PAEA EOC & Summative Practice
Questions With Complete
Solutions
Course
PAEA
Question 1
A 67-year-old man presents with crushing substernal chest pain radiating to his left arm for 45
minutes. His ECG demonstrates ST-segment elevation in leads II, III, and aVF.
What is the most appropriate next step?
A. Administer ibuprofen and discharge home
B. Begin proton pump inhibitor therapy
C. Activate the cardiac catheterization team for immediate reperfusion
D. Schedule an outpatient stress test
Answer
C. Activate the cardiac catheterization team for immediate reperfusion
Rationale
This patient has an inferior ST-elevation myocardial infarction (STEMI). Immediate
reperfusion with primary percutaneous coronary intervention (PCI) is the preferred treatment
when available. Initial management also includes aspirin, cardiac monitoring, and other
guideline-directed therapies as appropriate. Delaying reperfusion significantly increases
myocardial damage and mortality.
Question 2
A 24-year-old woman presents with dysuria, urinary frequency, and urgency for two days. She
denies flank pain, fever, or vaginal discharge.
Urinalysis shows positive leukocyte esterase and nitrites.
What is the most likely diagnosis?
A. Acute pyelonephritis
B. Uncomplicated cystitis
,C. Interstitial cystitis
D. Nephrolithiasis
Answer
B. Uncomplicated cystitis
Rationale
Classic lower urinary tract symptoms with positive nitrites and leukocyte esterase strongly
suggest acute uncomplicated cystitis, most commonly caused by Escherichia coli. Fever,
chills, nausea, vomiting, or costovertebral angle tenderness would raise concern for
pyelonephritis.
Question 3
A 58-year-old man with long-standing hypertension has a blood pressure of 172/106 mmHg
despite lifestyle modification.
Which medication class provides renal protection in patients with diabetes and hypertension?
A. ACE inhibitors
B. Calcium channel blockers
C. Loop diuretics
D. Alpha blockers
Answer
A. ACE inhibitors
Rationale
ACE inhibitors reduce intraglomerular pressure, decrease proteinuria, and slow the progression
of diabetic kidney disease. They are recommended first-line agents for many patients with
hypertension and diabetes.
Question 4
A 3-year-old child develops a barking cough, inspiratory stridor, and hoarseness that worsen at
night.
What is the most likely diagnosis?
,A. Epiglottitis
B. Croup (laryngotracheitis)
C. Asthma
D. Bronchiolitis
Answer
B. Croup (laryngotracheitis)
Rationale
Croup typically presents with a barking cough, inspiratory stridor, hoarseness, and symptoms
that worsen at night. Mild cases are treated with corticosteroids; moderate to severe cases may
require nebulized epinephrine.
Question 5
A 46-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance.
Laboratory studies reveal elevated TSH and low free T4.
What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Graves disease
Answer
B. Primary hypothyroidism
Rationale
Primary hypothyroidism results in inadequate thyroid hormone production, leading to elevated
TSH due to loss of negative feedback and decreased free T4 levels.
Question 6
A patient with atrial fibrillation suddenly develops right-sided weakness and aphasia.
Which diagnosis is most likely?
, A. Migraine headache
B. Ischemic stroke
C. Bell's palsy
D. Seizure disorder
Answer
B. Ischemic stroke
Rationale
Atrial fibrillation significantly increases the risk of cardioembolic ischemic stroke. Sudden focal
neurological deficits require emergency stroke evaluation and rapid determination of eligibility
for reperfusion therapies.
Question 7
A 72-year-old smoker presents with chronic productive cough for several years and progressive
dyspnea.
Spirometry demonstrates a post-bronchodilator FEV₁/FVC ratio below 0.70.
Which diagnosis is most likely?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD)
C. Pulmonary embolism
D. Pneumonia
Answer
B. Chronic obstructive pulmonary disease (COPD)
Rationale
Persistent airflow obstruction on spirometry combined with smoking history and chronic
respiratory symptoms is diagnostic of COPD.
Question 8
A patient develops generalized urticaria, wheezing, hypotension, and lip swelling immediately
after eating peanuts.
Questions With Complete
Solutions
Course
PAEA
Question 1
A 67-year-old man presents with crushing substernal chest pain radiating to his left arm for 45
minutes. His ECG demonstrates ST-segment elevation in leads II, III, and aVF.
What is the most appropriate next step?
A. Administer ibuprofen and discharge home
B. Begin proton pump inhibitor therapy
C. Activate the cardiac catheterization team for immediate reperfusion
D. Schedule an outpatient stress test
Answer
C. Activate the cardiac catheterization team for immediate reperfusion
Rationale
This patient has an inferior ST-elevation myocardial infarction (STEMI). Immediate
reperfusion with primary percutaneous coronary intervention (PCI) is the preferred treatment
when available. Initial management also includes aspirin, cardiac monitoring, and other
guideline-directed therapies as appropriate. Delaying reperfusion significantly increases
myocardial damage and mortality.
Question 2
A 24-year-old woman presents with dysuria, urinary frequency, and urgency for two days. She
denies flank pain, fever, or vaginal discharge.
Urinalysis shows positive leukocyte esterase and nitrites.
What is the most likely diagnosis?
A. Acute pyelonephritis
B. Uncomplicated cystitis
,C. Interstitial cystitis
D. Nephrolithiasis
Answer
B. Uncomplicated cystitis
Rationale
Classic lower urinary tract symptoms with positive nitrites and leukocyte esterase strongly
suggest acute uncomplicated cystitis, most commonly caused by Escherichia coli. Fever,
chills, nausea, vomiting, or costovertebral angle tenderness would raise concern for
pyelonephritis.
Question 3
A 58-year-old man with long-standing hypertension has a blood pressure of 172/106 mmHg
despite lifestyle modification.
Which medication class provides renal protection in patients with diabetes and hypertension?
A. ACE inhibitors
B. Calcium channel blockers
C. Loop diuretics
D. Alpha blockers
Answer
A. ACE inhibitors
Rationale
ACE inhibitors reduce intraglomerular pressure, decrease proteinuria, and slow the progression
of diabetic kidney disease. They are recommended first-line agents for many patients with
hypertension and diabetes.
Question 4
A 3-year-old child develops a barking cough, inspiratory stridor, and hoarseness that worsen at
night.
What is the most likely diagnosis?
,A. Epiglottitis
B. Croup (laryngotracheitis)
C. Asthma
D. Bronchiolitis
Answer
B. Croup (laryngotracheitis)
Rationale
Croup typically presents with a barking cough, inspiratory stridor, hoarseness, and symptoms
that worsen at night. Mild cases are treated with corticosteroids; moderate to severe cases may
require nebulized epinephrine.
Question 5
A 46-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance.
Laboratory studies reveal elevated TSH and low free T4.
What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Graves disease
Answer
B. Primary hypothyroidism
Rationale
Primary hypothyroidism results in inadequate thyroid hormone production, leading to elevated
TSH due to loss of negative feedback and decreased free T4 levels.
Question 6
A patient with atrial fibrillation suddenly develops right-sided weakness and aphasia.
Which diagnosis is most likely?
, A. Migraine headache
B. Ischemic stroke
C. Bell's palsy
D. Seizure disorder
Answer
B. Ischemic stroke
Rationale
Atrial fibrillation significantly increases the risk of cardioembolic ischemic stroke. Sudden focal
neurological deficits require emergency stroke evaluation and rapid determination of eligibility
for reperfusion therapies.
Question 7
A 72-year-old smoker presents with chronic productive cough for several years and progressive
dyspnea.
Spirometry demonstrates a post-bronchodilator FEV₁/FVC ratio below 0.70.
Which diagnosis is most likely?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD)
C. Pulmonary embolism
D. Pneumonia
Answer
B. Chronic obstructive pulmonary disease (COPD)
Rationale
Persistent airflow obstruction on spirometry combined with smoking history and chronic
respiratory symptoms is diagnostic of COPD.
Question 8
A patient develops generalized urticaria, wheezing, hypotension, and lip swelling immediately
after eating peanuts.
