California Physician Assistant Licensing
Examination with Practice Questions And
Correct
1. A patient with decompensated heart failure and a serum potassium of 6.8 mEq/L is
given intravenous calcium gluconate, insulin with dextrose, and sodium bicarbonate.
Which subsequent intervention most directly enhances potassium elimination?
A. Hemodialysis
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide
D. Albuterol nebulization
Answer: A. Hemodialysis
Rationale: Hemodialysis is the definitive therapy for severe hyperkalemia with renal failure
or life-threatening arrhythmias, removing potassium directly from the body.
Insulin/dextrose and bicarbonate shift potassium intracellularly but do not eliminate it.
Sodium polystyrene and furosemide have delayed or limited efficacy in acute severe
hyperkalemia.
2. Which mechanism best explains the increased bleeding risk when fluconazole is
co-administered with warfarin?
A. Fluconazole induces CYP2C9, reducing warfarin levels
B. Fluconazole inhibits CYP2C9, increasing warfarin levels
C. Fluconazole displaces warfarin from albumin
D. Fluconazole enhances platelet aggregation
Answer: B. Fluconazole inhibits CYP2C9, increasing warfarin levels
Rationale: Fluconazole is a potent inhibitor of CYP2C9, the enzyme primarily responsible
for metabolizing S-warfarin, leading to increased warfarin concentrations and elevated
INR. Displacement from albumin is clinically minor. Induction would decrease warfarin
effect, and fluconazole does not enhance platelet aggregation.
Page 1 of 75
,3. In California, a PA who has completed 10 years of practice under a supervising
physician may prescribe Schedule II controlled substances without a patient-specific
approval if:
A. The PA obtains a DEA registration and practices in a primary care setting
B. The supervising physician delegates the authority in a written practice agreement
C. The PA has completed a postgraduate residency program
D. The PA practices in a federally qualified health center
Answer: B. The supervising physician delegates the authority in a written practice
agreement
Rationale: California law permits PAs to prescribe Schedule II medications if the
supervising physician delegates this authority in a written practice agreement, and the PA
has a DEA number. Residency or practice setting alone does not confer this authority. A
DEA registration is necessary but not sufficient without the written delegation.
4. A 24-hour urine collection in a patient with recurrent calcium oxalate stones shows
hypercalciuria (320 mg/24h). Which dietary modification is most effective in reducing
stone recurrence?
A. Low-calcium diet (<400 mg/day)
B. High-sodium diet to increase fluid intake
C. Normal calcium intake with reduced sodium and oxalate
D. High-protein diet to acidify urine
Answer: C. Normal calcium intake with reduced sodium and oxalate
Rationale: A normal calcium intake (1000-1200 mg/day) binds dietary oxalate and reduces
oxalate absorption, while sodium restriction decreases urinary calcium excretion.
Low-calcium diets increase oxalate absorption and stone risk. High sodium and high
protein increase calciuria and stone formation.
Page 2 of 75
,5. A patient with major depressive disorder has failed two adequate trials of SSRIs.
Which augmentation strategy has the strongest evidence for improving remission
rates?
A. Adding buspirone
B. Adding aripiprazole
C. Adding thyroid hormone
D. Adding lithium
Answer: B. Adding aripiprazole
Rationale: Aripiprazole augmentation has robust randomized controlled trial evidence for
treatment-resistant depression and is FDA-approved for this indication. Buspirone has
weaker evidence. Thyroid hormone and lithium are older strategies with less consistent
efficacy and greater toxicity.
6. A 6-month-old infant presents with a 3-day history of fever, cough, and wheezing.
Which finding best distinguishes bronchiolitis from asthma?
A. Presence of tachypnea
B. Response to bronchodilators
C. Diffuse wheezing on auscultation
D. History of atopy
Answer: B. Response to bronchodilators
Rationale: Bronchiolitis typically does not respond to bronchodilators, whereas asthma
often does. Tachypnea and wheezing occur in both. A history of atopy is more common in
asthma but not diagnostic. The lack of bronchodilator response is a key differentiator in
this age group.
Page 3 of 75
, 7. Which electrocardiographic finding is most specific for hyperkalemia?
A. Peaked T waves
B. Prolonged QT interval
C. ST-segment elevation
D. U waves
Answer: A. Peaked T waves
Rationale: Peaked T waves are a classic and relatively specific early ECG sign of
hyperkalemia, reflecting altered repolarization. Prolonged QT and U waves suggest
hypokalemia. ST elevation indicates ischemia or injury. Peaked T waves are more specific
than other findings in hyperkalemia.
8. A 45-year-old man presents with sudden onset of severe abdominal pain and
distension. CT shows free air under the diaphragm. Which initial management step is
most appropriate?
A. Immediate laparotomy
B. Broad-spectrum antibiotics and observation
C. Nasogastric decompression and IV fluids
D. Upper endoscopy
Answer: A. Immediate laparotomy
Rationale: Free air under the diaphragm indicates perforated viscus, a surgical emergency
requiring immediate exploratory laparotomy. Antibiotics and decompression are
supportive but not definitive. Endoscopy is contraindicated as it may worsen perforation.
Page 4 of 75
Examination with Practice Questions And
Correct
1. A patient with decompensated heart failure and a serum potassium of 6.8 mEq/L is
given intravenous calcium gluconate, insulin with dextrose, and sodium bicarbonate.
Which subsequent intervention most directly enhances potassium elimination?
A. Hemodialysis
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide
D. Albuterol nebulization
Answer: A. Hemodialysis
Rationale: Hemodialysis is the definitive therapy for severe hyperkalemia with renal failure
or life-threatening arrhythmias, removing potassium directly from the body.
Insulin/dextrose and bicarbonate shift potassium intracellularly but do not eliminate it.
Sodium polystyrene and furosemide have delayed or limited efficacy in acute severe
hyperkalemia.
2. Which mechanism best explains the increased bleeding risk when fluconazole is
co-administered with warfarin?
A. Fluconazole induces CYP2C9, reducing warfarin levels
B. Fluconazole inhibits CYP2C9, increasing warfarin levels
C. Fluconazole displaces warfarin from albumin
D. Fluconazole enhances platelet aggregation
Answer: B. Fluconazole inhibits CYP2C9, increasing warfarin levels
Rationale: Fluconazole is a potent inhibitor of CYP2C9, the enzyme primarily responsible
for metabolizing S-warfarin, leading to increased warfarin concentrations and elevated
INR. Displacement from albumin is clinically minor. Induction would decrease warfarin
effect, and fluconazole does not enhance platelet aggregation.
Page 1 of 75
,3. In California, a PA who has completed 10 years of practice under a supervising
physician may prescribe Schedule II controlled substances without a patient-specific
approval if:
A. The PA obtains a DEA registration and practices in a primary care setting
B. The supervising physician delegates the authority in a written practice agreement
C. The PA has completed a postgraduate residency program
D. The PA practices in a federally qualified health center
Answer: B. The supervising physician delegates the authority in a written practice
agreement
Rationale: California law permits PAs to prescribe Schedule II medications if the
supervising physician delegates this authority in a written practice agreement, and the PA
has a DEA number. Residency or practice setting alone does not confer this authority. A
DEA registration is necessary but not sufficient without the written delegation.
4. A 24-hour urine collection in a patient with recurrent calcium oxalate stones shows
hypercalciuria (320 mg/24h). Which dietary modification is most effective in reducing
stone recurrence?
A. Low-calcium diet (<400 mg/day)
B. High-sodium diet to increase fluid intake
C. Normal calcium intake with reduced sodium and oxalate
D. High-protein diet to acidify urine
Answer: C. Normal calcium intake with reduced sodium and oxalate
Rationale: A normal calcium intake (1000-1200 mg/day) binds dietary oxalate and reduces
oxalate absorption, while sodium restriction decreases urinary calcium excretion.
Low-calcium diets increase oxalate absorption and stone risk. High sodium and high
protein increase calciuria and stone formation.
Page 2 of 75
,5. A patient with major depressive disorder has failed two adequate trials of SSRIs.
Which augmentation strategy has the strongest evidence for improving remission
rates?
A. Adding buspirone
B. Adding aripiprazole
C. Adding thyroid hormone
D. Adding lithium
Answer: B. Adding aripiprazole
Rationale: Aripiprazole augmentation has robust randomized controlled trial evidence for
treatment-resistant depression and is FDA-approved for this indication. Buspirone has
weaker evidence. Thyroid hormone and lithium are older strategies with less consistent
efficacy and greater toxicity.
6. A 6-month-old infant presents with a 3-day history of fever, cough, and wheezing.
Which finding best distinguishes bronchiolitis from asthma?
A. Presence of tachypnea
B. Response to bronchodilators
C. Diffuse wheezing on auscultation
D. History of atopy
Answer: B. Response to bronchodilators
Rationale: Bronchiolitis typically does not respond to bronchodilators, whereas asthma
often does. Tachypnea and wheezing occur in both. A history of atopy is more common in
asthma but not diagnostic. The lack of bronchodilator response is a key differentiator in
this age group.
Page 3 of 75
, 7. Which electrocardiographic finding is most specific for hyperkalemia?
A. Peaked T waves
B. Prolonged QT interval
C. ST-segment elevation
D. U waves
Answer: A. Peaked T waves
Rationale: Peaked T waves are a classic and relatively specific early ECG sign of
hyperkalemia, reflecting altered repolarization. Prolonged QT and U waves suggest
hypokalemia. ST elevation indicates ischemia or injury. Peaked T waves are more specific
than other findings in hyperkalemia.
8. A 45-year-old man presents with sudden onset of severe abdominal pain and
distension. CT shows free air under the diaphragm. Which initial management step is
most appropriate?
A. Immediate laparotomy
B. Broad-spectrum antibiotics and observation
C. Nasogastric decompression and IV fluids
D. Upper endoscopy
Answer: A. Immediate laparotomy
Rationale: Free air under the diaphragm indicates perforated viscus, a surgical emergency
requiring immediate exploratory laparotomy. Antibiotics and decompression are
supportive but not definitive. Endoscopy is contraindicated as it may worsen perforation.
Page 4 of 75
