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PAEA EOC 2025 | PAEA SUMMATIVE PRACTICE
| PHYSICIAN ASSISTANT EXAM | EOC
QUESTIONS AND ANSWERS | 150 QUESTIONS
AND CORRECT ANSWERS | ALREADY GRADED
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A 46-yr-old man presents with weakness, weight loss over the last 2 months and fatigue. He endorses melena and dark colored urine. His palms appear red and he has gynecomastia. Dx? ---------CORRECT ANSWER-----------------cirrhosis Other common s&sx include pruritus, jaundice, amenorrhea (women), hepato/splenomegaly, spider angiomata What sx of cirrhosis suggest advanced disease? ---------CORRECT ANSWER-----------------asterixis, jaundice, confusion, sleep disturbances, ascites What lab abnormalities are seen with cirrhosis? ---------CORRECT ANSWER-----------------Elevated AST/ALT with AST usually higher than ALT elevated alk phos thrombocytopenia (advanced disease) anemia low serum albumin prolonged PT, elevated INR hyponatremia elevated serum creatinine Clinical therapeutics for SVT? ---------CORRECT ANSWER----------------- Adenosine (if symptomatic) BB/CCB (if regular) radiofrequency ablation (definitive)
(if WPW do NOT give adenosine or CCB) Clinical manifestations of arterial embolism? ---------CORRECT ANSWER--- --------------6 Ps - paresthesias, pain, pulselessness, poikilothermic, paralysis Workup for acute arterial occlusion? ---------CORRECT ANSWER------------- ----arterial doppler to check pulses CT angiography Describe ECHO findings for a patient with HOCM ---------CORRECT ANSWER-----------------asymmetric ventricular wall thickness (esp. septal) 15mm or more, systolic anterior motion of the mitral valve, & small LV chamber size Initial lab workup for pt newly diagnosed with htn? ---------CORRECT ANSWER-----------------UA Spot urine albumin: creatinine ratio bloodwork (creatinine, K, Na, fasting plasma glucose, lipid profile, and often TSH), and ECG Most common cause of secondary htn? ---------CORRECT ANSWER--------- --------primary aldosteronism Management for AAA based on diameter of aorta? ---------CORRECT ANSWER------------------No further testing if aorta < 3.0 cm diameter
- Repeat US yearly if aorta 3.0 - 4.4 cm
What is factor V's role in the clotting cascade? ---------CORRECT ANSWER-----------------procoagulant clotting factor that amplifies the production of thrombin, the central enzyme that converts fibrinogen to fibrin A small amount of thrombin at the site of a wound activates factor V by limited proteolysis. Works as a positive feedback loop What is occuring in Factor V Leiden that leads to increased risk of VTE? --- ------CORRECT ANSWER-----------------a single point mutation of the factor V gene leads to factor V being insensitive to protein C (which is a natural anticoagulant) What anti-nausea medication is suggested for treatment of concussion? Which should be avoided? ---------CORRECT ANSWER----------------- ondansetron is recommended for the first 1-2 days post-concussion Avoid phenothiazines (metoclopromide & promethazine) due to adverse SEs such as drowsiness and orthostatic hypotension What route of administration should antibiotics be given for bacterial meningitis? What should be given along side the antibiotics while treating empirically? ---------CORRECT ANSWER-----------------IV works best to help better penetrate the BBB. Give dexamethasone while organism is unknown. Intravenous administration of glucocorticoids (usually dexamethasone) prior to or at the time of administering antibiotics has been associated with a reduction in the rate of hearing loss, other neurologic complications, and mortality in patients with meningitis caused by S. pneumoniae
What antibiotics can be used for empiric tx of bacterial meningitis? (give answers based on age: < 1 month old, 1-50 years old, > 50 years old) ------- --CORRECT ANSWER-----------------< 1 month: Ampicillin + cefotaxime 1 - 50 years old: vancomycin + 3rd gen cephalosporin
50 years old: vancomycin + ampicillin + 3rd gen cephalosporin 2 most common pathogens of community acquired bacterial meningitis ----- ----CORRECT ANSWER-----------------S. pneumoniae followed by N. meningitidis Treatment options for postherpetic neuralgia? (3) ---------CORRECT ANSWER-----------------Gabapentin, pregabalin, and tricyclic antidepressants (TCAs: amitriptyline) are generally the drugs of first choice What is the single most important treatable risk factor for stroke? --------- CORRECT ANSWER-----------------Hypertension What is used for long-term secondary prevention of stroke? --------- CORRECT ANSWER-----------------Aspirin is often used first line Other options: clopidogrel or aspirin-extended-release dipyridamole Which type of meningitis tends to have higher levels of WBCs in CSF? (WBCs may be as much as 1000+) ---------CORRECT ANSWER--------------- --bacterial meningitis (will also see elevated glucose and maybe elevated protein)
bradykinesia (generalized slowness of movement) - MC feature, but generally hard for patients to describe rigidity (increased resistance to passive movement about a joint. cogwheel seen in PD) Postural instability (a feeling of imbalance and a tendency to fall; appears later in PD course) When is treatment indicated for women with pelvic organ prolapse? --------- CORRECT ANSWER-----------------Obstructed urination or defecation hydronephrosis from chronic ureteral kinking Tx indicated if symptoms, regardless of degree of prolapse, not indicated for women with asymptomatic prolapse What conservative treatments are recommended for pelvic organ prolapse before moving to surgical options? ---------CORRECT ANSWER--------------- --vaginal pessary pelvic floor muscle training What gynecologic infection has vaginal epithelial cells studded with adherent coccobacilli that are best appreciated at the edge of the cell on microscopy? ---------CORRECT ANSWER-----------------bacterial vaginosis (clue cells) What is the amsel criteria and what is it used to diagnose? --------- CORRECT ANSWER-----------------used to dx BV At least 3 of the following criteria must be met:
- homogenous, thin, grayish-white discharge
- vaginal pH > 4.
- Postive whiff amine test
- clue cells on wet mount *technically gram stain is the gold standard for dx but its too expensive and time consuming. Only used in research. Name some common benign masses found in the breast ---------CORRECT ANSWER-----------------fibroadenoma simple cyst fibrocystic changes galactocele A 25 year old women presents with a palpable mass in her breast in the left outer quadrant. what would be the next step in the work up of this mass? --- ------CORRECT ANSWER-----------------diagnostic mammography An abnormal mammography should be followed up with US and biopsy. helps to differentiate solid from cystic masses, as well as detect axilla lymph nodes Most common site of endometriosis? ---------CORRECT ANSWER------------ -----ovaries What exactly causes the occlusive vascular disease of thromboangiitis obliterans? ---------CORRECT ANSWER-----------------aka Buerger's disease Inflammatory thrombi affecting the medium and small vessels (nonatherosclerosis) polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be presen
Can help distinguish between thrombosis and embolus Where are arterial emboli often found? ---------CORRECT ANSWER---------- -------lower extremities more common than upper extremities The common femoral, common iliac, and popliteal artery bifurcations are frequent locations majority originate in the heart fun fact: Compared with thromboemboli, atheroemboli are less likely to produce symptoms of acute limb ischemia how would you work up a patient with treatment resistant hypertension that you suspect a secondary cause? ---------CORRECT ANSWER----------------- 24 - hour ambulatory monitoring (to ensure not white coat) medical hx (assess adherence to meds, other meds) physical exam (look for abominal/renal bruits) labs (electrolytes, glucose, creatinine, UA) If pheo suspected: measure fractionated metanephrines and catecholamines in a 24-hour urine collection other than atherosclerosis leading to renal artery stenosis and secondary HTN, what is another causes of a renal-associated secondary HTN? --------
- CORRECT ANSWER-----------------fibromuscular dysplasia (usually in a young pt) most important modifable risk factor for AAA? ---------CORRECT ANSWER- ----------------smoking cessation!
when is it okay to do screening survelliance for AAA rather than repair and how often should you screen? ---------CORRECT ANSWER-----------------if AAA is <5.5 cm then annual screening with US is recommended. may need every 6 months if rapidly expanding or other concerns how should you educate a patient with AAA on exercise? ---------CORRECT ANSWER-----------------Patients should be counseled that moderate physical activity such as running, biking, swimming, hiking, or sexual activity and activities such as gardening, golfing, and horseback riding do not precipitate AAA rupture Moderate physical therapy may also limit aneurysm expansion. In experimental aneurysms, increased aortic blood flow appears to inhibit AAA expansion However, heavy lifting, especially while holding the breath, and other activities that lead to Valsalva transiently induce significant increases in blood pressure and should be avoided gold standard for dx renal artery stenosis? what can be used to monitor disease progression? ---------CORRECT ANSWER-----------------renal arteriography But really a spiral CT angiography is very useful and probably more likely done first duplex doppler US can be used to monitor disease progression what are some symptoms of mitral valve prolapse syndrome? --------- CORRECT ANSWER-----------------various nonspecific symptoms such as palpitations, dyspnea, exercise intolerance, anxiety disorders, and dizziness
purplish, reddish blue, or dark brown/black macules, plaques, and nodules on the skin. Nodular lesions may ulcerate and bleed easily common in poorly controlled HIV how would you treat hidradenitis suppurativa? ---------CORRECT ANSWER-----------------topical clindamycin if fail topical therapy, oral tetracyclines are suggested Antiandrogenic drugs and metformin are additional treatment options that may be used alone or in conjunction with antibiotic therapy Pt with hypertriglyceridemia >885 mg/dL that required medical therapy due to no improvement after lifestyle changes and statin. how would you treat? ---------CORRECT ANSWER-----------------fenofibrate fenofibrate is better than gemfibrozil bc can be used with a statin. Gemfibrozil has a higher risk of muscle toxicity how would you initially treat a pt with hypertriglyceridemia? --------- CORRECT ANSWER-----------------lifestyle changes (reduce EtOH consumption, aerobic exercise, better glycemic control) and statin what causes subacute thyroiditis? ---------CORRECT ANSWER----------------
- presumed to be caused by a viral infection or a postviral inflammatory process. Many patients have a history of an upper respiratory infection prior to the onset of thyroiditis seasonal incidence (higher in summer)
Large-needle thyroid biopsies reveal widespread infiltration with neutrophils, lymphocytes, histiocytes and giant cells, disruption and collapse of thyroid follicles, and necrosis of thyroid follicular cells how is the diagnosis of subacute thyroiditis made? ---------CORRECT ANSWER-----------------clinical dx neck pain, thyroid tenderness suppressed TSH T3/T4 mildly elevated if clinical dx is not certain, US can be used to distinguish subacute from Graves. Graves has increased flow and subacute has decreased flow. FNA rarely needed/used what is the first step in evaluation of a suspected thyroid nodule? --------- CORRECT ANSWER-----------------US Apparent nodularity in Hashimoto's thyroiditis may represent focal enlargement from lymphocytic infiltrates, TSH-induced hyperplasia of follicular tissue, or a thyroid tumor. Ultrasonography may also help to distinguish among these possibilities what is the sonographic criteria for FNA of a thyroid nodule? --------- CORRECT ANSWER-----------------Bx regardless of size if: Subcapsular locations adjacent to the recurrent laryngeal nerve or trachea Extrathyroidal extension Extrusion through rim calcifications Associated with sonographically abnormal cervical lymph nodes Bx if > 1cm and: Irregular margins Microcalcifications Taller than wide shape
HSV-1 oral leads to gingivostomatitis. usually self limiting but treat if symptomatic. earlier the tx the better it works Pt has an acute onset of eye pain, vision blurring, and discharge. On physical exam you see dendritic lesions on the cornea. Dx? - -------- CORRECT ANSWER-----------------herpes simplex keratitis how is the dx of herpes simplex keratitis established? ---------CORRECT ANSWER-----------------mostly clinical Dx should be made in conjunction with an ophthalmologist if dx uncertain can use detection of viral DNA via PCR testing from intraocular fluid what is the best imaging for suspected ludwig's angina or other deep neck space infections? ---------CORRECT ANSWER-----------------CT is the imaging modality of choice Where does Ludwig angina infection most commonly arise from? --------- CORRECT ANSWER-----------------an infected second or third mandibular molar tooth infection moves to the sublingual and submaxillary space bilaterally aggressive, rapidly spreading cellulitis, WITHOUT lymphadenopathy Pt in ED is unresponsive and noted to be in ventricular fibrillation on the monitor. What interventions should be initiated? ---------CORRECT
ANSWER-----------------intervention: unsynchronized cardioversion, start CPR Pt is newly diagnosed with WPW. What is the intervention for the following:
- stable (wide complex) tachycardia
- unstable
- definitive ---------CORRECT ANSWER------------------stable: 1st line procainamide. Amiodarone
- unstable: synchronized cardioversion
- definitive: radio frequency catheter ablation criteria and therapeutics for hypertensive emergency? ---------CORRECT ANSWER-----------------SBP > 180 and/or DBP >120 WITH EVIDENCE OF END ORGAN DAMAGE sodium nitroprusside what are some topical agents that can be used for painful external hemorrhoids? ---------CORRECT ANSWER-----------------topical vasoactive agents: nitroglycerin (helpful for thrombosed), phenylephrine (aka prep H, relief for acute sx) topical corticosteroids for short term analgesic/inflammation relief - hydrocortisone (Anusol) local topical anesthetics for pain/pruritus (benzocaine, dibucaine) zinc oxide paste how would you treat symptomatic internal hemorrhoids? ---------CORRECT ANSWER-----------------rubber band ligation (cannot use on external hemorrhoids, extremely painful)
role of upper endoscopy in the diagnosis of spontaneous perforation is controversial, as both the endoscope and insufflation of air can extend the perforation and introduce air into the mediastinum who requires pre or postexposure prophylaxis for Hep A with vaccination? - --------CORRECT ANSWER-----------------childcare workers when confirmed a child has Hep A individuals with chronic liver disease individuals with HIV infection homeless individuals injectible drug users men who have sex with men infants under 12 mo should get immune globulin individuals traveling to an endemic area should receive vaccine prior to travel A week old infant presents with dyspnea. You hear a high-pitched harsh holosystolic murmur at the left lower sternal border. Whats the dx? --------- CORRECT ANSWER-----------------Ventricular septal defect What is thromboangiitis obliterates (Buerger's disease? ---------CORRECT ANSWER-----------------nonatherosclerotic inflammatory small/medium vessel vasculitis leading to vas occlusive phenomena. Suspect in young smokers with distal extremity ischemia/ischemic ulcers or gangrenous digits maculopapular rash starts on neck/trunk and spreads to face/ extremities. Affects children with sudden high fever. As fever resolves, rash appears ---- -----CORRECT ANSWER-----------------Roseola
Only childhood viral exanthem that starts on the trunk and spreads to the legs/neck ---------CORRECT ANSWER-----------------roseola diagnostic studies for thyroid nodule? ---------CORRECT ANSWER------------ -----Ultrasound - > thyroid uptake scan - > fine needle aspiration history and physical for hypoparathyroidism? ---------CORRECT ANSWER-- ---------------Patients will show signs of neuromuscular irritability with carpopedal spasm, laryngeal spasm, tingling, tetany, and facial grimacing. Chvostek's sign - Tap of facial nerve elicits cheek twitch Trousseau's sign - BP cuff inflation elicits carpal spasm name secretory products for various pituitary adenomas? --------- CORRECT ANSWER-----------------prolactinoma (galactorrhea)- prolactin Somatotroph Adenoma (Acromegaly) - growth hormone/ prolactin Corticotroph Adenoma (Cushing's Syndrome) - ACTH Thyrotroph Adenoma (Hyperthyroidism) - TSH Non Secreting Adenoma - α alpha - subunit What is Samter's triad? Treatment? ---------CORRECT ANSWER-------------- ---Aspirin- exacerbated respiratory disease. asthma, sinus disease with recurrent nasal polyps, and sensitivity to aspirin and other NSAIDs. Treatment: managing asthma symptoms, taking corticosteroids, and having nasal surgery to remove polyps therapeutics for otitis externa? ---------CORRECT ANSWER----------------- Bacterial: Ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4
