PAEASY Emergency Medicine EOR
Practice Exam Questions and Answers
Latest Versions 2025 A+
What is the most common ECG abnormality in patients with a pulmonary
embolism (PE)?
A Atrial fibrillation
B Sinus tachycardia
C Ventricular ectopy
D Sinus bradycardia
sinus tachycardia
B In most cases, sinus tachycardia is the only abnormality in patients with a PE. You
may also find some ECGs that will have non-specific ST-T wave changes. Sinus
bradycardia and AV blocks are not common findings that are associated with PE.
In the emergency department, you are asked to evaluate a 77-year-old man with a
history of HTN who had a syncopal episode while chasing after his dog. He
admits to recent episodes of chest discomfort, also associated with activity, as
well as dyspnea at lower levels of activity including walking up one flight of
stairs. On physical exam, a grade III/IV crescendo-decrescendo systolic ejection
murmur can be heard best over the right upper sternal border. His EKG
demonstrates NSR @ 80 bpm, with evidence of left ventricular hypertrophy. His
troponin levels are negative for ischemia. What is the next most appropriate test
or procedure?
A Echocardiography
B VQ scan
C CT scan of the head
D Serum D-dimer levels
echo
A This patient exhibits all the signs of progression of aortic stenosis, thus
echocardiography is the next most appropriate test. A determination of severity can then
be made, with possible cardiac catheterization if severe aortic stenosis is suspected, in
preparation for surgical intervention if necessary. A VQ scan is appropriate if pulmonary
embolism were suspected. A CT scan of the head could be considered if a head injury
was suspected, but would not be the next step in the management of this patient.
Serum D-dimer levels might be used to rule out pulmonary embolism, although it is a
fairly nonspecific test. An MRI of the heart is not considered standard of care for aortic
stenosis
,A 56-year-old male, with history of hyperlipidemia and non-insulin-dependent
diabetes mellitus (NIDDM) presents to the emergency department with a history
of increasing peripheral edema over the past week. On examination he is noted to
have periorbital, scrotal, and +2 pretibial edema. His lungs are CTAB. He denies
any chest pain or shortness of breath. Urine dipstick reveals 4+ protein. Urine
microscopic reveals Maltese crosses consistent with lipiduria. Labs include a
decreased serum albumin of 2 g/dl, decreased total protein of 5.5 g/dl, and normal
glomerular filtration rate (GFR). What is the most likely diagnosis?
A pyelonephritis
B congestive heart failure (CHF)
C nephrotic syndrome
D prostatitis
Nephrotic syndrome
C The correct answer is (C). This patient has typical symptoms of nephrotic syndrome,
which includes significant proteinuria, hypoalbuminemia, and typical presentation of
edema. He also has a history of hyperlipidemia and laboratory findings of lipiduria,
which is also common in nephrotic syndrome. Furthermore, his history of diabetes
mellitus is also a potential cause of nephrotic syndrome. Pyelonephritis and prostatitis
would present with urine WBCs and is not consistent with the laboratory findings or
edema. CHF would more likely present with dyspnea, rales on exam, and peripheral
edema but would unlikely involve the periorbital area. DVT would likely present with
unilateral swelling of the LE, and discomfort and is not consistent with the laboratory
findings above.
Out of all cervical vertebrae, which two are responsible for the greatest amount of
rotation?
A C1 & C2
B C2 & C3
C C3 & C4
D C4 & C5
E C5 & C6
C1 & C2
A Approximately 50% of cervical rotation takes place between the C1 (atlas) and C2
(axis) vertebrae. These first two cervical vertebrae have a different shape from the other
cervical vertebrae that allow for this greater range of motion. The remaining 50 % of
cervical rotation is split fairly evenly between the remaining vertebrae. Approximately 50
% of flexion and extension occurs between the occiput at the base of the skull and C1
with the remaining 50% distributed fairly evenly between the remaining vertebrae with a
slightly higher percentage occurring at the C5 & C6 level.
A 15-year-old boy suddenly collapses on the basketball court; his sports physical
conducted at the beginning of the year did not elicit any abnormal findings. Basic
life support initiated at the scene, however, is unsuccessful in resuscitation.
,Which of the following is the most likely etiology of his sudden death?
A mitral valve prolapse
B surgically corrected aortic stenosis
C hypertrophic cardiomyopathy
D rheumatic heart disease
hypertrophic cardiomyopathy
C Hypertrophic cardiomyopathy in adolescence is typically due to familial hypertrophic
cardiomyopathy with an incidence of 1:500. Many patients are asymptomatic until a
sporting event, which may cause symptoms, specifically sudden cardiac death.
Examination may demonstrate a palpable or audible S 4 , an LV (left ventricular) heave,
systolic ejection murmur (may need to stimulate cardiac activity), and/or a left precordial
bulge. Echocardiography is the gold standard for diagnosis but family history should be
assessed. Stress testing is indicated to assess for ischemia and arrhythmias. Strenuous
activities are prohibited for these patients. The other cardiomyopathies (dilated and
restrictive) are next but are not as common. Congenital structural abnormalities of the
coronary arteries are the next most common cause. Valvular disorders, including
surgically repaired aortic stenosis, are typically not causes of sudden death, but these
patients should be screened for symptoms and stress tested as necessary.
A 46-year-old female presents with pain to her left wrist. She complains that it is
painful and swollen as she points to the volar aspect of the wrist on the radial
side. On examination, there is a small, soft bump on the dorsum of her wrist with
a jelly-like consistency. What is the most likely diagnosis?
A Cancerous tumor
B Fracture
C Ganglion cyst
D Hematoma
E Lipoma
Ganglion Cyst
C Ganglion cysts commonly occur on the dorsal or volar aspect of the wrist. They result
when a joint capsule or tendon sheath is damaged, allowing synovial fluid to escape
producing a one-way valve, which allows fluid into the cyst, but not back out. The
accumulating fluid forms the ganglion cyst. These cysts may or may not be tender and
can fluctuate in size depending on activity level of the affected extremity. Cancerous
tumors would tend to be much more firm, but also may be relatively pain free. Fractures
would generally be exquisitely tender and if the bump is due to a displaced bone, it
would be much more firm than a ganglion cyst. Hematomas are generally associated
with acute trauma and would be tender and ecchymotic in many situations. Lipomas are
benign fatty tumors that are more commonly seen on the thenar eminence than the
dorsum of the wrist and their size does not change based on activity level.
A 65-year-old male presents with pain and swelling to his right knee without any
history of injury. He has had this type of pain and swelling before, and does recall
, that he had fluid drained out of the knee several years ago. On examination the
patient has a swollen, tender knee with a palpable effusion. There is decreased
range of motion to the joint secondary to the effusion. An arthocentesis is
performed, and the analysis of the fluid reveals calcium pyrophosphonate
crystals. Based on these findings, what is the most likely diagnosis?
A Septic arthritis
B Acute synovitis
C Hemarthoma
D Pseudogout
Psuedogout
D Pseudogout is also known as Calcium Pyrophosphate Deposition Disease (CPDD)
and most commonly affects patients over the age of 65. The knee joint is most
commonly affected with the wrist joint second most common. An examination of
synovial fluid aspirated from the affect joints, will reveal calcium pyrophosphate crystal.
Ankle joints are rarely affected by pseudogout but are fairly common locations for gout
caused by urate crystal deposition. The first metatarsal phalangeal joint is the classic
location for gout (sometimes referred to as podagra), but it is not a typical pseudogout
location. The glenohumeral joint of the shoulder is affected by pseudogout much more
than gout. Distal interphalangeal joints of the hand are rare locations for either gout or
pseudogout, but are classic locations to see signs and symptoms of osteoarthritis.
When pseudogout does affect the hands it is generally seen in the
metacarpophalangeal joints.
An 18-year-old woman is transferred to your emergency department from a local
college infirmary. She presented yesterday with a complaint of headache but
became confused and is now febrile. You notice a petechial rash on physical
examination and her cerebrospinal fluid comes back with increased WBCs,
increased protein, and decreased glucose. What is the most likely organism
responsible for her meningitis?
A Haemophilus influenzae
B cytomegalovirus
C Neisseria meningitidis
D Mycobacterium tuberculosis
E coxsackievirus B
Neisseria meningitis
C Neisseria meningitidis and Streptococcus pneumoniae are the most common etiologic
agents for bacterial meningitis in this patient's age group. So much so that many
colleges and universities require a vaccine for students who live in dormitories. Her
fever and the cerebrospinal fluid values are consistent with a bacterial and not a viral
infectious source for the meningeal irritation.
A 24-year-old HIV-positive man comes to the emergency department complaining
of severe left-sided chest discomfort, which radiates through to the left trapezius
Practice Exam Questions and Answers
Latest Versions 2025 A+
What is the most common ECG abnormality in patients with a pulmonary
embolism (PE)?
A Atrial fibrillation
B Sinus tachycardia
C Ventricular ectopy
D Sinus bradycardia
sinus tachycardia
B In most cases, sinus tachycardia is the only abnormality in patients with a PE. You
may also find some ECGs that will have non-specific ST-T wave changes. Sinus
bradycardia and AV blocks are not common findings that are associated with PE.
In the emergency department, you are asked to evaluate a 77-year-old man with a
history of HTN who had a syncopal episode while chasing after his dog. He
admits to recent episodes of chest discomfort, also associated with activity, as
well as dyspnea at lower levels of activity including walking up one flight of
stairs. On physical exam, a grade III/IV crescendo-decrescendo systolic ejection
murmur can be heard best over the right upper sternal border. His EKG
demonstrates NSR @ 80 bpm, with evidence of left ventricular hypertrophy. His
troponin levels are negative for ischemia. What is the next most appropriate test
or procedure?
A Echocardiography
B VQ scan
C CT scan of the head
D Serum D-dimer levels
echo
A This patient exhibits all the signs of progression of aortic stenosis, thus
echocardiography is the next most appropriate test. A determination of severity can then
be made, with possible cardiac catheterization if severe aortic stenosis is suspected, in
preparation for surgical intervention if necessary. A VQ scan is appropriate if pulmonary
embolism were suspected. A CT scan of the head could be considered if a head injury
was suspected, but would not be the next step in the management of this patient.
Serum D-dimer levels might be used to rule out pulmonary embolism, although it is a
fairly nonspecific test. An MRI of the heart is not considered standard of care for aortic
stenosis
,A 56-year-old male, with history of hyperlipidemia and non-insulin-dependent
diabetes mellitus (NIDDM) presents to the emergency department with a history
of increasing peripheral edema over the past week. On examination he is noted to
have periorbital, scrotal, and +2 pretibial edema. His lungs are CTAB. He denies
any chest pain or shortness of breath. Urine dipstick reveals 4+ protein. Urine
microscopic reveals Maltese crosses consistent with lipiduria. Labs include a
decreased serum albumin of 2 g/dl, decreased total protein of 5.5 g/dl, and normal
glomerular filtration rate (GFR). What is the most likely diagnosis?
A pyelonephritis
B congestive heart failure (CHF)
C nephrotic syndrome
D prostatitis
Nephrotic syndrome
C The correct answer is (C). This patient has typical symptoms of nephrotic syndrome,
which includes significant proteinuria, hypoalbuminemia, and typical presentation of
edema. He also has a history of hyperlipidemia and laboratory findings of lipiduria,
which is also common in nephrotic syndrome. Furthermore, his history of diabetes
mellitus is also a potential cause of nephrotic syndrome. Pyelonephritis and prostatitis
would present with urine WBCs and is not consistent with the laboratory findings or
edema. CHF would more likely present with dyspnea, rales on exam, and peripheral
edema but would unlikely involve the periorbital area. DVT would likely present with
unilateral swelling of the LE, and discomfort and is not consistent with the laboratory
findings above.
Out of all cervical vertebrae, which two are responsible for the greatest amount of
rotation?
A C1 & C2
B C2 & C3
C C3 & C4
D C4 & C5
E C5 & C6
C1 & C2
A Approximately 50% of cervical rotation takes place between the C1 (atlas) and C2
(axis) vertebrae. These first two cervical vertebrae have a different shape from the other
cervical vertebrae that allow for this greater range of motion. The remaining 50 % of
cervical rotation is split fairly evenly between the remaining vertebrae. Approximately 50
% of flexion and extension occurs between the occiput at the base of the skull and C1
with the remaining 50% distributed fairly evenly between the remaining vertebrae with a
slightly higher percentage occurring at the C5 & C6 level.
A 15-year-old boy suddenly collapses on the basketball court; his sports physical
conducted at the beginning of the year did not elicit any abnormal findings. Basic
life support initiated at the scene, however, is unsuccessful in resuscitation.
,Which of the following is the most likely etiology of his sudden death?
A mitral valve prolapse
B surgically corrected aortic stenosis
C hypertrophic cardiomyopathy
D rheumatic heart disease
hypertrophic cardiomyopathy
C Hypertrophic cardiomyopathy in adolescence is typically due to familial hypertrophic
cardiomyopathy with an incidence of 1:500. Many patients are asymptomatic until a
sporting event, which may cause symptoms, specifically sudden cardiac death.
Examination may demonstrate a palpable or audible S 4 , an LV (left ventricular) heave,
systolic ejection murmur (may need to stimulate cardiac activity), and/or a left precordial
bulge. Echocardiography is the gold standard for diagnosis but family history should be
assessed. Stress testing is indicated to assess for ischemia and arrhythmias. Strenuous
activities are prohibited for these patients. The other cardiomyopathies (dilated and
restrictive) are next but are not as common. Congenital structural abnormalities of the
coronary arteries are the next most common cause. Valvular disorders, including
surgically repaired aortic stenosis, are typically not causes of sudden death, but these
patients should be screened for symptoms and stress tested as necessary.
A 46-year-old female presents with pain to her left wrist. She complains that it is
painful and swollen as she points to the volar aspect of the wrist on the radial
side. On examination, there is a small, soft bump on the dorsum of her wrist with
a jelly-like consistency. What is the most likely diagnosis?
A Cancerous tumor
B Fracture
C Ganglion cyst
D Hematoma
E Lipoma
Ganglion Cyst
C Ganglion cysts commonly occur on the dorsal or volar aspect of the wrist. They result
when a joint capsule or tendon sheath is damaged, allowing synovial fluid to escape
producing a one-way valve, which allows fluid into the cyst, but not back out. The
accumulating fluid forms the ganglion cyst. These cysts may or may not be tender and
can fluctuate in size depending on activity level of the affected extremity. Cancerous
tumors would tend to be much more firm, but also may be relatively pain free. Fractures
would generally be exquisitely tender and if the bump is due to a displaced bone, it
would be much more firm than a ganglion cyst. Hematomas are generally associated
with acute trauma and would be tender and ecchymotic in many situations. Lipomas are
benign fatty tumors that are more commonly seen on the thenar eminence than the
dorsum of the wrist and their size does not change based on activity level.
A 65-year-old male presents with pain and swelling to his right knee without any
history of injury. He has had this type of pain and swelling before, and does recall
, that he had fluid drained out of the knee several years ago. On examination the
patient has a swollen, tender knee with a palpable effusion. There is decreased
range of motion to the joint secondary to the effusion. An arthocentesis is
performed, and the analysis of the fluid reveals calcium pyrophosphonate
crystals. Based on these findings, what is the most likely diagnosis?
A Septic arthritis
B Acute synovitis
C Hemarthoma
D Pseudogout
Psuedogout
D Pseudogout is also known as Calcium Pyrophosphate Deposition Disease (CPDD)
and most commonly affects patients over the age of 65. The knee joint is most
commonly affected with the wrist joint second most common. An examination of
synovial fluid aspirated from the affect joints, will reveal calcium pyrophosphate crystal.
Ankle joints are rarely affected by pseudogout but are fairly common locations for gout
caused by urate crystal deposition. The first metatarsal phalangeal joint is the classic
location for gout (sometimes referred to as podagra), but it is not a typical pseudogout
location. The glenohumeral joint of the shoulder is affected by pseudogout much more
than gout. Distal interphalangeal joints of the hand are rare locations for either gout or
pseudogout, but are classic locations to see signs and symptoms of osteoarthritis.
When pseudogout does affect the hands it is generally seen in the
metacarpophalangeal joints.
An 18-year-old woman is transferred to your emergency department from a local
college infirmary. She presented yesterday with a complaint of headache but
became confused and is now febrile. You notice a petechial rash on physical
examination and her cerebrospinal fluid comes back with increased WBCs,
increased protein, and decreased glucose. What is the most likely organism
responsible for her meningitis?
A Haemophilus influenzae
B cytomegalovirus
C Neisseria meningitidis
D Mycobacterium tuberculosis
E coxsackievirus B
Neisseria meningitis
C Neisseria meningitidis and Streptococcus pneumoniae are the most common etiologic
agents for bacterial meningitis in this patient's age group. So much so that many
colleges and universities require a vaccine for students who live in dormitories. Her
fever and the cerebrospinal fluid values are consistent with a bacterial and not a viral
infectious source for the meningeal irritation.
A 24-year-old HIV-positive man comes to the emergency department complaining
of severe left-sided chest discomfort, which radiates through to the left trapezius
