100+ Free COMLEX Level 2-CE Practice Questions

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A 5-year-old presents with a 2-day history of fever and bilateral inflamed tympanic membranes. He has had recurrent ear infections. After standard antibiotic therapy, OMT may be added. Which technique specifically promotes eustachian tube drainage in pediatric otitis media?

Mesenteric release

Sacral rocking

Cervical HVLA

Galbreath maneuver (mandibular drainage)

to track

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COMLEX-USA Level 3

Practice Questions100 questions

2026 Statistics

Key Facts: COMLEX Level 2-CE Exam

320

Total MCQs (June 2026)

NBOME — reduced from 352

$715

Registration Fee

NBOME Bulletin 2025-2026

400

Passing Standard Score

NBOME scale 9-999, mean 500

~92-95%

First-Attempt Pass Rate

NBOME annual technical reports

~10-15%

OMM/Osteopathic Content

Integrated across COMLEX Master Blueprint

8 hr

Total Testing Time

Two 4-hour sessions, 1 day

COMLEX Level 2-CE is required for DO licensure and is taken during the third or fourth year of osteopathic medical school. The 2026 exam contains 320 questions delivered in two 4-hour sessions at Pearson VUE; the passing score is 400 on the NBOME 9-999 standard score scale (mean 500). The exam is built on the COMLEX-USA Master Blueprint Dimension 1 (seven competency domains) and Dimension 2 (ten clinical presentations), with osteopathic principles and OMM woven throughout (~10-15% of items). The 2025-2026 NBOME registration fee is $715.

Sample COMLEX Level 2-CE Practice Questions

Try these sample questions to test your COMLEX Level 2-CE exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man with diabetes and hypertension presents to the emergency department with crushing substernal chest pain for 45 minutes. ECG shows 3-mm ST elevation in leads II, III, and aVF with reciprocal depression in I and aVL. Which artery is most likely occluded?

A.Left anterior descending (LAD)

B.Right coronary artery (RCA)

C.Left circumflex artery (LCx)

D.Left main coronary artery

Explanation: ST elevation in the inferior leads (II, III, aVF) localizes the infarct to the inferior wall, which is most commonly supplied by the right coronary artery (RCA) in approximately 80-90% of patients (right-dominant circulation). Reciprocal depressions in the high lateral leads (I, aVL) further support an inferior STEMI from RCA occlusion.

2A 62-year-old woman with HFrEF (EF 28%) is on lisinopril, metoprolol succinate, and furosemide. She remains NYHA class II despite optimization. Per current ACC/AHA HF guidelines, which addition provides the greatest mortality benefit?

A.Digoxin

B.Spironolactone plus dapagliflozin (and switch lisinopril to sacubitril-valsartan)

C.Amlodipine

D.Ivabradine alone

Explanation: Modern HFrEF four-pillar GDMT consists of an ARNI (sacubitril-valsartan replacing ACE-I/ARB), a beta-blocker, an MRA (spironolactone or eplerenone), and an SGLT2 inhibitor (dapagliflozin or empagliflozin). All four classes independently reduce all-cause mortality and HF hospitalization in HFrEF. Adding the MRA and SGLT2i while transitioning to ARNI delivers the largest incremental survival benefit for this patient.

3A 45-year-old woman with chronic neck pain presents for OMT. On exam, she reports dizziness, dysarthria, and visual disturbance when looking up. Which OMT technique is absolutely contraindicated?

A.Cervical soft-tissue technique

B.Cervical high-velocity, low-amplitude (HVLA) thrust

C.Suboccipital release

D.Myofascial release of the cervical fascia

Explanation: The patient's symptoms (dizziness, dysarthria, visual disturbance with cervical extension) are classic for vertebrobasilar insufficiency (VBI), an absolute contraindication to cervical HVLA. HVLA in this setting can precipitate vertebral artery dissection and posterior circulation stroke. Indirect, soft-tissue, and gentle myofascial techniques remain safe alternatives.

4A 30-year-old patient is found to have a tender, gangliform nodule located at the second intercostal space near the sternum on the left side. Which Chapman's reflex point does this most likely represent and what visceral organ is associated?

A.Anterior cardiac reflex — associated with cardiac dysfunction

B.Anterior pulmonary reflex — associated with bronchitis

C.Anterior pancreatic reflex — associated with pancreatic dysfunction

D.Anterior thyroid reflex — associated with thyroid dysfunction

Explanation: Chapman's anterior cardiac reflex point is located in the second intercostal space near the sternum and is associated with cardiac dysfunction; the corresponding posterior reflex point lies between the transverse processes of T2-T3. Treatment involves rotary deep pressure for 30-90 seconds until the nodule softens.

5A 22-year-old college student presents with 3 days of sore throat, fever, and posterior cervical lymphadenopathy. Monospot is positive. Splenic palpation reveals mild splenomegaly. What is the best advice regarding return to contact sports?

A.Return immediately if asymptomatic

B.Avoid contact sports for at least 3-4 weeks from symptom onset

C.Lifelong avoidance of contact sports

D.Resume in 1 week once fever resolves

Explanation: Infectious mononucleosis (EBV) causes splenomegaly in up to 50% of patients, with the highest risk of splenic rupture in the first 3 weeks of illness. Standard sports-medicine guidance is to avoid contact and strenuous exertion for a minimum of 3-4 weeks from symptom onset, with some experts recommending imaging-confirmed splenic recovery before return to play.

6A 70-year-old man presents with a tearing pain radiating to the back. CT angiography shows a dissection beginning at the aortic arch and extending through the descending aorta. What is the initial management?

A.IV labetalol and emergent cardiothoracic surgery consultation

B.Oral aspirin and outpatient cardiology follow-up

C.Heparin drip and TPA administration

D.PO metoprolol and discharge with close follow-up

Explanation: This is a Stanford type A aortic dissection (involves the ascending aorta or aortic arch), which is a surgical emergency requiring immediate operative repair. Initial medical management focuses on rapid heart rate and blood pressure control with IV beta-blockers (labetalol or esmolol) to reduce aortic shear stress, targeting HR <60 and SBP 100-120 mmHg before adding vasodilators if needed.

7A 32-week pregnant woman presents with BP 165/110, headache, and urine dipstick showing 3+ proteinuria. She has hyperreflexia and clonus. What is the first-line treatment to prevent eclamptic seizures?

A.IV magnesium sulfate

B.Oral nifedipine

C.IV diazepam

D.IV phenytoin

Explanation: This patient has severe preeclampsia with features (BP >=160/110, hyperreflexia, clonus). IV magnesium sulfate is the first-line seizure prophylaxis and has superior efficacy to phenytoin and diazepam (MAGPIE and Collaborative Eclampsia Trial). Therapeutic level is 4-7 mg/dL; monitor for loss of patellar reflex, respiratory depression, and oliguria. IV calcium gluconate is the antidote.

8A 4-year-old presents with barking cough, inspiratory stridor at rest, and mild retractions. Temperature is 38.5 C. He is alert and not toxic-appearing. What is the best initial management?

A.IM ceftriaxone and admission

B.Single dose of oral dexamethasone and nebulized racemic epinephrine

C.Albuterol nebulizer and discharge

D.Cool mist therapy and discharge home

Explanation: Moderate croup (stridor at rest with retractions) requires a single dose of dexamethasone (0.6 mg/kg PO/IM/IV) plus nebulized racemic epinephrine. Observe for 3-4 hours after epinephrine for rebound stridor before discharge. Severe disease (cyanosis, exhaustion, altered mental status) requires admission and possible airway support.

9A 28-year-old presents with hopelessness, anhedonia, and insomnia for 4 weeks. PHQ-9 score is 18. She admits to passive suicidal ideation without plan. Which is the most appropriate first-line pharmacotherapy?

A.Lithium 600 mg twice daily

B.Sertraline 50 mg daily

C.Risperidone 2 mg daily

D.Lorazepam 1 mg three times daily

Explanation: Moderate-to-severe major depressive disorder (PHQ-9 15-19 moderate, >=20 severe) responds to first-line SSRIs such as sertraline, escitalopram, or fluoxetine. Sertraline 50 mg daily is a standard starting dose with titration to therapeutic effect in 4-6 weeks. The black box warning regarding suicidality in patients <25 mandates close monitoring during the first 1-2 weeks.

10A 55-year-old patient presents with new-onset atrial fibrillation. CHA2DS2-VASc score is 3 (HTN, diabetes, age 55-65 male = 1). Per current guidelines, what is the preferred anticoagulant for stroke prevention?

A.Aspirin 81 mg daily

B.Warfarin with INR 2-3

C.Apixaban 5 mg twice daily (a DOAC)

D.Clopidogrel 75 mg daily

Explanation: For non-valvular AF with CHA2DS2-VASc >=2 (men) or >=3 (women), 2023 AHA/ACC/HRS guidelines recommend a direct oral anticoagulant (DOAC such as apixaban, rivaroxaban, edoxaban, or dabigatran) as preferred over warfarin due to lower intracranial hemorrhage rates and no need for routine INR monitoring. Warfarin is reserved for moderate-to-severe mitral stenosis or mechanical valves.

About the COMLEX Level 2-CE Exam

COMLEX-USA Level 2 Cognitive Evaluation (Level 2-CE) is the second of three NBOME osteopathic licensure exams. It is a 1-day, ~8-hour computer-based exam consisting of 320 single-best-answer multiple-choice questions (reduced from 352 effective June 2026) covering clinical sciences, osteopathic principles, and osteopathic manipulative medicine (OMM) integrated within clinical patient presentations. It assesses readiness for supervised clinical practice in the OMS-IV year and beyond.

Questions

320 scored questions

Time Limit

1-day CBT: two 4-hour sessions (~8 hours) plus 60 min pooled break

Passing Score

400 (3-digit standard score; range 9-999, mean 500)

Exam Fee

$715 (NBOME 2025-2026) (National Board of Osteopathic Medical Examiners (NBOME) / Pearson VUE)

COMLEX Level 2-CE Exam Content Outline

~30%

Management — Medical, Surgical & Osteopathic Manipulative Treatment

Pharmacologic and surgical management across organ systems plus OMT techniques (HVLA, muscle energy, counterstrain, myofascial release, soft tissue, lymphatic, cranial, Still, BLT, FPR). Absolute OMT contraindications include vertebrobasilar insufficiency for cervical HVLA, metastatic disease at site, fracture, and severe osteoporosis at HVLA sites. Evidence-based OMT — Spinal Manipulative Therapy for acute/subacute low back pain (ATSU/AOA guidelines), lymphatic and rib raising for community-acquired pneumonia (MOPSE trial), thoracic OMT for COPD exacerbation, post-op ileus rib raising and mesenteric release.

~14%

Internal Medicine & Cardiovascular

HTN ACC/AHA stage 1 >=130/80 (2017), hyperlipidemia high-intensity statin (atorva 40-80, rosuva 20-40), ACS STEMI door-to-balloon <=90 min, HFrEF four-pillar GDMT (ARNI/beta-blocker/MRA/SGLT2i), AF CHA2DS2-VASc DOAC preferred, COPD GOLD (LABA + LAMA), asthma GINA (ICS-formoterol Track 1), CAP CURB-65, diabetes ADA 2026 (metformin + SGLT2i/GLP-1), CKD, anemia (iron studies, B12/folate), thyroid (TSH-first). Chapman reflex points and viscerosomatic reflexes (T1-T4 cardiac, T5-T9 GI, T10-T11 renal/genitourinary).

~14%

Psychiatry, Neurology & Emergency Medicine

Depression PHQ-9 SSRI first-line, bipolar I lithium 0.6-1.2, schizophrenia atypical APs with metabolic monitoring, suicide risk C-SSRS, alcohol withdrawal CIWA-Ar with thiamine BEFORE glucose, MOUD (buprenorphine/methadone/naltrexone). Stroke NIHSS, tPA <=4.5 h / thrombectomy <=24 h LVO, status epilepticus IV lorazepam then fosphenytoin/levetiracetam, migraine triptan, dementia cholinesterase inhibitors. ACLS, sepsis qSOFA + lactate + 1-hour bundle, DKA fluids/insulin/K, hyperkalemia calcium gluconate.

~12%

History, Physical Exam & Osteopathic Structural Exam

Complete history (HPI, ROS, PMH, FH, SH), problem-focused vs comprehensive exam. Osteopathic structural exam: TART criteria (Tissue texture changes, Asymmetry, Restriction of motion, Tenderness). Segmental diagnosis named by where the segment moves MOST freely (Fryette's laws). Viscerosomatic reflexes: T1-T5 heart/lungs, T5-T9 upper GI/liver/gallbladder/spleen, T10-T11 kidneys, T12-L2 GU/lower GI. Chapman's anterior/posterior reflex points are tender nodules associated with visceral dysfunction.

~12%

Surgery, OB/GYN & Pediatrics

Acute abdomen — appendicitis (McBurney, Rovsing, psoas), cholecystitis (Murphy, HIDA), SBO (air-fluid levels), mesenteric ischemia (pain out of proportion). Prenatal screening, preeclampsia (>=140/90 + proteinuria or end-organ; magnesium sulfate seizure prophylaxis), gestational diabetes (1-hour GCT then 3-hour GTT), postpartum hemorrhage (uterine atony — oxytocin/methylergonovine/carboprost/misoprostol). Well-child immunization schedule, developmental milestones, febrile infant <60 days full workup, bronchiolitis supportive, croup steroids + racemic epi.

~10%

Health Promotion & Disease Prevention

USPSTF — colorectal CA screening starts age 45 (FIT annually or colonoscopy q10y), mammography 40-74 q2y (USPSTF 2024), cervical Pap+HPV co-test 30-65 q5y, lung CT 50-80 with 20 pack-year, AAA US once for male 65-75 ever-smokers, statin primary prevention 40-75 with >=7.5% ASCVD. ACIP adult — Tdap, annual influenza, COVID-19 updated, Shingrix age 50, PCV15/PCV20 age 65, HPV catch-up to age 26. Counseling — SBIRT, 5As tobacco, Mediterranean diet, 150 min moderate exercise.

~10%

Diagnostic Technologies

Lab interpretation — CBC (MCV anemia workup), CMP (anion gap, AG = Na - (Cl + HCO3) >=12), lipid panel, troponin (high-sensitivity), BNP, D-dimer (rule out only when low pretest probability), ABG acid-base (Winters formula). Imaging — CXR PA/lateral, CT chest/abdomen with vs without contrast, MRI for soft tissue/spine, US first-line in pregnancy/RUQ pain. Diagnostic test characteristics — sensitivity (rule out — SnNOut), specificity (rule in — SpPIn), positive/negative predictive values depend on prevalence, likelihood ratios.

~8%

Health Care Delivery, Ethics & Professionalism

Informed consent elements (capacity, voluntariness, disclosure of risks/benefits/alternatives, understanding). Capacity vs competency (capacity is clinician-assessed; competency is legal). Advance directives — living will and durable POA. End-of-life — palliative vs hospice (terminal prognosis <=6 months for hospice). HIPAA minimum necessary; PHI sharing exceptions. Mandatory reporting — suspected child abuse, elder abuse in many states, intimate partner violence in some states, gunshot wounds, certain communicable diseases. Cultural humility and health disparities.

How to Pass the COMLEX Level 2-CE Exam

What You Need to Know

Passing score: 400 (3-digit standard score; range 9-999, mean 500)
Exam length: 320 questions
Time limit: 1-day CBT: two 4-hour sessions (~8 hours) plus 60 min pooled break
Exam fee: $715 (NBOME 2025-2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

COMLEX Level 2-CE Study Tips from Top Performers

1Master OMT contraindications cold. ABSOLUTE contraindications to HVLA: vertebrobasilar insufficiency (any positional symptoms — drop attacks, vertigo, dysarthria, diplopia) for cervical HVLA, fracture or instability at the segment, metastatic bone disease at the segment, severe osteoporosis at the segment, aortic aneurysm for thoracolumbar HVLA, and infection at the segment. Relative contraindications include acute herniated disc with radiculopathy, anticoagulation, and recent surgery. Indirect, lymphatic, and soft-tissue techniques are usually safe when HVLA is contraindicated.

2Memorize Chapman's reflex points. These are anterior and posterior tender, gangliform nodules associated with visceral dysfunction. Highest yield: posterior cardiac reflex at T2-T3 transverse processes (anterior between ribs 2-3 near sternum), pulmonary reflex between ribs 3-5, appendix reflex at the tip of the 12th rib on the right, ovary/testis reflex at the upper inner thigh (posterior at T10-T11). Treatment is rotary deep pressure for 30-90 seconds until the nodule softens.

3Know Fryette's laws and segmental naming. T2 ERS-R means the T2 segment is Extended, Rotated right, and Sideben right — and the segment moves most freely in extension/right rotation/right sidebending. Fryette I: neutral mechanics, sidebending and rotation occur to OPPOSITE sides (group curves). Fryette II: non-neutral (flexed or extended), sidebending and rotation occur to the SAME side (typically single-segment dysfunctions). Fryette III: introducing motion in one plane reduces the available motion in the other two planes.

4Drill viscerosomatic reflexes by spinal level. T1-T4: head/neck and HEART. T2-T7: lungs/upper GI. T5-T9: stomach, liver, gallbladder, spleen, pancreas, duodenum. T10-T11: kidneys, upper ureter, gonads. T12-L2: lower GI (cecum to mid-transverse colon is T10-T11; descending and sigmoid T12-L2). S2-S4: bladder, lower ureter, reproductive organs (parasympathetic via pelvic splanchnics). Tenderness and tissue texture changes at these segments suggest visceral disease and guide OMT prescription.

5Practice with COMLEX-style stems. NBOME items emphasize integrated reasoning — a vignette typically requires you to (1) recognize the clinical presentation, (2) apply osteopathic principles, and (3) select the BEST next step or treatment that may include OMT. Always read the question stem LAST after the vignette to avoid anchoring. Eliminate distractors with absolute language (always/never) and choose answers that account for both biomedical management and the osteopathic structure-function paradigm.

Frequently Asked Questions

What is the COMLEX-USA Level 2-CE exam?

COMLEX-USA Level 2 Cognitive Evaluation is the second of three NBOME exams required for DO (Doctor of Osteopathic Medicine) licensure in the United States. It is a 1-day computer-based exam administered at Pearson VUE professional test centers, typically taken in the third or fourth year of osteopathic medical school. It assesses application of clinical knowledge integrated with osteopathic principles and OMM in supervised clinical care.

How many questions are on Level 2-CE in 2026?

Effective the June 2026 test cycle, COMLEX-USA Level 2-CE contains 320 single-best-answer multiple-choice questions, reduced from the prior 352. The questions are delivered in two 4-hour sessions on a single day, with 60 minutes of pooled break time. The change aligns the exam length with the COMLEX-USA Master Blueprint and improves the candidate experience while maintaining content coverage.

What is the passing score for COMLEX Level 2-CE?

The passing 3-digit standard score for COMLEX-USA Level 2-CE is 400 on the NBOME scale (range 9-999, mean approximately 500, standard deviation ~100 for first-time test-takers). NBOME uses criterion-referenced scoring — your score reflects performance relative to a fixed content-validity standard set by NBOME's Standard Setting Committee, not performance relative to other test-takers.

How much does Level 2-CE cost?

The 2025-2026 NBOME registration fee for COMLEX-USA Level 2-CE is $715, per the NBOME Bulletin of Information. Additional fees apply for late registration, rescheduling, and certain administrative services. Verify current pricing at nbome.org before applying. Test scheduling is through Pearson VUE after NBOME registration approval.

What is the blueprint and how is OMM tested?

The COMLEX-USA Master Blueprint has two dimensions: Dimension 1 consists of seven Competency Domains (Osteopathic Principles & OMT; History, Physical Exam & Diagnostic Studies; Diagnosis & Clinical Management; Health Promotion & Disease Prevention; Professionalism; Inter-professional Communication; Practice-Based Learning & Systems-Based Practice), and Dimension 2 contains ten Clinical Presentations. Osteopathic principles and OMM are integrated throughout, comprising approximately 10-15% of total content.

How should I prepare for Level 2-CE?

Most candidates spend 300-500 hours preparing during third year and the early part of fourth year. Use a comprehensive QBank (TrueLearn COMBANK, COMQUEST, UWorld), Savarese's OMT Review, First Aid for the USMLE Step 2 CK (clinical content largely overlaps), OnlineMedEd for clinical reasoning, and complete 2-3 timed full-length practice exams. Emphasize OMM (Chapman points, viscerosomatic reflexes, contraindications), pharmacology, and bread-and-butter primary care.

Is Level 2-CE the same as USMLE Step 2 CK?

No. COMLEX-USA Level 2-CE is the osteopathic licensure exam administered by NBOME and includes osteopathic principles and OMM in addition to MD-equivalent clinical content. USMLE Step 2 CK is the allopathic Step 2 exam administered by NBME/FSMB. Many DO students take both — Level 2-CE for DO licensure and Step 2 CK to broaden residency program options, since some MD programs prefer or require USMLE scores.

When are Level 2-CE scores released?

Scores are typically released approximately 4-6 weeks after the test date during NBOME's published release windows. NBOME posts the score release calendar on its website at the start of each academic year. The score report includes the 3-digit standard score, pass/fail status, and a domain-level performance profile that highlights relative strengths and weaknesses across competency domains and clinical presentations.