PAEA EOR IM miss 2025 COMPREHENSIVE EXAM
QUESTIONS |FREQUENTLY TESTED QUESTIONS
|RECENTLY TESTING REAL EXAM
QUESTIONS|VERIFIED SOLUTIONS (100% CORRECT)! -
150 Questions
This comprehensive exam assesses mastery of cardiovascular medicine at the PAEA EOR level, covering
pathophysiology, diagnosis, and management of common and complex cardiac conditions. Questions are designed
to test clinical reasoning, evidence-based decision-making, and interpretation of diagnostic data. It contains 150
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 12 focused sections: Cardiovascular, Pulmonary, Gastrointestinal,
Renal/Genitourinary, Musculoskeletal, Neurology, Endocrine, Hematology/Oncology, Infectious Disease,
Dermatology, Psychiatry/Behavioral Health, Women's Health. Targeted learning outcomes include: Apply
evidence-based guidelines for the management of acute coronary syndromes, heart failure, arrhythmias, and
valvular disease.; Interpret ECG, echocardiographic, hemodynamic, and laboratory data to diagnose
cardiovascular conditions.; Differentiate between treatment strategies and anticipate complications in
cardiovascular disease.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so
that students can study with confidence and self-correct as they work through the bank. Use it as a high-yield
review immediately before the exam, or as a structured practice tool during the unit - the rationales double as
concise teaching notes. The recommended writing time is 2 hours, with a passing score of 70%. Aligned with
Meets PAEA End of Rotation standards for US physician assistant programs at R1 universities. standards and
Section 1: Cardiovascular (Questions 1-13)
1 In a patient with non-ST-segment elevation myocardial infarction (NSTEMI) and
a GRACE risk score of 140, which of the following management strategies is
most appropriate within the first 24 hours?
A) Immediate coronary angiography within 2 hours
B) Early invasive strategy (angiography within 24 hours)
C) Ischemia-guided medical management only
D) Routine angiography after 48-72 hours
Answer: B
Rationale: A GRACE risk score >140 indicates high risk, warranting an early
invasive strategy (angiography within 24 hours). Immediate angiography (<2 h) is
reserved for very high-risk features (e.g., refractory ischemia, hemodynamic
instability). Ischemia-guided management is for low-risk patients.
2 Which of the following hemodynamic profiles is most consistent with acute
decompensated heart failure with preserved ejection fraction (HFpEF) in a patient
with severe hypertension?
,A) Low cardiac output, high pulmonary capillary wedge pressure (PCWP), low
systemic vascular resistance (SVR)
B) Normal cardiac output, elevated PCWP, elevated SVR
C) High cardiac output, low PCWP, low SVR
D) Low cardiac output, low PCWP, high SVR
Answer: B
Rationale: HFpEF typically presents with preserved cardiac output, elevated left
ventricular filling pressures (PCWP), and elevated afterload (SVR) due to
hypertension. Option A describes cardiogenic shock; C suggests high-output failure
(e.g., sepsis); D indicates hypovolemia or low-output state without congestion.
3 A patient with severe aortic stenosis is scheduled for valve replacement.
Preoperative coronary angiography reveals a 70% stenosis in the proximal left
anterior descending artery. Which of the following is the most appropriate
management?
A) Proceed with aortic valve replacement alone
B) Perform percutaneous coronary intervention (PCI) to the LAD before valve
surgery
C) Perform combined aortic valve replacement and coronary artery bypass grafting
(CABG)
D) Delay surgery and initiate intensive medical therapy for coronary disease
Answer: C
Rationale: In patients with severe aortic stenosis and significant coronary artery
disease (70% stenosis), concurrent CABG at the time of aortic valve replacement is
indicated to reduce perioperative ischemic risk. PCI is not preferred due to need for
dual antiplatelet therapy and risk of bleeding during surgery.
4 Which of the following ECG findings is most specific for the diagnosis of acute
pericarditis?
A) Diffuse ST-segment elevation with PR depression
B) Localized ST-segment elevation with reciprocal changes
C) T-wave inversions in leads V1-V3
D) ST-segment depression with upright T waves in V1-V2
Answer: A
Rationale: Diffuse ST-segment elevation with PR depression (especially in limb
leads and V5-V6) is classic for acute pericarditis. Localized ST elevation with
reciprocal changes suggests STEMI. T-wave inversions in V1-V3 are common in
pulmonary embolism or right ventricular hypertrophy.
,5 A patient with dilated cardiomyopathy and New York Heart Association (NYHA)
class III symptoms has a left ventricular ejection fraction (LVEF) of 25%. Current
medications include lisinopril, carvedilol, and furosemide. Which additional
therapy has been shown to reduce mortality in this population?
A) Digoxin
B) Spironolactone
C) Amiodarone
D) Ivabradine
Answer: B
Rationale: Spironolactone (an aldosterone antagonist) reduces mortality in patients
with HFrEF (LVEF 35%) and NYHA class II-IV symptoms despite ACE inhibitor
and beta-blocker therapy. Digoxin improves symptoms but not mortality.
Amiodarone is for arrhythmia control. Ivabradine is indicated if heart rate >70 bpm
on beta-blocker.
6 A patient presents with palpitations and syncope. ECG shows a regular
wide-complex tachycardia at 220 bpm, with a QRS duration of 160 ms and a
history of prior myocardial infarction. Which of the following findings would
most reliably differentiate ventricular tachycardia (VT) from supraventricular
tachycardia with aberrancy?
A) Presence of fusion beats
B) QRS duration >140 ms
C) Left axis deviation
D) R wave in aVR
Answer: A
Rationale: Fusion beats (hybrid QRS complexes from simultaneous ventricular and
supraventricular activation) are pathognomonic for VT. While QRS >140 ms, left
axis deviation, and a dominant R in aVR are suggestive, fusion beats provide
definitive evidence of VT in the setting of structural heart disease.
7 Which of the following is the most appropriate initial anticoagulant for a patient
with acute pulmonary embolism (PE) and hemodynamic instability (systolic BP
85 mm Hg)?
A) Unfractionated heparin (UFH) intravenous bolus followed by infusion
B) Enoxaparin subcutaneous twice daily
C) Rivaroxaban orally
D) Warfarin with bridging enoxaparin
, Answer: A
Rationale: In massive PE with hemodynamic instability, UFH is preferred due to its
short half-life, reversibility, and ability to quickly adjust dosing. Enoxaparin and
rivaroxaban are contraindicated in hypotension due to risk of unpredictable
absorption and lack of reversal. Warfarin is not appropriate acutely.
8 A patient with chronic hypertension and left ventricular hypertrophy is found to
have a blood pressure of 158/96 mm Hg on three medications including a thiazide
diuretic, ACE inhibitor, and calcium channel blocker. Which of the following is
the most appropriate next step?
A) Add spironolactone
B) Increase thiazide dose
C) Switch to a beta-blocker
D) Add hydralazine
Answer: A
Rationale: In patients with resistant hypertension (BP "e140/90 on three agents
including a diuretic) and LVH, spironolactone is the preferred fourth agent based on
PATHWAY-2 trial evidence. Increasing thiazide may cause electrolyte disturbances.
Beta-blockers are less effective in resistant hypertension. Hydralazine is reserved for
later steps.
9 Which of the following echocardiographic findings is most consistent with
chronic severe mitral regurgitation?
A) Left atrial enlargement and left ventricular dilation
B) Left atrial enlargement and right ventricular hypertrophy
C) Left ventricular hypertrophy and small left atrial size
D) Normal left atrial size and left ventricular cavity
Answer: A
Rationale: Chronic severe mitral regurgitation leads to volume overload of the left
atrium and left ventricle, causing dilation of both chambers. Left ventricular
hypertrophy is typical of pressure overload (e.g., aortic stenosis). Right ventricular
hypertrophy suggests pulmonary hypertension from left-sided disease but is not the
primary finding.
10 A patient with atrial fibrillation and a CHA2DS2-VASc score of 3 is started on
apixaban. Which of the following laboratory parameters is most important to
monitor during therapy?
A) INR
QUESTIONS |FREQUENTLY TESTED QUESTIONS
|RECENTLY TESTING REAL EXAM
QUESTIONS|VERIFIED SOLUTIONS (100% CORRECT)! -
150 Questions
This comprehensive exam assesses mastery of cardiovascular medicine at the PAEA EOR level, covering
pathophysiology, diagnosis, and management of common and complex cardiac conditions. Questions are designed
to test clinical reasoning, evidence-based decision-making, and interpretation of diagnostic data. It contains 150
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 12 focused sections: Cardiovascular, Pulmonary, Gastrointestinal,
Renal/Genitourinary, Musculoskeletal, Neurology, Endocrine, Hematology/Oncology, Infectious Disease,
Dermatology, Psychiatry/Behavioral Health, Women's Health. Targeted learning outcomes include: Apply
evidence-based guidelines for the management of acute coronary syndromes, heart failure, arrhythmias, and
valvular disease.; Interpret ECG, echocardiographic, hemodynamic, and laboratory data to diagnose
cardiovascular conditions.; Differentiate between treatment strategies and anticipate complications in
cardiovascular disease.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so
that students can study with confidence and self-correct as they work through the bank. Use it as a high-yield
review immediately before the exam, or as a structured practice tool during the unit - the rationales double as
concise teaching notes. The recommended writing time is 2 hours, with a passing score of 70%. Aligned with
Meets PAEA End of Rotation standards for US physician assistant programs at R1 universities. standards and
Section 1: Cardiovascular (Questions 1-13)
1 In a patient with non-ST-segment elevation myocardial infarction (NSTEMI) and
a GRACE risk score of 140, which of the following management strategies is
most appropriate within the first 24 hours?
A) Immediate coronary angiography within 2 hours
B) Early invasive strategy (angiography within 24 hours)
C) Ischemia-guided medical management only
D) Routine angiography after 48-72 hours
Answer: B
Rationale: A GRACE risk score >140 indicates high risk, warranting an early
invasive strategy (angiography within 24 hours). Immediate angiography (<2 h) is
reserved for very high-risk features (e.g., refractory ischemia, hemodynamic
instability). Ischemia-guided management is for low-risk patients.
2 Which of the following hemodynamic profiles is most consistent with acute
decompensated heart failure with preserved ejection fraction (HFpEF) in a patient
with severe hypertension?
,A) Low cardiac output, high pulmonary capillary wedge pressure (PCWP), low
systemic vascular resistance (SVR)
B) Normal cardiac output, elevated PCWP, elevated SVR
C) High cardiac output, low PCWP, low SVR
D) Low cardiac output, low PCWP, high SVR
Answer: B
Rationale: HFpEF typically presents with preserved cardiac output, elevated left
ventricular filling pressures (PCWP), and elevated afterload (SVR) due to
hypertension. Option A describes cardiogenic shock; C suggests high-output failure
(e.g., sepsis); D indicates hypovolemia or low-output state without congestion.
3 A patient with severe aortic stenosis is scheduled for valve replacement.
Preoperative coronary angiography reveals a 70% stenosis in the proximal left
anterior descending artery. Which of the following is the most appropriate
management?
A) Proceed with aortic valve replacement alone
B) Perform percutaneous coronary intervention (PCI) to the LAD before valve
surgery
C) Perform combined aortic valve replacement and coronary artery bypass grafting
(CABG)
D) Delay surgery and initiate intensive medical therapy for coronary disease
Answer: C
Rationale: In patients with severe aortic stenosis and significant coronary artery
disease (70% stenosis), concurrent CABG at the time of aortic valve replacement is
indicated to reduce perioperative ischemic risk. PCI is not preferred due to need for
dual antiplatelet therapy and risk of bleeding during surgery.
4 Which of the following ECG findings is most specific for the diagnosis of acute
pericarditis?
A) Diffuse ST-segment elevation with PR depression
B) Localized ST-segment elevation with reciprocal changes
C) T-wave inversions in leads V1-V3
D) ST-segment depression with upright T waves in V1-V2
Answer: A
Rationale: Diffuse ST-segment elevation with PR depression (especially in limb
leads and V5-V6) is classic for acute pericarditis. Localized ST elevation with
reciprocal changes suggests STEMI. T-wave inversions in V1-V3 are common in
pulmonary embolism or right ventricular hypertrophy.
,5 A patient with dilated cardiomyopathy and New York Heart Association (NYHA)
class III symptoms has a left ventricular ejection fraction (LVEF) of 25%. Current
medications include lisinopril, carvedilol, and furosemide. Which additional
therapy has been shown to reduce mortality in this population?
A) Digoxin
B) Spironolactone
C) Amiodarone
D) Ivabradine
Answer: B
Rationale: Spironolactone (an aldosterone antagonist) reduces mortality in patients
with HFrEF (LVEF 35%) and NYHA class II-IV symptoms despite ACE inhibitor
and beta-blocker therapy. Digoxin improves symptoms but not mortality.
Amiodarone is for arrhythmia control. Ivabradine is indicated if heart rate >70 bpm
on beta-blocker.
6 A patient presents with palpitations and syncope. ECG shows a regular
wide-complex tachycardia at 220 bpm, with a QRS duration of 160 ms and a
history of prior myocardial infarction. Which of the following findings would
most reliably differentiate ventricular tachycardia (VT) from supraventricular
tachycardia with aberrancy?
A) Presence of fusion beats
B) QRS duration >140 ms
C) Left axis deviation
D) R wave in aVR
Answer: A
Rationale: Fusion beats (hybrid QRS complexes from simultaneous ventricular and
supraventricular activation) are pathognomonic for VT. While QRS >140 ms, left
axis deviation, and a dominant R in aVR are suggestive, fusion beats provide
definitive evidence of VT in the setting of structural heart disease.
7 Which of the following is the most appropriate initial anticoagulant for a patient
with acute pulmonary embolism (PE) and hemodynamic instability (systolic BP
85 mm Hg)?
A) Unfractionated heparin (UFH) intravenous bolus followed by infusion
B) Enoxaparin subcutaneous twice daily
C) Rivaroxaban orally
D) Warfarin with bridging enoxaparin
, Answer: A
Rationale: In massive PE with hemodynamic instability, UFH is preferred due to its
short half-life, reversibility, and ability to quickly adjust dosing. Enoxaparin and
rivaroxaban are contraindicated in hypotension due to risk of unpredictable
absorption and lack of reversal. Warfarin is not appropriate acutely.
8 A patient with chronic hypertension and left ventricular hypertrophy is found to
have a blood pressure of 158/96 mm Hg on three medications including a thiazide
diuretic, ACE inhibitor, and calcium channel blocker. Which of the following is
the most appropriate next step?
A) Add spironolactone
B) Increase thiazide dose
C) Switch to a beta-blocker
D) Add hydralazine
Answer: A
Rationale: In patients with resistant hypertension (BP "e140/90 on three agents
including a diuretic) and LVH, spironolactone is the preferred fourth agent based on
PATHWAY-2 trial evidence. Increasing thiazide may cause electrolyte disturbances.
Beta-blockers are less effective in resistant hypertension. Hydralazine is reserved for
later steps.
9 Which of the following echocardiographic findings is most consistent with
chronic severe mitral regurgitation?
A) Left atrial enlargement and left ventricular dilation
B) Left atrial enlargement and right ventricular hypertrophy
C) Left ventricular hypertrophy and small left atrial size
D) Normal left atrial size and left ventricular cavity
Answer: A
Rationale: Chronic severe mitral regurgitation leads to volume overload of the left
atrium and left ventricle, causing dilation of both chambers. Left ventricular
hypertrophy is typical of pressure overload (e.g., aortic stenosis). Right ventricular
hypertrophy suggests pulmonary hypertension from left-sided disease but is not the
primary finding.
10 A patient with atrial fibrillation and a CHA2DS2-VASc score of 3 is started on
apixaban. Which of the following laboratory parameters is most important to
monitor during therapy?
A) INR
