread bilateral axial and peripheral muscle tenderness. Upper and lower extremity muscle strength is 5/5 bilaterally, and deep tendon reflexes are +2/4 globally. Sensory examination findings are normal. What is the most likely explanation for this patient’s symptoms?
A. fibromyalgia
B. neuropathy
C. polymyositis
D. radiculopathy
E. somatoform disorder

A 33-year-old female presents to the office for a follow-up evaluation after she was diagnosed with systemic lupus erythematosus. What is the most appropriate way for the physician to start the discussion about the patient’s new diagnosis?
A. begin with the basic pathophysiology of autoimmune diseases and then focus on lupus
B. explain that this is a chronic condition that can be life-threatening
C. explore what she already knows about lupus and try to uncover misconceptions
D. provide a complete description of symptoms and the various forms of treatment
E. provide detailed information even if she does not completely understand

A 21-year-old male presents to the office for evaluation of an ankle injury. He was playing football 3 days ago when he turned his right ankle inward while stepping on another player’s foot. He has been icing the ankle since the injury and is able to walk on it. Ibuprofen helps decrease the pain. An anterior drawer test at the ankle yields a negative result. Which of the following somatic dysfunctions is most likely present in this patient?
A. anterior fibular head
B. dorsal glide of the cuboid
C. external rotation of the femur
D. internal rotation of the tibia
E. alocalcaneal inversion

A 29-year-old female presents to the emergency department with an 8-day history of acute, worsening pain and swelling in her ankles. She describes the pain as severe and throbbing. The patient denies any history of trauma. Surgical history is negative. Examination reveals tender, swollen ankles with synovitis. Active range of motion is painful but only slightly decreased. Neurovascular findings are unremarkable. The patient has no ecchymosis, rashes, or breaks in the skin. Several tender nodules are palpated adjacent to the calcaneal tendons bilaterally. Results from a complete blood count and a basic metabolic profile are normal. The patient’s erythrocyte sedimentation rate is 45 mm/h (reference range: 0-20 mm/h). Rheumatoid factor level and antinuclear antibody titer results are normal. Radiographs of the ankles reveal normal findings. What is the most likely diagnosis?
A. Lyme disease
B. reactive arthritis
C. rheumatic fever
D. rheumatoid arthritis
E. sarcoidosis

An 18-month-old female is brought to the office for the third time in 6 months for evaluation of nausea, vomiting, fever, and decreased urine output. She is diagnosed with a urinary tract infection. She is placed on oral antibiotics for 10 days, and the symptoms resolve. An ultrasound of the kidneys reveals normal findings. Which of the following diagnostic tools is most likely to be helpful in formulating a plan to prevent future episodes?

A. CT scan of the abdomen
B. CT urography
C. postvoid residual ultrasonography of the bladder
D. renal scintigraphy
E. voiding cystourethrography

A 34-year-old male presents to the office for a health maintenance examination before his upcoming wedding. Past medical history is unremarkable, and surgical history is negative. When asked how he met his future spouse, he says that ever since she gave him “the glance” a month ago he knew that this was the signal that she wanted to marry him. He says that the only thing he’s worried about is how he’s going to turn down all of the other woman who give him “the glance.” In fact, he’s pretty certain that the clerk who took his insurance card at the front desk gave him “the glance” as well. He denies alcohol or substance use and says that he has never been to a therapist. He is not taking any medications. The patient is well dressed, well groomed, and cooperative in answering questions during the interview. He reports having a good mood. He exhibits goal-directed thought processes. He denies any thoughts of self-harm or harm to others. He also denies any auditory or visual hallucinations. The most likely diagnosis is

A. brief reactive psychosis
B. delusional disorder
C. paranoid personality disorder
D. schizophrenia
E. schizophreniform disorder

A 28-year-old primigravid female at 32 weeks’ gestation presents to the office for a prenatal examination. Her pregnancy is significant for dichorionic/diamniotic twin gestation but otherwise unremarkable, and she has received regular prenatal care. On ultrasound, both fetuses are in the occipitoanterior position and are normal-sized for twin gestation. What is the most significant risk to this patient’s pregnancy at this stage of gestation?

A. gestational diabetes
B. fetal demise
C. twin-twin transfusion syndrome
D. preeclampsia
E. preterm labor

A 70-year-old female is evaluated in the hospital on postoperative day 1 due to mental status changes and agitation, which caused her to pull out her intravenous line and Foley catheter. The patient underwent surgery to repair a fractured hip associated with a fall. Past medical history reveals heart failure and diabetes mellitus. The patient lives by herself and still drives. She drinks 1 glass of wine per week and denies tobacco use. Vital signs are normal. The patient is awake and alert but exhibits a flat affect. She is oriented to person only and has difficulty following commands. What is the most likely diagnosis?

A. acute stress disorder
B. agoraphobia
C. brief psychotic disorder
D. delirium
E. major vascular neurocognitive disorder

A 42-year-old male is brought to the office by his wife, who says he has exhibited irritability, decreased sleep, and distractibility for the past 2 weeks. She says that he keeps coming up with ridiculous, grand ideas and has been gambling excessively. He has had similar episodes in the past that typically resolve after a month; however, this episode seems more extreme. On questioning, the patient exhibits loud, pressured speech. He says that he feels fine and is not having any problems. Physical examination findings are otherwise normal. The results of laboratory studies, including complete blood count, basic metabolic profile, urinalysis, and erythrocyte sedimentation rate, are normal. The most appropriate initial treatment includes lithium and

A. aripiprazole
B. fluoxetine
C. imipramine
D. valproate
E. ziprasidone

A 22-year-old male infantry soldier presents to the office with the complaint of recurrent foot pain that began after he experienced a stress fracture of the right second metatarsal during basic training 18 months ago. After initial healing of the fracture, the pain has continued to improve with ongoing osteopathic manipulative treatment, which he has been receiving since his return home from deployment 3 months ago. He says that the pain worsens after long training marches, and he fears that he may develop another fracture. On examination, the first metatarsal is shorter than the second, and calluses are noted under the second and third metatarsal heads. For this patient to reduce the incidence of recurrence, the most appropriate recommendation is for him to:

A. apply ice packs to his feet after long marches
B. limit his pack weight to 9.1 kg (20.0 lb) for long marches
C. obtain a single steroid injection into the plantar fascia
D. use warm magnesium sulfate foot soaks after long marches
E. wear proper fitting shoes with custom orthotics


A 59-year-old male presents to the office with a 2-year history of excessive daytime sleepiness, nasal obstruction, fatigue, and snoring. He has been falling asleep in meetings at work, and he fell asleep once while driving. Past medical history reveals hypertension and hypothyroidism with a nontoxic goiter. His body mass index is 37 kg/m2. Physical examination reveals a markedly deviated septum, an elongated uvula, absent tonsils, a Mallampati classification of grade I, and a palpable, nontender thyroid. Polysomnography reveals an apnea-hypopnea index of 15. A trial of continuous positive airway pressure is immediately discontinued by the patient because of his intolerance of the device. The most appropriate alternate treatment option for this patient is:

A. hypoglossal nerve stimulation
B. septoplasty
C. subtotal thyroidectomy
D. turbinectomy
E. uvulopalatopharyngoplasty


A 29-year-old female presents to the office with a 2-day history of vaginal discharge. Pelvic examination reveals frothy, voluminous, and foul-smelling discharge. Saline wet mount of the discharge reveals motile organisms. The most likely diagnosis is

A. bacterial vaginosis
B. candidiasis
C. gonorrhea
D. herpes
E. trichomoniasis


A 24-year-old female presents to the office with a 3-day history of a cough that is occasionally productive of yellowish sputum. She also reports facial pressure and pain in her teeth over the same time period. Examination reveals pain to percussion over the maxillary sinuses and an injected posterior pharynx. The lungs are clear to auscultation. The most likely diagnosis is

A. acute bronchitis
B. acute pharyngitis
C. acute pneumonia
D. acute sinusitis
E. chronic bronchitis

A 31-year-old female presents to the office with a 1-year history of infertility. Records reveal that the patient was hospitalized for right upper quadrant abdominal pain, fever, nausea, and vomiting 2 months ago. Laparoscopic examination reveals adhesions between the liver capsule and anterior abdominal wall. The most likely diagnosis is:

A. Budd-Chiari syndrome
B. Dubin-Johnson syndrome
C. Fitz-Hugh-Curtis syndrome

D. reactive arthritis
E. Waterhouse-Friderichsen syndrome


A 22-month-old male is brought to the office with a 24-hour history of nausea, vomiting, diarrhea, and fever with temperatures up to 39.4°C (103.0°F). Examination reveals an erythematous, bulging tympanic membrane and lymphatic congestion at the thoracic inlet. What is the most likely cause of this patient’s symptoms?

A. herpes zoster oticus
B. impaction of the molars
C. otitis media
D. perforation of the tympanic membrane
E. trigeminal neuralgia

A 39-year-old female presents to the office with a 3-day history of pain in the right calf. Past medical history is unremarkable. She smokes cigarettes and has a 21 pack-year history. She denies alcohol use. She has taken oral contraceptives for the past 15 years. Physical examination reveals swelling of the right calf and ankle. There is pain in the calf on dorsiflexion of the right foot. A D-dimer level is 900 ng/mL (reference range: 220-740 ng/mL). The most appropriate treatment is:

A. factor VIII
B. heparin
C. plasmapheresis
D. platelet transfusion
E. thrombin

A 24-year-old female presents to the office with a 1-week history of bloody diarrhea. She reports no weight loss. Her temperature is 37.1°C (98.8°F). Physical examination reveals increased muscle tension in the paravertebral tissue at T10-L2 on the left. Endoscopy reveals superficial ulcers diffusely distributed in the rectum and distal colon. The most likely diagnosis is:

A. celiac sprue
B. Crohn disease
C. ischemic bowel disease
D. ulcerative colitis
E. Whipple disease

A 58-year-old female presents to the office with a history of 3 episodes of abrupt-onset syncope without any premonitory symptoms. Neurologic examination findings are normal. Physical examination reveals a blowing systolic murmur over the second intercostal space on the right with radiation to the base of the neck. Her syncopal episodes are most likely due to:

A. Aortic stenosis
B. Mitral stenosis
C. Orthostasis
D. Seizure
E. Vasovagal syncope

A 40-year-old male is developing an exaggerated concave anterior curvature of the thoracic vertebral column. He was successfully treated for tuberculosis 10 years ago. Radiographic analysis reveals degeneration of the anterior aspect of the bodies of T6 and T7. This causes a sharp anterior angulation in the vertebral column. This abnormal curvature of the vertebral column is known as:

A. Kyphosis
B. Lordosis
C. Myeloschisis
D. Scoliosis
E. Spina Bifida

A 22-year-old female presents to the office for a preemployment physical examination. Auscultation of the heart reveals a systolic murmur that radiates to the apex. History reveals rheumatic fever. This patient’s murmur will be best heard by placing the stethoscope bell over the:

A. Fifth intercostal space on the left side of the sternum
B. Fifth intercostal space on the right side of the sternum
C. Second intercostal space on the left side of the sternum
D. Second intercostal space on the right side of the sternum
E. Third intercostal space on the right side of the sternum

A 28-year-old male presents to the office with a 1-month history of fatigue when he walks up the 3 flights of stairs to his apartment. He denies becoming fatigued after moderate physical activity. Physical examination reveals mild bilateral hypertrophy of the gastrocnemius. Laboratory studies reveal a creatine kinase level of 525 U/L (reference range: 38-174 U/L). ECG results suggest right ventricular hypertrophy. Which of the following molecular methods is most appropriate to determine the underlying etiology?

A. Array comparative gene hybridization
B. Fluorescent in situ hybridization
C. Karyotyping with banding
D. Northern blot
E. Polymerase chain reaction

A 46-year-old male presents to the office with a 3-month history of polyuria and polydipsia. His body mass index is 32 kg/m2. Vital signs are normal, and physical examination reveals normal findings. Laboratory studies reveal:

Test Patient’s Value Reference Ranges
Sodium 142 mEq/L 136-145 mEq/L
Potassium 4.2 mEq/L 3.5-5.1 mEq/L
Chloride 105 mEq/L 98-107 mEq/L
Bicarbonate 23 mEq/L 22-29 mEq/L
Blood urea nitrogen 18 mg/dL 6-20 mg/dL
Creatinine 1.10 mg/dL 0.62-1.10 mg/dL
Glucose 220 mg/dL 70-125 mg/dL
Hemoglobin A1c 8.2% 4.0-5.6%

What is the most common adverse effect of the drug of choice for this patient?

A. Diarrhea
B. Hypoglycemia
C. Lactic acidosis
D. Peripheral edema
E. Weight gain

A 33-year-old female presents to the office after being referred by a counselor due to despair, anxiety, lack of motivation, and inability to concentrate. She says that these symptoms have been persistent since both her parents died in the past year. She has never been treated for a mood disorder. Questioning reveals no overt suicidal or violent ideation. Past medical history reveals a seizure disorder during adolescence. The most appropriate pharmacotherapy for this patient’s condition is most likely to produce which of the following chronic adverse effects?

A. Arrhythmia
B. Diarrhea
C. Diminished libido
D. Hypotension
E. Nausea

A 71-year-old male presents to the office with a 6-week history of difficulty walking and moving. He states that “everything seems to be going slower and taking longer.” Physical examination reveals muscle rigidity, a resting tremor, and postural imbalance. What is the mechanism of action of the most appropriate agent treatment of this patient?

A. Blocking dopamine reuptake
B. Increasing dopamine synthesis
C. Inhibiting dopamine metabolism
D. Stimulating dopamine receptors
E. Stimulating dopamine release

A 3-year-old female is brought to the emergency department by her mother due to possible accidental drug ingestion. The mother states that she left her daughter alone for a few minutes while she showered and then discovered that several medicine bottles were misplaced. She thinks her daughter may have ingested something but does not know what. Past medical history is noncontributory. The patient’s respiratory rate is 22/min. While the patient is in the emergency department, she develops abdominal pain and diarrhea, vomits brownish liquid, and becomes drowsy and lethargic. Subsequent physical examination reviews cyanosis of the lips and fingers. Based on the patient’s medical evaluation, a pharmacologic agent is administered to reverse the effects of the ingested substance. What is the mechanism of the most likely administered agent?

A. Acts as an antioxidant and decreases oxidative damage caused by the substance
B. Changes the pH of the urine and increases the elimination of the substance
C. Decreases the absorption of the substance in the gut
D. Increases the metabolism of the substance to inactive metabolites
E. Prevents the substance from binding to tissues

A 21-year-old female presents to the office with a 4-day history of suprapubic pain and dysuria. Past medical history reveals that the patient was treated for similar symptoms 6 months ago and is hypersensitive to sulfonamides. Her temperature is 38.4℃ (101.1℉). Urinalysis reveals a leukocyte count of 10/hpf (reference range: 0-5/hpf) and the presence of gram-negative bacilli. What is the mechanism of action of the most appropriate pharmacologic agent for this patient?

A. Disruption of lipid A synthesis
B. Disruption of membrane potential
C. Inhibition of cell wall synthesis
D. Inhibition of folate synthesis
E. Inhibition of protein synthesis

A 57-year-old male presents to the office for evaluation of chronic low back pain. The pain is worse in the morning, but usually improves after a few minutes of movement. The pain then returns later in the day, after he has been on his feet for a while at work. Physical examination reveals general lumbar stiffness with L2-L4 neutral, sidebent right, rotated left. Muscle strength, tone, and reflexes are normal. Localized low back pain is reproduced with lumbar extension and rotation. The most likely diagnosis is:

A. Lumbar Facet Degeneration
B. Lumbar Nerve Root Compression
C. Piriformis Muscle Spasm
D. Spinal Stenosis
E. Unilateral Sacral Flexion


We will be sharing more questions throughout the year. Look out for the announcements on our social media pages at the beginning of every month