6 Common COMLEX PE Cases

Alright, lets squash this issue before we even get into this article.

This post will not and does not tell you what specific cases I experienced on my own COMLEX PE. That would be against the paperwork and stuff I signed. I will not be telling you what cases I experienced.

For each case I will list a link directly to the NBOME website showing where I pulled that information to prove that I am not discussing my experience, but rather extrapolating on what the NBOME has on their website.

I will though, be telling you based off of the NBOME’s website what the common COMLEX PE cases could possibly be.

Here are a few examples of what you can expect on test day, clicking each link will dive into the topic more.

Once again, these cases are not what I experienced on test day nor are they what you will get on test day. If you look at the NBOME website here, you will see how simple it is to deduce these. Let’s dive into how to go about these common COMLEX PE cases.

Common COMLEX PE Case #1: URI

URI’s are such a common primary care complaint that the likelihood of you seeing one of these on your COMLEX PE is fairly high. For each case we will walk through what questions to ask, what PE to do, and ultimately what your differential and treatment could be.

  • URI History to ask: When did it start, what symptoms, and fever, is the cough productive, any shortness of breath, what meds have they taken
  • URI PE to perform: Look in ears, look in nose, look in mouth, press on sinuses, listen to lungs, cervical lymph node exam, cardiac exam (because you are close to it anyways with the lungs)
  • URI Assessment: URI, pharyngitis, seasonal allergies, pneumonia, sinusitis
  • URI Treatment (Plan): OTC cold medications, rest, hydration, OTC antihistamine of patients choice, Xray to R/O pneumonia (not now), if not better in 10 days come back for a reassessment

URI is a huge one, you should brush up on your URI H and P skills. Check out the NBOME reference page here (this is where I got the idea for URI).

Common COMLEX PE Case #2: Preventative screenings

This section will be a little different, simply because there are so many different screening scenarios. Let’s cover the most important one here, for testing purposes at least.


  • Colonoscopy History: Ask about previous history of cancer, previous family history of cancer, any stool changes, any weight loss, and medications
  • Colonoscopy Physical: Abdominal exam, heart and lung exam (for pre-procedure purposes), and signs of anemia
  • Colonoscopy Assessment: preventative screen: colonoscopy, hypertension (if they have it), other vaccination counseling (if you did it)

Learn the basic screening and preventative measures that are recommended by the USPSTF. Check out the USPSTF here.

NBOME reference page here.

Common COMLEX PE Case #3: Chest Pain

This can be a tough one for sure. There are a lot of different concerns for a patient that comes in with chest pain, but you have to rule out the scariest thing first, an MI.

  • History to ask: When did it start, has it ever happened before, history of heart disease, history of high cholesterol, history of smoking, typical diet, does the pain radiate, any sweating, any nausea, worse with exertion, better with rest
  • Physical to perform: Inspect the chest, auscultate the heart and lungs, JVD, check the legs for swelling, check the pulse (on each arm), auscultate the abdomen for bruits (if a smoker)
  • Assessment: MI, Angina, GERD, CAD
  • Treatment (Plan): EKG, Troponin, CKMB, start a stating, manage blood pressure, check lipids, Abodminal ultrasound (if a smoker and you suspect AAA), anxiety, panic attack

It is incredibly important that you understand how to properly evaluate a patient with chest pain and to rule out the things that will kill that patient. Not all chest pains are going to be cardiac related, but it is your job to make sure it is not cardiac related.

NBOME reference page here.

Common COMLEX PE Case #4: Smoking/Drug/Something Cessation

In real life these cases may not be so straight forward and easy, but on the COMLEX PE this should be fairly simple. Despite popular belief, I don’t think the COMLEX PE was designed to trick you at all, so these cases should be fairly simple and easy as long as your prepare for them adequately.

  • History: Depends highly on what they are trying to quit. If they are smoking cigarettes then how long have they smoked, how much have they smoked, do they cough up any blood, any weight loss
  • Physical: Cardiac and lungs, look at their fingers for clubbing or cyanosis, do they appear cachectic
  • Assessment: smoking cessation counseling, nicotine use disorder, HTN (if they have it), diabetes (if they have it), list out their current health problems
  • Plan: Talk to them about the options for quitting (patches, medications, lozenges), chest Xray to establish baseline, counsel them on the emotional difficulties of quitting

The keys to this patient encounter will be that you know the options for helping patients quit smoking, doing drugs, or drinking. Spend time getting to know the different types of cessations methods.

Above all else though, your behavior and emotions during these encounters will dictate a lot of your overall score. If you spend time being excited that the patient is desiring to quit and show that you are excited to the patient then you will get some good bonus points.

These are straight forward cases as long as you know the basic cessation methods for smoking, alcohol, or drugs.

NBOME reference page here.

Common COMLEX PE Case #5: Shortness of Breath

This could be a million different things, and your ability to nail it down based on a 14 minute encounter is not what the NBOME is looking for.

If you get a patient encounter on your COMLEX PE that has the complaint of shortness of breath then the important thing is that you are able to effectively work the patient up and rule out the bad things (like PE or pneumonia).

  • History to ask: When did it start, cough associated, do you feel weak, what makes it better, what makes it worse, any chest pain, smoker, travel, hypercoagulability disorders
  • Physical to perform: Look in throat, listen to heart and lungs, look at legs for swelling or redness
  • Assessment: Depends on what you find. Could be pneumonia, could be PE, could be anxiety (young patient), could be a URI
  • Plan: Once again, depends on what you find. If Pneumonia (chest xray and antibiotics), if PE (CT angio chest, D-Dimer), if anxiety (counsel patient, start SSRI)

The key to this one is to be able to rule out the serious or scary things, and if it is related to anxiety that you appropriately counsel and discuss medication options.

NBOME reference page here.

Common COMLEX PE Case #6: OMM Cases

It is pretty obvious that you will have a few OMM cases on the COMLEX PE. The issue is, how are you supposed to talk to, diagnose, and treat the patient in such a short timeline. You only have 14 minutes to do it all.

Also, not only do you have to do it all, but you are being graded on your confidence and proficiency with which you perform OMM on the patients.

Instead of going through the typical SOAP note outline with OMM, we will instead talk about preparing for the OMM portion, and some important points of it. Let’s hit three important tips that you need to know about your OMM patients for the COMLEX PE.

Tip#1: Don’t do OMM on everyone. This is a recommended strategy by so many students, and I can tell you that it is just plain wrong. You will actually lose points if you just perform OMM on each standardized patient. You need to be selective about which patients you do OMM on.

Tip #2: Don’t do the same two techniques on each case. You need to have an idea on how to perform multiple different techniques. If you do the same thing over and over again you run the risk of not getting full credit for your OMM portion of grading.

Tip #3: Learn and plan on using a specific technique for every body region. Know something for the upper extremities, know something for the lower extremities, know ribs, know what you want to perform for a patient with a URI or sinusitis, know what will work for chronic constipation, know something for each body region.

The biggest thing with the COMLEX PE is that you need to know the grading standards and then you just need to practice. Once you know how you are graded and the expectations of you, then you can basically go through a process of knowing how you will approach each patient and the soap note.

If you are struggling and need help with learning the ins and outs, how to succeed, and each individual component of the COMLEX PE then check out Com Prep Med’s Crush the COMLEX PE Course.

This course will walk you through each step of the PE, how to maximize your points on said sections, and ultimately how to know you will pass.

Crush the COMLEX PE also comes with over 40 practice cases that are extremely high yield and were built in the same manner as this post, off of what the NBOME says directly on their site.

I really hope this article can help you prepare for and absolutely crush your COMLEX PE.

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