COMLEX Level 2 PE Cases

1- 48 yo f c/o abdominal pain

Differentials
1) peptic ulcer disease
2) cholecystitis
3) gastritis
4) functional dyspepsia
5) perforated ulcer
6) gastric cancer
2- 21 yo f at the ED c/o abdominal pain
Differentials
1) pelvic inflammatory disease
2) appendicitis
3) ruptured ectopic pregnancy
4) ruptured ovarian cyst
5) adnexal torsion
6) gastroenteritis
7) abortion
8) endometriosis
3- 74 yo m at the ED c/o R arm pain
Differentials
1) humeral fracture
2) osteoporosis
3) shoulder dislocation
4) elder abuse
5) rotator cuff tear
4- 21 yo m c/o sore throat
Differentials
1) infectious mononucleosis
2) acute HIV infection
3) viral pharyngitis
4) bacterial pharyngitis
5- 55 yo m c/o blood in his stool
Differentials
1) colorectal cancer
2) hemorrhoids
3) diverticulosis
4) angiodysplasia
5) pseudomembranous colitis
6) other infectious colitis
7) ulcerative colitis

6- 46 yo m at the ED c/o chest pain

Differentials
1) MI or ischemia
2) cocaine induced/drug induced MI
3) GERD
4) aortic dissection
5) pericarditis
6) pneumothorax
7) pulmonary embolism
8) costochondritis
7- 7 mos old m c/o fever
Differentials
1) viral URI
2) pneumonia
3) meningitis
4) UTI
5) otitis media
6) gastroenteritis
7) occult bacteremia
8- 18 mos old f c/o fever
Differentials
1) otitis media
2) meningococcal meningitis
3) scarlet fever
4) fifth disease or other viral exanthem
5) varicella
9- 26 yo m c/o cough
Differentials
1) URI
2) acute bronchitis
3) pneumonia
4) pleurodynia
5) aspiration
10- 54 yo f c/o persistent cough
Differentials
1) pulmonary tuberculosis
2) lung cancer
3) lung abscess
4) atypical pneumonia
5) typical pneumonia
6) COPD exacerbation
7) Wegners granulomatosis

11- 52 yo f c/o yellow skin and eyes

Differentials
1) extrahepatic biliary obstruction
2) viral hepatitis
3) acetaminophen liver toxicity
4) alcoholic hepatitis
5) primary biliary cirrhosis
12- 65 yo f c/o forgetfulness and confusion
Differentials
1) Alzheimers dementia
2) vascular dementia
3) depression with pseudodementia
4) hypothyroidism
5) vitamin B12 deficiency
6) subdural hematoma
13- 56 yo m f/u for diabetes
Differentials
1) insulin induced hypoglycemia
2) peripheral neuropathy
3) multiple myeloma
4) diabetic autonomic neuropathy
5) vascular disease, medication induced erectile dysfunction
14- 53 yo m at the ED c/o dizziness
Differentials
1) Menieres diseases
2) orthostatic hypotension
3) benign paroxysmal positional vertigo
4) labyrinthitis
5) perilymphatic fistula
6) acoustic neuroma
15- 46 yo m c/o fatigue
Differentials
1) depression
2) adjustment disorder with depressed mood
3) hypothyroidism
4) obstructive sleep apnea
5) post-traumatic stress disorder
6) HIV infection
16- 32 yo f c/o fatigue
Differentials
1) domestic violence

2) depression
3) diabetes mellitus
4) diabetes insipidus
5) anemia
6) myasthenia gravis
7) hypothyroidism
17- 61 yo m c/o fatigue
Differentials
1) depression
2) pancreatic cancer
3) chronic pancreatitis
4) peptic ulcer disease
5) hypothyroidism
18- 35 yo f at the ED c/o headache
Differentials
1) migraine
2) tension headache
3) depression
4) pseudotumor cerebri
5) intracranial mass lesion
6) cluster headache
7) sinusitis
19- 57 yo m at the ED c/o bloody urine
Differentials
1) bladder cancer
2) urolithiasis
3) BPH
4) prostate cancer
5) renal cell carcinoma
6) glomerulonephritis
7) UTI
20- 54 yo m f/u for HTN
Differentials
1) drug induced erectile dysfunction
2) hypogonadism
3) erectile dysfunction caused by vascular disease
4) depression
5) alcohol related erectile dysfunction
6) Peyronies disease
21- 33 yo f c/o knee pain
Differentials

1) gout
2) pseudogout
3) systemic lupus erythematosus
4) rheumatoid arthritis
5) gonococcal septic arthritis
6) nongonococcal septic arthritis
7) osteoarthritis
22- 66 yo m c/o tremor
Differentials
1) Parkinsons disease
2) essential tremor
3) physiologic tremor
4) midbrain lesion
5) drug induced tremor
6) psychogenic tremor
7) Wilsons disease
8) hyperthyroidism
23- 49 yo m at the ED c/o passing out a few hours earlier
Differentials
1) convulsive syncope
2) vasovagal syncope
3) cardiac arrhythmia
4) drug induced orthostatic hypotension
5) seizure
6) aortic stenosis
24- 30 yo f c/o weight gain
Differentials
1) smoking cessation
2) hypothyroidism
3) lithium related obesity
4) familial obesity
5) pregnancy
6) Cushings syndrome
25- 36 yo f c/o irregular menstrual period
Differentials
1) pregnancy
2) hyperprolactinemia
3) polycystic ovary syndrome
4) thyroid disease
5) premature ovarian failure
6) Ashermans syndrome

26- 28 yo f c/o pain during sex

Differentials
1) vulvovaginitis
2) cervicitis
3) endometriosis
4) vulvodynia
5) domestic violence
6) pelvic tumor
7) vaginismus
27- 51 yo m c/o back pain
Differentials
1) disc herniation
2) lumbar muscle strain
3) degenerative arthritis
4) lumbar spinal stenosis
5) metastatic prostate cancer
6) multiple myeloma
7) malingering
28- 6 mos old f c/o diarrhea
Differentials
1) rotavirus
2) bacterial diarrhea
3) malabsorption
4) UTI
5) intussusception
6) bacteremia
29- 75 yo m c/o hearing loss
Differentials
1) presbycusis
2) cochlear nerve damage due to loud noise
3) otosclerosis
4) Menieres disease
5) ototoxicity
6) acoustic neuroma
30- 8 yo m c/o bedwetting
Differentials
1) primary nocturnal enuresis
2) secondary enuresis
3) UTI
4) constipation
5) sleep apnea
6) functional bladder disorder

31- 25 yo m at the ED following MVA

Differentials
1) pneumothorax
2) hemothorax
3) pneumonia
4) rib fracture
5) splenic rupture
6) pleuritis
32- 25 yo f at the ED after being assaulted
Differentials
1) rib/bone fracture
2) pneumothorax/hemothorax
3) STDs
4) pregnancy
33- 28 yo f c/o positive pregnancy test
Differentials
1) normal pregnancy
2) ectopic pregnancy
3) molar pregnancy
34- 20 yo f c/o sleeping problems
Differentials
1) anxiety
2) caffeine induced insomnia
3) hyperthyroidism
4) insomnia related to depression
5) adjustment insomnia
6) illicit drug abuse
7) obstructive sleep apnea
35- 27 yo m at the ED c/o seeing strange writing on the wall
Differentials
1) substance induced psychosis
2) brief psychotic disorder
3) psychosis secondary to a medical condition
4) narcolepsy
5) seizure
36- 10 yo f recently diagnosed with diabetes
Differentials
1) Type 1 diabetes mellitus
2) Type 2 diabetes mellitus
3) secondary causes of diabetes mellitus

37- 35 yo f c/o pain in her R calf

Differentials
1) deep vein thrombosis
2) cellulitis
3) myositis
4) hematoma
5) ruptured Bakers cyst
6) rupture of gastrocnemius
7) lower extremity muscle spasm due to injury or sprain
38- 31 yo m c/o heel pain
Differentials
1) plantar fasciitis
2) calcaneal stress fracture
3) Achilles tendinitis
4) retrocalcaneal bursitis
5) tarsal tunnel syndrome
6) foreign body
7) ankle sprain
39- 5 day old m c/o yellow skin and eyes
Differentials
1) physiologic jaundice
2) ABO or Rh incompatibility
3) neonatal sepsis
4) cephalohematoma
5) breast feeding jaundice
6) polycythemia
7) familial neonatal hyperbilirubinemia
40- 2 yo f c/o noisy and strange breathing
Differentials
1) foreign body aspiration
2) croup
3) laryngitis
4) epiglottitis
5) retropharyngeal abscess
6) angioedema
7) peritonsillar abscess
8) laryngeal papilloma