,PA Review Arsenal: 7th Ed. Practice
Questions & Rationales
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 (Questions 1–14)
1. A 7-year-old boy presents with painless, yellowish
deposit at the limbus of both eyes. Visual acuity is
normal. Which of the following is the most likely
diagnosis?
A. Bitot spots
B. Kayser-Fleischer ring
C. Pinguecula
D. Xanthelasma
Answer: C. Pinguecula
Rationale: Pingueculae are benign, yellowish conjunctival
lesions on either side of the cornea in older patients or
with sun exposure; they do not affect vision. Bitot spots
(vitamin A deficiency) are foamy patches on conjunctiva;
Kayser-Fleischer rings (Wilson disease) are brown copper
rings at Descemet’s membrane; xanthelasma are
periorbital lipid-laden plaques.
2. A 55-year-old diabetic patient complains of sudden,
painless loss of vision in one eye. Funduscopic exam
shows a “cherry red spot” at the macula. What is the
most likely etiology?
A. Central retinal artery occlusion
, B. Central retinal vein occlusion
C. Retinal detachment
D. Wet age-related macular degeneration
Answer: A. Central retinal artery occlusion
Rationale: Sudden, painless vision loss with a pale retina
and macular cherry red spot indicates central retinal artery
occlusion. Central retinal vein occlusion shows “blood and
thunder” hemorrhages; retinal detachment has flashing
lights and floaters; wet AMD presents with
metamorphopsia.
3. A 30-year-old woman reports halos around lights and
blurred vision in low light. On exam, intraocular pressure
is 30 mmHg and corneal edema is noted. Which
maneuver confirms acute angle-closure glaucoma?
A. Gonioscopy
B. Schirmer test
C. Fluorescein staining
D. Amsler grid
Answer: A. Gonioscopy
Rationale: Gonioscopy visualizes the anterior chamber
angle to differentiate open vs. closed. Schirmer tests tear
production (dry eye); fluorescein stains corneal defects;
Amsler grid assesses macular function.
4. A patient presents with rapid onset of painful red eye,
photophobia, and decreased vision. Slit lamp reveals
dendritic ulcer on cornea. Best initial treatment?
, A. Topical ciprofloxacin
B. Topical acyclovir
C. Topical prednisolone
D. Cycloplegic drops only
Answer: B. Topical acyclovir
Rationale: Dendritic corneal ulcers are pathognomonic for
herpes simplex keratitis and require topical antivirals.
Fluoroquinolones are for bacterial keratitis; steroids
worsen HSV; cycloplegics are adjunctive.
5. A 3-month-old infant fails to follow faces with one eye.
Cover test shows inward deviation when covering the
other eye. Diagnosis?
A. Esotropia
B. Exotropia
C. Nystagmus
D. Amblyopia
Answer: A. Esotropia
Rationale: Esotropia is inward deviation; covering the
good eye reveals the misaligned eye shifting outward.
Amblyopia is lazy eye effect but not the deviation itself;
nystagmus is oscillatory movement; exotropia is outward
turn.
6. A 65-year-old cataract patient describes sudden flashing
lights followed by “curtain coming down.” Exam shows
retina elevated with folds. Next step?
A. Immediate ophthalmology referral for surgical repair
, B. Start topical antibiotics
C. Prescribe patching and rest
D. Manage with observation
Answer: A. Immediate ophthalmology referral for surgical
repair
Rationale: Rhegmatogenous retinal detachment is an
emergency requiring prompt surgical intervention;
antibiotics, patching, or observation are inappropriate.
7. A contact lens wearer has red eye, mucopurulent
discharge, and eyelid crusting. Culture grows gram-
negative rod. Which organism most likely?
A. Staphylococcus aureus
B. Pseudomonas aeruginosa
C. Streptococcus pneumoniae
D. Haemophilus influenzae
Answer: B. Pseudomonas aeruginosa
Rationale: Pseudomonas causes aggressive contact lens–
related keratitis; Staph and Strep are more common in
non–contact lens bacterial conjunctivitis; H. influenzae in
children.
8. An elderly patient complains of difficulty reading fine
print despite good distance vision. Examination shows
opacification of lens nucleus. What type of cataract?
A. Nuclear sclerosis
B. Cortical spokes
C. Posterior subcapsular
, D. Congenital lamellar
Answer: A. Nuclear sclerosis
Rationale: Nuclear sclerosis causes yellow-brown central
lens opacification affecting near vision (presbyopia
paradox). Cortical spokes appear radial; posterior
subcapsular causes glare; congenital lamellar seen in
infants.
9. A farmer complains of a foreign body sensation after
debris hits his eye. Slit lamp exam with fluorescein shows
epithelial uptake. Management?
A. Remove with moistened cotton swab and prescribe
antibiotic drops
B. Patch eye for 24 hours
C. Immediate irrigate only
D. Start topical steroids
Answer: A. Remove with moistened cotton swab and
prescribe antibiotic drops
Rationale: Superficial corneal foreign bodies should be
removed then antibiotic prophylaxis to prevent infection.
Patching is no longer recommended; steroids
contraindicated; irrigation alone does not remove
embedded debris.
10. Which finding is most specific for open-angle
glaucoma on visual field testing?
A. Central scotoma
B. Superior arcuate defect
Questions & Rationales
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 (Questions 1–14)
1. A 7-year-old boy presents with painless, yellowish
deposit at the limbus of both eyes. Visual acuity is
normal. Which of the following is the most likely
diagnosis?
A. Bitot spots
B. Kayser-Fleischer ring
C. Pinguecula
D. Xanthelasma
Answer: C. Pinguecula
Rationale: Pingueculae are benign, yellowish conjunctival
lesions on either side of the cornea in older patients or
with sun exposure; they do not affect vision. Bitot spots
(vitamin A deficiency) are foamy patches on conjunctiva;
Kayser-Fleischer rings (Wilson disease) are brown copper
rings at Descemet’s membrane; xanthelasma are
periorbital lipid-laden plaques.
2. A 55-year-old diabetic patient complains of sudden,
painless loss of vision in one eye. Funduscopic exam
shows a “cherry red spot” at the macula. What is the
most likely etiology?
A. Central retinal artery occlusion
, B. Central retinal vein occlusion
C. Retinal detachment
D. Wet age-related macular degeneration
Answer: A. Central retinal artery occlusion
Rationale: Sudden, painless vision loss with a pale retina
and macular cherry red spot indicates central retinal artery
occlusion. Central retinal vein occlusion shows “blood and
thunder” hemorrhages; retinal detachment has flashing
lights and floaters; wet AMD presents with
metamorphopsia.
3. A 30-year-old woman reports halos around lights and
blurred vision in low light. On exam, intraocular pressure
is 30 mmHg and corneal edema is noted. Which
maneuver confirms acute angle-closure glaucoma?
A. Gonioscopy
B. Schirmer test
C. Fluorescein staining
D. Amsler grid
Answer: A. Gonioscopy
Rationale: Gonioscopy visualizes the anterior chamber
angle to differentiate open vs. closed. Schirmer tests tear
production (dry eye); fluorescein stains corneal defects;
Amsler grid assesses macular function.
4. A patient presents with rapid onset of painful red eye,
photophobia, and decreased vision. Slit lamp reveals
dendritic ulcer on cornea. Best initial treatment?
, A. Topical ciprofloxacin
B. Topical acyclovir
C. Topical prednisolone
D. Cycloplegic drops only
Answer: B. Topical acyclovir
Rationale: Dendritic corneal ulcers are pathognomonic for
herpes simplex keratitis and require topical antivirals.
Fluoroquinolones are for bacterial keratitis; steroids
worsen HSV; cycloplegics are adjunctive.
5. A 3-month-old infant fails to follow faces with one eye.
Cover test shows inward deviation when covering the
other eye. Diagnosis?
A. Esotropia
B. Exotropia
C. Nystagmus
D. Amblyopia
Answer: A. Esotropia
Rationale: Esotropia is inward deviation; covering the
good eye reveals the misaligned eye shifting outward.
Amblyopia is lazy eye effect but not the deviation itself;
nystagmus is oscillatory movement; exotropia is outward
turn.
6. A 65-year-old cataract patient describes sudden flashing
lights followed by “curtain coming down.” Exam shows
retina elevated with folds. Next step?
A. Immediate ophthalmology referral for surgical repair
, B. Start topical antibiotics
C. Prescribe patching and rest
D. Manage with observation
Answer: A. Immediate ophthalmology referral for surgical
repair
Rationale: Rhegmatogenous retinal detachment is an
emergency requiring prompt surgical intervention;
antibiotics, patching, or observation are inappropriate.
7. A contact lens wearer has red eye, mucopurulent
discharge, and eyelid crusting. Culture grows gram-
negative rod. Which organism most likely?
A. Staphylococcus aureus
B. Pseudomonas aeruginosa
C. Streptococcus pneumoniae
D. Haemophilus influenzae
Answer: B. Pseudomonas aeruginosa
Rationale: Pseudomonas causes aggressive contact lens–
related keratitis; Staph and Strep are more common in
non–contact lens bacterial conjunctivitis; H. influenzae in
children.
8. An elderly patient complains of difficulty reading fine
print despite good distance vision. Examination shows
opacification of lens nucleus. What type of cataract?
A. Nuclear sclerosis
B. Cortical spokes
C. Posterior subcapsular
, D. Congenital lamellar
Answer: A. Nuclear sclerosis
Rationale: Nuclear sclerosis causes yellow-brown central
lens opacification affecting near vision (presbyopia
paradox). Cortical spokes appear radial; posterior
subcapsular causes glare; congenital lamellar seen in
infants.
9. A farmer complains of a foreign body sensation after
debris hits his eye. Slit lamp exam with fluorescein shows
epithelial uptake. Management?
A. Remove with moistened cotton swab and prescribe
antibiotic drops
B. Patch eye for 24 hours
C. Immediate irrigate only
D. Start topical steroids
Answer: A. Remove with moistened cotton swab and
prescribe antibiotic drops
Rationale: Superficial corneal foreign bodies should be
removed then antibiotic prophylaxis to prevent infection.
Patching is no longer recommended; steroids
contraindicated; irrigation alone does not remove
embedded debris.
10. Which finding is most specific for open-angle
glaucoma on visual field testing?
A. Central scotoma
B. Superior arcuate defect
