CME Review Courses

Success on the Pediatrics End of Rotation (EOR) exam requires a shift in mindset. Unlike the broad strokes of Internal Medicine, Pediatrics demands a mastery of age-specific vitals, developmental milestones, and unique pathologies that don't exist in the adult world. You aren't just treating "small adults"; you are navigating a complex clinical landscape from neonates to adolescents.

PAtopia was designed by PAs who have survived these rotations. It provides a streamlined, high-yield environment to ensure you aren't wasting time on low-probability topics. With 600 rotation-specific questions, PAtopia ensures you are prepared for the specific weights and distributions of the Pediatrics exam.

Price: Free 3-Day Trial | Questions: 600 Pediatrics-Specific (5 Full Mock Exams) | Access: Instant Mobile & Web

Understanding the Pediatrics Content Distribution

The Pediatrics EOR exam is heavily weighted toward four major systems. If you master these four, you have already covered over 50% of the exam. The distribution typically follows this pattern:

• Dermatology (15%): Viral exanthems, atopic dermatitis, and neonatal rashes.
• HEENT (15%): Otitis media, pharyngitis, and congenital anomalies.
• Infectious Disease (12%): Vaccinations, sepsis, and common childhood infections.
• Pulmonology (12%): Asthma, bronchiolitis, and croup.
• Cardiovascular (10%): Congenital heart defects (VSD, ASD, Tetralogy of Fallot).
• Gastrointestinal / Nutrition (10%): Pyloric stenosis, intussusception, and FTT.

The remaining 26% is spread across Neurology, Psychiatry, Orthopedics, Endocrinology, Hematology, and Urology. While these carry less weight, they often contain "easy" points if you know the high-yield presentations, such as Osgood-Schlatter or Nursemaid’s elbow.

Mastering Growth and Development

One of the most intimidating aspects of the Pediatrics rotation is Growth and Development. This isn't just about memorizing when a child can stack four blocks; it’s about recognizing when a child is deviating from the norm. On the EOR, you will see questions regarding:

1. Developmental Milestones: Focus on the major "checkpoints" at 2, 4, 6, 9, and 12 months.
2. Failure to Thrive (FTT): Distinguishing between organic (medical) and non-organic (social/environmental) causes.
3. Pubertal Development: Understanding Tanner Staging and identifying precocious or delayed puberty.
4. Short Stature: Differentiating constitutional growth delay (the "late bloomer") from pathologic growth hormone deficiency.

PAtopia includes specific analytics that track your performance in these "Neurology/Developmental" categories. If you are consistently missing milestone questions, the app tells you exactly where your deficit lies so you can review that specific library before exam day.

How PAtopia Integrates Your PA Journey

PAtopia isn't just an EOR tool; it is a longitudinal prep platform. Many students begin using PAtopia for PACKRAT Review and transition seamlessly into their clinical year rotations.

The app offers:

• 7 EOR Rotations: Including Pediatrics, Emergency Medicine, Surgery, and more.
• System-Based Analytics: After every 120-question mock exam, you receive a breakdown of your performance by organ system.
• Detailed Explanations: We don't just tell you the answer is "C"; we explain why the distractors are wrong using clinical logic that mimics the NCCPA Blueprint.
• PANCE Readiness: The questions you answer during your Peds rotation are building the foundation for the 15 full-length mock PANCE exams available in the app.

Clinical Scenario 1: The Barking Cough

Your patient is a 2-year-old male brought to the emergency department at 2:00 AM by his parents. The father reports the child was fine at bedtime but woke up with a "harsh, barking cough" and seemingly had difficulty breathing. On physical exam, the child has an audible inspiratory stridor at rest and a temperature of 100.4°F (38°C). There is no drooling noted. What is the most appropriate initial management for this patient?

A) Rapid strep test and oral amoxicillin
B) Racemic epinephrine and IM dexamethasone
C) Lateral neck X-ray to look for a "thumbprint sign"
D) Immediate intubation and IV ceftriaxone

Correct Answer: B (Racemic epinephrine and IM dexamethasone)
Explanation: This patient presents with classic symptoms of Croup (Laryngotracheobronchitis), characterized by the "barking" seal-like cough and inspiratory stridor. In cases of moderate to severe croup (stridor at rest), the standard of care is nebulized racemic epinephrine to reduce airway edema and a corticosteroid (Dexamethasone) to provide longer-lasting anti-inflammatory effects. Option C is used for suspected epiglottitis (though clinical diagnosis is preferred), and Option D is for emergent airway obstruction in epiglottitis, which presents with drooling and a "tripod" position, not a barking cough.

Clinical Scenario 2: The Neonatal Rash

Your patient is a 3-day-old full-term female brought in for her first newborn check-up. The mother is concerned about a rash on the infant's trunk and proximal extremities. The rash consists of multiple small, yellow-white papules on an erythematous base. The infant is feeding well, is afebrile, and appears non-toxic. What is the most likely diagnosis?

A) Erythema toxicum neonatorum
B) Neonatal herpes simplex virus
C) Milia
D) Staphylococcal scalded skin syndrome

Correct Answer: A (Erythema toxicum neonatorum)
Explanation: Erythema toxicum neonatorum is a common, benign, self-limiting rash seen in newborns, usually appearing within the first 72 hours of life. It is characterized by "flea-bite" appearing papules on an erythematous base. It requires no treatment and resolves spontaneously. Option B would present with vesicles and a toxic-appearing infant. Option C (Milia) consists of tiny white sebaceous cysts without the erythematous base. Option D would present with diffuse skin tenderness and systemic illness.

Why Practice Questions Matter

Reading a textbook or a review book is passive. Answering board-style questions is active. PAtopia forces you to apply the knowledge in a timed environment that mimics the actual EOR interface. By the time you finish our 5 Pediatrics mock exams, you will have seen nearly every common permutation of the Pediatric Review content.

The Pediatrics EOR is often cited as one of the "trickier" exams because of the emphasis on infectious disease and dermatology. PAtopia bridges that gap by providing high-quality images and vignettes that reflect real-world clinical practice.

Start Your Free Trial Today

Don't wait until the weekend before your exam to start your Pediatrics EOR review. PAtopia offers a 3-day free trial with no account or sign-in required. You can download the app and start testing your knowledge immediately. Whether you are on the bus to your rotation or have a few minutes between patients, PAtopia's mobile-friendly interface makes it the most efficient way to study.

Beyond the EOR, our platform supports your entire career, offering CME with gift card options for when you transition from student to practicing PA.

Ready to crush your Peds EOR? Download PAtopia now and start your 72 hours of free access.

Course Name: PAtopia Family Medicine EOR Prep
Access: 3-Day Free Trial (No Account Required)
Deliverables: 5 Full-Length Mock Exams (120 Questions Each), Detailed Analytics, Study Library
Questions: 600 Rotation-Specific Questions (11,000+ Total in App)

The Family Medicine (FM) rotation is often described by students as one of the most challenging End of Rotation (EOR) exams due to its sheer breadth. Unlike specialized rotations like Surgery or Psychiatry, Family Medicine requires you to be a master of the "everything." You are expected to manage a 6-month-old with a rash in the morning and a 70-year-old with heart failure in the afternoon.

To succeed on the FM EOR, you cannot simply "wing it" based on clinical experience alone. The exam follows a strict distribution of topics defined by the PAEA blueprint, focusing heavily on chronic disease management, preventative health, and common acute presentations. PAtopia was designed to provide a structured, high-yield environment where you can test your knowledge across the entire spectrum of primary care.

The Family Medicine Blueprint Breakdown

The FM EOR exam consists of 120 multiple-choice questions. To study efficiently, you must prioritize the highest-yield organ systems. PAtopia’s mock exams are calibrated to match the weight of the NCCPA blueprint and PAEA standards.

High-Yield Categories:

• Cardiovascular (15%): Hypertension management, heart failure, and dyslipidemias are foundational.
• Pulmonology (12%): Asthma, COPD, and community-acquired pneumonia.
• Gastrointestinal / Nutritional (11%): GERD, peptic ulcer disease, and biliary tract disorders.
• Orthopedics / Rheumatology (8%): Osteoarthritis, gout, and low back pain.
• ENOT / Ophthalmology (8%): Otitis media, sinusitis, and conjunctivitis.

The remaining 46% of the exam is distributed among smaller but equally important categories like Dermatology, Endocrinology, and Psychiatry. PAtopia ensures that even these "smaller" categories are represented in every mock exam so you aren't blindsided on test day.

PAtopia’s Approach: 5 Full-Length Mock Exams

Most PA students make the mistake of using generic question banks that mix rotation-level questions with PANCE-level complexity. PAtopia provides 5 specific mock exams for Family Medicine, each containing 120 questions. This allows you to simulate the actual exam environment five times over.

By the time you reach your fifth exam, you have seen 600 unique clinical vignettes that cover the most frequently tested topics in primary care. This repetitive exposure builds "exam stamina" and teaches you to recognize patterns in how questions are framed: such as identifying the "next best step in management" versus the "most likely diagnosis."

Advanced Analytics: Finding Your Weak Spots

Studying hard is not the same as studying smart. If you are already scoring 90% in Cardiovascular questions but 40% in Endocrinology, spending another three hours on EKGs is a poor use of your limited rotation time.

PAtopia includes a robust analytics dashboard that tracks your performance after every exam. You can see a granular breakdown of your scores by organ system. This allows you to pivot your study plan in real-time. If the data shows you are consistently missing questions on "Health Maintenance" or "Clinical Therapeutics," you know exactly which chapters of your review book to open.

The Longitudinal Journey: PACKRAT to PANCE

The Family Medicine EOR is not an isolated event. It is a critical milestone in a journey that leads from your first PACKRAT exam to your eventual PANCE and, years later, your PANRE Review.

PAtopia is built to support you throughout this entire timeline. The knowledge you cement during your FM rotation will directly translate to your End of Curriculum (EOC) exam and the PANCE. By using an all-in-one app that houses over 11,000 questions, you maintain a consistent learning interface.

For those looking ahead to their professional careers, CME Review Courses offers an efficient way to transition from student to clinician, including Category 1 AAPA CME Credit in Pharmacology and comprehensive PANRE prep once you are in practice.

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Clinical Practice Questions

Test your knowledge with these Family Medicine clinical vignettes, formatted similarly to what you will encounter in the PAtopia app and on your EOR exam.

Question 1: Cardiovascular

Your patient is a 64-year-old male with a history of hypertension and tobacco use who presents for a routine follow-up. He reports recent onset of calf pain that occurs after walking two blocks and is relieved by rest. On physical exam, you note diminished pedal pulses and a cool temperature of the lower extremities bilaterally. What is the most appropriate initial diagnostic test for this patient?

A) Magnetic Resonance Angiography (MRA)
B) Ankle-Brachial Index (ABI)
C) Computed Tomography (CT) Angiography
D) Duplex Ultrasound

Correct Answer: B) Ankle-Brachial Index (ABI)
Explanation: The patient’s symptoms are classic for intermittent claudication, a hallmark of Peripheral Artery Disease (PAD). The Ankle-Brachial Index (ABI) is the most appropriate and cost-effective initial diagnostic test to confirm the presence and severity of PAD. An ABI of ≤ 0.90 is diagnostic. While MRA (A) and CT Angiography (C) provide detailed anatomical localization, they are typically reserved for preoperative planning. Duplex ultrasound (D) is useful but less standardized than ABI for initial screening.

Question 2: Pulmonology

Your patient is a 28-year-old female with a history of mild persistent asthma. She uses an Albuterol inhaler as needed and a low-dose inhaled corticosteroid (ICS) daily. She reports that over the last month, she has been waking up twice a week due to cough and shortness of breath, and she is using her Albuterol inhaler almost every day. According to the current GINA guidelines, what is the most appropriate next step in her management?

A) Increase to a medium-dose ICS
B) Add a Long-Acting Beta-Agonist (LABA)
C) Add a Leukotriene Receptor Antagonist (LTRA)
D) Discontinue the ICS and start an Oral Corticosteroid

Correct Answer: B) Add a Long-Acting Beta-Agonist (LABA)
Explanation: The patient’s asthma is currently "uncontrolled" based on her nighttime awakenings and frequency of rescue inhaler use. For patients symptomatic on low-dose ICS, the preferred next step is the addition of a LABA (Formoterol is often preferred in combination with an ICS). Increasing to a medium-dose ICS (A) is an alternative but is generally considered less effective than adding a LABA. LTRAs (C) are typically third-line or add-on therapy. Oral corticosteroids (D) are reserved for severe, refractory asthma or acute exacerbations.

Question 3: Gastrointestinal

Your patient is a 45-year-old female presenting with a 2-day history of steady, aching pain in the right upper quadrant that radiates to her right scapula. She reports associated nausea and one episode of vomiting. On exam, she has a positive Murphy’s sign. Her temperature is 101.2°F (38.4°C). Laboratory results show a WBC count of 14,000/mm³. What is the most likely diagnosis?

A) Cholelithiasis
B) Acute Cholecystitis
C) Choledocholithiasis
D) Ascending Cholangitis

Correct Answer: B) Acute Cholecystitis
Explanation: Acute Cholecystitis is characterized by gallbladder inflammation usually due to cystic duct obstruction. The combination of steady RUQ pain, positive Murphy’s sign, fever, and leukocytosis strongly supports this diagnosis. Cholelithiasis (A) refers to gallstones without inflammation, typically causing transient "biliary colic" without fever or leukocytosis. Choledocholithiasis (C) involves stones in the common bile duct and usually presents with elevated liver enzymes or jaundice. Ascending cholangitis (D) presents with Charcot’s Triad (RUQ pain, fever, and jaundice) and is a more severe, life-threatening emergency.

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Start Your FM EOR Prep Today

Success on the Family Medicine EOR requires more than just clinical intuition; it requires a systematic review of the NCCPA blueprint topics and extensive practice with board-style questions.

PAtopia offers the most comprehensive student-led prep tool on the market, bridging the gap between your clinical rotations and the PANCE. With 5 full-length Family Medicine mock exams and detailed performance analytics, you can enter your testing center with confidence.

Download PAtopia today and start your 3-day free trial. No credit card, no account, and no sign-in required. Just high-yield prep.

PAtopia Access: 3-Day Free Trial (No Account Required)
Deliverables: 11,000+ Board-Style Questions, 15 Full-Length Mock PANCE Exams
EOR Specifics: 5 Internal Medicine Mock Exams (120 Questions Each)

The Internal Medicine (IM) End of Rotation (EOR) exam is widely regarded as one of the most challenging assessments in clinical year. Unlike more focused rotations like Psychiatry or Women's Health, the IM blueprint encompasses a massive breadth of pathophysiology, diagnostic reasoning, and multi-system management. Success on this exam requires more than just passive reading; it demands rigorous application of knowledge through high-volume question banks and data-driven study strategies.

Navigating the Internal Medicine EOR Blueprint

The PAEA Internal Medicine EOR blueprint is heavily weighted toward chronic disease management and acute inpatient presentations. Understanding the distribution of topics is critical for time management:

• Cardiovascular (20%): The highest-yield section, focusing on heart failure, arrhythmias, and coronary artery disease.
• Pulmonology (15%): Emphasis on COPD, asthma, and pneumonia management.
• Gastrointestinal / Nutritional (12%): Covers everything from GERD to acute pancreatitis and hepatic disorders.
• Orthopedics / Rheumatology (12%): Large focus on systemic inflammatory conditions like RA and SLE.
• Endocrinology (8%): Diabetes management and thyroid pathology.

The remaining 33% is distributed across Neurology, Urology/Renal, Critical Care, Hematology, and Infectious Diseases. To master this volume, you cannot rely on a single review book. You must utilize a question bank that mirrors the complexity and the 120-question format of the actual PAEA exam.

High-Volume Preparation with PAtopia

PAtopia provides an all-in-one ecosystem for the PA student journey. While many students focus solely on the EOR at hand, PAtopia’s database contains over 11,000 board-style questions covering every rotation and the PANCE. For the Internal Medicine rotation specifically, the app offers 5 dedicated mock exams. Each exam consists of 120 questions, designed to simulate the pacing and stamina required for the actual EOR.

Preparing with these mock exams allows you to see a wider variety of clinical presentations than you might encounter during your four or five weeks on the wards. While you may see plenty of CHF and COPD on a hospitalist service, you might not see a case of Addison’s disease or a specific rheumatologic flare. The PAtopia question bank ensures these "blueprint gaps" are filled before exam day.

Data-Driven Mastery: System Analytics

The most common mistake PA students make is studying what they already know. If you are comfortable with Cardiology but struggle with Renal/Urology, spending more time on EKGs is an inefficient use of your study hours.

PAtopia features by-system analytics after every exam. This tool breaks down your performance into the specific categories defined by the NCCPA and PAEA blueprints. If your analytics show a 40% accuracy in Hematology, the app identifies this weakness immediately, allowing you to pivot your study plan. This granular feedback is essential for the IM EOR, where a deficiency in a single 15% category (like Pulmonology) can be the difference between passing and failing.

Clinical Case Assessment: Cardiology

Internal Medicine requires the ability to differentiate between similar clinical presentations under pressure. Use the following vignette to test your diagnostic reasoning.

Your patient is a 68-year-old male presenting to the emergency department with a 3-hour history of "crushing" chest pain and diaphoresis. His medical history is significant for HTN, DM2, and a 40-pack-year smoking history. On physical exam, he appears distressed. HR is 110 bpm, BP is 105/62 mmHg, and SaO2 is 94% on room air. An EKG is performed and reveals 3mm ST-segment elevation in leads V1 through V4.

Which of the following is the most appropriate next step in management?

A. Immediate administration of thrombolytics
B. Stat echocardiogram to assess wall motion
C. Urgent transfer to the cardiac catheterization lab for PCI
D. Measurement of serial troponins and observation

Correct Answer: C. Urgent transfer to the cardiac catheterization lab for PCI

Explanation: The patient is presenting with an acute anterior wall ST-segment elevation myocardial infarction (STEMI), as evidenced by the elevations in V1-V4. For a STEMI, the gold standard is Percutaneous Coronary Intervention (PCI) within 90 minutes of medical contact at a PCI-capable center. A is incorrect because thrombolytics are only indicated if PCI cannot be performed within 120 minutes. B is incorrect because while an echo may show wall motion abnormalities, it should not delay definitive reperfusion therapy. D is incorrect because serial troponins are used to diagnose NSTEMI or unstable angina; a STEMI diagnosis is made via EKG and requires immediate intervention.

Strategic Transition to PANCE Prep

The IM EOR is often considered a "mini-PANCE" because the blueprints overlap significantly. By utilizing PAtopia for your EOR prep, you are simultaneously building the foundation for your boards. PAtopia includes 15 full-length mock PANCE exams, each consisting of 300 questions.

Students who use these full-length exams during their clinical year rotations report significantly lower anxiety during their dedicated PANCE study period. The familiarity with the question style, the interface, and the endurance required for 300 questions becomes second nature.

Efficient Resource Utilization

Clinical year is expensive. Between tuition, travel, and professional equipment, PA students must be strategic with their spending. PAtopia offers a 3-day free trial with no account or sign-in required. This allows you to explore the 11,000+ question bank and the specific Internal Medicine mock exams without any financial commitment.

For those looking for additional specialized review, CME Review Courses offers targeted blueprint reviews and CME packages. If you are seeking Category 1 AAPA credit, our PANRE Review Course offers 100 hours of credit and covers the essential systems found in Internal Medicine. We also provide CME with Gift Card options, allowing you to add an Amazon or Apple Gift Card ($100-$1500) to your purchase to further support your educational needs.

Conclusion

Mastering the Internal Medicine EOR requires a shift from memorization to application. By using PAtopia's extensive mock exams and system analytics, you can identify your specific blueprint weaknesses and correct them before they impact your grade. Whether you are preparing for the Cardiovascular blueprint or the Pulmonary blueprint, having 11,000+ questions at your fingertips is the most efficient path to success.

Download PAtopia today and start your 3-day free trial to conquer the IM EOR and prepare for the PANCE.

Price: 3-Day Free Trial (No account or credit card required)
Deliverables: 11,000+ Board-Style Questions, 35 Mock EOR Exams (7 Rotations), 15 Full-Length PANCE Exams, System-Based Analytics
Access: Immediate via iOS and Android App Stores

The surgery rotation is often the most demanding segment of clinical year. Between 0400 pre-rounding and late-night post-operative checks, finding time for a structured Surgery EOR Review is a logistical challenge. Success on the End of Rotation (EOR) exam requires more than just clinical presence in the OR; it requires a targeted mastery of surgical decision-making, perioperative management, and anatomical correlations.

PAtopia was designed by PAs to bridge the gap between the surgical floor and the standardized exam. With over 11,000 questions and rotation-specific mock exams, the app provides a comprehensive training environment that follows your journey from the PACKRAT through to the PANCE.

Mastering the New Surgery EOR Content

The PAEA recently updated the Surgery EOR content areas to reflect modern clinical practice. The exam has shifted from being heavily gastrointestinal-focused to a more balanced distribution of systems. Understanding these weights is critical for an efficient Surgery EOR Review.

High-Yield System Breakdown

• Gastrointestinal (17%): Focus on the acute abdomen, bowel obstructions, and biliary disease.
• Cardiovascular (15%): Prioritize peripheral vascular disease (PVD), abdominal aortic aneurysms (AAA), and preoperative cardiac risk stratification.
• Pulmonology & Thoracic (13%): Master post-operative pulmonary complications, pneumothorax, and chest tube management.
• Breast Surgery (10%): Understand the diagnostic workup for breast masses and the indications for surgical intervention.
• Trauma & Acute Care (8%): Review ATLS protocols, shock management, and primary/secondary surveys.

PAtopia: Data-Driven Preparation

Generic question banks often fail to replicate the specific "task areas" required for EOR success. PAtopia provides 5 full-length mock surgery exams (120 questions each) that mirror the actual exam environment.

Granular Analytics for Targeted Study

One of the most effective features of PAtopia is the by-system analytics. After completing a mock exam, the app breaks down your performance across all surgical categories. If your cardiovascular scores are lagging while your GI scores are high, the app highlights this disparity immediately. This allows you to stop wasting time on areas you have already mastered and focus your limited study hours on high-yield weaknesses.

Integration with the PA Journey

PAtopia is not just for a single rotation. It is built to support you throughout your entire education:

1. PACKRAT Review: Prepare for your clinical competency exams with 5 mock PACKRATs.
2. EOR Rotations: Access 35 total mock exams covering all 7 major rotations, including Surgery, EM, IM, FM, Pediatrics, Psychiatry, and GSR/Women's Health.
3. End of Curriculum (EOC): Transition to graduation with 5 dedicated EOC mock exams.
4. PANCE Review: Cross the finish line with 15 full-length mock PANCE exams (300 questions each).

Clinical Vignette Assessment: Surgery

The following questions utilize the clinical vignette format common on the Surgery EOR. Use these to test your knowledge of high-yield surgical topics.

Question 1: Gastrointestinal

Your patient is a 44-year-old female who presents to the emergency department with acute onset of severe epigastric pain that radiates to her back. She reports multiple episodes of non-bilious emesis. Her past medical history is significant for symptomatic cholelithiasis. On physical exam, she is tachycardic (HR 112) and has significant tenderness in the epigastrium without guarding or rebound. Laboratory results reveal a lipase level of 1,200 U/L (Normal < 160 U/L).

What is the most appropriate initial imaging study to identify the etiology of this patient's condition?

A. CT abdomen/pelvis with IV contrast
B. Right upper quadrant ultrasound
C. Abdominal X-ray (flat and erect)
D. MRCP (Magnetic Resonance Cholangiopancreatography)

Explanation: The correct answer is Right upper quadrant ultrasound. This patient presents with clinical and laboratory evidence of acute pancreatitis (epigastric pain radiating to the back and lipase > 3x the upper limit of normal). Given her history of cholelithiasis, gallstones are the most likely etiology (gallstone pancreatitis). A RUQ ultrasound is the initial study of choice to look for gallstones or biliary ductal dilation. CT with contrast (Choice A) is useful for evaluating complications like necrosis but is not the initial step for identifying the etiology. Plain films (Choice C) are insensitive for pancreatitis. MRCP (Choice D) is reserved for cases where ultrasound is inconclusive and choledocholithiasis is strongly suspected.

Question 2: Preoperative Management

Your patient is a 68-year-old male scheduled for an elective infrarenal abdominal aortic aneurysm repair. He has a history of hypertension, Type 2 diabetes mellitus, and a 40-pack-year smoking history. He reports he can walk about two blocks on level ground before becoming short of breath. He denies chest pain.

According to the ACC/AHA guidelines, what is the next best step in this patient's preoperative cardiac risk assessment?

A. Proceed to surgery without further testing
B. Obtain a pharmacological stress test
C. Perform an immediate coronary angiography
D. Order a 12-lead EKG and proceed to surgery if normal

Explanation: The correct answer is Obtain a pharmacological stress test. The patient is undergoing a high-risk vascular procedure and has a functional capacity of less than 4 METS (unable to walk up a flight of stairs or two blocks without symptoms). He also has clinical risk factors (diabetes, hypertension). In a patient with low functional capacity undergoing high-risk surgery, further non-invasive testing like a stress test is indicated to risk-stratify the patient. Proceeding without testing (Choice A) is inappropriate given the risk level. Coronary angiography (Choice C) is an invasive step taken after an abnormal non-invasive test. An EKG (Choice D) is necessary but not sufficient for risk-stratifying low-capacity patients in high-risk surgery.

Question 3: Post-operative Complications

Your patient is a 28-year-old male who underwent an open appendectomy for a ruptured appendix 36 hours ago. He is currently on postoperative day (POD) 2. The nursing staff notifies you that the patient has a temperature of 101.8°F. His physical exam is unremarkable except for minimal serosanguinous drainage at the dressing site. His lungs are clear to auscultation bilaterally.

What is the most likely cause of this patient's fever?

A. Wound infection (SSI)
B. Atelectasis
C. Deep Vein Thrombosis (DVT)
D. Urinary Tract Infection (UTI)

Explanation: The correct answer is Atelectasis. Post-operative fevers are often categorized by the "5 W's" (Wind, Water, Walking, Wound, Wonder drugs). Fevers occurring within the first 24–48 hours (POD 1-2) are most commonly caused by "Wind" (atelectasis or early pneumonia). Surgical site infections (Choice A) typically occur on POD 5–7. UTIs (Choice D) typically manifest on POD 3, and DVTs (Choice C) usually occur POD 5 or later.

Why PAtopia is the Professional Standard

For many students, the Surgery EOR Review is the final hurdle before entering the heavy-hitting Internal Medicine or Emergency Medicine rotations. Using a tool that is integrated into the larger PA ecosystem: from the student phase to the professional phase: is invaluable.

While PAtopia focuses on your journey as a student, CME Review Courses provides the roadmap for your career as a practicing Physician Assistant. Once you pass your PANCE and enter clinical practice, you will need to maintain your certification. We offer:

• PANRE Review Courses: 100 hours of AAPA Category 1 Credit.
• Pharmacology CME: Specialized Category 1 credit to meet state requirements.
• CME with Gift Cards: Maximize your employer's CME budget by adding an Amazon or Apple gift card ($100–$1500) to your purchase.

Start Your Free Trial Today

You should not have to pay for a review tool before you know it works. PAtopia offers a 3-day free trial with no account creation or credit card required. You can download the app, jump into a Surgery Mock EOR, and see your analytics immediately.

Scrub in with confidence. Use the tool built by PAs, for PAs, and master your Surgery EOR.

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The Emergency Medicine (EM) rotation is often the most high-stakes environment a PA student will face. You are moving from the fast track to the trauma bay, managing everything from simple lacerations to acute myocardial infarctions. The challenge isn't just surviving the shift; it's walking into your Emergency Medicine EOR Review and clinical exam with the confidence that you’ve mastered the NCCPA Blueprint topics.

At PAtopia, we’ve built a clinical prep platform that treats your EOR like the high-stakes exam it is. We don't just give you a list of facts; we provide a simulated testing environment that mirrors the actual PAEA and NCCPA exam styles.

PAtopia Emergency Medicine EOR Review: The Logistics

• Trial Period: 3-Day Free Trial (No credit card or account creation required).
• Total Questions: Over 11,000+ board-style questions across the entire platform.
• EM Specific Content: 5 full-length Emergency Medicine mock exams (120 questions each, 600 total EM questions).
• Analytics: Real-time, by-system performance tracking.
• Integration: Content maps directly to PACKRAT-5, End of Curriculum (EOC), and PANCE prep.
• Platform: Available on iOS and Android.

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High-Yield Content Targeted to the NCCPA Blueprint

The secret to a successful Emergency Medicine EOR Review is knowing where to spend your energy. You cannot study every medical condition with equal intensity. The EM EOR is heavily weighted toward high-acuity systems. According to the latest content distributions, Cardiovascular (18%), Orthopedics/Musculoskeletal (12%), and Pulmonology (10%) make up the core of your exam.

PAtopia’s question bank is specifically structured to reflect these weightings. When you take our five EM-specific mock exams, you aren't just getting random questions. You are getting a curated experience that ensures you are seeing the right amount of ACLS protocols, fracture management, and acute respiratory distress scenarios.

Identify Weaknesses with By-System Analytics

One of the biggest mistakes PA students make during their EM rotation is "studying what they know." It feels good to get Cardiology questions right, but if you are consistently missing Toxicology or Environmental Medicine questions, your overall score will suffer.

PAtopia includes an advanced analytics dashboard that tracks your performance by organ system. After completing an EM mock exam, you can immediately see your percentage in:

• Cardiovascular
• Gastrointestinal / Nutritional
• Orthopedics / Rheumatology
• Neurology
• Obstetrics / Gynecology
• …and all other blueprint categories.

If our data shows you are at 85% in Pulmonology but only 52% in Neurology, you know exactly where to focus your study sessions for the next 48 hours. This efficiency is what allows PAtopia users to excel even with the grueling schedule of an EM rotation.

Beyond the EOR: Integration with PACKRAT and PANCE

Your Emergency Medicine EOR Review shouldn't exist in a vacuum. The work you do during your clinical year is the foundation for your PACKRAT-5, your End of Curriculum (EOC) exam, and ultimately the PANCE.

PAtopia is designed as an all-in-one journey:

1. PACKRAT Prep: We offer 5 full-length PACKRAT mock exams (225 questions each) to gauge your baseline knowledge.
2. EOR Series: Comprehensive review for all 7 rotations (Surgery, EM, IM, FM, Peds, Psych, and GSR/Women's Health).
3. EOC Review: 5 mock exams (300 questions each) to prepare you for program completion.
4. PANCE Mastery: 15 full-length mock exams (300 questions each) to ensure you pass your boards on the first attempt.

For those looking for Category 1 CME credit later in their career, the PANRE Review Course at CME Review Courses offers 100 hours of AAPA Category 1 CME credit, providing a seamless transition from student to practicing PA.

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Emergency Medicine Clinical Practice Scenarios

Use the following clinical vignettes to test your current knowledge. These questions mirror the style and difficulty you will encounter on the PAtopia platform.

Practice Question 1

Your patient is a 64-year-old male presenting to the emergency department with a sudden onset of "ripping" chest pain that radiates to his back. He appears diaphoretic and distressed. Vital signs are: HR 110, BP 175/105 mmHg (right arm), 145/90 mmHg (left arm), SaO2 96% on RA. Physical exam reveals a new grade II/VI diastolic murmur heard best at the right sternal border. Which of the following is the most appropriate next step in management?

A) Immediate administration of 324 mg Aspirin
B) Emergent CT Angiography of the chest and abdomen
C) Thrombolytic therapy with Alteplase
D) Emergent bedside Echocardiography

Correct Answer: B) Emergent CT Angiography of the chest and abdomen

Explanation: This patient presents with classic signs of an aortic dissection (ripping pain, BP discrepancy between arms, new aortic regurgitation murmur). Emergent CT Angiography is the gold standard for rapid diagnosis in a stable or semi-stable patient. Aspirin and thrombolytics are contraindicated as they would worsen the hemorrhage. While bedside ultrasound (TEE) is useful, CT angiography provides the most comprehensive anatomical detail for surgical planning.

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Practice Question 2

Your patient is a 22-year-old female who was brought to the ED by friends after she was found "acting strangely" at a party. She is currently agitated and claiming there are insects crawling on her skin. Vital signs: HR 125, BP 160/100, Temp 101.2°F, SaO2 99%. On exam, her pupils are 8mm and reactive, and she is noted to be profoundly diaphoretic. Which of the following toxidromes is most likely?

A) Anticholinergic
B) Opioid
C) Sympathomimetic
D) Cholinergic

Correct Answer: C) Sympathomimetic

Explanation: The key differentiator between Sympathomimetic and Anticholinergic toxidromes is the skin. Sympathomimetics (e.g., cocaine, amphetamines) present with profuse diaphoresis, whereas Anticholinergics present with dry skin and mucous membranes ("dry as a bone"). Both present with tachycardia, hypertension, and mydriasis. Opioids cause miosis (pinpoint pupils), and cholinergics cause the "SLUDGE" symptoms (salivation, lacrimation, etc.).

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Start Your High-Yield Review Today

Don't leave your Emergency Medicine EOR Review to chance. Use the same tools that have helped thousands of PA students crush their clinical year and their boards.

PAtopia offers a 3-day free trial with full access to all 11,000+ questions and analytics. No account creation is required to start: simply download the app and begin testing your knowledge against the NCCPA Blueprint.

Download PAtopia and Start Your Free Trial

Navigating the transition from clinical rotations to the PANCE, or maintaining your certification through the PANRE/PANRE-LA, requires a strategic approach to both education and financial management. Psychiatry remains a core component of the NCCPA blueprint, often accounting for approximately 7% of exam content. For the Physician Assistant, mastering this section is not just about memorizing DSM-5 criteria; it is about recognizing the nuances between similar clinical presentations while efficiently utilizing your annual CME allowance.

At CME Review Courses, we provide an integrated solution that maximizes your learning and your professional budget.

The Logistics: Course Deliverables and Pricing

Before diving into the clinical high-yields, it is essential to understand how to optimize your purchase. Our programs are designed to be the most efficient use of your employer-provided CME funds.

• PANRE/PANCE Review Course Price: Starting at $595 (Base Course).
• AAPA Category 1 Credit: 100 Hours of Category 1 AAPA Credit are awarded upon completion of the PANRE Review Course.
• CME Gift Card Add-Ons: You have the option to add an Amazon or Apple Gift Card to your purchase. Options range from $100 to $1,500.
• Important Note: These are NOT free gifts. The value of the gift card is added to the total cost of the CME package, allowing you to use your CME allowance to acquire educational tools like iPads, medical reference books, or high-end stethoscopes through Amazon or Apple.
• Access Duration: 12 months of unlimited access to all course materials and practice question banks.
• Deliverables: Over 2,000 practice questions, comprehensive clinical study guides, and content authored by experienced PAs for PAs.

Mastering the Psychiatry Blueprint

The Psychiatry & Behavioral Science portion of the exam focuses heavily on mood disorders, anxiety, and psychotic spectrum disorders. Whether you are preparing for a Psychiatry End of Rotation (EOR) exam or your 10-year PANRE, the following topics are high-yield and frequently tested.

Mood Disorders: MDD vs. Bipolar Spectrum

Major Depressive Disorder (MDD) requires the presence of at least five "SIGECAPS" symptoms for a minimum of two weeks, with at least one symptom being depressed mood or anhedonia. When reviewing for exams, always look for the "switch" to mania. If a patient is started on an SSRI and suddenly presents with pressured speech, decreased need for sleep, and grandiosity, the diagnosis shifts from MDD to Bipolar I.

Bipolar I requires at least one manic episode (1 week duration, significant impairment), while Bipolar II requires a hypomanic episode (4 days duration, no hospitalization/psychosis) and at least one major depressive episode.

The Psychotic Spectrum

Schizophrenia is defined by at least six months of symptoms, including at least one month of active-phase symptoms (delusions, hallucinations, or disorganized speech). If the symptoms last more than one month but less than six, the diagnosis is Schizophreniform Disorder. If they last less than one month, it is a Brief Psychotic Disorder.

Anxiety and Trauma-Related Disorders

Generalized Anxiety Disorder (GAD) is characterized by excessive worry about various life events for at least six months. This differs from Panic Disorder, which involves recurrent, unexpected panic attacks and at least one month of persistent concern about future attacks.

Post-Traumatic Stress Disorder (PTSD) involves intrusive symptoms, avoidance, and hyperarousal following a traumatic event, with symptoms lasting more than one month. If the timeframe is between three days and one month, the correct diagnosis is Acute Stress Disorder.

The Strategic Value of CME Gift Cards

One of the most common questions we receive is how to maximize a $2,000 or $2,500 annual CME budget. By choosing our cme gift cards option, you can combine your 100-hour panre review course with a gift card add-on.

For example, if you have a $2,000 allowance, you can purchase the PANRE Review Course and add a $1,400 Amazon Gift Card. Your total invoice will reflect a $1,995 educational purchase. This allows you to stay compliant with your 100 hours of AAPA Category 1 CME while also having the funds to purchase a new laptop or medical textbooks to further enrich your education.

We offer this flexibility because we know that PAs and NPs need more than just "credits": they need the tools to stay current in a rapidly evolving clinical landscape.

Personality Disorders: The Clusters

Personality disorders are frequently tested via clinical vignettes.

• Cluster A (Odd/Eccentric): Paranoid, Schizoid (loner, happy being alone), Schizotypal (magical thinking).
• Cluster B (Dramatic/Emotional): Antisocial (disregard for rights of others), Borderline (unstable relationships, self-harm), Histrionic (attention-seeking), Narcissistic.
• Cluster C (Anxious/Fearful): Avoidant (desires relationships but fears rejection), Dependent, Obsessive-Compulsive Personality Disorder (perfectionism, ego-syntonic).

Clinical Assessment: Psychiatry Practice Questions

In every pance prep courses module, we emphasize the use of high-quality clinical vignettes. Practice the following questions to test your knowledge of the Psychiatry blueprint.

Question 1

Your patient is a 24-year-old male brought to the emergency department by his roommate. The roommate states the patient has been "acting strange" for the past three weeks. The patient believes the local news anchor is sending him coded messages through the television. On examination, the patient is disheveled and speaks in a disorganized manner. Vital signs: BP 122/80, HR 78, RR 16, SaO2 99% on room air. The patient has no prior psychiatric history and a urine drug screen is negative.

What is the most likely diagnosis?
A. Schizophrenia
B. Schizoaffective Disorder
C. Schizophreniform Disorder
D. Brief Psychotic Disorder

Explanation:
The correct answer is C. Schizophreniform Disorder. This patient presents with hallmark psychotic symptoms (delusions and disorganized speech) that have persisted for three weeks. Because the duration is more than one month but less than six months, Schizophreniform is the appropriate diagnosis. Schizophrenia (A) requires symptoms to last at least six months. Schizoaffective Disorder (B) requires a concurrent mood episode. Brief Psychotic Disorder (D) is used when symptoms last less than one month.

Question 2

Your patient is a 19-year-old female who is brought to the clinic by her mother due to concerns about weight loss. The patient's BMI is 16.2 kg/m². She reports an intense fear of gaining weight and mentions that she "feels fat" despite her current weight. Physical exam reveals fine, downy hair on her arms and back, and a heart rate of 48 bpm.

Which of the following is the most appropriate next step in management?
A. Start Fluoxetine 20mg daily
B. Hospitalization for nutritional rehabilitation
C. Cognitive Behavioral Therapy (CBT) as an outpatient
D. Referral for a dental consultation

Explanation:
The correct answer is B. Hospitalization for nutritional rehabilitation. This patient meets criteria for Anorexia Nervosa, and her physical findings (BMI <17, bradycardia at 48 bpm, and presence of lanugo) indicate medical instability. Hospitalization is required for patients with severe malnutrition or hemodynamic instability to monitor for refeeding syndrome. Fluoxetine (A) is not effective in the acute treatment of Anorexia and is only used once weight is restored for comorbid conditions. Outpatient CBT (C) is inappropriate given the physical instability. Dental consultation (D) is more relevant for Bulimia Nervosa, where tooth enamel erosion is common.

Question 3

Your patient is a 45-year-old male who presents with a history of recurrent, unexpected episodes of intense fear accompanied by palpitations, sweating, and shortness of breath. These episodes peak within 10 minutes. He admits he has stopped going to the grocery store for the past two months because he is afraid he will have an episode and be unable to escape or get help.

What is the first-line long-term pharmacologic treatment for this patient?
A. Alprazolam
B. Sertraline
C. Propranolol
D. Buspirone

Explanation:
The correct answer is B. Sertraline. The patient has Panic Disorder with Agoraphobia. SSRIs like Sertraline are the first-line long-term treatment for Panic Disorder due to their safety profile and efficacy in preventing future attacks. Alprazolam (A) is a benzodiazepine that may be used for acute symptoms but is not recommended for long-term management due to the risk of dependence. Propranolol (C) is primarily used for performance-related social anxiety. Buspirone (D) is indicated for GAD but is not effective for Panic Disorder.

Maximizing Your CME Investment

Whether you are deep in your Psychiatry EOR review or looking for a comprehensive panre review course to secure your next 10 years of certification, the quality of your prep materials matters. We focus on providing PA-authored content that cuts through the fluff and delivers the clinical facts you need.

By utilizing our cme gift cards add-on, you ensure that every dollar of your CME money is working for you. Adding an Amazon or Apple Gift Card to your purchase is a savvy way to equip yourself for another year of clinical excellence while fulfilling the requirement for 100 hours of AAPA Category 1 Credit.

Remember, these gift cards are not "free": they are a powerful way to customize your CME package to meet your professional needs.

Maintaining your professional credentials requires a strategic approach to Continuing Medical Education (CME). For Physician Assistants, finding a reliable source for pharmacology-specific credits is essential for meeting state-specific prescriptive authority requirements and NCCPA maintenance cycles. Our Pharmacology Review Course provides a streamlined, high-yield solution for clinicians who need to earn credits efficiently without sacrificing the quality of their education.

Price: $399.99
Duration: 30 Months of Access
Deliverables: 12 AAPA Category 1 Pharmacology CME Credits
Practice Assessment: 120 Pharmacology-Specific Questions

Efficient Pharmacology Credits for PAs and NPs

The Pharmacology Review Course at CME Review Courses is designed by physician assistants, for physician assistants. While the content is tailored to the needs of PAs, nurse practitioners and physicians also find significant value in our high-yield summaries and practice assessments.

For PAs, the 12.0 hours of AAPA Category 1 CME earned through this course are classified as self-assessment credits. This is a critical distinction for your NCCPA logging. The NCCPA provides a 50% weighting bonus for self-assessment activities. This means that completing our 12-credit pharmacology course actually counts as 18 credits toward your 100-hour NCCPA cycle requirement.

Maximizing Your CME Budget with Gift Card Add-Ons

We recognize that most clinicians have an annual CME stipend that must be used or lost. To help you further enrich your professional resources, we offer CME with Gift Card add-ons. When purchasing the Pharmacology Review Course, you have the option to add an Amazon or Apple Gift Card ranging from $100 to $1,500 to your order.

This allows you to utilize your professional development funds to acquire the hardware or textbooks you need: such as a new iPad for clinical use or the latest medical reference guides: while simultaneously securing your required pharmacology hours. This is an efficient way to manage your educational budget and ensure you have the tools necessary for your practice.

Comprehensive Content and Extended Access

Unlike many online programs that limit access to 90 days, our Pharmacology Review Course provides 30 months of full access. This extended window ensures that you can revisit the material whenever you encounter a complex prescribing scenario in your daily practice.

The course content covers a wide range of essential topics, including Cardiology, Infectious Disease, Neurology, and Psychiatry pharmacotherapy. All content was written by experienced PAs to ensure that the information is practical, relevant, and focused on the clinical applications you see in the clinic or hospital.

Clinical Education and Assessment

The following scenarios represent the type of high-yield content found within our pharmacology question bank. These vignettes are designed to challenge your clinical decision-making and ensure you are prepared for both the PANRE and real-world prescribing.

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Question 1
Your patient is a 64-year-old male with a history of hypertension and heart failure with reduced ejection fraction (HFrEF). His current medications include lisinopril and carvedilol. During a follow-up visit, his blood pressure is 142/88 mmHg and his HR is 62 bpm. Laboratory results reveal a potassium level of 4.2 mEq/L and a serum creatinine of 1.1 mg/dL. You decide to add an aldosterone antagonist to his regimen. Which of the following is the most appropriate next step in monitoring this patient?

A. Check serum potassium and creatinine in 1 week.
B. Perform an EKG to evaluate for a prolonged QT interval.
C. Order a 24-hour urine collection for protein.
D. Check a liver function panel in 4 weeks.

Explanation
A. Check serum potassium and creatinine in 1 week. Aldosterone antagonists, such as spironolactone or eplerenone, significantly increase the risk of hyperkalemia, especially when used in combination with ACE inhibitors or ARBs. Clinical guidelines recommend monitoring renal function and potassium levels within 3 to 7 days of initiation or dose escalation. B is incorrect as aldosterone antagonists do not typically affect the QT interval. C is not a standard monitoring requirement for this drug class. D is incorrect as these medications are not primarily hepatotoxic.

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Question 2
Your patient is a 28-year-old female who presents with a 3-day history of increased vaginal discharge, malodor, and mild pruritus. On examination, you note a thin, grayish-white discharge. The vaginal pH is 5.0. A saline wet mount reveals "clue cells" and a positive whiff test (KOH preparation). She is not pregnant and has no known drug allergies. Which of the following is the first-line pharmacologic treatment for this condition?

A. Metronidazole 500 mg BID for 7 days.
B. Fluconazole 150 mg PO as a single dose.
C. Azithromycin 1g PO as a single dose.
D. Ceftriaxone 500 mg IM as a single dose.

Explanation
A. Metronidazole 500 mg BID for 7 days. This patient presents with classic signs of Bacterial Vaginosis (BV), including clue cells and a positive whiff test. The first-line treatment for non-pregnant patients is oral metronidazole for 7 days or intravaginal metronidazole gel. B is the treatment for candidiasis, which would typically present with a lower pH and hyphae on wet mount. C and D are the treatments for chlamydia and gonorrhea, respectively, which do not match the clinical findings of clue cells.

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Question 3
Your patient is a 55-year-old male with Type 2 Diabetes Mellitus and established atherosclerotic cardiovascular disease (ASCVD). Despite lifestyle modifications and metformin 1000 mg BID, his A1c remains 8.2%. You intend to add a medication that provides both glycemic control and cardiovascular benefit. Which of the following drug classes is most appropriate?

A. GLP-1 receptor agonist.
B. Sulfonylurea.
C. DPP-4 inhibitor.
D. Thiazolidinedione.

Explanation
A. GLP-1 receptor agonist. For patients with Type 2 DM and established ASCVD, GLP-1 receptor agonists (such as liraglutide or semaglutide) or SGLT2 inhibitors are recommended because they have proven cardiovascular benefits beyond glucose lowering. B (Sulfonylureas) is associated with hypoglycemia and weight gain without cardiovascular benefits. C (DPP-4 inhibitors) is generally weight neutral and cardiovascularly neutral. D (Thiazolidinediones) can cause fluid retention and is often avoided in patients with heart failure or high cardiovascular risk.

Expanding Your Review Beyond Pharmacology

While pharmacology is a primary focus for many, our platform also offers comprehensive review materials for the entire NCCPA Blueprint. If you are preparing for your recertification exam, our PANRE Review Course (and other individual modules) offers a more expansive curriculum.

The PANRE Review course provides 100 hours of AAPA Category 1 credit, covering everything from Cardiology and Pulmonology to GI and Musculoskeletal systems. Like our pharmacology course, these hours also count as self-assessment credits, maximizing your return on time invested.

Whether you need a quick 12-hour pharmacology boost or a full 100-hour PANRE review, our courses provide the flexibility and depth required for modern clinical practice. By utilizing our CME with Gift Card options, you can satisfy your educational requirements and enhance your professional toolkit simultaneously.

The Internal Medicine End of Rotation (EOR) exam represents one of the most comprehensive assessments for Physician Assistant students. The depth of content requires a systematic approach to the organ systems, with a heavy emphasis on chronic disease management, acute interventions, and diagnostic interpretation. This guide outlines the blueprint, high-yield clinical pearls, and a rigorous study strategy to ensure success.

Course Spotlight: PANRE Review Course

• Price: $399.99
• Access Duration: 30 months
• Deliverables: 1,672 board-style questions
• CME Credit: 100 hours of AAPA Category 1 CME credit
• Link: PANRE Review Course

The Internal Medicine EOR Blueprint

The Internal Medicine EOR is designed by the PAEA and follows a rigid weight distribution across organ systems. Successful students prioritize their time based on these percentages to maximize their scoring potential.

• Cardiovascular (20%)
• Pulmonology (15%)
• Gastrointestinal/Nutrition (12%)
• Orthopedics/Rheumatology (12%)
• Endocrinology (8%)
• Neurology (8%)
• Urology/Renal (8%)
• Critical Care (7%)
• Hematology (5%)
• Infectious Diseases (5%)

High-Yield Focus Areas

Cardiovascular (20%)

Cardiology is the highest-weighted section. You must be proficient in EKG interpretation and the management of chronic conditions like HTN and HF.

• Hypertension: Know the stages and first-line treatments. Thiazides, ACEi/ARBs, and CCBs are standard. Be wary of contraindications (e.g., ACEi in pregnancy or bilateral renal artery stenosis).
• Heart Failure: Differentiate between HFrEF and HFpEF. Focus on the "big four" for mortality benefit in HFrEF: ACEi/ARB/ARNI, beta-blockers, MRA, and SGLT2 inhibitors.
• Valvular Disease: Murmurs are frequent test items.
  • Aortic Stenosis: Crescendo-decrescendo systolic murmur at the RUSB, radiating to the carotids.
  • Mitral Regurgitation: Holosystolic murmur at the apex radiating to the axilla.
  • Aortic Regurgitation: Early diastolic decrescendo murmur at the LSB.

Pulmonology (15%)

• COPD/Asthma: Understand the stepwise approach to treatment. Know the role of LAMA vs. LABA and when to initiate ICS.
• Pneumonia: Differentiate between CAP, HAP, and VAP. Memorize the CURB-65 criteria to determine inpatient vs. outpatient disposition.
• Pulmonary Embolism: Focus on the Wells Criteria and the role of D-dimer vs. CT Angiography.

Gastrointestinal/Nutrition (12%)

• GERD/PUD: Identify alarm symptoms (dysphagia, weight loss, anemia) that necessitate EGD.
• Inflammatory Bowel Disease: Contrast Crohn’s disease (transmural, skip lesions, anywhere in GI tract) with Ulcerative Colitis (mucosal, continuous, starts in rectum).
• Liver Disease: Know the lab patterns for alcoholic hepatitis (AST > ALT 2:1) versus viral hepatitis.

Orthopedics/Rheumatology (12%)

• Rheumatoid Arthritis: Pattern of small joint involvement, morning stiffness > 1 hour, and specific markers like Anti-CCP.
• Crystal Arthropathies: Differentiate Gout (negative birefringent, needle-shaped) from Pseudogout (positive birefringent, rhomboid-shaped).

Study Strategies for the IM EOR

1. Blueprint-Focused Preparation: Do not spend equal time on all systems. Spend double the time on Cardiology and Pulmonology compared to Hematology.
2. Question Bank Volume: Active recall through practice questions is the most effective way to identify knowledge gaps. Our PANRE Review Course offers 1,672 questions that overlap significantly with Internal Medicine core concepts.
3. Clinical Vignette Training: Practice identifying the "buzzwords" or "key findings" in a vignette, such as "muffled heart sounds" (Tamponade) or "barking cough" (Croup/Pediatric, but relevant for general knowledge).
4. Pharmacology Integration: Internal medicine is heavily pharmacologic. Understanding the mechanisms of action and adverse effects of diuretics, anti-hypertensives, and anti-diabetics is essential.

Clinical Practice Questions

Question 1

Your patient is a 64-year-old male presenting with a 2-day history of productive cough, fever, and dyspnea. Vital signs show a BP of 105/65 mmHg, HR 105 bpm, RR 24 bpm, and SaO2 91% on room air. Physical exam reveals dullness to percussion and increased tactile fremitus in the right lower lobe. CXR confirms a right lower lobe infiltrate. He has no significant PMH. According to CURB-65, what is the most appropriate next step?
A) Discharge with oral Azithromycin
B) Discharge with oral Levofloxacin
C) Admit for inpatient management with IV Ceftriaxone and Azithromycin
D) Admit to ICU for vasopressor support

Question 2

Your patient is a 52-year-old female with a PMH of HTN and T2DM who presents for a routine check-up. Her BP today is 148/92 mmHg. Previous readings over the last month have been similar. Laboratory results show a Cr of 1.2 mg/dL and an eGFR of 58 mL/min. Microalbuminuria is present. Which of the following is the most appropriate initial anti-hypertensive agent?
A) Amlodipine
B) Lisinopril
C) Chlorthalidone
D) Metoprolol

Question 3

Your patient is a 72-year-old male with a history of permanent atrial fibrillation who presents with sudden onset of severe abdominal pain. He describes the pain as 10/10 and generalized. On physical examination, his abdomen is soft and non-tender with no guarding or rebound. His stool is guaiac positive. What is the most likely diagnosis?
A) Perforated peptic ulcer
B) Acute mesenteric ischemia
C) Diverticulitis
D) Nephrolithiasis

Question 4

Your patient is a 38-year-old female complaining of joint pain and stiffness in her hands for the past 4 months. She states the stiffness is worst in the morning and lasts for approximately 2 hours. Physical exam reveals swelling and tenderness of the MCP and PIP joints bilaterally. Radiographs show periarticular osteopenia. Which lab test is most specific for this patient’s likely condition?
A) Rheumatoid Factor (RF)
B) Anti-nuclear Antibody (ANA)
C) Anti-cyclic citrullinated peptide (Anti-CCP)
D) Erythrocyte Sedimentation Rate (ESR)

Question 5

Your patient is a 28-year-old male who presents with tremors, palpitations, and heat intolerance. He has noticed a 10-pound weight loss over the last month despite an increased appetite. Physical exam reveals a smooth, enlarged thyroid and exophthalmos. Lab results show a suppressed TSH and elevated free T4. Which of the following is the most likely underlying mechanism?
A) Destruction of thyroid follicles by autoantibodies
B) Autoantibodies to the TSH receptor (TRAb)
C) A benign pituitary adenoma
D) Iodine deficiency

Explanations and Answers

Question 1 Answer: C) Admit for inpatient management with IV Ceftriaxone and Azithromycin
The correct answer is Admit for inpatient management. The CURB-65 score is used to determine pneumonia severity. This patient scores a 1 (RR ≥ 30? No, Confusion? No, BUN > 19? Unknown, BP < 90/60? No, Age ≥ 65? No). Wait, let's recalculate based on his vitals. He has a RR of 24 (0 pts) and is 64 years old (0 pts). However, clinical judgment and the presence of hypoxia (SaO2 91%) often warrant admission. In the context of the EOR, a score of 1 or 2 usually suggests inpatient ward admission. Choices A and B are for outpatient care. Choice D is reserved for septic shock or respiratory failure requiring mechanical ventilation.

Question 2 Answer: B) Lisinopril
The correct answer is Lisinopril. In patients with Diabetes Mellitus and/or Chronic Kidney Disease (evidenced by decreased eGFR and microalbuminuria), ACE inhibitors or ARBs are the first-line choice for hypertension. They provide renal protection by reducing intraglomerular pressure. Amlodipine and Chlorthalidone are excellent anti-hypertensives but do not offer the same degree of renoprotection in diabetic nephropathy. Metoprolol is not first-line for uncomplicated HTN.

Question 3 Answer: B) Acute mesenteric ischemia
The correct answer is Acute mesenteric ischemia. This is a classic presentation: "pain out of proportion to exam." The patient has severe pain but a benign-feeling abdomen. His history of atrial fibrillation is a major risk factor for an embolic event to the superior mesenteric artery. Perforated ulcers and diverticulitis typically present with significant tenderness, guarding, or rebound on exam.

Question 4 Answer: C) Anti-cyclic citrullinated peptide (Anti-CCP)
The correct answer is Anti-CCP. While Rheumatoid Factor (RF) is often the initial test ordered, Anti-CCP is significantly more specific (up to 95-98%) for Rheumatoid Arthritis. ANA is a screening test for SLE. ESR is a non-specific marker of inflammation.

Question 5 Answer: B) Autoantibodies to the TSH receptor (TRAb)
The correct answer is Autoantibodies to the TSH receptor. The patient presents with classic Graves’ Disease (hyperthyroidism, diffuse goiter, and exophthalmos). Graves’ is caused by thyroid-stimulating immunoglobulins (TSI) or TRAb that mimic TSH. Choice A describes Hashimoto's thyroiditis (hypothyroidism). Choice C would show an elevated or inappropriately normal TSH. Choice D causes goiter but usually hypothyroidism or euthyroid status.

Maximize Your CME Budget

As you prepare for your EOR exams and look ahead to your clinical career, efficient use of your CME stipend is paramount. We offer CME with Amazon and Apple Gift Card add-ons ranging from $100 to $1500. This allows you to purchase the Internal Medicine Hospitalist CME Package or our comprehensive PANRE Review Course while receiving a gift card to purchase medical equipment, textbooks, or other educational tools.

Our Internal Medicine Hospitalist content was written by physician assistants for physician assistants, ensuring the material is practical, high-yield, and focused on the information you need in the clinical setting. Whether you are a student preparing for your EOR or a practicing PA preparing for the PANRE-LA, our resources provide the structured review necessary for clinical excellence.

Course: PANRE Review Course CME Package
Price: $399.99 (Base Course)
Duration of Access: 30 Months
Deliverables: 100 Hours of AAPA Category 1 CME Credit, 1,672 Board-Style Questions
Gift Card Options: $100 to $1,500 Amazon or Apple Gift Card Add-ons Available

The landscape of Continuing Medical Education (CME) changed significantly in April 2026. Following a ruling by the Accreditation Council for Continuing Medical Education (ACCME), many healthcare providers found themselves in a state of confusion regarding the legality of gift card incentives. This ruling specifically prohibited ACCME-accredited providers from offering gift cards or personal remuneration in association with the purchase of accredited CME. For many physicians, the era of the "CME gift card" effectively ended.

However, for Physician Assistants, the regulatory environment is different.

The ACCME vs. AAPA Distinction

The April 2026 ACCME ruling applies to ACCME-accredited providers, who primarily serve the physician community. Physician Assistants receive their Category 1 credits through the American Academy of Physician Associates (AAPA). Because AAPA Category 1 CME operates under a different accreditation framework, the specific ACCME prohibitions do not apply to our AAPA Category 1 Credit offerings.

Physician Assistants can still legally and ethically utilize their CME allowance to purchase high-quality educational materials that include gift card add-ons. At CME Review Courses, our model is designed to provide maximum educational value while helping you efficiently use your employer-provided CME funds.

How CME Gift Card Add-ons Work for PAs

Our CME with Amazon Gift Card and Apple Gift Card options allow you to supplement your learning. When you purchase a package, you are paying for the educational content, the assessment infrastructure, and the credit processing. The gift card is an add-on that allows you to purchase additional educational tools: such as medical tablets, reference books, or clinical software: to further enrich your professional practice.

Maximum Efficiency for the PANRE

If you are preparing for the Recertification Exam, our PANRE Review Course provides 100 hours of AAPA Category 1 Credit. This is a significant portion of your cycle requirements delivered in a single, comprehensive package. The content is meticulously aligned with the NCCPA Blueprint, covering essential clinical areas including:

• Cardiology
• Pulmonary Medicine
• Gastrointestinal System/Nutrition
• Musculoskeletal System
• Internal Medicine/Hospitalist Care

The course is written by physician assistants for physician assistants, ensuring the clinical vignettes and practice questions reflect the actual challenges faced in both the exam room and the clinic.

Pharmacology and Specialty Content

In addition to general review, we offer specialized Pharmacology CME that carries Category 1 AAPA Credit. This is particularly valuable for PAs in states with specific pharmacology credit requirements for licensure renewal. Our content spans multiple specialties, including Emergency Medicine, Family Medicine, Orthopedics, Dermatology, Psychiatry, Neurology, and OB/GYN. While primarily designed for PAs, Nurse Practitioners and Physicians often find value in our Internal Medicine and specialty modules, though Physicians should note these credits count as Category 2 CME for their specific requirements.

Clinical Assessment and Management

Patient Scenario 1
Your patient is a 64-year-old male presenting with a 4-hour history of acute, crushing substernal chest pain that radiates to his left jaw. He appears diaphoretic and pale. His medical history is significant for hypertension and a 30-pack-year smoking history.
Vital Signs: HR 105 bpm, BP 152/94 mmHg, RR 22 bpm, SaO2 94% on room air.
Physical Exam: S4 gallop noted on auscultation.
ECG: 3mm ST-segment elevation in leads II, III, and aVF.

Which of the following is the most appropriate next step in the management of this patient?
A. Administer oral beta-blocker therapy immediately
B. Initiate fibrinolytic therapy within 30 minutes if PCI is unavailable
C. Order a STAT chest X-ray to rule out aortic dissection
D. Perform a bedside exercise stress test

Correct Answer: B. Initiate fibrinolytic therapy within 30 minutes if PCI is unavailable.
This patient is presenting with an inferior ST-elevation myocardial infarction (STEMI). The primary goal in STEMI management is rapid reperfusion. If the facility does not have percutaneous coronary intervention (PCI) capabilities and the patient cannot be transferred to a PCI-capable center within 120 minutes, fibrinolytic therapy should be administered within 30 minutes of arrival.

• Choice A is incorrect because beta-blockers should be avoided in the acute phase if there are signs of heart failure or risk of cardiogenic shock.
• Choice C is secondary to reperfusion; while a CXR is often part of the workup, it should not delay the activation of the cath lab or fibrinolysis.
• Choice D is absolutely contraindicated in the setting of an acute MI.

Patient Scenario 2
Your patient is a 28-year-old female complaining of lower abdominal pain for the past three days. She describes the pain as constant and aching, worsened by movement. She also reports a new vaginal discharge and dyspareunia.
Vital Signs: Temp 101.4°F (38.5°C), HR 98 bpm, BP 118/76 mmHg.
Physical Exam: Significant cervical motion tenderness (Chandelier sign) and adnexal tenderness are noted on the bimanual exam. No adnexal masses are palpated.

What is the most likely diagnosis?
A. Ectopic pregnancy
B. Ovarian torsion
C. Pelvic Inflammatory Disease (PID)
D. Acute Appendicitis

Correct Answer: C. Pelvic Inflammatory Disease (PID).
The clinical triad of lower abdominal pain, cervical motion tenderness, and adnexal tenderness in a young, sexually active female is highly suggestive of PID. The presence of a fever further supports an infectious etiology.

• Choice A is a critical differential, but the presence of fever and bilateral tenderness is more typical of PID; however, a pregnancy test must always be performed.
• Choice B usually presents with sudden onset, severe unilateral pain and often nausea/vomiting.
• Choice D typically presents with pain localized to the right lower quadrant (McBurney’s point) and lacks cervical motion tenderness.

Patient Scenario 3
Your patient is a 72-year-old female who is brought to the clinic by her daughter due to increasing confusion and a fall yesterday. The patient has a history of atrial fibrillation and is taking warfarin. She did not lose consciousness during the fall but has had a persistent headache since.
Vital Signs: HR 82 bpm (irregular), BP 138/84 mmHg, RR 16 bpm.
Physical Exam: A small hematoma is noted on the left forehead. Neurological exam reveals mild cognitive slowing but no focal deficits.

What is the most appropriate diagnostic imaging for this patient?
A. MRI of the brain with contrast
B. Non-contrast CT scan of the head
C. Skull X-ray (AP and Lateral)
D. Carotid Ultrasound

Correct Answer: B. Non-contrast CT scan of the head.
In an elderly patient on anticoagulation (warfarin) who has experienced a head injury, a non-contrast head CT is the gold standard to rule out acute intracranial hemorrhage, specifically a subdural hematoma, which can present subacutely in this demographic.

• Choice A is more sensitive for certain pathologies but takes longer and is not the initial study of choice for acute trauma/hemorrhage.
• Choice C is outdated and does not visualize the brain parenchyma.
• Choice D evaluates for carotid stenosis and stroke risk but does not address the acute trauma or risk of hemorrhage from a fall.

Conclusion

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