,PA Proficiency Builder: 7th Ed.
Certification MCQs
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. A 28-year-old contact lens wearer presents with acute
onset red eye, photophobia, and a white corneal opacity.
On slit-lamp exam you note a dendritic lesion. What is
the most likely diagnosis?
A. Bacterial keratitis
B. Herpes simplex keratitis
C. Acanthamoeba keratitis
D. Allergic conjunctivitis
Correct Answer: B
Rationale: Dendritic ulcer is pathognomonic for HSV
keratitis. Bacterial keratitis shows dense stromal
infiltrates; Acanthamoeba is ring infiltrate; allergic
conjunctivitis has papillae not corneal ulceration.
2. A 67-year-old diabetic patient complains of gradual,
painless central vision loss. Fundoscopy reveals drusen
and pigment epithelium changes at the macula. Which
form of macular degeneration is this?
A. Wet (neovascular)
B. Dry (atrophic)
C. Exudative
D. Central serous
Correct Answer: B
, Rationale: Drusen and RPE atrophy define dry AMD. Wet
AMD features choroidal neovascularization and
hemorrhage.
3. A patient reports flashes of light and “floaters,” then a
curtain-like shadow in one eye. What is the most
concerning diagnosis?
A. Vitreous hemorrhage
B. Retinal detachment
C. Posterior vitreous detachment
D. Optic neuritis
Correct Answer: B
Rationale: Curtain vision loss plus flashes/floaters suggests
retinal detachment; PVD can cause floaters but not
shadow.
4. Which finding on pupil examination helps distinguish a
third-nerve palsy from an afferent pupillary defect?
A. Marcus Gunn pupil
B. Relative afferent pupillary defect
C. Light-near dissociation
D. Efferent pupillary defect with ptosis and
“down-and-out” eye
Correct Answer: D
Rationale: CN III palsy yields efferent defect with ptosis
and “down-and-out.” Marcus Gunn is afferent.
5. A child presents with epiphora and intermittent
discharge. On exam, the punctum appears normal but
, probing reveals a blockage. What is the most likely
diagnosis?
A. Dacryocystitis
B. Nasolacrimal duct obstruction
C. Canaliculitis
D. Chalazion
Correct Answer: B
Rationale: NL duct obstruction presents with tearing and
discharge; dacryocystitis has pain, swelling over lacrimal
sac; canaliculitis pain in canaliculus.
6. A patient with a history of diabetes reports sudden,
painless loss of peripheral vision (“tunnel vision”).
Intraocular pressure is elevated. Which condition is most
consistent?
A. Acute angle-closure glaucoma
B. Chronic open-angle glaucoma
C. Central retinal artery occlusion
D. Retinitis pigmentosa
Correct Answer: B
Rationale: Chronic open-angle is painless, insidious
peripheral visual field loss with high IOP. Angle-closure is
acute pain and halos.
7. Which ophthalmic condition is characterized by an acute,
firm, tender eyelid nodule, often pointing to lash margin?
A. Hordeolum
B. Chalazion
, C. Blepharitis
D. Preseptal cellulitis
Correct Answer: A
Rationale: Hordeolum is acute, tender infection of glands
at lid margin. Chalazion is painless, granulomatous.
8. A 55-year-old smoker complains of diplopia and eyelid
retraction. Lab shows elevated TSH receptor antibodies.
What is the ocular diagnosis?
A. Myasthenia gravis
B. Thyroid eye disease
C. Horner syndrome
D. CN VI palsy
Correct Answer: B
Rationale: Thyroid (Graves’) ophthalmopathy causes
proptosis, eyelid retraction, diplopia in smokers with
TSH-R antibodies.
9. A 60-year-old complains of distorted vision
(metamorphopsia). Amsler grid testing is positive. Which
structure is most likely affected?
A. Optic nerve
B. Macula
C. Lens
D. Cornea
Correct Answer: B
Rationale: Metamorphopsia indicates macular pathology,
e.g., macular edema or degeneration.
, 10. A patient presents with painless vision loss in one
eye, cherry-red spot on fundus, and a history of atrial
fibrillation. The most likely cause is:
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Branch retinal artery occlusion
D. Vitreous hemorrhage
Correct Answer: A
Rationale: Cherry-red spot in acute, painless mono-ocular
blindness suggests CRAO from an embolus.
Disorders of the Ears
11. A 4-year-old with URI symptoms develops acute ear
pain, fever, and bulging tympanic membrane. The most
probable diagnosis is:
A. Otitis externa
B. Serous otitis media
C. Acute otitis media
D. Cholesteatoma
Correct Answer: C
Rationale: Fever, pain, bulging TM signal acute otitis
media. Otitis externa has pain on tragus manipulation;
serous has effusion without acute inflammation.
12. A swimmer presents with ear pain, pruritus, and
discharge; canal is erythematous and edematous.
Diagnosis?
Certification MCQs
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. A 28-year-old contact lens wearer presents with acute
onset red eye, photophobia, and a white corneal opacity.
On slit-lamp exam you note a dendritic lesion. What is
the most likely diagnosis?
A. Bacterial keratitis
B. Herpes simplex keratitis
C. Acanthamoeba keratitis
D. Allergic conjunctivitis
Correct Answer: B
Rationale: Dendritic ulcer is pathognomonic for HSV
keratitis. Bacterial keratitis shows dense stromal
infiltrates; Acanthamoeba is ring infiltrate; allergic
conjunctivitis has papillae not corneal ulceration.
2. A 67-year-old diabetic patient complains of gradual,
painless central vision loss. Fundoscopy reveals drusen
and pigment epithelium changes at the macula. Which
form of macular degeneration is this?
A. Wet (neovascular)
B. Dry (atrophic)
C. Exudative
D. Central serous
Correct Answer: B
, Rationale: Drusen and RPE atrophy define dry AMD. Wet
AMD features choroidal neovascularization and
hemorrhage.
3. A patient reports flashes of light and “floaters,” then a
curtain-like shadow in one eye. What is the most
concerning diagnosis?
A. Vitreous hemorrhage
B. Retinal detachment
C. Posterior vitreous detachment
D. Optic neuritis
Correct Answer: B
Rationale: Curtain vision loss plus flashes/floaters suggests
retinal detachment; PVD can cause floaters but not
shadow.
4. Which finding on pupil examination helps distinguish a
third-nerve palsy from an afferent pupillary defect?
A. Marcus Gunn pupil
B. Relative afferent pupillary defect
C. Light-near dissociation
D. Efferent pupillary defect with ptosis and
“down-and-out” eye
Correct Answer: D
Rationale: CN III palsy yields efferent defect with ptosis
and “down-and-out.” Marcus Gunn is afferent.
5. A child presents with epiphora and intermittent
discharge. On exam, the punctum appears normal but
, probing reveals a blockage. What is the most likely
diagnosis?
A. Dacryocystitis
B. Nasolacrimal duct obstruction
C. Canaliculitis
D. Chalazion
Correct Answer: B
Rationale: NL duct obstruction presents with tearing and
discharge; dacryocystitis has pain, swelling over lacrimal
sac; canaliculitis pain in canaliculus.
6. A patient with a history of diabetes reports sudden,
painless loss of peripheral vision (“tunnel vision”).
Intraocular pressure is elevated. Which condition is most
consistent?
A. Acute angle-closure glaucoma
B. Chronic open-angle glaucoma
C. Central retinal artery occlusion
D. Retinitis pigmentosa
Correct Answer: B
Rationale: Chronic open-angle is painless, insidious
peripheral visual field loss with high IOP. Angle-closure is
acute pain and halos.
7. Which ophthalmic condition is characterized by an acute,
firm, tender eyelid nodule, often pointing to lash margin?
A. Hordeolum
B. Chalazion
, C. Blepharitis
D. Preseptal cellulitis
Correct Answer: A
Rationale: Hordeolum is acute, tender infection of glands
at lid margin. Chalazion is painless, granulomatous.
8. A 55-year-old smoker complains of diplopia and eyelid
retraction. Lab shows elevated TSH receptor antibodies.
What is the ocular diagnosis?
A. Myasthenia gravis
B. Thyroid eye disease
C. Horner syndrome
D. CN VI palsy
Correct Answer: B
Rationale: Thyroid (Graves’) ophthalmopathy causes
proptosis, eyelid retraction, diplopia in smokers with
TSH-R antibodies.
9. A 60-year-old complains of distorted vision
(metamorphopsia). Amsler grid testing is positive. Which
structure is most likely affected?
A. Optic nerve
B. Macula
C. Lens
D. Cornea
Correct Answer: B
Rationale: Metamorphopsia indicates macular pathology,
e.g., macular edema or degeneration.
, 10. A patient presents with painless vision loss in one
eye, cherry-red spot on fundus, and a history of atrial
fibrillation. The most likely cause is:
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Branch retinal artery occlusion
D. Vitreous hemorrhage
Correct Answer: A
Rationale: Cherry-red spot in acute, painless mono-ocular
blindness suggests CRAO from an embolus.
Disorders of the Ears
11. A 4-year-old with URI symptoms develops acute ear
pain, fever, and bulging tympanic membrane. The most
probable diagnosis is:
A. Otitis externa
B. Serous otitis media
C. Acute otitis media
D. Cholesteatoma
Correct Answer: C
Rationale: Fever, pain, bulging TM signal acute otitis
media. Otitis externa has pain on tragus manipulation;
serous has effusion without acute inflammation.
12. A swimmer presents with ear pain, pruritus, and
discharge; canal is erythematous and edematous.
Diagnosis?
