COMLEX Level 2 Experience Threat 2011

[Dakayus]

I figured one should be started since there isn't any. I haven't taken it yet, but apparently it's very OB/GYN and peds heavy this year.

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[blahwhatever]

Anyone know how to prepare for the heavily tested ob/gyn and peds material?

I know when I took COMLEX level 1, the ob/gyn questions I got hit with, I don't think I knew where I could've studied that stuff even if I had tried.

 

[digitlnoize]

Anyone know how to prepare for the heavily tested ob/gyn and peds material?

I know when I took COMLEX level 1, the ob/gyn questions I got hit with, I don't think I knew where I could've studied that stuff even if I had tried.

I know! I actually thought for a while that I was taking the Step 2 exam by mistake. I found myself going: "But I haven't had an OBGYN rotation yet!"

I think the Step 2 OBGYN is more straight forward, partly because we've done the rotation and shelf exams now. I'm sure there'll be some random BS questions, but from reports I've heard so far it hasn't been too crazy. The OBGYN questions on the COMSAE C I took weren't too bad either, fairly straight forward for the most part.

Just learn everything. They could throw anything at you, so just know all the mainstream stuff you can, and if they ask you about the toxicity of the dust inside a Nintendo NES cartridge, just pick an answer and roll your eyes.

I did Blueprints for my OB shelf and sucked hard. I've been doing the OBGYN Kaplan videos and it's much improved my scores on the question banks (although still not perfect, I'm happy so far).

 

[TexasTriathlete]

My COMLEX 2 experience: it was a bloodbath

I was pretty well-prepared too. 681 on COMSAE C the night before the real deal. About 74% on Quest, I think. I have no idea what my score is yet (only took it a couple weeks ago), but the test was flat out nasty.

The possibility exists that I just have a bad feeling about it because I was pissed off the whole day. After I checked in, put all my crap in a locker, and waited around forever, the lady at prometric told me she wasn't going to let me test since I arrived late, even though I was actually there about 15 minutes early. I was on hold with prometric candidate care when she came back out and told me she changed her mind and was going to let me test after all. I was fired up though. It sort of set the stage for my temper for the rest of the day.

 

[danzman]

My COMLEX 2 experience: it was a bloodbath

I was pretty well-prepared too. 681 on COMSAE C the night before the real deal. About 74% on Quest, I think. I have no idea what my score is yet (only took it a couple weeks ago), but the test was flat out nasty.

The possibility exists that I just have a bad feeling about it because I was pissed off the whole day. After I checked in, put all my crap in a locker, and waited around forever, the lady at prometric told me she wasn't going to let me test since I arrived late, even though I was actually there about 15 minutes early. I was on hold with prometric candidate care when she came back out and told me she changed her mind and was going to let me test after all. I was fired up though. It sort of set the stage for my temper for the rest of the day.

What a ****storm. I love the authority of some idiot behind the counter.

So why do you think it was a bloodbath? You seem to be pretty well prepped for it. Any advice?

 

[lion2013]

Glad step 2 is not much different from step I

 

[PistolPete]

Thanks guys... keep them coming...

 

[WDeagle]

I thought it was alot less peds and ob/gyn heavy than i expected. Comlex is such a strange test. You never have any idea whats gonna be on it and there are not really any great sources for studying for this test. The good thing is that most of the stuff people get wrong are things nobody could have known. Unfortunately its all about how good of a test taker you are or how lucky you get. If you are a hard worker and a better than average test taker i would just take USMLE. USMLE is a pretty consistent test and is easier to prepare for. The only people who should study hard for COMLEX are the Derm and Ortho gunners who need to do well on comlex.

 

[TexasTriathlete]

What a ****storm. I love the authority of some idiot behind the counter.

So why do you think it was a bloodbath? You seem to be pretty well prepped for it. Any advice?

I don't know. It just seemed tough. It probably wasn't nearly as hard as I am thinking.

 

[digitlnoize]

I thought it was alot less peds and ob/gyn heavy than i expected. Comlex is such a strange test. You never have any idea whats gonna be on it and there are not really any great sources for studying for this test. The good thing is that most of the stuff people get wrong are things nobody could have known. Unfortunately its all about how good of a test taker you are or how lucky you get. If you are a hard worker and a better than average test taker i would just take USMLE. USMLE is a pretty consistent test and is easier to prepare for. The only people who should study hard for COMLEX are the Derm and Ortho gunners who need to do well on comlex.

Oddly enough, I just read a study that showed a pretty strong linear correlation between COMLEX scores and USMLE scores among residency applicants. Meaning, people who got a 500 on COMLEX, were likely to have gotten a 220 on USMLE. For both steps 1 and 2. I expected the COMLEX 2 scores to be a crappier predictor based on what people are saying.

I think the weird, random questions stand out in people's minds (out of 400!) because they're more memorable. But, at the same time, there should be lots of questions that you know and can figure out what they're looking for.

I hope. Let you know after Friday. Gulp.

 

[TPBC]

Can you post the reference on that article correlating COMLEX and USMLE scores? thanks...

Oddly enough, I just read a study that showed a pretty strong linear correlation between COMLEX scores and USMLE scores among residency applicants. Meaning, people who got a 500 on COMLEX, were likely to have gotten a 220 on USMLE. For both steps 1 and 2. I expected the COMLEX 2 scores to be a crappier predictor based on what people are saying.

I think the weird, random questions stand out in people's minds (out of 400!) because they're more memorable. But, at the same time, there should be lots of questions that you know and can figure out what they're looking for.

I hope. Let you know after Friday. Gulp.

 

[Vergie]

I just took it today and thought it had a pretty good amount of OB questions. Lots of this G3P2 pregnant girl shows up with a problem crap. Most of it was pretty straightforward though so that part wasnt that bad.

Lots of OMT. I had a couple cranial torsion rotation problems so make sure you refresh yourself on that. some ankle sprain questions, plenty of autonomics and sacral. some cervical and thoracic dysfunctions. Quite a few exhalation/inhalation dysfunctions. couple of falling forward/backward on an outstretched hand questions. I did 2 of the practice tests in savarese but I'm thinking I prob should have done all 4 and paid closer attention to the answers. There was just a wide variety of OMT on there it seemed. Not many chapmans points for me though.

The peds wasnt that bad for me. Make sure you know your rashes that spread like rubella/measles etc. Oddly enough I felt like the "whats the best imaging study" questions were more straightforward than comquest. The Law questions were kinda bizzare but comquest helped out with some of those. Some biostats questions which wasnt too bad if you've studied for USMLE.

Just glad its over and done.

 

[Gpan]

taking it tomorrow

 

[digitlnoize]

I'll post that article sometime this weekend after my test tomorrow (and I'll let you know how it goes).

 

[H2DO]

From what I have heard, they are trying to integrate OMM into system questions and there has been some bizarre OMT.

 

[Vergie]

There are clearly multiple forms out there. Also, on what sounds like an "easy" form like this one, you have to get more correct to get the same score as more wrong on a hard one. So, a hard form with 70% correct and an easy form with 75% correct might both be a 550.

Still, that makes me feel better. Praying for this form.

I'll post that article sometime this weekend after my test tomorrow (and I'll let you know how it goes).

I wasnt trying to say it was easy, I just remember more of the ones i got correct than the ones i didnt (I try to block those from my memory ). It did feel a lot like comlex 1 though believe it or not, with the addition of next step in management + biostats/justice. Most of the exibits were X-rays/CT and EKGs fyi. I dont think I had any histo slides.

 

[PistolPete]

Took it today also. Had a large share of obgyn and peds, as expected, but also a large amount of neuro/psych kind of questions (various forms of dementia vs delirium). Some specific psych drug treatments.

Didn't have too much OMM actually. There were of course quite a bit of viscerosomatics, but the other OMM questions were fairly weird, various lower extremity crap. A couple of cranial, couple sacrum.

Quite a bit of law/ethics questions, sometimes seemed like 2 right answers. Overall COMBANK should prepare you OK, though.

Know your HIV complications.

Had 1 stats calculation that was straight forward, and 5 other stat-like questions that was not in first aid, no idea where those came from.

Decent amount of male sexual infertility type of questions.

Decent amount of GI.

The rest was spread out. Definitely felt like a pretty broad test. Not as much MSK/nerve injury questions as I thought there would be.

Bleh... don't feel like I rocked it, but we'll see how it goes.

 

[Rollo]

Can you folks post the resources you used? Throughout the year, and for your dedicated study?

 

[Gpan]

Took it today also. Had a large share of obgyn and peds, as expected, but also a large amount of neuro/psych kind of questions (various forms of dementia vs delirium). Some specific psych drug treatments.

Didn't have too much OMM actually. There were of course quite a bit of viscerosomatics, but the other OMM questions were fairly weird, various lower extremity crap. A couple of cranial, couple sacrum.

Quite a bit of law/ethics questions, sometimes seemed like 2 right answers. Overall COMBANK should prepare you OK, though.

Know your HIV complications.

Had 1 stats calculation that was straight forward, and 5 other stat-like questions that was not in first aid, no idea where those came from.

Decent amount of male sexual infertility type of questions.

Decent amount of GI.

The rest was spread out. Definitely felt like a pretty broad test. Not as much MSK/nerve injury questions as I thought there would be.

Bleh... don't feel like I rocked it, but we'll see how it goes.

same for me. There seems to be more questions toward preventitive medicine this time. some questions make you go wtf, and some that were like OH THAT's IT?
typical comlex, We'll see how it goes

 

[PistolPete]

Master The Boards Step 2CK. Good book but weak in obgyn and neuro. Otherwise very decent.

Filled in holes with First Aid Step 2CK. Savarese for OMM.

COMBANK was good prep, especially for ethics/legal terms. Money for those questions... Comquest I just mainly did OMM/jurisprudence/Obgyn... was alright but not as great as COMBANK.

USMLE 2 CK in just under 2 weeks for me... gaaaaah

 

[PistolPete]

Just wanted to take this opportunity to emphasize the divergent nature of the COMLEX vs USMLE (for those that might be taking it next year or something).

Studying for USMLE Step 1 and then adding some OMM may work for Level/Step 1, but I think this method is less effective for Step 2. Why? Because my COMLEX had maybe 10% of the test as pure internal medicine questions. USMLE? Probably has 40-50%, if not more.

If you were to study for USMLE and try to apply that to the COMLEX, you may not do as well as you think simply because the content of the tests is much different.

Definitely two different tests, that do not test the same things, as previous posters have alluded.

Anyway, others may agree or disagree, just my two cents. Good luck everybody.

 

[digitlnoize]

Master The Boards Step 2CK. Good book but weak in obgyn and neuro. Otherwise very decent.

Filled in holes with First Aid Step 2CK. Savarese for OMM.

COMBANK was good prep, especially for ethics/legal terms. Money for those questions... Comquest I just mainly did OMM/jurisprudence/Obgyn... was alright but not as great as COMBANK.

USMLE 2 CK in just under 2 weeks for me... gaaaaah

Some brief thoughts, just got done, on my phone so I will keep it short.

Overall, I am VERY happy. Broad test, mostly fair. A few off the wall Q's but mostly straight forward. Sometimes seemed TOO easy. OMM wasn't too crazy...

Ethics and Legal were good prep from COMBANK and Comquest. Overall, I'd say Comquest was the most representative.

OB and Peds were pretty straight forward.

I'm very very happy. Prepped with Kaplan Vids, Secrets, and all 3 q banks. Did Step Up to Medicine throughout 3rd year.

Kaplan was awesome and total overkill. Green book good enough for most of the OMM, but not all...

Now to chillax!

 

[americanpie]

Just wanted to take this opportunity to emphasize the divergent nature of the COMLEX vs USMLE (for those that might be taking it next year or something).

Studying for USMLE Step 1 and then adding some OMM may work for Level/Step 1, but I think this method is less effective for Step 2. Why? Because my COMLEX had maybe 10% of the test as pure internal medicine questions. USMLE? Probably has 40-50%, if not more.

If you were to study for USMLE and try to apply that to the COMLEX, you may not do as well as you think simply because the content of the tests is much different.

Definitely two different tests, that do not test the same things, as previous posters have alluded.

Anyway, others may agree or disagree, just my two cents. Good luck everybody.

It would be great if you guys also share the resources which you guys used specifically for COMLEX Level 2CE.
Thank you very much!

 

[TexasTriathlete]

Anyone have any idea how long its taking to get these scores to show up online?

 

[kissmyasthma99]

I just took this thing yesterday...wow.


.

 

[Gpan]

I just took this thing yesterday...wow.

.

well said. moving on man

 

[Gpan]

this might be a dumb question and i can't believe I even ask this. When a pt has tension pneumothorax with a blood pressure of 80/45 with no other clues in the question, would you thoracentesis right away OR do u give IV fluid recussitation then thoracentesis?

 

[Jwalker9]

immediate needle thoracostomy, always. bp will resolve after.

 

[danzman]

Took it yesterday, it was a mess. I was honestly a little surprised by how much info I had never even heard of before. Many questions seemed to have multiple answers that could have been correct, poor images, and a handful of biostats that I couldn't answer.

Test prep
Master the Boards. I literally made flash cards for almost every page of this book and knew it inside and out. I got it about 4 months ago and was able to go through it on rotations. Anything extra that I saw and added directly to this book. I feel that this is probably the easiest review book to use. I had all the Kaplan material (books vids etc') but didn't use them. I don't like videos at all and found their books too long. I feel that MTB is a solid foundation but found it lacking in GYN and Neuro, and there is no Biostats section. Also, the book kinda jumps around a lot and could be revised to flow a little better. I used First Aid to add to gyn, neuro, ob and GI, but in the end I don't think adding anything really mattered. Read Boards and Wards throughout the year and used the NMS books on rotations. NMS is hit or miss, but the OB book is really good.
COMQUEST. I found this to be really helpful. I went through the entire program in about a week and added every single bit of info into MTB. Their customer service was great, they would email me back info on specific test questions the same day and offer journal articles to explain stuff. They were even willing to change a quesiton around after we discussed it. Interestingly there were probably about 5-10 questions that I would have not gotten if I had not used this. I didn't use COMBANK but heard very good things about it. It seems they have a better OMM section than COMQUEST.
OMM. Read over the Kaplan OMM material and used my schools review. Was very sufficient. Made a chart of all the spinal levels and chapmans points that I just copied down on my whiteboard, probably got me 8=10 easy points. I highly recommend doing it this way.
Study time. Had exactly 6weeks to hit it hard. The month before had a really easy outpt IM rotation that gave me plenty of study time. I think 4weeks would have been plenty though.

Test.
As stated before, the test is essentially a family medicine only test. None of the questions ever strayed outside the relm of FM. Even the few surgical cases were "a surgeon did this, now the pt has this problem."
Breakdown = OB=GYN=Peds=preventative med>OMM>pulm>GI>Neuro
My test had two xrays, both easy, a couple of OD quesitons that were easy, a lot of UTIs, two CTs, one colonoscopy pic, No sounds, and essentially No zebras. Had one quesiton that I guess could be called a zebra but it was covered in MTB. Handful of vaccine questions, a few easy ethical quesitons, and about 8 biostats that I didn't know. I had been told to look over biostats so I pulled out first aid for step 1 and memorized all the basic equations. Not a single question I had was covered in any book that I have read. They were all about interpreting statistics but not about using any equations etc'.
OMM was very fair, lots of ribs and pelvis, 2 sacrum, maybe 3 cranial, and but all fair. Couple of things I had never heard of before, but really not too bad.

Now the above covered probably 65% of the test. The rest of it was absolute nonsense. The kind of questions that people bitch about on here, multiple answers that could be correct (during lunch I looked up one question, and sure enough three resources claim that two answers were correct), poor structure, not enough info, and repetitive. Some of them were just esoteric, some just silly, and a lot of preventitve medicine that I have never seen. I feel that it is impossible to study for this kind of stuff. Although I did get lucky with a few random ones.

What I would have done differently. I would have tried to hit peds preventative medicine more. People complain about the OB but most of it was in MTB. Other than that, I don't know how better to study for this test. The material just seems so random. I would definitely spend less time on the zebras, my weakness has always been rheum and endo so I hit them hard for nothing. I think that there is value in going over some AAFP guidelines for common workups like UTI's pneumonia, and OBGYN stuff.

Just remember that these questions are almost uniformly written by PCPs, try to look at the review material as such.

 

[digitlnoize]

Best bio stats prep is definitely Secrets. I could answer almost every bio stats question from that, although I did take 2 easy basic stats classes in college...

Agree with much of the above, sounds like we had the same test. I highly recommend the Kaplan videos now. They're very good at prepping you for what to do when the "real" next best step isn't there (which happens often as explained above).

TT, I think scores are taking around 4 weeks or so.

 

[danzman]

Best bio stats prep is definitely Secrets. I could answer almost every bio stats question from that, although I did take 2 easy basic stats classes in college...

Agree with much of the above, sounds like we had the same test. I highly recommend the Kaplan videos now. They're very good at prepping you for what to do when the "real" next best step isn't there (which happens often as explained above).

The most cost effective treatment is the cheapest one that works the best. Study designs were a little more than I was prepared for.

I agree that it was a very non-zebra test, which I like. You actually had to know lipid cutoffs and important things (mostly) rather than zebras like Prader Willi. Green OMM was good, but make sure to do all the questions and explanations in the back.

TT, I think scores are taking around 4 weeks or so.

Thats interesting. I have been trying to figure out how they distribute the questions of these tests. I didn't have any "most cost effective" questions, and the stats questions were not in secrets, first aid, or any kaplan material as I tried to go back and look them up.

 

[digitlnoize]

Thats interesting. I have been trying to figure out how they distribute the questions of these tests. I didn't have any "most cost effective" questions, and the stats questions were not in secrets, first aid, or any kaplan material as I tried to go back and look them up.

Just prep for everything. I felt like Kaplan over prepared me. We'll see if that was true or not in a month or so! Good luck everybody!

 

[Pegasus1731]

well said. moving on man

 

[H2DO]

Anyone else take the test recently? I take mine on the 4th. Just plan on runnign through step up and combank until then

 

[Slevin]

Anyone else take the test recently? I take mine on the 4th. Just plan on runnign through step up and combank until then

Have you gone through conquest as well?

 

[SteelCity2013]

wrong forum....

 

[AngelBear]

I just took it today and thought it had a pretty good amount of OB questions. Lots of this G3P2 pregnant girl shows up with a problem crap. Most of it was pretty straightforward though so that part wasnt that bad.

Lots of OMT. I had a couple cranial torsion rotation problems so make sure you refresh yourself on that. some ankle sprain questions, plenty of autonomics and sacral. some cervical and thoracic dysfunctions. Quite a few exhalation/inhalation dysfunctions. couple of falling forward/backward on an outstretched hand questions. I did 2 of the practice tests in savarese but I'm thinking I prob should have done all 4 and paid closer attention to the answers. There was just a wide variety of OMT on there it seemed. Not many chapmans points for me though.

The peds wasnt that bad for me. Make sure you know your rashes that spread like rubella/measles etc. Oddly enough I felt like the "whats the best imaging study" questions were more straightforward than comquest. The Law questions were kinda bizzare but comquest helped out with some of those. Some biostats questions which wasnt too bad if you've studied for USMLE.

Just glad its over and done.

Hey Vergie- I too felt that my test was pretty straightforward. I was getting scared cause it seemed that people that did well thought it was an ambiguous test or something. I'm not sure if I just got an easier version or it was due to my hard work and preparation but I thought the exam was pretty fair and almost a little too easy at times. Hopefully that doesn't translate to a fail. YIKES !!

 

[psychphan]

Well, it is the COMLEX so although the content of the questions wasn't particularly difficult, the ambiguity of a large number of questions would have made the whole experience pretty aggravating if I wouldn't have seen it coming. The term "most appropriate" was used all over the test, which is a pain in the ass cause then you have to determine what most approriate means. For example, it would describe a pretty obvious disease then ask "What is the most appropriate imaging study". And the answer section would contain both the gold standard, and the next best step study. So the hardest part of the exam, in my opinion, was decrypting the wording to try to figure out what the writers were actually asking. Pretty annoying. I'm glad I took the USMLE. Much harder content but at least you know what they are asking.

 

[AngelBear]

Well, it is the COMLEX so although the content of the questions wasn't particularly difficult, the ambiguity of a large number of questions would have made the whole experience pretty aggravating if I wouldn't have seen it coming. The term "most appropriate" was used all over the test, which is a pain in the ass cause then you have to determine what most approriate means. For example, it would describe a pretty obvious disease then ask "What is the most appropriate imaging study". And the answer section would contain both the gold standard, and the next best step study. So the hardest part of the exam, in my opinion, was decrypting the wording to try to figure out what the writers were actually asking. Pretty annoying. I'm glad I took the USMLE. Much harder content but at least you know what they are asking.

Totally agree psychpan. I only took COMLEX so I went pretty crazy with COMBANK/COMQUEST combo. I did both qbanks 3x ( 1st pass around 65% and then final pass 85%) along with Boards and Wards and Px for Boards to supplement. So I guess you can say I got pretty used to the questioning style and what "most appropriate" meant in terms of COMLEX. When test day came I was surprised that it wasn't as ambiguous as what other people have commented on.

 

[all stock]

good luck to you guys taking the comlex. i thought it was way harder than the usmle. less integration, more random knowledge was asked. ethics, some sampling study types, peds and obgyn was ridiculous. i felt i was pretty prepared. i scored a 747 on the comsae. i hope to at least match my level 1 score now.

 

[Slevin]

Still waiting on grades for the first cohort. The waiting game stinks

 

[TPBC]

Took the exam yesterday. Scored in mid to high eighties consistently on Comquest and Combank, did well on all three COMSAEs, expected to do well on the real thing, but I walked out thinking, "Man did I even pass??" Scary. Lots of questions where I narrowed the choices down to two answer options but was uncertain of the right one. Also, the question stems were longer than either 'quest or 'bank and there were a fair number of questions that I could not anticipate nor study for. My fingers are crossed! Best of luck to everyone else!!

 

[Tourterm]

The breakdown mentioned in previous posts is spot on. OB/GYN, OMM, pediatrics, GI, pulm, and neuro combined make up the bulk of the exam (in roughly that order). Infectious disease is well represented in pediatrics, GI, and pulm.

They also focus on certain diseases, asking multiple questions from differing angles, situations, or complications. If you were a family med doc, what "bread and butter" topics would you want on an exam?

Only a few x-rays, CTs, EKGs. Nothing unusual. Did have 2 micro images which I wasn't expecting any of. They weren't needed, but was a nice confirmation. Stats, study design/flaws, ethics, law, as mentioned by others, all there.

If I could do it over again, I'd study it a lot more from a family med aspect, and cut back on the IM, which wasn't present much outside of a FM point of view. I did make sure to really go after ob/gyn//pediatrics, and it served me well. A quick review of laws and ethics not present in COMQUEST would have been helpful.

 

[H2DO]

My exam was about the same as what everyone else mentioned. A TON of peds/GU/OB/GYN and then some neuro, pulm. Hardly any cardio or heme/onc. The test wasn't that hard, pretty straight forward for the most part, I just wish I had spent more time looking over the common FM problems rather than actually studying.

I had like 10 statistics questions, random study designs and sampling stuff that I made guesses on. Ofcourse some horrible pictures and xrays where you don't even know what you are looking at. Some colonscopy pictures.

Omm was probably 1/3 of the exam. Lots of UE and LE and lots and lots of ribs.

 

[AngelBear]

My exam was about the same as what everyone else mentioned. A TON of peds/GU/OB/GYN and then some neuro, pulm. Hardly any cardio or heme/onc. The test wasn't that hard, pretty straight forward for the most part, I just wish I had spent more time looking over the common FM problems rather than actually studying.

I had like 10 statistics questions, random study designs and sampling stuff that I made guesses on. Ofcourse some horrible pictures and xrays where you don't even know what you are looking at. Some colonscopy pictures.

Omm was probably 1/3 of the exam. Lots of UE and LE and lots and lots of ribs.

Glad to hear someone else with my same experience. I made guesses on the statistics portion as well. I had no idea where the heck to look up some of them. I think I may have marked 5-8 questions that I needed to go back again but otherwise everything else was pretty much what I expected.

Other than that I felt the test was pretty straightforward as well. I studied a ton from comquest/combank question banks. I redid both at least 3x and made sure I knew why the other answers where wrong and what the reasoning behind the right answer was. I pretty much got the most out of studying that way since I don't really absorb from straight reading.

I walked out of the test pretty much feeling that it was fair and on point with what I studied. Let's see if my feeling is right ! Yikes !

 

[psychphan]

Ofcourse some horrible pictures and xrays where you don't even know what you are looking at.

I forgot to mention this, but it is 100% true. I had multiple questions with very generic stems, whose answers could not have been differentiated without the image. Unfortunately the image was completely illegible. Also, as others have mentioned, there were some ridiculous "ethics and law" questions, that you could have studied for years and never came across. That's my issue with comlex, there are always a decent number of questions that either 1) You don't know what they're asking; 2) No matter how prepared or intelligent you are, they are so random you would have never came across the topics 3) They ask questions who's answers rely wholly on images which you can't even see.

That being said, these questions were in the minority and as a whole I felt the content of the exam was on the easy side, with lots of questions being 1st order and pretty much gimmie's. I thought USMLE was infinitely harder, however, after getting my scores on USMLE I have a feeling I'm going to be one of those people who score higher on the USMLE than the COMLEX.