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NBOME

COMLEX-USA Question of the Month

Here are some sample COMLEX-USA questions…

 

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

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