Free COMLEX Level 2 Practice Questions

We understand that it’s all about the content. That’s why we have high-yield practice questions written and screened by physician authors that are updated on a regular basis to ensure our COMLEX Level 2 CE SmartBank stays up-to-date with exam blueprint changes.

See why TrueLearn is a trusted resource for thousands of medical students and residents.

Here’s Your Free COMLEX Level 2 Practice Question

A 44-year-old female presents to her primary care physician with a 6-month history of vague epigastric abdominal pain. In the last 2 weeks, she has had early satiety with meals, bloating, and nausea. She has had 2 episodes of emesis after meals in the last week, both nonbilious with undigested food. She recently started a course of over-the-counter antacids, which have previously relieved the pain but have not helped since she started feeling the bloating. She denies fevers or chills, unexplained weight loss, or other significant symptoms. She says she has never experienced these symptoms before. She has never had abdominal surgery, and she has no allergies. Physical examination is remarkable for epigastric tenderness and paravertebral hypertonicity from T7–9. She is sent for endoscopy. Which of the following diagnoses is most consistent with her symptoms?

• A. duodenal ulcer
• B. gastric outlet obstruction
• C. gastroesophageal reflux disease
• D. small bowel obstruction
• E. Zenker diverticulum

Incorrect Answer Explanations

Answer A: Duodenal ulcers often cause epigastric abdominal pain, which is often relieved by food consumption. This results in frequent meals, which can lead to weight gain. This patient may have initially had a proximal duodenal ulcer or a gastric ulcer, but her symptoms now have progressed to gastric outlet obstruction, which is a possible long-term sequella of peptic ulcer disease.

Answer C: Gastroesophageal reflux (GERD) is a chronic syndrome characterized by gastric contents that reflux into the esophagus. It is primarily caused by dysfunction of the lower esophageal sphincter. Patients with GERD typically complain of a burning sensation that radiates to the chest or throat. In addition, food exacerbates GERD. It can cause nausea, but vomiting and satiety associated with meals would be more consistent with gastric outlet obstruction.

Answer D: Small bowel obstructions are often due to functional or mechanical pathologies and present with nausea, bilious vomiting, and often without passing bowel movements or gas. The most common etiology is abdominal adhesions from surgical interventions. This patient has had no surgeries and has nonbilious emesis. Additionally, the diagnosis of small bowel obstruction would not be confirmed with endoscopy.

Answer E: A Zenker diverticulum is a false diverticulum resulting from a partial thickness herniation of the esophagus through the muscles that form the Killian triangle in the throat. Patients are typically older men and, while they can experience regurgitation of undigested food, they do not typically have epigastric pain.

Bottom Line: Peptic ulcer disease can cause long term complications, such as gastric outlet obstruction that results in bloating, anorexia, and vomiting.

For more information, see:

• Peptic Ulcer Disease: Clinical Manifestations and Diagnosis on UpTo Date
• Lew E. Peptic Ulcer Disease. In: Greenberger NJ, Blumberg RS, Burakoff R. Eds. Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy. 3rd ed. New York, NY: McGraw-Hill Education; 2016.