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PHYSICIAN ASSISTANT EDUCATION ASSOCIATION (PAEA) END OF
CURRICULUM (EOC) EXAM QUESTIONS WITH DETAILED- VERIFIED
ANSWERS- ALREADY GRADED A+ || NEWEST EXAM
Physician Assistant (Pa) Education / Clinical Medicine
• Clinical Vignette Format: All questions are presented as patient
scenarios (vignettes) that assess clinical reasoning, diagnostic
skills, and management decisions, mirroring the actual EOC exam
format.
• High-Yield Topics: Covers the most frequently tested conditions,
including heart failure, STEMI, stroke, COPD, pneumonia, diabetes,
thyroid disorders, depression, anxiety, and rheumatoid arthritis.
• Evidence-Based Management: Questions reflect current guidelines
(ACC/AHA, GOLD, ADA, NCCN, etc.) and standard-of-care
practices.
• Comprehensive Clinical Scope: Includes diagnostics,
pharmacotherapy, surgical indications, preventive care, and
patient education across all major medical specialties.
• Troubleshooting and Emergency Recognition: Many questions
require identifying life-threatening conditions (e.g., testicular
torsion, ectopic pregnancy, septic arthritis, bacterial meningitis)
and initiating appropriate emergency management.
• RATIONALE for Deep Learning: Every answer includes a scholarly
explanation of the correct choice and why the distractors are
incorrect, reinforcing the "why" behind clinical decisions.
• Certification Readiness: The difficulty and style are calibrated to
the EOC and PANCE level, making this an ideal self-assessment
tool for PA students preparing for summative evaluations and
national certification.
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• No Niche Specialisation: The exam covers broad clinical medicine
expected of an entry-level physician assistant, without diving into
subspecialty or research-level content
Questions
Q1. A 58-year-old male with a 35-pack-year smoking history presents
with progressive dyspnoea on exertion, orthopnoea, and peripheral
oedema. His blood pressure is 148/92 mmHg, heart rate 88 bpm, and
respiratory rate 20/min. Jugular venous pressure is elevated at 12 cm
H₂O, and auscultation reveals an S₃ gallop. His ejection fraction is 35%
on echocardiography. He has a history of hypertension and type 2
diabetes. Which of the following medication combinations provides the
greatest mortality benefit and is considered first-line therapy for his
condition according to current guideline-directed medical therapy?
A. Amlodipine 5 mg daily and metoprolol tartrate 25 mg twice daily –
amlodipine is not a first-line agent for heart failure with reduced ejection
fraction; metoprolol tartrate is not the preferred beta-blocker
formulation.
B. Sacubitril/valsartan 49/51 mg twice daily, bisoprolol 2.5 mg daily, and
spironolactone 25 mg daily ✔️ – sacubitril/valsartan (an ARNI) has
been shown to reduce cardiovascular death and heart failure
hospitalisation compared to enalapril; bisoprolol (a beta-blocker with
evidence in HFrEF) and spironolactone (a mineralocorticoid receptor
antagonist) are guideline-recommended foundational therapies.
C. Lisinopril 20 mg daily, carvedilol 6.25 mg twice daily, and furosemide
40 mg daily – while ACE inhibitors and beta-blockers are foundational,
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ARNI is preferred over ACE inhibitors in patients who can tolerate it, and
furosemide provides symptomatic relief but does not improve mortality.
D. Hydralazine 25 mg three times daily and isosorbide dinitrate 20 mg
three times daily – this combination is indicated as add-on therapy in
African American patients with HFrEF, not as first-line for all patients.
RATIONALE: The patient has heart failure with reduced ejection fraction
(HFrEF). Current guideline-directed medical therapy (GDMT) includes an
ARNI (sacubitril/valsartan), a beta-blocker with mortality benefit
(bisoprolol, carvedilol, or metoprolol succinate), and a mineralocorticoid
receptor antagonist (spironolactone). Loop diuretics are used for volume
management but do not confer mortality benefit. Hydralazine/nitrates
are reserved for specific populations.
Q2. A 72-year-old female with a history of hypertension and
hyperlipidaemia presents to the emergency department with acute onset
of substernal chest pressure that radiates to her left arm, accompanied
by diaphoresis and nausea. Her initial ECG shows ST-segment elevation
in leads V1–V4. Her blood pressure is 110/70 mmHg, and heart rate is 92
bpm. She is immediately given aspirin and nitroglycerin. Which of the
following is the most appropriate definitive management strategy within
the first 90 minutes of presentation?
A. Administer intravenous thrombolytic therapy with tenecteplase –
thrombolytics are indicated if percutaneous coronary intervention (PCI)
cannot be performed within 120 minutes of first medical contact.
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B. Emergent percutaneous coronary intervention (PCI) of the culprit
vessel ✔️ – for STEMI, primary PCI is the preferred reperfusion strategy
if it can be performed within 90 minutes of first medical contact; door-to-
balloon time should be ≤90 minutes.
C. Initiate dual antiplatelet therapy with ticagrelor and observe for 24
hours – medical management alone is insufficient for STEMI; urgent
revascularisation is required.
D. Perform coronary artery bypass grafting (CABG) – CABG is not the first-
line treatment for acute STEMI; it is reserved for specific anatomical
findings or failed PCI.
RATIONALE: ST-segment elevation myocardial infarction (STEMI)
requires immediate reperfusion. Primary PCI is the gold standard with a
goal door-to-balloon time of ≤90 minutes. Thrombolytics are used if PCI
is not available within 120 minutes. CABG is not an acute reperfusion
strategy for STEMI.
Q3. A 45-year-old male with no significant past medical history presents
with episodic palpitations, light-headedness, and diaphoresis. He
reports that these episodes are associated with headaches and occur
after eating. His blood pressure during an episode is 190/110 mmHg,
and heart rate is 110 bpm. Between episodes, his blood pressure is
130/80 mmHg. Laboratory studies reveal elevated plasma
metanephrines. Which of the following is the most appropriate initial
management step?
PHYSICIAN ASSISTANT EDUCATION ASSOCIATION (PAEA) END OF
CURRICULUM (EOC) EXAM QUESTIONS WITH DETAILED- VERIFIED
ANSWERS- ALREADY GRADED A+ || NEWEST EXAM
Physician Assistant (Pa) Education / Clinical Medicine
• Clinical Vignette Format: All questions are presented as patient
scenarios (vignettes) that assess clinical reasoning, diagnostic
skills, and management decisions, mirroring the actual EOC exam
format.
• High-Yield Topics: Covers the most frequently tested conditions,
including heart failure, STEMI, stroke, COPD, pneumonia, diabetes,
thyroid disorders, depression, anxiety, and rheumatoid arthritis.
• Evidence-Based Management: Questions reflect current guidelines
(ACC/AHA, GOLD, ADA, NCCN, etc.) and standard-of-care
practices.
• Comprehensive Clinical Scope: Includes diagnostics,
pharmacotherapy, surgical indications, preventive care, and
patient education across all major medical specialties.
• Troubleshooting and Emergency Recognition: Many questions
require identifying life-threatening conditions (e.g., testicular
torsion, ectopic pregnancy, septic arthritis, bacterial meningitis)
and initiating appropriate emergency management.
• RATIONALE for Deep Learning: Every answer includes a scholarly
explanation of the correct choice and why the distractors are
incorrect, reinforcing the "why" behind clinical decisions.
• Certification Readiness: The difficulty and style are calibrated to
the EOC and PANCE level, making this an ideal self-assessment
tool for PA students preparing for summative evaluations and
national certification.
, Page 2 of 130
• No Niche Specialisation: The exam covers broad clinical medicine
expected of an entry-level physician assistant, without diving into
subspecialty or research-level content
Questions
Q1. A 58-year-old male with a 35-pack-year smoking history presents
with progressive dyspnoea on exertion, orthopnoea, and peripheral
oedema. His blood pressure is 148/92 mmHg, heart rate 88 bpm, and
respiratory rate 20/min. Jugular venous pressure is elevated at 12 cm
H₂O, and auscultation reveals an S₃ gallop. His ejection fraction is 35%
on echocardiography. He has a history of hypertension and type 2
diabetes. Which of the following medication combinations provides the
greatest mortality benefit and is considered first-line therapy for his
condition according to current guideline-directed medical therapy?
A. Amlodipine 5 mg daily and metoprolol tartrate 25 mg twice daily –
amlodipine is not a first-line agent for heart failure with reduced ejection
fraction; metoprolol tartrate is not the preferred beta-blocker
formulation.
B. Sacubitril/valsartan 49/51 mg twice daily, bisoprolol 2.5 mg daily, and
spironolactone 25 mg daily ✔️ – sacubitril/valsartan (an ARNI) has
been shown to reduce cardiovascular death and heart failure
hospitalisation compared to enalapril; bisoprolol (a beta-blocker with
evidence in HFrEF) and spironolactone (a mineralocorticoid receptor
antagonist) are guideline-recommended foundational therapies.
C. Lisinopril 20 mg daily, carvedilol 6.25 mg twice daily, and furosemide
40 mg daily – while ACE inhibitors and beta-blockers are foundational,
, Page 3 of 130
ARNI is preferred over ACE inhibitors in patients who can tolerate it, and
furosemide provides symptomatic relief but does not improve mortality.
D. Hydralazine 25 mg three times daily and isosorbide dinitrate 20 mg
three times daily – this combination is indicated as add-on therapy in
African American patients with HFrEF, not as first-line for all patients.
RATIONALE: The patient has heart failure with reduced ejection fraction
(HFrEF). Current guideline-directed medical therapy (GDMT) includes an
ARNI (sacubitril/valsartan), a beta-blocker with mortality benefit
(bisoprolol, carvedilol, or metoprolol succinate), and a mineralocorticoid
receptor antagonist (spironolactone). Loop diuretics are used for volume
management but do not confer mortality benefit. Hydralazine/nitrates
are reserved for specific populations.
Q2. A 72-year-old female with a history of hypertension and
hyperlipidaemia presents to the emergency department with acute onset
of substernal chest pressure that radiates to her left arm, accompanied
by diaphoresis and nausea. Her initial ECG shows ST-segment elevation
in leads V1–V4. Her blood pressure is 110/70 mmHg, and heart rate is 92
bpm. She is immediately given aspirin and nitroglycerin. Which of the
following is the most appropriate definitive management strategy within
the first 90 minutes of presentation?
A. Administer intravenous thrombolytic therapy with tenecteplase –
thrombolytics are indicated if percutaneous coronary intervention (PCI)
cannot be performed within 120 minutes of first medical contact.
, Page 4 of 130
B. Emergent percutaneous coronary intervention (PCI) of the culprit
vessel ✔️ – for STEMI, primary PCI is the preferred reperfusion strategy
if it can be performed within 90 minutes of first medical contact; door-to-
balloon time should be ≤90 minutes.
C. Initiate dual antiplatelet therapy with ticagrelor and observe for 24
hours – medical management alone is insufficient for STEMI; urgent
revascularisation is required.
D. Perform coronary artery bypass grafting (CABG) – CABG is not the first-
line treatment for acute STEMI; it is reserved for specific anatomical
findings or failed PCI.
RATIONALE: ST-segment elevation myocardial infarction (STEMI)
requires immediate reperfusion. Primary PCI is the gold standard with a
goal door-to-balloon time of ≤90 minutes. Thrombolytics are used if PCI
is not available within 120 minutes. CABG is not an acute reperfusion
strategy for STEMI.
Q3. A 45-year-old male with no significant past medical history presents
with episodic palpitations, light-headedness, and diaphoresis. He
reports that these episodes are associated with headaches and occur
after eating. His blood pressure during an episode is 190/110 mmHg,
and heart rate is 110 bpm. Between episodes, his blood pressure is
130/80 mmHg. Laboratory studies reveal elevated plasma
metanephrines. Which of the following is the most appropriate initial
management step?
