,Ultimate PA Quiz Vault: 7th Edition
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
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
, 7 Gynecology 8 Obstetrics
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
Maculopapular and Plaque Disorders Sepsis
Vesiculobullous Disorders Bacterial Infections
, 13 Dermatology 14 Infectious Disease
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 (14 questions)
1. A 65-year-old woman presents with gradual, painless blurring
of vision in both eyes, worse in bright sunlight and when
reading. On exam, she has decreased red reflex and
opacification of both lenses. What is the next best step?
A. Prescribe bifocal lenses and re-evaluate in 1 year
B. Initiate topical NSAID drops
C. Schedule for cataract extraction with intraocular lens
placement
D. Start topical beta-blocker drops
Answer: C
Rationale: Age-related cataracts cause painless, progressive
lens opacification with reduced red reflex. Definitive
management is phacoemulsification with IOL implantation.
Bifocals do not address opacities (A). Topical NSAIDs (B) and
beta-blockers (D) are not indicated.
2. A 30-year-old contact‐wearing man notes sudden onset of
severe eye pain, photophobia, and decreased vision in his right
eye over 12 hours. Slit-lamp exam reveals an epithelial defect
with underlying stromal infiltrate and hypopyon. The most
appropriate initial management is:
,A. Hourly topical fluoroquinolone drops
B. Oral acyclovir
C. Topical corticosteroids
D. Warm compresses and observation
Answer: A
Rationale: Bacterial keratitis in contact wearers is an
ophthalmic emergency. Hourly broad-spectrum antibiotics
(e.g., fluoroquinolones) should be started immediately.
Antivirals (B) treat herpetic disease, steroids (C) worsen
infection, and observation (D) risks corneal perforation.
3. A 45-year-old diabetic complains of “curtain coming down”
over his left visual field. He notes flashing lights and new
floaters for 2 days. Fundoscopy reveals a detached retina.
Which symptom most strongly predicts macula-involving
detachment?
A. Photopsia (flashes)
B. Sudden floaters
C. Central scotoma
D. Conjunctival injection
Answer: C
Rationale: A central scotoma (“curtain” over vision) indicates
macular involvement in retinal detachment, signaling urgent
surgical repair. Flashes (A) and floaters (B) are early warning
signs but not macular. Injection (D) is not typical.
,4. A child presents with a “white pupil” instead of normal red
reflex on flash photography. This finding suggests:
A. Retinoblastoma
B. Strabismus
C. Myopia
D. Amblyopia
Answer: A
Rationale: Leukocoria (“white pupillary reflex”) in a child raises
concern for retinoblastoma. Strabismus (B), myopia (C), and
amblyopia (D) do not alter red reflex.
5. A 28-year-old woman with rheumatoid arthritis reports dry,
gritty sensation in both eyes. Schirmer’s test shows 3 mm
wetting at 5 minutes. Which underlying mechanism explains
her symptoms?
A. Corneal nerve injury
B. Meibomian gland hypersecretion
C. Lacrimal gland lymphocytic infiltration
D. Hyperosmolar tears
Answer: C
Rationale: Sjögren’s syndrome causes lymphocytic destruction
of lacrimal glands leading to aqueous-deficient dry eye;
Schirmer’s ≤5 mm is diagnostic. Nerve injury (A) is neurotrophic
,keratitis; meibomian hypersecretion (B) produces oily tears;
hyperosmolarity (D) is a consequence, not primary.
6. A patient presents with sudden, painful vision loss and an
afferent pupillary defect. Fundoscopy shows a pale retina with
a cherry-red spot at the fovea. The most likely diagnosis is:
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Optic neuritis
D. Retinal detachment
Answer: A
Rationale: CRAO presents with acute, painless (though often
described as painful) vision loss, pale retina, cherry-red spot,
and RAPD. CRVO (B) shows “blood and thunder.” Optic neuritis
(C) has pain with eye movement, normal fundus early. Retinal
detachment (D) has “floaters/flashes” not cherry-red.
7. A 50-year-old man with chronic poorly controlled
hypertension complains of blurry vision. Fundoscopy reveals
flame hemorrhages, cotton-wool spots, and papilledema.
Which grade of hypertensive retinopathy is this?
A. Grade I
B. Grade II
C. Grade III
D. Grade IV
, Answer: C
Rationale: Grade III has hemorrhages, exudates (cotton-wool).
Papilledema appears in Grade IV. Grade I: arterial narrowing; II:
AV nicking.
8. A 22-year-old presents with sudden severe ocular pain,
headache, mid-dilated nonreactive pupil, and cloudy cornea.
Intraocular pressure is 55 mm Hg. The immediate next step is:
A. Intravenous acetazolamide
B. Topical pilocarpine
C. Oral ibuprofen
D. Emergent YAG laser peripheral iridotomy
Answer: A
Rationale: Acute angle-closure glaucoma requires rapid IOP
lowering: IV acetazolamide first. Once pressure is reduced
(<40 mm Hg), pilocarpine (B) and definitive iridotomy (D)
follow. Ibuprofen (C) provides no IOP effect.
9. A 35-year-old woman complains of intermittent double
vision and drooping eyelid that worsen as day progresses.
Ice-pack test improves ptosis. The most likely diagnosis is:
A. Myasthenia gravis
B. Horner’s syndrome
C. Third-nerve palsy
D. Graves’ ophthalmopathy
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
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
, 7 Gynecology 8 Obstetrics
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
Maculopapular and Plaque Disorders Sepsis
Vesiculobullous Disorders Bacterial Infections
, 13 Dermatology 14 Infectious Disease
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 (14 questions)
1. A 65-year-old woman presents with gradual, painless blurring
of vision in both eyes, worse in bright sunlight and when
reading. On exam, she has decreased red reflex and
opacification of both lenses. What is the next best step?
A. Prescribe bifocal lenses and re-evaluate in 1 year
B. Initiate topical NSAID drops
C. Schedule for cataract extraction with intraocular lens
placement
D. Start topical beta-blocker drops
Answer: C
Rationale: Age-related cataracts cause painless, progressive
lens opacification with reduced red reflex. Definitive
management is phacoemulsification with IOL implantation.
Bifocals do not address opacities (A). Topical NSAIDs (B) and
beta-blockers (D) are not indicated.
2. A 30-year-old contact‐wearing man notes sudden onset of
severe eye pain, photophobia, and decreased vision in his right
eye over 12 hours. Slit-lamp exam reveals an epithelial defect
with underlying stromal infiltrate and hypopyon. The most
appropriate initial management is:
,A. Hourly topical fluoroquinolone drops
B. Oral acyclovir
C. Topical corticosteroids
D. Warm compresses and observation
Answer: A
Rationale: Bacterial keratitis in contact wearers is an
ophthalmic emergency. Hourly broad-spectrum antibiotics
(e.g., fluoroquinolones) should be started immediately.
Antivirals (B) treat herpetic disease, steroids (C) worsen
infection, and observation (D) risks corneal perforation.
3. A 45-year-old diabetic complains of “curtain coming down”
over his left visual field. He notes flashing lights and new
floaters for 2 days. Fundoscopy reveals a detached retina.
Which symptom most strongly predicts macula-involving
detachment?
A. Photopsia (flashes)
B. Sudden floaters
C. Central scotoma
D. Conjunctival injection
Answer: C
Rationale: A central scotoma (“curtain” over vision) indicates
macular involvement in retinal detachment, signaling urgent
surgical repair. Flashes (A) and floaters (B) are early warning
signs but not macular. Injection (D) is not typical.
,4. A child presents with a “white pupil” instead of normal red
reflex on flash photography. This finding suggests:
A. Retinoblastoma
B. Strabismus
C. Myopia
D. Amblyopia
Answer: A
Rationale: Leukocoria (“white pupillary reflex”) in a child raises
concern for retinoblastoma. Strabismus (B), myopia (C), and
amblyopia (D) do not alter red reflex.
5. A 28-year-old woman with rheumatoid arthritis reports dry,
gritty sensation in both eyes. Schirmer’s test shows 3 mm
wetting at 5 minutes. Which underlying mechanism explains
her symptoms?
A. Corneal nerve injury
B. Meibomian gland hypersecretion
C. Lacrimal gland lymphocytic infiltration
D. Hyperosmolar tears
Answer: C
Rationale: Sjögren’s syndrome causes lymphocytic destruction
of lacrimal glands leading to aqueous-deficient dry eye;
Schirmer’s ≤5 mm is diagnostic. Nerve injury (A) is neurotrophic
,keratitis; meibomian hypersecretion (B) produces oily tears;
hyperosmolarity (D) is a consequence, not primary.
6. A patient presents with sudden, painful vision loss and an
afferent pupillary defect. Fundoscopy shows a pale retina with
a cherry-red spot at the fovea. The most likely diagnosis is:
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Optic neuritis
D. Retinal detachment
Answer: A
Rationale: CRAO presents with acute, painless (though often
described as painful) vision loss, pale retina, cherry-red spot,
and RAPD. CRVO (B) shows “blood and thunder.” Optic neuritis
(C) has pain with eye movement, normal fundus early. Retinal
detachment (D) has “floaters/flashes” not cherry-red.
7. A 50-year-old man with chronic poorly controlled
hypertension complains of blurry vision. Fundoscopy reveals
flame hemorrhages, cotton-wool spots, and papilledema.
Which grade of hypertensive retinopathy is this?
A. Grade I
B. Grade II
C. Grade III
D. Grade IV
, Answer: C
Rationale: Grade III has hemorrhages, exudates (cotton-wool).
Papilledema appears in Grade IV. Grade I: arterial narrowing; II:
AV nicking.
8. A 22-year-old presents with sudden severe ocular pain,
headache, mid-dilated nonreactive pupil, and cloudy cornea.
Intraocular pressure is 55 mm Hg. The immediate next step is:
A. Intravenous acetazolamide
B. Topical pilocarpine
C. Oral ibuprofen
D. Emergent YAG laser peripheral iridotomy
Answer: A
Rationale: Acute angle-closure glaucoma requires rapid IOP
lowering: IV acetazolamide first. Once pressure is reduced
(<40 mm Hg), pilocarpine (B) and definitive iridotomy (D)
follow. Ibuprofen (C) provides no IOP effect.
9. A 35-year-old woman complains of intermittent double
vision and drooping eyelid that worsen as day progresses.
Ice-pack test improves ptosis. The most likely diagnosis is:
A. Myasthenia gravis
B. Horner’s syndrome
C. Third-nerve palsy
D. Graves’ ophthalmopathy
