2025/2026 PAEA EOC /PAEA SUMMATIVE PRACTICE /PHYSICIAN ASSISTANT EXAM AND EOC ACTUAL QUESTIONS COMPLETE EXAM ALL 200 QUESTIONS AND WELL ELABORATED ANSWERS (CORRECT VERIFIED ANSWERS) A NEW UPDATED VERSION |GUARANTEED PASS + (BRAND NEW!!)

what exactly causes the occlusive vascular disease of thromboangiitis obliterans?

aka Buerger's disease

inflammatory thrombi affecting the medium and small vessels (nonatherosclerosis)

polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be presen

Treatment options for thromboangiitis obliterans?

smoking cessation most important!

cilostazol (PDE 3 inhibitor) has vasodilator properties (alleviated symptoms)

if raynauds also present, CCB (nifedipine)

what heart failure treatment provides a benefit of reduction in morbidity and mortality?

ACE inhibitors

beta blockers can also reduce M&M

diuretics have no reduction in mortality

how would you manage a patient with a MI in the setting of cocaine use?

benzodiazepine early

no beta blockers

If PCI cannot be done for a STEMI patient within 120 minutes, what should be done?

fibrolytic therapy

then do PCI & coronary angiography when it can be done

ideally PCI is done within 90 minutes

fibrolytic therapy can be used up to 12 hours of symptoms

If you suspect an acute limb ischemia due to arterial embolism, what imaging should you get?

catheter-based arteriography (digital subtraction arteriography) provides the most useful information. can also help with treatment

can help distinguish between thrombosis and embolus

where are arterial emboli often found?

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?

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?

fibromuscular dysplasia (usually in a young pt)

most important modifable risk factor for AAA?

smoking cessation!

when is it okay to do screening survelliance for AAA rather than repair and how often should you screen?

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?

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?

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?

various nonspecific symptoms such as palpitations, dyspnea, exercise intolerance, anxiety disorders, and dizziness

since symptoms are relatively uncommon, what physical exam findings are associated with mitral valve prolapse?

non-ejection click in systole

click is mobile, meaning its timing varies with maneuvers that change the left ventricular volume, occurring earlier in systole with sitting, standing, or other interventions that reduce ventricular size, or later with those interventions that increase chamber size such as squatting

People with MVP tend to have lower BMIs

how would you distinguish vasospastic angina and angina associated with CAD?

quality of the CP is typically indistinguishable of the two

patients with vasospastic angina report that their episodes are predominantly at rest and that many occur from midnight to early morning, while effort tolerance is usually preserved. CP generally lasts 5 to 15 minutes

Patients with vasospastic angina are often younger and exhibit fewer classic cardiovascular risk factors and may be associated with other vasospastic disorders, such as Raynaud's phenomenon and migraine headache

Exercise does not usually provoke an episode of spasm

ECG may reveal transient ST-segment elevation or depression in multiple lead but troponins will not be elevated

where do karposi sarcoma lesions typically occur? describe their appearance.

often on distal extremities, such as lower legs and feet

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?

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?

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?

lifestyle changes (reduce EtOH consumption, aerobic exercise, better glycemic control) and statin

what causes subacute thyroiditis?

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?

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?

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?

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

Rim calcifications with extrusion of soft tissue

what makes up aspirin exacerbated respiratory disease (or NSAID-exacerbated respiratory disease)?

asthma, chronic rhinosinusitis (CRS) with nasal polyposis, and acute upper and lower respiratory tract reactions

symptoms of nasal congestion and bronchoconstriction typically begin 20 minutes to 3 hours after administration

what type of allergy is aspirin exacerbated respiratory diseaase (AERD)?

pseudoallergy, not IgE mediated

In contrast, IgE-mediated "allergic" reactions result from the formation of antibodies against a specific drug, haptenated drug, or a group of structurally similar drugs

how would you treat otitis externa? what if the TM is perforated?

mild disease - topical acetic acid + hydrocortisone

moderate disease - topical abx + steroid to cover staph and pseudomonas (first line consider quinolones (cipro) or polymyxin-neomycin to cover both)

Preparations containing aminoglycosides should be avoided in ears where the integrity of the tympanic membrane cannot be confirmed

Treatment approach to HSV-1?

Acyclovir has the greatest in vitro activity against HSV-1 and HSV-2. However, famciclovir and valacyclovir have greater oral bioavailability than acyclovir and are dosed less frequently

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?

herpes simplex keratitis

how is the dx of herpes simplex keratitis established?

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?

CT is the imaging modality of choice

Where does Ludwig angina infection most commonly arise from?

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?

intervention: unsynchronized cardioversion, start CPR

Pt is newly diagnosed with WPW. What is the intervention for the following:

-stable (wide complex) tachycardia

-unstable

-definitive

-stable: 1st line procainamide. Amiodarone

-unstable: synchronized cardioversion

-definitive: radio frequency catheter ablation

criteria and therapeutics for hypertensive emergency?

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?

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?

rubber band ligation (cannot use on external hemorrhoids, extremely painful)

sclerotherapy (phenol 5%)

conservative treatment options for hemorrhoids

diet (increased insoluble fiber intake, drink more water)

regular exercise

avoid straining

Sitz baths

stool softeners (docusate)

what vessel is most commonly involved in acute mesenteric ischemia?

SMA (superior mesenteric a.)

Pt with a hx of HTN and PAD presents with acute abdominal pain out of proportion to PE with N/V. Pt denies bloody BMs. EKG shows atrial fibrillation. Your suspicions are confirmed with CT angiography. Dx?

acute mesenteric ischemia

how would you manage a pt with acute mesenteric ischemia?

NPO

fluid therapy

avoid vasopressors

anticoagulation (LMWH)

endovascular intervention vs. surgery

what imaging is used to establish the dx of esophageal rupture (borhaave syndrome)?

contrast esophagram or computed tomography (CT) scan

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?

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 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?

cirrhosis

other common s&sx include pruritus, jaundice, amenorrhea (women), hepato/splenomegaly, spider angiomata

what sx of cirrhosis suggest advanced disease?

asterixis, jaundice, confusion, sleep disturbances, ascites

what lab abnormalities are seen with cirrhosis?

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?

Adenosine (if symptomatic)

BB/CCB (if regular)

radiofrequency ablation (definitive)

(if WPW do NOT give adenosine or CCB)

clinical manifestations of arterial embolism?

6 Ps - paresthesias, pain, pulselessness, poikilothermic, paralysis

Workup for acute arterial occlusion?

arterial doppler to check pulses

CT angiography

Describe ECHO findings for a patient with HOCM

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?

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?

primary aldosteronism

Management for AAA based on diameter of aorta?

-No further testing if aorta < 3.0 cm diameter

-Repeat US yearly if aorta 3.0 - 4.4 cm

-Repeat US every 6 months if aorta 4.5 - 5.0 cmReferral to vascular surgery at this stage

-Repeat US every 3 months if aorta 5-5.4 cm

> 5.5 or > 0.5 cm expansion in 6 months - Immediate surgical repair (even if asymptomatic)

Name the murmur: non-radiating, high-pitched, mid-systolic ejection click heard at apex

mitral prolapse

Pt describes angina occurring at rest, usually occurs at night or early morning. What's the dx?

Prinztmetal angina

A week old infant presents with dyspnea. You hear a high-pitched harsh holosystolic murmur at the left lower sternal border. Whats the dx?

Ventricular septal defect

What is thromboangiitis obliterates (Buerger's disease?

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

Roseola

Only childhood viral exanthem that starts on the trunk and spreads to the legs/neck

roseola

diagnostic studies for thyroid nodule?

Ultrasound -> thyroid uptake scan -> fine needle aspiration

history and physical for hypoparathyroidism?

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?

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?

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?

Bacterial: Ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID × 7 days or ofloxacin: 0.3% solution 10 drops once a day × 7 days

Fungal: % acetic acid 3-4 drops QID; clotrimazole 1% solution

Pt presents with eye pain. On fluorescein stain, you see dendritic lesions. what's the dx?

herpes simplex virus keratitis

What is hairy oral leukoplakia?

an Epstein-Barr virus-induced lesion that is not premalignant disorder that occurs almost entirely in HIV infected patients

When is it appropriate to prescribe antidiarrheals? When is it not appropriate?

Can use for patients with watery diarrhea and no signs of systemic toxicity.

Do NOT use in bloody diarrhea of unknown cause.

Describe Virchow's node

left supraclavicular lymphadenopathy is often associated with gastric cancer

What is Gilbert's syndrome?

unconjugated hyperbilirubinemia. usually asymptomatic aside from jaundice

which anemia commonly has neurologic symptoms?

B12 deficient anemia

what type of anemia is common among alcoholics?

folate deficiency anemia

what is the mechanism of hypercoagulability with factor V Leiden mutation?

Mutated factor V resistant to breakdown by activated Protein C

treatment for salmonellosis?

ceftriaxone 1 G IM, ciprofloxacin 500 mg po bid for 10 to 14 days, levofloxacin 500 mg po or IV once/day for 14 days

how to dx histoplasmosis?

culture gold standard

fungal staining for quicker/less sensitive results

test for antigen and antibodies

therapeutic options for postherpetic neuralgia?

Gabapentin or TCA, topical lidocaine gel, capsaicin

describe the epidemiology of neurocysticercosis

Cysticercosis is transmitted by ingestion of T. solium eggs shed in the stool of a human tapeworm carrier. Following ingestion, embryos (oncospheres) hatch in the small intestine, invade the bowel wall, and disseminate hematogenously to brain, muscles, and/or other tissues. One becomes a carrier by ingestion of Taenia solium eggs, often found in infected pork.

clinical intervention for premenstrual syndrome?

exercise, stress reduction, SSRI (Can be administered as continuous daily therapy or may be used cyclically 2 weeks prior to the menstrual cycle), OCP (Start with a 3 mg drospirenone (DRSP)/20 mcg ethinyl estradiol (EE) COC (Yazmin) with a four-day pill-free interval as the first-line pill)

Vaginal discharge with PH greater than 4.5 suggests what diagnosis?

Bacterial vaginosis

clinical therapeutics for osteoporosis

calcium (1200 - 1500 mg/day), vitamin D (800 - 1000 IU/day), bisphosphonates, Teriparatide

labs and testing to diagnose compartment syndrome?

compartment pressure > 30-45 mmHg (Delta pressure = diastolic BP - measure compartment pressure.) increased CK and myoglobin

What is the Budapest consensus criteria? what is it used to diagnose?

used to diagnose complex regional pain syndrome.

- continuing pain, which is disproportionate to any inciting event

- patient must report at least one symptom in three of the following four categories:

--Sensory: Reports of hyperesthesia and/or allodynia

--Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry

--Sudomotor/edema: Reports of edema and/or sweating changes and/or sweating asymmetry

--Motor/trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

physical exam and lab findings for polymyositis?

proximal symmetric bilateral muscle weakness and pain, early fatigue while walking, inability to rise from seated position.

↑ Muscle enzymes: ↑ aldolase, creatine kinase (CK); ↑ ESR, (+) muscle biopsy, abnormal EMG, ↑ AST, ALT, and LDH

with anterior humeral dislocation, how is the arm positioned?

abducted and externally rotated

symptoms of axillary nerve injury?

numbness/tingling over lateral shoulder

(axillary nerve: C5-C6 fibers. Motor: deltoid, teres minor, triceps. Sensation: shoulder joint, inferior deltoid)

(Musculocutaneous nerve: C5-C7 fibers. Motor: coracobrachialis, biceps, brachialis. Sensory: radial side forearm. Decreased biceps reflex)

5 principles for treatment of serotonin syndrome?

1. Discontinuation of all serotonergic agents, 2. Supportive care aimed at normalization of vital signs,

3. Sedation with benzodiazepines,

4. Administration of serotonin antagonists, 5. Assessment of the need to resume use of causative serotonergic agents after resolution of symptoms

mechanism of action of stimulants (methamphetamines, dextroamphetamine, cocaine, and methylphenidate)?

block amine (dopamine, norepinephrine & 5HT) reuptake

symptoms of stimulant intoxication?

mydriasis (pupillary dilation), hyperactivity, euphoria, perspiration, hyperactivity, excessive talking followed by depression, go long periods without eating or sleeping, weight loss, dry mouth and nose bleeding, septal perforation, hallucinations, paranoia

diagnostics when viral pneumonia is suspected?

CXR -> bilateral interstitial infiltrates, rapid antigen test for flu, RSV nasal swab, cold agglutinin titer that is negative

what are two primary risk factors for development and progression of diabetic retinopathy?

duration of diabetes

level of glycemic control

Good glycemic control is the primary preventive measure. Diabetic retinopathy occurs exclusively in the setting of hyperglycemia

besides glucose control, what are some other measures to help reduce the incidence of diabetic retinopathy?

blood pressure control

Statin therapy for dyslipidemia

when does nystagmus occur in the Dix Hallpike manuever in a pt with BPPV? how would you describe the eye movement?

when the pt is laid back the nystagmus and vertigo typically occur a few seconds later and lasts less than 30 seconds

Nystagmus direction depends on the canal involved. Posterior and anterior canals typically have a torsional aspect

what are some symptoms commonly associated with anemia related to B12/folate deficiency?

shortness of breath & CP (severe anemia), fatigue, irritability, cognitive decline, palpitations, pallor

what are some GI tract sx associated with B12 and folate deficiencies?

B12 - glossitis (including pain, swelling, tenderness, and loss of papillae of the tongue)

folate - oral ulcers

what serum level can help differentiate folate from B12 deficiency?

elevated homocysteine with a normal MMA (methylmalonic acid)

both elevated homocysteine and MMA is a B12 deficiency, but additional folate deficiency cannot be ruled out

what is factor V's role in the clotting cascade?

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?

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?

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?

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)

< 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

S. pneumoniae followed by N. meningitidis