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COMLEX-USA Level 2-CE exam help guide

Official-policy-first prep, setup, readiness, and test-day guidance built for this exam.

COMLEX-USA Level 2-CE guide with NBOME eligibility, 2026 format transition, three-digit scoring, 400 passing standard, Pearson exam-day rules, residency timing, accommodations, fees, retakes, and clinical prep strategy.

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COMLEX-USA Level 2-CE exam help coverage

May 10, 2026

Exam-specific guidance for COMLEX-USA Level 2-CE, not generic study advice.
Official-policy-first workflow with explicit verification steps for unstable rules.
Clear setup, practice, readiness, and test-day execution checkpoints.

COMLEX-USA Level 2-CE exam help quick summary

Use this section for the shortest path through the guide before you dig into the full workflow below.

Format

Platform

NBOME / Pearson VUE rules can change by delivery mode. Verify the official handbook and scheduler page before test day.

Focus

Use the guide below to map blueprint coverage, pacing checkpoints, and the operational issues that can derail an otherwise ready candidate.

Verify

Re-check dates, IDs, accommodations, devices, and reschedule rules shortly before the exam if any of those items are handled by a third party.

Exam Help

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Prep Support

Help with online exam logistics including practice environment setup, proctoring dry-runs, and day-of contingency planning so nothing is left to chance.

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Full guide

COMLEX-USA Level 2-CE exam help guide

Category: Prometric Medical Licensing

COMLEX-USA Level 2-CE Overview

Topic	Current Level 2-CE answer	Primary source
What it is	The COMLEX-USA cognitive examination focused on clinical sciences, osteopathic principles, and physician competencies for entry into supervised graduate medical education.	NBOME Description of Examinations
Who takes it	DO students who passed Level 1, completed second year at an accredited COM, and have dean attestation of good academic/professional standing.	NBOME Eligibility
Score reporting	Three-digit standard score plus pass/fail designation and performance profile.	NBOME Scoring & Reporting
Passing score	400.	NBOME Scoring & Reporting and FAQ
Delivery partner	NBOME partners with Pearson to deliver COMLEX-USA exams.	NBOME exam-day page

COMLEX-USA Level 2-CE is the residency-facing COMLEX score for many DO students because Level 1 is pass/fail. It assesses whether the candidate can apply clinical sciences, osteopathic principles, patient-care reasoning, professionalism, communication, practice-based learning, and systems-based practice at the level expected before graduate medical education.

Important 2026 format note: NBOME’s 2025-2026 Bulletin still displays the older Level 2-CE outline of 352 questions in two four-hour sessions, but includes a footnote that effective June 2026 the total number of Level 2-CE questions will be reduced to 320 and break structure revised. NBOME’s December 16, 2024 enhancement notice says Level 1 and Level 2-CE will move from 352 to 320 questions while keeping eight hours of exam time, with Level 2-CE targeted for June 2026. Candidates should verify the exact format on the current NBOME page and their authorization.

COMLEX Level 2-CE vs USMLE Step 2 CK vs COMLEX-only strategy:

Route	Best use	Decision guidance
COMLEX-USA Level 2-CE	Required for the osteopathic licensure pathway and DO graduation progression.	Every DO candidate should treat it as a major clinical-readiness milestone.
USMLE Step 2 CK	Optional additional exam for some residency strategies.	Consider specialty competitiveness, program preferences, advisor input, prior Step 1 choice, and score readiness.
COMLEX-only application	Appropriate for many students and specialties when advisor and program research support it.	Requires a strong Level 2-CE plan, clinical grades, letters, MSPE, and specialty fit.

Eligibility & Requirements (Location-Specific)

Requirement	NBOME policy	Student action
Prior exam	Passing COMLEX-USA Level 1.	Confirm Level 1 status and school progression rules.
Education status	Completion of second year at an accredited COM.	Verify school clearance.
Standing	Good academic and professional standing attestation by COM dean.	Resolve professionalism or academic holds early.
Identity	Unexpired government-issued photo ID with picture and signature.	Match ID to NBOME portal.
Name change	NBOME BOI gives a 14-calendar-day notice rule for testing under a new name; exam-day page also warns name match is required.	Correct name issues well before the appointment.

Location-specific considerations include Pearson VUE seat availability, clerkship schedule, audition rotation calendar, ERAS/residency timing, school graduation deadlines, and state licensing implications. NBOME policy controls eligibility and scoring; Pearson VUE controls site delivery; the COM controls school approval; residency programs decide how they interpret scores.

Accommodations: NBOME recommends submitting requests at least 90 days before the first preferred testing-window date. Completed requests are generally evaluated in about 75 days, with longer timelines if documentation is incomplete. If accommodations are approved after a standard appointment is scheduled, the candidate must cancel and schedule a new accommodated exam to use them.

Exam Sections & Content Blueprint (COMLEX-Correct)

Blueprint dimension	Series minimum / Level 2-CE relevance	How to study
Osteopathic Principles, Practice, and Manipulative Treatment	Important clinical integration domain	Treat OPP as clinical decision-making, not Level 1 trivia.
Osteopathic Patient Care and Procedural Skills	High clinical emphasis	Diagnose, manage, triage, prevent, and counsel.
Application of Knowledge for Osteopathic Medical Practice	Core clinical reasoning	Convert facts into next-best-step decisions.
Practice-Based Learning and Improvement	Evidence and improvement	Study guidelines, diagnostic accuracy, quality and safety.
Interpersonal and Communication Skills	Patient-centered decisions	Handle informed consent, shared decisions, difficult conversations.
Professionalism	Ethics and responsibility	Confidentiality, boundaries, impairment, reporting, fairness.
Systems-Based Practice	Health systems	Cost, access, transitions of care, population health.

NBOME’s blueprint uses two dimensions: competency domains and clinical presentations. Clinical presentations include wellness/community health, development/reproduction/sexuality, endocrine/metabolism, nervous system/mental health, musculoskeletal, genitourinary/renal/breasts, gastrointestinal/nutrition, circulatory/hematologic, respiratory, and integumentary. Level 2-CE demands more clinical action than Level 1: diagnosis, management, risk stratification, prevention, counseling, and disposition.

Question archetypes include next best step, most likely diagnosis, initial management, osteopathic structural diagnosis and treatment choice, contraindications to OMT, emergency stabilization, preventive screening, adverse drug effect, diagnostic test interpretation, ethics, patient communication, quality improvement, and systems-of-care decisions. Use official NBOME practice resources and reputable clinical question banks; do not reproduce or discuss secure exam content.

Exam Format, Timing & Delivery

Format item	NBOME current guidance	Verify before testing
Exam time	Two four-hour computer-based sessions, one day, eight hours exam time.	Current NBOME format and authorization.
Question count	Legacy BOI outline: 352 questions; June 2026 change: 320 questions.	Exact count for your date.
Tutorial	BOI lists 16 minutes pre-exam information/tutorial.	Use it to set preferences and provided tools.
Breaks	60 minutes pooled break time; revised break opportunities beginning June 2026 for Level 2-CE.	Current exam-day screen.
Delivery	Pearson test centers with NBOME security rules.	Confirmation receipt and Pearson requirements.

NBOME says questions can be answered, reviewed, and changed one section at a time; after moving to a new section, prior sections are no longer accessible. Individual sections are not separately timed, so pacing must be managed within each four-hour session. Build a practical pacing target from your verified question count. For the 320-question format, eight hours equals about 90 seconds per question before breaks/tutorial; for the legacy 352-question format, it is about 82 seconds per question. Real pacing should include review and hard-question triage.

Scoring & Interpretation

Score issue	Level 2-CE rule	Practical impact
Numeric score	Three-digit standard score reported.	Used in residency advising and applications.
Passing score	400.	Passing is necessary, but competitiveness varies by specialty and program.
Raw score	Three-digit score is not a raw percent or number correct.	Do not interpret 400 as 40% or 400 questions.
Score profile	Graphical performance profile by blueprint and disciplines.	Useful for learning, but NBOME cautions against misuse.
Release timing	Scores generally available within two to six weeks from the end of the Level 2-CE testing window.	Plan around ERAS and school deadlines.

NBOME states that, except for unscored pretest questions, each question contributes equally to the exam score, while the model-based standard score considers candidate responses and psychometric properties. Passing is criterion-based; the percentage who pass or fail is not predetermined.

Because Level 2-CE has a reported three-digit score, retake strategy is different from Level 1. Passing with a low score may still be a strategic concern for competitive specialties, but NBOME does not permit retaking a passed examination to improve the score. Readiness must be built before the first attempt.

Registration & Scheduling (Step-by-Step)

Step	Action	Avoid this mistake
1	Confirm Level 1 pass, completion of second year, and dean attestation.	Assuming school clearance is automatic.
2	Check clerkship, COMAT, audition, ERAS, and graduation timelines.	Scheduling during an impossible rotation week.
3	Register in the NBOME Portal for the correct testing cycle.	Purchasing the wrong cycle.
4	Schedule through Pearson as soon as your preferred window is known.	Waiting until local seats disappear.
5	NBOME advises attempting to schedule at least 120 days ahead when possible.	Treating six-month scheduling as unlimited availability.
6	Verify ID, name, accommodations, receipt, and test-center location.	Losing the appointment to a name mismatch.
7	Put score release date into the residency timeline.	Missing ERAS/program deadlines.

NBOME reschedule/cancel fees for Level 2-CE mirror Level 1: more than 30 days, no fee and full refund for cancellation; 6-30 days, $85 forfeited; 1-5 days, $250 forfeited; within 24 hours, no-show forfeits $400. Level 1/2-CE candidates may not schedule an exam day less than five calendar days before the exam date.

Costs, Fees & Budgeting

Cost item	Current listed amount or risk	Source
Level 2-CE exam fee	$745	NBOME FAQ
Reschedule/cancel >30 days	$0	NBOME Registration & Scheduling
Reschedule/cancel 6-30 days	$85 forfeited	NBOME Registration & Scheduling
Reschedule/cancel 1-5 days	$250 forfeited	NBOME Registration & Scheduling
No-show within 24 hours	$400 forfeited	NBOME Registration & Scheduling
Residency timing cost	ERAS delay, audition conflicts, graduation risk	COM and residency calendar

Budget for exam fee, clinical question bank, OPP/OMT refresh, COMSAE or school assessment, travel/lodging, food and break supplies, and a reschedule reserve. Veterans should verify NBOME’s 2026 VA reimbursement notice for COMLEX-USA education and training benefits.

Prep Strategy (Beginner to Residency-Ready)

Timeline	Best for	Strategy
2 weeks	Final consolidation	Mixed timed sets, OPP refresh, ethics/stats, weakest clerkship topics, sleep alignment.
4 weeks	Strong baseline	Daily mixed clinical blocks, missed-COMAT remediation, OMM integration, practice exam checkpoint.
8 weeks	Typical clinical-dedicated plan	Clerkship-by-clerkship review, cumulative mixed blocks, full-length stamina, residency timeline check.
12+ weeks	Weak clinical base or prior failure risk	Rebuild medicine/surgery/OB/peds/psych/FM, structured advising, repeated readiness milestones.

Diagnostic workflow: use COMAT history, question-bank data, official/self-assessment data, shelf-style weakness patterns, and rotation feedback. Categorize misses into diagnosis, next step, management, OPP, ethics, screening, stats, and systems errors. Level 2-CE rewards clinical decision quality more than isolated recall.

Daily templates: 30 minutes means 20 timed questions plus review of missed reasoning. 60 minutes means 40 questions, deep review, and five OPP cases. 120 minutes means 80 questions, content repair, OPP/ethics/statistics rotation, and one clinical algorithm review.

Section-by-Section High-ROI Strategies

Area	High-ROI move	Why it matters
Internal medicine	Master common presentations, diagnostics, risk stratification, and treatment sequencing.	Large share of clinical reasoning.
Surgery/emergency	Stabilize first, recognize red flags, choose imaging/intervention timing.	Next-step traps are frequent.
OB/GYN	Prenatal care, bleeding, hypertension, labor, contraception, screening.	High-yield clinical algorithms.
Pediatrics	Development, vaccination, congenital disease, infections, emergencies.	Distinct age-based management.
Psychiatry	Diagnosis, safety, medication adverse effects, capacity, emergency risk.	Ethics and management overlap.
OPP/OMT	Pair structural findings with treatment and contraindications.	COMLEX-specific differentiator.
Ethics/systems	Consent, confidentiality, impairment, reporting, quality, access.	Often decisive easy-to-miss points.

Top 25 mistakes: treating Level 2-CE like Level 1 with more facts; not studying OPP clinically; relying only on USMLE Step 2 CK prep; ignoring COMAT weaknesses; delaying scheduling; missing the June 2026 format transition; confusing raw percent with standard score; aiming only for 400 when specialty goals need more; skipping ethics/stats; doing questions without deep review; never practicing mixed blocks; not rehearsing full-day stamina; scheduling too close to ERAS; ignoring score release windows; not reading the BOI; failing to fix name/ID issues; waiting on accommodations; underestimating family medicine/preventive care; ignoring OMT contraindications; not reviewing incorrects twice; using outdated question banks; studying passively after rotations; ignoring sleep and food logistics; discussing secure content; and retaking after a fail without objective improvement.

Official Resources & High-Quality Prep

Resource	Use it for	Freshness check
NBOME Bulletin of Information	Eligibility, administration, scores, retakes, cancellations	Use current cycle
NBOME Scoring & Reporting	400 passing score, score profile, release timing	Confirm current page
NBOME Blueprint revised February 2025	Competencies and clinical presentations	Confirm latest revision
NBOME testing windows	Score release timing and ERAS planning	Use exact cycle
Pearson/NBOME exam-day page	ID, lockers, biometrics, breaks	Confirm before test day
COM advisor and rotation data	School readiness and residency timing	Use your class policy

Provider red flags: no COMLEX-specific OPP, outdated Prometric references, failure to mention Pearson, no 2026 question-count update, guarantees of a score, copied questions, or advice that conflicts with NBOME confidentiality.

Test-Day Strategy & Anxiety Control

Phase	Action	Reason
Arrival	Arrive at least 30 minutes early with matching government photo ID.	Pearson/NBOME check-in is security-heavy.
Tutorial	Set preferences and prepare provided tools.	Exam time should not be spent on setup.
Sections	Answer all questions, mark uncertain ones, review only within current section.	Prior sections lock after advancing.
Breaks	Use planned nutrition, hydration, restroom, stretch, and reset.	Pooled break time is a resource.
After exam	Do not discuss content; wait for official NBOME release.	Protects exam integrity and your record.

Anxiety plan: decide before test day how you will handle a brutal block. The rule is: no post-mortem during the exam. Use a 20-second reset, return to clinical first principles, and protect time for later questions. A residency-important score is built by steady execution, not by winning every single vignette.

After Level 2-CE: Residency Strategy

Outcome	Next move	Strategic note
Strong score	Align specialty list, letters, auditions, and ERAS narrative.	Score can support program reach.
Passing but lower score	Strengthen clinical grades, letters, personal statement, specialty fit, and program targeting.	You cannot retake a passed exam for improvement.
Fail	Meet COM advisor immediately, protect graduation/residency timeline, rebuild with objective data.	Retake timing must be evidence-based.
Delayed score	Use NBOME testing windows and communicate with advisors.	ERAS timing can be affected.
Considering USMLE Step 2 CK	Decide with advisor using specialty goals and readiness evidence.	Do not add a second exam without a clear upside.

Retaking helps only when the failure pattern is clear and corrected. Retaking quickly without fixing clinical reasoning, OPP, timing, or stamina risks a second failure. Use NBOME performance profile, question-bank analytics, COMAT history, and faculty guidance.

Comprehensive COMLEX Level 2-CE FAQs

#	Question	Answer
1	Who administers Level 2-CE?	NBOME owns COMLEX-USA; Pearson delivers the exam.
2	Is Level 2-CE pass/fail only?	No. NBOME reports a three-digit standard score and pass/fail designation.
3	What is passing?	400.
4	Is 400 a raw percentage?	No. NBOME says three-digit scores are not raw scores or percent correct.
5	How many questions are on Level 2-CE?	NBOME’s June 2026 change moves Level 2-CE from 352 to 320 questions. Verify your exam date format.
6	How long is the exam?	Eight hours of exam time in two four-hour sessions, plus tutorial and break time.
7	When does the 320-question format start?	NBOME announced the target as June 2026 for Level 2-CE.
8	How much break time is available?	60 minutes pooled break time, with revised scheduled break opportunities beginning with the 2026 change.
9	Can I review prior sections?	No. Only the current section is accessible.
10	Are sections individually timed?	NBOME says individual sections are not timed; session time controls pacing.
11	What eligibility is required?	Pass Level 1, complete second year at an accredited COM, and have dean attestation.
12	Can I retake after passing?	No, not to improve the score.
13	How many attempts are allowed?	Four scored attempts per level, and no more than four times in 12 months including incomplete or voided attempts.
14	What is the fee?	NBOME FAQ lists Level 2-CE at $745.
15	What are reschedule fees?	$0 more than 30 days, $85 at 6-30 days, $250 at 1-5 days, and $400 no-show within 24 hours for Level 2-CE.
16	How early should I schedule?	NBOME advises attempting to schedule at least 120 days before the desired date.
17	Can I schedule less than five days out?	No for Level 1/2-CE under NBOME rules.
18	What ID is needed?	One unexpired government-issued ID with photo and signature.
19	What if my name changed?	Correct it with NBOME early; use at least the BOI’s 14-day safety window.
20	Who receives my score?	You and your COM dean’s office receive Level 2-CE score reports.
21	Are scores emailed?	NBOME notifies by email when released, but reports are accessed in the portal.
22	Are results released by phone?	No. NBOME says no phone, email, or fax reporting of results.
23	How long until scores post?	Generally two to six weeks from the end of the Level 2-CE testing window.
24	Does Level 2-CE matter for residency?	Yes, it is often a key numeric board score for DO applicants.
25	Should I also take USMLE Step 2 CK?	Decide with advisor based on specialty, program research, and readiness.
26	Does Step 2 CK replace Level 2-CE?	No. DO students still need COMLEX for the osteopathic licensure pathway.
27	What content is highest yield?	Clinical management, diagnosis, OPP/OMT, ethics, preventive care, emergency stabilization, and systems-based care.
28	How should I use COMAT scores?	Treat them as clerkship-specific diagnostic data for Level 2-CE.
29	Should I use only USMLE resources?	No. Add COMLEX-specific OPP and osteopathic clinical reasoning.
30	How many practice questions per day?	During dedicated, many students use 40-80 deeply reviewed questions, adjusted to baseline.
31	Should I use timed blocks?	Yes. Level 2-CE is a stamina and pacing exam.
32	How do I improve OPP?	Practice structural diagnosis, treatment selection, contraindications, viscerosomatics, and clinical integration daily.
33	What if I fail?	Meet your COM advisor, analyze NBOME profile and question data, and retake only after objective improvement.
34	Can score confirmation help?	It is available for a fee within 120 days; NBOME says confirmation is limited and unlikely to change results.
35	How long does score confirmation take?	NBOME FAQ says Level 1/2-CE confirmation should be received within 10 business days.
36	Are pretest items scored?	No. NBOME says research/pretest items do not contribute to score or passing status.
37	Is the exam adaptive?	NBOME FAQ describes COMLEX-USA as computerized non-adaptive examinations.
38	Can I bring food into the room?	No. Food and drink stay in the locker and can be accessed during scheduled breaks.
39	Can I access a phone during break?	NBOME permits locker access during scheduled breaks but all rules must be followed.
40	Can I leave during unscheduled time?	Leaving outside scheduled breaks is reported and may reduce exam time.
41	When should accommodations be requested?	At least 90 days before the preferred testing window.
42	How long does accommodation review take?	Generally about 75 days for complete applications.
43	Can I schedule a standard exam while accommodations are pending?	Yes, but to use approved accommodations you must cancel and reschedule an accommodated exam.
44	What if I sit for the standard exam while pending?	NBOME says the accommodation application is deemed withdrawn.
45	Can Pearson staff explain NBOME policy?	NBOME says test administrators cannot answer NBOME policy questions.
46	What if the computer fails?	Notify staff immediately, document, and contact NBOME Client Services as needed.
47	Can I discuss remembered questions later?	No. NBOME security rules prohibit sharing secure content.
48	What is the best final week plan?	Mixed timed blocks, OPP, ethics/stats, weak algorithms, sleep, and test-day logistics.
49	How do I set a target score?	Use specialty competitiveness, advisor guidance, practice data, and program research.
50	Is just passing enough?	It depends on specialty and application strength. Passing is necessary; competitiveness is contextual.
51	What if my practice scores fluctuate?	Look at trend, conditions, weak domains, and fatigue rather than one block.
52	How do I interpret percentile?	Use NBOME’s cycle-specific percentile converter after the annual cycle or interim tools when provided.
53	Does NBOME send official transcripts?	Official transcript processes are handled by NBOME; processing takes time.
54	Can a pending score appear on transcript?	NBOME FAQ says pending scores do not appear until available.
55	What should I bring?	Matching ID, confirmation details, and locker food/drink; avoid prohibited items.
56	Can I wear a watch?	Watches are prohibited in the testing room.
57	What matters for pacing?	Answer every item, avoid overinvesting in one vignette, and review only within current section.
58	What is the biggest strategic error?	Taking Level 2-CE before score readiness because the residency timeline feels urgent.
59	What if my ERAS date is close?	Use NBOME score release windows and your advisor to decide if the date is still wise.
60	What matters most?	Clinical reasoning, OPP integration, score readiness, early scheduling, and exact NBOME/Pearson compliance.

Location Guide

Information to collect	Why it changes the plan
COM policy and graduation deadline	Determines clearance, remediation, and latest safe test date.
Specialty target	Determines target score and whether USMLE Step 2 CK is useful.
ERAS/application timeline	Score release timing can affect application completeness.
Clerkship/COMAT profile	Reveals clinical weaknesses.
Testing city	Pearson availability and travel risk matter.
Accommodations status	NBOME timeline can require 90+ days.

Verification checklist: confirm Level 1 pass and COM eligibility; read the NBOME BOI; verify whether your date uses legacy 352 or June 2026 320-question format; check testing windows and score release date; schedule early; correct name/ID; submit accommodations 90+ days ahead if needed; build a clinical and OPP plan; and align the score date with residency strategy.

Official pages to verify: NBOME Description of Examinations at https://www.nbome.org/assessments/comlex-usa/bulletin-of-information/description-of-examinations/; NBOME Eligibility at https://www.nbome.org/assessments/comlex-usa/bulletin-of-information/eligibility/; NBOME Scoring & Reporting at https://www.nbome.org/assessments/comlex-usa/scoring-and-reporting/; NBOME Registration & Scheduling at https://www.nbome.org/assessments/comlex-usa/bulletin-of-information/registration-scheduling/; NBOME Testing Windows & Score Release Dates at https://www.nbome.org/assessments/comlex-usa/testing-windows-score-release-dates/; NBOME Exam Day at https://www.nbome.org/assessments/comlex-usa/what-to-expect-on-exam-day/; NBOME Blueprint PDF at https://www.nbome.org/app/uploads/2025/05/COMLEX-USA-Blueprint-2025.pdf; and NBOME 2026 enhancements at https://www.nbome.org/news/enhancements-to-comlex-usa-exams-in-2026-2027/.

Quick facts

Vendor / platform: NBOME / Pearson VUE
Category: Prometric Medical Licensing
Last updated: May 10, 2026

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Verify Rules

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Map Weaknesses

Use the official blueprint and a timed baseline to decide what needs review, drilling, or remediation first.

Simulate Timing

Run timed sets or full-length practice under the same delivery conditions you expect on exam day whenever possible.

Make the Call

Decide whether to sit COMLEX-USA Level 2-CE now, delay briefly, or rebuild fundamentals based on measurable readiness instead of hope.

Jump to guide

COMLEX-USA Level 2-CE Overview
Eligibility & Requirements (Location-Specific)
Exam Sections & Content Blueprint (COMLEX-Correct)
Exam Format, Timing & Delivery
Scoring & Interpretation
Registration & Scheduling (Step-by-Step)
Costs, Fees & Budgeting
Prep Strategy (Beginner to Residency-Ready)
Section-by-Section High-ROI Strategies
Official Resources & High-Quality Prep
Test-Day Strategy & Anxiety Control
After Level 2-CE: Residency Strategy

COMLEX-USA Level 2-CE exam help next steps

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