,PA Certification Confidence: 7th Ed.
Practice Quizbook
Based on A Comprehensive Review for the
Certification and Recertification
Examinations for PAs, 7th Edition
By Claire Babcock O’Connell & Thea
Cogan-Drew
“Your Ultimate PA Exam MCQ Workbook: All Chapters, All
Topics, Fully Explained”
“Ace the PANCE & PANRE: 7th Edition-Based Complete
Question Review Guide”
table of contents
1 Ophthalmology and Otolaryngology 2 Pulmonology
Disorders of the Eyes Infectious Disorders
Disorders of the Ears Neoplastic Diseases
Disorders of the Nose, Sinus, and Throat Obstructive Pulmonary Diseases
Pleural Diseases
Pulmonary Circulation
Restrictive Pulmonary Diseases
, 1 Ophthalmology and Otolaryngology 2 Pulmonology
Other Pulmonary Diseases
3 Cardiovascular Medicine 4 Hematology
Major Principles of Cardiac Care Red Cell Disorders
Hypertension White Cell Disorders
Heart Failure (HF) Lymphomas and Myeloma
Shock Platelet and Bleeding Disorders
Hypotension Thrombotic Disorders and Hypercoagulable Conditions
Atherosclerosis
Ischemic Heart Disease (Angina)
Acute Coronary Syndromes
Valvular Disorders
Cardiomyopathies
Congenital Heart Anomalies
Rate and Rhythm Disorders
Conduction Disturbances
Pericardial Disorders
Infective Endocarditis
Rheumatic Heart Disease
Peripheral Vascular Disorders
Giant Cell Arteritis
Aortic Aneurysms
5 Gastroenterology 6 Nephrology and Urology
Diseases of the Esophagus Renal Failure
Diseases of the Stomach Glomerular Disorders
Diseases of the Small Intestine and Colon Polycystic Kidney Disease
Diseases of the Rectum and Anus Nephrolithiasis
Appendicitis Disorders of Salt and Water
Diseases of the Pancreas Electrolyte Disorders
Diseases of the Biliary Tract Acid–Base Disorders
Diseases of the Liver Urinary Tract Infection
Hernias Benign Prostatic Hyperplasia (BPH)
Congenital Abnormalities Incontinence
Nutritional Deficiencies Neoplasms of the Urinary Tract
Metabolic Disorders Male Reproductive Disorders
, 7 Gynecology 8 Obstetrics
Menstrual Disorders Routine Prenatal Care and Prenatal Diagnostic Testing
Uterine Disorders High-Risk Pregnancy
Ovarian Disorders Complications of Pregnancy
Cervical Dysplasia and Neoplasia Labor and Delivery
Vaginal and Vulvar Neoplasms Puerperium
Breast Disorders
Contraceptive Methods
Infertility
Pelvic Inflammatory Disease
9 Rheumatology and Orthopedics (Musculoskeletal System) 10 Endocrinology
Arthritis/Rheumatologic Conditions Parathyroid Disorders
Bone and Joint Disorders Thyroid Disorders
Fractures, Dislocations, Sprains, and Strains Pituitary Gland
Disorders of the Head and Neck Diabetes Mellitus
Disorders of the Shoulder and Upper Extremity Hyperlipidemia
Disorders of the Back Adrenal Gland Disorders
Disorders of the Hip and Lower Extremity
11 Neurology 12 Psychiatry
Diagnosis of Neurologic Disorders Diagnosis of Psychiatric Disorders
Schizophrenia and Other Psychotic
Cerebrovascular Disease
Disorders
Seizure Disorders Somatic Symptom Disorders
Multiple Sclerosis Mood Disorders
Dementia Personality Disorders
Headache Anxiety Disorders
Movement Disorders Trauma- and Stressor-Related Disorders
Diseases of Peripheral Nerves Eating Disorders
Central Nervous System Infection Substance-Related and Addictive Disorders
Central Nervous System Trauma Childhood Disorders
Primary Central Nervous System
Abuse and Neglect
Neoplasms
Sleep Disorders Sexual Violence and Rape
Uncomplicated Bereavement
13 Dermatology 14 Infectious Disease
Diagnosis Fever
, 13 Dermatology 14 Infectious Disease
Maculopapular and Plaque Disorders Sepsis
Vesiculobullous Disorders Bacterial Infections
Papulopustular Inflammatory Disorders Viral Infections
Localized Skin Infections Fungal Infections
Dermatophytosis Parasitic Infections
Parasitic Infestations Sexually Transmitted Diseases
Warts (Verrucae) Tick-Borne Illnesses
Tumors
Ulcers, Burns, and Wounds
Hair and Nails
Pigmentation Disorders
Angioedema and Urticaria
15 Surgery 16 Geriatrics
Patient History Background
Preoperative Evaluation Patient Care
Selected Common Diseases and Disorders with Unique
Trauma
Features in the Elderly
Burns Legal, Ethical, and Financial Issues
Orthopedic Injuries
Postoperative Complications
Laparoscopic and Bariatric
Surgery
17 Pediatrics
Examination of the Newborn
Problems Common to the Term Newborn
Developmental Milestones and Disorders
Inborn Errors of Metabolism, Chromosomal Abnormalities, and Common Dysmorphic
Syndromes
Failure to Thrive, Growth Delay, and Selected Nutritional Disorders of Childhood
Immunization of Infants and Children
Common Pediatric Poisonings
Common Pediatric Disorders
Caring for the Adolescent
,Chapter 1: Ophthalmology and Otolaryngology (Disorders of
the Eyes; Disorders of the Ears; Disorders of the Nose, Sinus,
and Throat)
Disorders of the Eyes (1–12)
1. A 65-year-old diabetic patient complains of gradual,
painless, bilateral vision loss described as “blurry spots” in
the center of vision. Fundoscopy reveals microaneurysms,
hard exudates, and macular edema. Which intervention is
most appropriate to reduce risk of further vision loss?
A. Immediate cataract extraction
B. Intravitreal anti-VEGF injections
C. Topical corticosteroid drops
D. Peripheral panretinal photocoagulation
Correct Answer: B
Rationale: Central macular edema from diabetic
retinopathy responds best to anti-VEGF therapy to reduce
vascular permeability. Panretinal photocoagulation (D)
treats proliferative changes, not macular edema. Cataract
extraction and steroids are not first-line.
2. A 55-year-old reports halos around lights, ocular pain, and
headache. Examination shows mid-dilated nonreactive
pupil, corneal edema, and IOP 56 mm Hg. What’s the next
step?
A. Topical pilocarpine
B. Intravenous mannitol
C. Oral acetazolamide only
, D. Begin topical prostaglandin analog
Correct Answer: B
Rationale: Acute angle-closure glaucoma is an emergency:
IV mannitol to rapidly lower IOP, then pilocarpine once
pressure starts to fall. Acetazolamide is adjunctive;
prostaglandin analog is too slow.
3. A 4-year-old boy with Down syndrome has amblyopia risk.
On exam, one eye consistently turns inward. What is the
best next step?
A. Patch the unaffected eye
B. Prescribe plano lenses
C. Refer for strabismus surgery evaluation
D. Observe until age 6
Correct Answer: C
Rationale: Early strabismus surgery (by age 4–5) prevents
amblyopia. Patching alone (A) helps amblyopia but
underlying alignment needs correction. Observation risks
permanent vision loss.
4. A patient presents with red eye, gritty sensation, and
mucopurulent discharge. Conjunctival injection spares the
cornea. Which finding suggests bacterial conjunctivitis
over viral?
A. Tender preauricular lymphadenopathy
B. Matting of eyelids on awakening
C. Watery discharge
D. Subepithelial infiltrates
, Correct Answer: B
Rationale: Lid matting is classic for bacterial; viral often
has watery discharge and preauricular nodes. Subepithelial
infiltrates occur in adenoviral keratitis.
5. A 70-year-old complains of progressive peripheral vision
loss (“tunnel vision”) but normal central acuity. IOP is
elevated, and optic cup–disc ratio is increased. Which form
of glaucoma?
A. Primary open-angle glaucoma
B. Narrow‐angle glaucoma
C. Normal‐tension glaucoma
D. Uveitic glaucoma
Correct Answer: A
Rationale: Painless peripheral field loss with high IOP and
optic cupping describes primary open angle. Narrow‐angle
is acute; normal‐tension has normal IOP.
6. A 30-year-old with HIV has cotton-wool spots and
microaneurysms on retinal exam but no visual symptoms.
What is the recommended management?
A. Observation with quarterly eye exams
B. Immediate panretinal photocoagulation
C. Intravitreal antivirals
D. Oral ganciclovir
Correct Answer: A
Rationale: Asymptomatic nonproliferative HIV retinopathy
, requires observation; invasive therapy reserved for
proliferative changes or CMV retinitis (C, D).
7. A patient complains of sudden, painless monocular vision
loss described as “a curtain descending” followed by
persistent blindness. Fundoscopy shows a pale retina with
a “cherry-red spot.” Diagnosis?
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Retinal detachment
D. Optic neuritis
Correct Answer: A
Rationale: The classic cherry-red macula with pale retina
indicates arterial occlusion. Vein occlusion has
hemorrhages; detachment has floaters; neuritis is painful.
8. A 6-year-old fails vision screening. Cover test shows equal
movement of each eye when the other is covered.
Refractive exam shows +4.00 D hyperopia bilaterally.
What’s indicated?
A. Occlusion therapy
B. Corrective hyperopic glasses
C. Surgical correction
D. Cycloplegic drops only
Correct Answer: B
Rationale: High hyperopia causes accommodative
esotropia and amblyopia risk; glasses correct refraction.
Patching (A) only if amblyopia persists after correction.
, 9. A patient with long‐standing diabetes complains of new
floaters and blurred vision. Fundoscopy shows preretinal
hemorrhages and neovascularization. Best next step?
A. Grid laser photocoagulation
B. Panretinal photocoagulation
C. Intravitreal steroids
D. Observation
Correct Answer: B
Rationale: Proliferative diabetic retinopathy with
neovascularization requires panretinal photocoagulation
to regress vessels and prevent tractional detachment.
10. A 45-year-old complains of gradual difficulty reading
small print despite good distance vision. Exam reveals
decreased accommodation with normal lens clarity.
Diagnosis?
A. Presbyopia
B. Nuclear sclerotic cataract
C. Myopia
D. Early macular degeneration
Correct Answer: A
Rationale: Age‐related loss of accommodation causes
presbyopia; lens remains clear. Cataract blurs all vision;
myopia affects distance only.
11. A patient presents with itching, tearing, and redness
in both eyes associated with “cobblestone” papillae on
tarsal conjunctiva. What’s the most likely cause?
Practice Quizbook
Based on A Comprehensive Review for the
Certification and Recertification
Examinations for PAs, 7th Edition
By Claire Babcock O’Connell & Thea
Cogan-Drew
“Your Ultimate PA Exam MCQ Workbook: All Chapters, All
Topics, Fully Explained”
“Ace the PANCE & PANRE: 7th Edition-Based Complete
Question Review Guide”
table of contents
1 Ophthalmology and Otolaryngology 2 Pulmonology
Disorders of the Eyes Infectious Disorders
Disorders of the Ears Neoplastic Diseases
Disorders of the Nose, Sinus, and Throat Obstructive Pulmonary Diseases
Pleural Diseases
Pulmonary Circulation
Restrictive Pulmonary Diseases
, 1 Ophthalmology and Otolaryngology 2 Pulmonology
Other Pulmonary Diseases
3 Cardiovascular Medicine 4 Hematology
Major Principles of Cardiac Care Red Cell Disorders
Hypertension White Cell Disorders
Heart Failure (HF) Lymphomas and Myeloma
Shock Platelet and Bleeding Disorders
Hypotension Thrombotic Disorders and Hypercoagulable Conditions
Atherosclerosis
Ischemic Heart Disease (Angina)
Acute Coronary Syndromes
Valvular Disorders
Cardiomyopathies
Congenital Heart Anomalies
Rate and Rhythm Disorders
Conduction Disturbances
Pericardial Disorders
Infective Endocarditis
Rheumatic Heart Disease
Peripheral Vascular Disorders
Giant Cell Arteritis
Aortic Aneurysms
5 Gastroenterology 6 Nephrology and Urology
Diseases of the Esophagus Renal Failure
Diseases of the Stomach Glomerular Disorders
Diseases of the Small Intestine and Colon Polycystic Kidney Disease
Diseases of the Rectum and Anus Nephrolithiasis
Appendicitis Disorders of Salt and Water
Diseases of the Pancreas Electrolyte Disorders
Diseases of the Biliary Tract Acid–Base Disorders
Diseases of the Liver Urinary Tract Infection
Hernias Benign Prostatic Hyperplasia (BPH)
Congenital Abnormalities Incontinence
Nutritional Deficiencies Neoplasms of the Urinary Tract
Metabolic Disorders Male Reproductive Disorders
, 7 Gynecology 8 Obstetrics
Menstrual Disorders Routine Prenatal Care and Prenatal Diagnostic Testing
Uterine Disorders High-Risk Pregnancy
Ovarian Disorders Complications of Pregnancy
Cervical Dysplasia and Neoplasia Labor and Delivery
Vaginal and Vulvar Neoplasms Puerperium
Breast Disorders
Contraceptive Methods
Infertility
Pelvic Inflammatory Disease
9 Rheumatology and Orthopedics (Musculoskeletal System) 10 Endocrinology
Arthritis/Rheumatologic Conditions Parathyroid Disorders
Bone and Joint Disorders Thyroid Disorders
Fractures, Dislocations, Sprains, and Strains Pituitary Gland
Disorders of the Head and Neck Diabetes Mellitus
Disorders of the Shoulder and Upper Extremity Hyperlipidemia
Disorders of the Back Adrenal Gland Disorders
Disorders of the Hip and Lower Extremity
11 Neurology 12 Psychiatry
Diagnosis of Neurologic Disorders Diagnosis of Psychiatric Disorders
Schizophrenia and Other Psychotic
Cerebrovascular Disease
Disorders
Seizure Disorders Somatic Symptom Disorders
Multiple Sclerosis Mood Disorders
Dementia Personality Disorders
Headache Anxiety Disorders
Movement Disorders Trauma- and Stressor-Related Disorders
Diseases of Peripheral Nerves Eating Disorders
Central Nervous System Infection Substance-Related and Addictive Disorders
Central Nervous System Trauma Childhood Disorders
Primary Central Nervous System
Abuse and Neglect
Neoplasms
Sleep Disorders Sexual Violence and Rape
Uncomplicated Bereavement
13 Dermatology 14 Infectious Disease
Diagnosis Fever
, 13 Dermatology 14 Infectious Disease
Maculopapular and Plaque Disorders Sepsis
Vesiculobullous Disorders Bacterial Infections
Papulopustular Inflammatory Disorders Viral Infections
Localized Skin Infections Fungal Infections
Dermatophytosis Parasitic Infections
Parasitic Infestations Sexually Transmitted Diseases
Warts (Verrucae) Tick-Borne Illnesses
Tumors
Ulcers, Burns, and Wounds
Hair and Nails
Pigmentation Disorders
Angioedema and Urticaria
15 Surgery 16 Geriatrics
Patient History Background
Preoperative Evaluation Patient Care
Selected Common Diseases and Disorders with Unique
Trauma
Features in the Elderly
Burns Legal, Ethical, and Financial Issues
Orthopedic Injuries
Postoperative Complications
Laparoscopic and Bariatric
Surgery
17 Pediatrics
Examination of the Newborn
Problems Common to the Term Newborn
Developmental Milestones and Disorders
Inborn Errors of Metabolism, Chromosomal Abnormalities, and Common Dysmorphic
Syndromes
Failure to Thrive, Growth Delay, and Selected Nutritional Disorders of Childhood
Immunization of Infants and Children
Common Pediatric Poisonings
Common Pediatric Disorders
Caring for the Adolescent
,Chapter 1: Ophthalmology and Otolaryngology (Disorders of
the Eyes; Disorders of the Ears; Disorders of the Nose, Sinus,
and Throat)
Disorders of the Eyes (1–12)
1. A 65-year-old diabetic patient complains of gradual,
painless, bilateral vision loss described as “blurry spots” in
the center of vision. Fundoscopy reveals microaneurysms,
hard exudates, and macular edema. Which intervention is
most appropriate to reduce risk of further vision loss?
A. Immediate cataract extraction
B. Intravitreal anti-VEGF injections
C. Topical corticosteroid drops
D. Peripheral panretinal photocoagulation
Correct Answer: B
Rationale: Central macular edema from diabetic
retinopathy responds best to anti-VEGF therapy to reduce
vascular permeability. Panretinal photocoagulation (D)
treats proliferative changes, not macular edema. Cataract
extraction and steroids are not first-line.
2. A 55-year-old reports halos around lights, ocular pain, and
headache. Examination shows mid-dilated nonreactive
pupil, corneal edema, and IOP 56 mm Hg. What’s the next
step?
A. Topical pilocarpine
B. Intravenous mannitol
C. Oral acetazolamide only
, D. Begin topical prostaglandin analog
Correct Answer: B
Rationale: Acute angle-closure glaucoma is an emergency:
IV mannitol to rapidly lower IOP, then pilocarpine once
pressure starts to fall. Acetazolamide is adjunctive;
prostaglandin analog is too slow.
3. A 4-year-old boy with Down syndrome has amblyopia risk.
On exam, one eye consistently turns inward. What is the
best next step?
A. Patch the unaffected eye
B. Prescribe plano lenses
C. Refer for strabismus surgery evaluation
D. Observe until age 6
Correct Answer: C
Rationale: Early strabismus surgery (by age 4–5) prevents
amblyopia. Patching alone (A) helps amblyopia but
underlying alignment needs correction. Observation risks
permanent vision loss.
4. A patient presents with red eye, gritty sensation, and
mucopurulent discharge. Conjunctival injection spares the
cornea. Which finding suggests bacterial conjunctivitis
over viral?
A. Tender preauricular lymphadenopathy
B. Matting of eyelids on awakening
C. Watery discharge
D. Subepithelial infiltrates
, Correct Answer: B
Rationale: Lid matting is classic for bacterial; viral often
has watery discharge and preauricular nodes. Subepithelial
infiltrates occur in adenoviral keratitis.
5. A 70-year-old complains of progressive peripheral vision
loss (“tunnel vision”) but normal central acuity. IOP is
elevated, and optic cup–disc ratio is increased. Which form
of glaucoma?
A. Primary open-angle glaucoma
B. Narrow‐angle glaucoma
C. Normal‐tension glaucoma
D. Uveitic glaucoma
Correct Answer: A
Rationale: Painless peripheral field loss with high IOP and
optic cupping describes primary open angle. Narrow‐angle
is acute; normal‐tension has normal IOP.
6. A 30-year-old with HIV has cotton-wool spots and
microaneurysms on retinal exam but no visual symptoms.
What is the recommended management?
A. Observation with quarterly eye exams
B. Immediate panretinal photocoagulation
C. Intravitreal antivirals
D. Oral ganciclovir
Correct Answer: A
Rationale: Asymptomatic nonproliferative HIV retinopathy
, requires observation; invasive therapy reserved for
proliferative changes or CMV retinitis (C, D).
7. A patient complains of sudden, painless monocular vision
loss described as “a curtain descending” followed by
persistent blindness. Fundoscopy shows a pale retina with
a “cherry-red spot.” Diagnosis?
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Retinal detachment
D. Optic neuritis
Correct Answer: A
Rationale: The classic cherry-red macula with pale retina
indicates arterial occlusion. Vein occlusion has
hemorrhages; detachment has floaters; neuritis is painful.
8. A 6-year-old fails vision screening. Cover test shows equal
movement of each eye when the other is covered.
Refractive exam shows +4.00 D hyperopia bilaterally.
What’s indicated?
A. Occlusion therapy
B. Corrective hyperopic glasses
C. Surgical correction
D. Cycloplegic drops only
Correct Answer: B
Rationale: High hyperopia causes accommodative
esotropia and amblyopia risk; glasses correct refraction.
Patching (A) only if amblyopia persists after correction.
, 9. A patient with long‐standing diabetes complains of new
floaters and blurred vision. Fundoscopy shows preretinal
hemorrhages and neovascularization. Best next step?
A. Grid laser photocoagulation
B. Panretinal photocoagulation
C. Intravitreal steroids
D. Observation
Correct Answer: B
Rationale: Proliferative diabetic retinopathy with
neovascularization requires panretinal photocoagulation
to regress vessels and prevent tractional detachment.
10. A 45-year-old complains of gradual difficulty reading
small print despite good distance vision. Exam reveals
decreased accommodation with normal lens clarity.
Diagnosis?
A. Presbyopia
B. Nuclear sclerotic cataract
C. Myopia
D. Early macular degeneration
Correct Answer: A
Rationale: Age‐related loss of accommodation causes
presbyopia; lens remains clear. Cataract blurs all vision;
myopia affects distance only.
11. A patient presents with itching, tearing, and redness
in both eyes associated with “cobblestone” papillae on
tarsal conjunctiva. What’s the most likely cause?
