CME Review Courses

Product: PANRE Review Exam 1
Deliverables: 240-question practice examination with comprehensive explanations
Format: Ebook/Print via Amazon or Digital via CME Review Courses
Access: Permanent ownership; no subscription or login required
CME Credit: 100 hours of AAPA Category 1 Credit available through the full PANRE Review Course

Preparing for the Physician Assistant National Recertification Exam (PANRE) or the PANRE-LA requires a shift from passive reading to active clinical reasoning. Most question banks encourage "answer-peeking" by displaying the correct choice immediately, which bypasses the cognitive effort required for long-term retention. PANRE Review Exam 1 is engineered to eliminate this habit. It provides a full-length, 240-question mock exam designed to mirror the actual testing environment of the NCCPA.

This resource is written by physician assistants for physician assistants. It prioritizes high-yield clinical facts and evidence-based medicine over esoteric details. Whether you are a seasoned PA-C or nearing your first recertification cycle, this exam provides the diagnostic and management scenarios you will encounter on test day.

The Active Recall Advantage

Passive study methods, such as highlighting text or rereading notes, offer a false sense of mastery. Real mastery is built through retrieval practice. The format of this exam forces you to commit to an answer before the correct choice and explanation are revealed.

Each question follows a 5-answer multiple-choice format, consistent with the NCCPA standard. By committing to an answer before checking the key, you engage the neural pathways responsible for recall. When a mistake is made, the subsequent correction is more likely to be retained. This "forced recall" method is particularly effective for the longitudinal assessment format (PANRE-LA), where speed and accuracy are paramount across various clinical systems.

Precise NCCPA Blueprint Alignment

Success on the PANRE depends on studying the right topics in the right proportions. PANRE Review Exam 1 is mapped directly to the NCCPA Blueprint categories. You will not find a skewed distribution of questions; instead, the 240 items are allocated based on the weight of each organ system as defined for the 2025 exam cycle.

The question distribution for Exam 1 is as follows:

• Cardiovascular: 26 questions
• Pulmonary: 22 questions
• Gastrointestinal/Nutrition: 19 questions
• Musculoskeletal: 19 questions
• Infectious Diseases: 17 questions
• Neurology: 17 questions
• Psychiatry/Behavioral Science: 17 questions
• Reproductive: 17 questions
• Endocrine: 14 questions
• EENT: 14 questions
• Professional Practice: 14 questions
• Hematology: 12 questions
• Renal: 12 questions
• Dermatology: 10 questions
• Genitourinary: 10 questions

This is Exam 1 of a 3-exam series. Utilizing all three exams provides a total of 720 blueprint-aligned questions, offering comprehensive coverage of all 15 organ systems.

Strategic CME Spending with Gift Card Add-ons

Physician assistants often have fixed annual CME allowances. We provide an efficient way to utilize these funds. Through cmereviewcourses.com, you can purchase CME packages that include Amazon or Apple gift card add-ons ranging from $100 to $1500. This allows you to secure high-yield educational materials while simultaneously acquiring the tools: such as tablets, medical equipment, or reference books: needed to further your clinical practice.

While our content is highly valued by nurse practitioners and physicians, note that AAPA Category 1 Credit for nurse practitioners is subject to state-specific regulations. For physicians, this content typically qualifies for Category 2 CME credit.

Clinical Assessment Practice Questions

The following scenarios represent the level of clinical complexity found in PANRE Review Exam 1. Use these to test your current knowledge.

Question 1

Your patient is a 54-year-old male with a history of hypertension and tobacco use who presents to the clinic with complaints of progressive exertional dyspnea and a non-productive cough. Physical examination reveals fine bibasilar inspiratory crackles and clubbing of the fingers. High-resolution CT (HRCT) of the chest demonstrates subpleural reticular opacities and honeycombing, primarily in the lower lobes. Pulmonary function testing (PFT) shows a restrictive pattern with a reduced DLCO. What is the most likely diagnosis?

A) Sarcoidosis
B) Idiopathic Pulmonary Fibrosis (IPF)
C) Hypersensitivity Pneumonitis
D) Asbestosis
E) Congestive Heart Failure

Correct Answer: B) Idiopathic Pulmonary Fibrosis (IPF)
IPF is the correct diagnosis based on the clinical presentation of progressive dyspnea, finger clubbing, and the classic HRCT finding of "honeycombing" and subpleural reticulation in the lower lobes. PFTs in IPF typically show a restrictive pattern (decreased FVC, normal FEV1/FVC ratio) and a decreased DLCO. Sarcoidosis usually presents with hilar lymphadenopathy and non-caseating granulomas. Hypersensitivity Pneumonitis typically involves an identifiable environmental exposure and centrilobular nodules on CT. Asbestosis would require a significant occupational history and often shows pleural plaques. Congestive Heart Failure would present with cardiomegaly, Kerley B lines, and symptoms like orthopnea.

Question 2

Your patient is a 29-year-old female, G1P0 at 34 weeks gestation, who presents to the labor and delivery unit with a headache, blurry vision, and epigastric pain. Her blood pressure is 164/112 mmHg. Urinalysis shows 3+ proteinuria. AST and ALT are twice the upper limit of normal, and her platelet count is 88,000/µL. Which of the following is the most appropriate next step in management?

A) Outpatient monitoring with weekly NSTs
B) Immediate delivery via Cesarean section
C) Administration of Magnesium Sulfate and preparation for delivery
D) Oral Labetalol and discharge home with follow-up in 24 hours
E) Bed rest and repeat labs in 48 hours

Correct Answer: C) Administration of Magnesium Sulfate and preparation for delivery
The correct management is Magnesium Sulfate for seizure prophylaxis and proceeding toward delivery. This patient meets the criteria for Preeclampsia with Severe Features (BP >160/110, headache, visual changes, epigastric pain, and thrombocytopenia). At 34 weeks, the definitive treatment for severe preeclampsia is delivery. Outpatient monitoring or bed rest is contraindicated in severe preeclampsia due to the risk of maternal and fetal morbidity. Immediate Cesarean is not necessarily required; induction of labor is often preferred unless there are other obstetric indications for surgery. Oral Labetalol alone is insufficient and discharging the patient is dangerous.

Question 3

Your patient is a 62-year-old male presenting with sudden onset of severe "tearing" chest pain that radiates to the back between the scapulae. On examination, he is diaphoretic with a blood pressure of 185/105 mmHg in the right arm and 155/90 mmHg in the left arm. A chest X-ray shows a widened mediastinum. What is the most appropriate initial diagnostic test?

A) Transthoracic Echocardiogram (TTE)
B) CT Angiography (CTA) of the chest and abdomen
C) Exercise Stress Test
D) Cardiac Catheterization
E) D-dimer assay

Correct Answer: B) CT Angiography (CTA) of the chest and abdomen
CT Angiography is the preferred initial diagnostic test for suspected aortic dissection in a hemodynamically stable patient due to its high sensitivity and ability to delineate the extent of the dissection. The presentation of "tearing" pain and a blood pressure discrepancy between arms is classic for aortic dissection. TTE is often insufficient to visualize the descending aorta; a Transesophageal Echocardiogram (TEE) would be more sensitive but is more invasive. Stress testing is contraindicated in acute chest pain of this nature. Cardiac Catheterization might be used to evaluate coronaries but is not the initial test for dissection. D-dimer is non-specific and should not delay imaging when clinical suspicion is high.

Preparation Summary

The journey to recertification does not have to be an overwhelming process of trial and error. By utilizing a blueprint-aligned, active recall-based practice exam, you can identify knowledge gaps and refine your clinical reasoning before the stakes are high.

PANRE Review Exam 1 is available for purchase today. You can find the printed or ebook version directly on Amazon. For those looking to maximize their CME allowance with gift card add-ons, visit CME Review Courses to explore our full suite of PANRE and Pharmacology review options.

Invest in your education effectively. Commit to the answer, master the blueprint, and secure your recertification.

Price: $9.99
Format: Paperback / eBook
Content: 100% PAEA Blueprint Aligned
Deliverables: 14 Clinical System Reviews + 120-Question Practice Exam

The Family Medicine End of Rotation (EOR) exam is the broadest assessment in the physician assistant clinical year. Unlike specialty rotations where the scope is narrow, family medicine requires proficiency across the entire lifespan, from pediatric developmental milestones to geriatric end-of-life care. To pass with a high score, you must move beyond passive reading and focus on high-yield clinical presentations, initial diagnostic workups, and first-line treatment protocols.

Direct Alignment with the 2026 PAEA Blueprint

Success on the EOR requires studying specifically for what is tested. The Family Medicine End of Rotation Review: High-Yield Prep for Physician Assistants is built around the official PAEA topic list. This guide eliminates the noise of traditional textbooks and focuses on the high-probability topics that will actually appear on your 120-question exam.

The exam is weighted heavily toward three key areas:

• Cardiovascular Disorders (15%)
• Pulmonology Disorders (12%)
• Gastrointestinal & Nutritional Disorders (11%)

Mastering these three systems alone accounts for nearly 40% of your total score. Our guide prioritizes these high-yield systems while providing comprehensive coverage of the remaining 11 categories, including EENT, OB/GYN, Orthopedics, and Psychiatry.

Strategic Content Breakdown

Clinical rotations are fast-paced, and your study time is limited. Each chapter in this review book is written in a functional, declarative style. We emphasize pathophysiology only where it clarifies the "why" behind the clinical presentation.

Cardiovascular Pearls: Focus on the differentiation of murmurs, the management of hypertension according to current JNC and ACC/AHA guidelines, and the initial workup of stable vs. unstable angina in an outpatient setting.

Pulmonology High-Yields: You must be able to distinguish between obstructive and restrictive lung diseases on PFTs. Expect questions on the stepwise management of asthma and the appropriate antibiotic selection for community-acquired pneumonia (CAP) based on comorbidities.

Gastrointestinal Focus: The exam frequently tests the PALM-COEIN classification for abnormal uterine bleeding and the management of common primary care complaints like GERD, PUD, and biliary disease.

Master the 120-Question Practice Exam

The best way to prepare for a 120-question exam is to take a 120-question exam. At the conclusion of this book, you will find a full-length practice bank designed to simulate the real exam environment.

Each clinical vignette is crafted to mirror the difficulty level of the PAEA exam. We provide five answer choices for every item and detailed explanations that explain why the correct answer is the gold standard and why the distractors are incorrect. This active recall method is the most efficient way to identify and correct your knowledge gaps before test day.

Maximize Your CME Efficiency

While students focus on passing the EOR, practicing PAs must focus on maintaining certification. CME Review Courses offers an efficient way to use your CME money through our PANRE Review Course, which provides 100 hours of Category 1 AAPA Credit.

For those looking to enrich their education further, we offer CME with Amazon and Apple Gift Card add-ons. These packages allow you to add a gift card ranging from $100 to $1500 to your CME purchase, providing a streamlined way to acquire the medical resources or technology you need for your practice.

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Clinical Assessment: Practice Questions

Question 1

Your patient is a 64-year-old male presenting with a 3-month history of exertional chest pain that is relieved by rest. He has a history of hypertension and tobacco use. His HR is 82, BP is 138/88 mmHg, and SaO2 is 98% on room air. An EKG performed in the office is normal. What is the most appropriate initial diagnostic test to evaluate for coronary artery disease in this patient?

A. Cardiac Catheterization
B. Exercise Stress Test
C. Coronary CT Angiography
D. Resting Echocardiogram
E. Pharmacologic Stress Test

Correct Answer: B. Exercise Stress Test
Explanation: In a patient with stable angina symptoms and a normal baseline EKG, the Exercise Stress Test is the appropriate initial non-invasive choice to evaluate for ischemia. It is cost-effective and provides functional data regarding the patient's exercise capacity. Cardiac Catheterization (A) is the gold standard but is invasive and reserved for patients with high-risk findings or refractory symptoms. Coronary CT Angiography (C) is useful for ruling out CAD in low-to-intermediate risk patients but is not the standard first-line functional test here. Resting Echocardiogram (D) evaluates wall motion and valves but does not assess for inducible ischemia. Pharmacologic Stress Test (E) is only indicated if the patient cannot exercise.

Question 2

Your patient is a 24-year-old female presenting with a "sore throat" and malaise for one week. On physical exam, you note posterior cervical lymphadenopathy and an enlarged spleen. Rapid strep test is negative. What is the most appropriate next step in diagnosis?

A. Throat Culture
B. Monospot (Heterophile Antibody) Test
C. CT Abdomen
D. Lateral Neck X-ray
E. CBC with Differential

Correct Answer: B. Monospot (Heterophile Antibody) Test
Explanation: The clinical presentation of posterior cervical lymphadenopathy and splenomegaly is highly suggestive of Infectious Mononucleosis. The Monospot test is the appropriate next step. Throat Culture (A) is redundant if the concern is viral mononucleosis. CT Abdomen (C) is not indicated for initial diagnosis, though it may visualize splenomegaly. Lateral Neck X-ray (D) is used for suspected epiglottitis, which presents with acute airway distress. CBC with Differential (E) may show atypical lymphocytosis but is less specific than the heterophile antibody test.

Question 3

Your patient is a 55-year-old male with a history of COPD presenting with increased cough and purulent sputum production. He is afebrile with a RR of 20 and SaO2 of 91% on room air. Chest X-ray shows no acute infiltrates. What is the first-line antibiotic treatment for this acute exacerbation of chronic bronchitis?

A. Vancomycin
B. Azithromycin
C. Ciprofloxacin
D. Metronidazole
E. Amoxicillin-clavulanate

Correct Answer: E. Amoxicillin-clavulanate
Explanation: In patients with COPD exacerbation and increased sputum purulence, Amoxicillin-clavulanate is a first-line choice to cover common pathogens like H. influenzae and M. catarrhalis. Vancomycin (A) is for MRSA and is not appropriate here. Azithromycin (B) is often used but has increasing resistance. Ciprofloxacin (C) is a fluoroquinolone typically reserved for suspected Pseudomonas. Metronidazole (D) covers anaerobes and is not indicated for standard COPD exacerbation.

Question 4

Your patient is a 42-year-old female complaining of a "burning" sensation in her chest that is worse after eating spicy foods and when lying down at night. She has tried OTC antacids with minimal relief. What is the most appropriate initial management step?

A. Upper Endoscopy (EGD)
B. Lifestyle modifications and H2-receptor antagonist
C. Referral to General Surgery
D. 24-hour pH monitoring
E. H. pylori stool antigen test

Correct Answer: B. Lifestyle modifications and H2-receptor antagonist
Explanation: For uncomplicated Gastroesophageal Reflux Disease (GERD) without "alarm symptoms" (dysphagia, weight loss, anemia), the initial step is lifestyle modifications and H2-receptor antagonists or PPIs. Upper Endoscopy (A) is reserved for patients over 50 or those with alarm symptoms. Referral to General Surgery (C) is only for refractory cases requiring fundoplication. 24-hour pH monitoring (D) is the gold standard but is not the initial step. H. pylori testing (E) is more relevant for suspected peptic ulcer disease rather than classic GERD.

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About the Author

Jeremy Boroff PA-C is a veteran healthcare provider with over 30 years of experience in the medical field. Having served as a Physician Assistant for over 24 years and a Registered Respiratory Therapist for 7 years, Jeremy has a profound understanding of clinical education. He has spent over two decades in the Emergency Department at St. Rita’s Medical Center and is the CEO of CME Review Courses. His mission is to provide PAs and PA students with the high-yield tools they need to succeed in their careers.

Secure your copy today and master the Family Medicine EOR:
Buy on Amazon: Family Medicine End of Rotation Review

Course: PANRE Review Course
Price: $499.99
Access: 1 Year
Deliverables: 100 Hours of AAPA Category 1 CME Credit, 1,000+ Practice Questions

Course: Category 1 AAPA Credit Pharmacology Course
Price: $499.99
Access: 1 Year
Deliverables: 20 Hours of AAPA Category 1 CME Credit

Successfully navigating the Gynecologic, Sexual, and Reproductive Health (GSR) End of Rotation exam requires more than a casual review of patient charts. It demands a systematic mastery of the 2025 PAEA topic list and blueprint. The volume of information: spanning from prenatal genetics to complex pelvic floor pathology: often overwhelms students. Efficient preparation hinges on identifying high-yield clinical pearls and understanding the diagnostic hierarchies that the NCCPA and PAEA prioritize.

The newly released ebook, Master the Gynecologic, Sexual, and Reproductive Health End of Rotation exam, is designed specifically for this purpose. This resource provides a clinically focused roadmap, distilling complex guidelines into actionable exam knowledge. It features high-yield comparison tables for PALM-COEIN and the "4 Ts" of postpartum hemorrhage, alongside a 120-question practice exam with detailed rationales.

Purchase Master the Gynecologic, Sexual, and Reproductive Health End of Rotation exam on Amazon

Clinical Scenarios and Practice Questions

Application of knowledge is the final step in exam readiness. Review the following clinical vignettes to assess your current understanding of high-yield OB/GYN concepts.

Question 1

Your patient is a 24-year-old G1P0 at 32 weeks gestation who presents to the triage unit complaining of a sudden onset of severe headache and "spots" in her vision. Her BP is 162/114 mmHg. Her baseline BP in the first trimester was 110/70 mmHg. Urinalysis reveals 3+ protein. The fetal heart rate (FHR) is 145 bpm with moderate variability and no decelerations. What is the most appropriate next step in the management of this patient?

A. Immediate Cesarean section
B. Administration of IV Magnesium Sulfate and Hydralazine
C. Repeat BP in 4 hours to confirm diagnosis
D. Discharge with instructions for bed rest and outpatient follow-up
E. Administration of Betamethasone and discharge

Correct Answer: B. Administration of IV Magnesium Sulfate and Hydralazine
This patient meets the criteria for preeclampsia with severe features (BP ≥160/110 mmHg and visual disturbances). Immediate management requires seizure prophylaxis with Magnesium Sulfate and blood pressure control with rapid-acting antihypertensives like Hydralazine or Labetalol. Immediate delivery is indicated if there is evidence of maternal or fetal distress, but initial stabilization is paramount. Choice C is incorrect because the diagnosis is already established by the presence of severe features. Choice D and E are inappropriate given the acute risk of eclampsia and stroke.

Question 2

Your patient is a 19-year-old female presenting with lower abdominal pain, fever (101.4°F), and a foul-smelling vaginal discharge. On physical exam, there is significant cervical motion tenderness (chandelier sign) and bilateral adnexal tenderness. Her pregnancy test is negative. What is the most likely diagnosis?

A. Ectopic pregnancy
B. Appendicitis
C. Pelvic Inflammatory Disease (PID)
D. Ovarian torsion
E. Urinary tract infection

Correct Answer: C. Pelvic Inflammatory Disease (PID)
The clinical triad of pelvic pain, fever, and cervical motion tenderness in a young, sexually active female is highly suggestive of PID. Ectopic pregnancy is excluded by the negative pregnancy test. Appendicitis typically presents with localized RLQ pain (McBurney’s point) and lacks cervical motion tenderness. Ovarian torsion presents with sudden, severe, unilateral pain, often associated with nausea/vomiting, and is less likely to cause a high fever and discharge.

High-Yield Content Areas

Prenatal Care and Pregnancy Complications

Obstetrics constitutes approximately 45% of the GSR exam. You must master the timing of prenatal screenings, including the first-trimester nuchal translucency scan and the second-trimester anatomy survey. Understanding the Rho(D) immune globulin administration schedule (at 28 weeks and within 72 hours of delivery for Rh-negative mothers) is a frequent exam target.

Complications such as Gestational Diabetes (GDM) require knowledge of the two-step screening process (1-hour GTT followed by a 3-hour GTT). You must also differentiate between placenta previa (painless bleeding) and placental abruption (painful bleeding, firm uterus), as these carry vastly different management protocols.

Menstruation and Abnormal Uterine Bleeding (AUB)

The PALM-COEIN acronym is essential for classifying the etiology of AUB.

• Polyp
• Adenomyosis
• Leiomyoma
• Malignancy/Hyperplasia
• Coagulopathy
• Ovulatory dysfunction
• Endometrial
• Iatrogenic
• Not yet classified

Exam questions often require you to differentiate between Leiomyoma (fibroids), which present as an irregularly enlarged, firm uterus, and Adenomyosis, which typically presents as a symmetrically enlarged, "boggy," and tender uterus.

Infections and Vulvovaginal Disorders

Vaginitis remains a high-frequency topic. You must be able to distinguish between Bacterial Vaginosis (Clue cells, Whiff test positive), Candidiasis (pseudohyphae, cottage cheese discharge), and Trichomoniasis (strawberry cervix, motile trichomonads). Treatment for Trichomoniasis always involves treating the partner, whereas BV does not.

Maximizing Your CME Dollars

While the GSR EOR book provides the foundation for rotation success, long-term professional growth and certification maintenance require high-quality Category 1 CME. CME Review Courses offers an efficient way to fulfill your requirements while adding tangible value to your professional life.

Our PANRE Review Course provides 100 hours of AAPA Category 1 CME credit. This is the most efficient way to prepare for recertification while satisfying your state and national credit requirements. Furthermore, our Pharmacology Course provides Category 1 AAPA credit, which is highly valued by nurse practitioners in many states and counts as Category 2 credit for physicians.

We understand that PAs often have dedicated CME budgets. To help you maximize this resource, we offer CME with Amazon and Apple Gift Card add-ons. You can add a gift card ranging from $100 to $1500 to your purchase. This allows you to invest in your education while obtaining the tools you need: like new medical equipment, books, or technology: to further your clinical practice.

Explore CME Packages with Gift Card Add-ons

Red-Flag Recognition

The ability to identify surgical emergencies is a hallmark of a competent clinician.

1. Ectopic Pregnancy: Any female of childbearing age with abdominal pain and a positive hCG is an ectopic pregnancy until proven otherwise. Transvaginal ultrasound (TVUS) is the diagnostic tool of choice.
2. Ovarian Torsion: Sudden, sharp unilateral pain. Doppler ultrasound will show decreased or absent blood flow to the ovary. This is a surgical emergency.
3. Postpartum Hemorrhage (PPH): Remember the 4 Ts: Tone (Atony – most common), Tissue (Retained products), Trauma (Lacerations), and Thrombin (Coagulopathy). Initial management focuses on fundal massage and oxytocin.

Conclusion

Preparation for the OB/GYN EOR exam should not be left to chance. By utilizing blueprint-aligned resources like the Master the Gynecologic, Sexual, and Reproductive Health End of Rotation exam ebook, you ensure that your study time is spent on high-yield topics that translate directly to exam success. Combine this targeted study with the long-term benefits of our PANRE Review Course and Pharmacology Course to stay ahead in your career.

Get your copy of the OB/GYN EOR Review Book on Amazon today

Price: $9.99
Format: Kindle / Paperback
Deliverables: 81-Page Study Guide, 120-Question Practice Exam
Access: Instant via Amazon

The Psychiatry and Behavioral Health End of Rotation (EOR) exam requires a precise understanding of diagnostic criteria and pharmacological management. Navigating the DSM-5 without a structured roadmap is an inefficient use of study time. Success on this exam depends on recognizing the subtle clinical distinctions between similar psychiatric conditions and understanding the specific weight of the PAEA psychiatry blueprint.

Ace the Psychiatry & Behavioral Health EOR: The Ultimate Study Guide & Question Bank is designed to provide Physician Assistant students with a high-yield, streamlined resource. This guide is fully updated for the July 2026 standards, ensuring you are studying the most current clinical guidelines and exam weightings.

Comprehensive PAEA blueprint Alignment

Efficiency in test preparation requires focusing on the content areas with the highest impact. This guide is built directly around the PAEA psychiatry blueprint and topic list. By prioritizing the heavy hitters, you maximize your score potential.

• Depressive and Bipolar Disorders (17%): Master the nuances between Major Depressive Disorder (MDD), Bipolar I, Bipolar II, and Cyclothymic disorder.
• Substance-Related Disorders (15%): Understand the diagnostic criteria for intoxication and withdrawal for alcohol, opioids, and stimulants.
• Trauma and Stress-Related Disorders (13%): Differentiate between PTSD, Acute Stress Disorder, and Adjustment Disorder.

The guide also provides exhaustive coverage of Schizophrenia Spectrum disorders, Personality Disorders, and Feeding/Eating Disorders.

High-Yield Clinical Pearls

Facts alone are insufficient for clinical vignettes. This resource provides the "must-know" distinctions that often appear on the EOR.

1. Mood Disorders: Differentiating the duration and severity of symptoms in Bipolar I vs. II and Persistent Depressive Disorder (Dysthymia).
2. Anxiety and Somatic Symptoms: Identifying the hallmark signs of Generalized Anxiety Disorder (GAD) versus Panic Disorder, and the external incentives in Malingering versus Factitious Disorder.
3. Neurodevelopmental and Sleep-Wake Disorders: Rapid review of ADHD diagnostic criteria, Autism Spectrum milestones, and Insomnia management.

Practice Makes Proficient: 120-Question Exam

At the conclusion of the guide, you will find a 120-question practice exam. This full-length, multiple-choice question bank is designed to simulate the real exam environment. Testing your stamina and application of knowledge is critical before sitting for the actual EOR.

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Clinical Assessment: Practice Questions

The following clinical scenarios represent the format and depth of knowledge required for the Psychiatry EOR.

Case Scenario 1

Your patient is a 24-year-old male brought to the emergency department by his roommate. The roommate reports that for the past 6 days, the patient has been "overflowing with energy," sleeping only 2 hours a night, and has spent his entire savings account on a new business venture he described as "revolutionary." On examination, the patient is speaking rapidly, jumping from one topic to another, and claims he has discovered a way to "code the human soul." He has no prior psychiatric history.

What is the most likely diagnosis?

A) Bipolar II Disorder
B) Cyclothymic Disorder
C) Bipolar I Disorder
D) Schizoaffective Disorder

Correct Answer: C) Bipolar I Disorder

Explanation: The patient is experiencing a manic episode, characterized by a distinct period of abnormally elevated or irritable mood and increased activity lasting at least one week (or any duration if hospitalization is required). The presence of grandiosity, decreased need for sleep, pressured speech, and flight of ideas are hallmark symptoms. Bipolar I Disorder requires only one manic episode for diagnosis. Bipolar II requires at least one hypomanic episode (shorter duration, no marked impairment) and one major depressive episode. Cyclothymic disorder involves at least two years of fluctuating hypomanic and depressive symptoms that do not meet full criteria for either. Schizoaffective disorder would require a period of at least two weeks of delusions or hallucinations in the absence of a major mood episode.

Case Scenario 2

Your patient is a 32-year-old female who presents with a 2-month history of intense fear of having another "attack." She describes previous episodes of sudden onset heart palpitations, sweating, trembling, and a feeling of impending doom that peak within 10 minutes. Her medical workup, including an EKG and thyroid-stimulating hormone (TSH) level, is within normal limits.

What is the first-line pharmacological treatment for long-term management?

A) Alprazolam
B) Selective Serotonin Reuptake Inhibitors (SSRIs)
C) Propropanol
D) Buspirone

Correct Answer: B) Selective Serotonin Reuptake Inhibitors (SSRIs)

Explanation: The patient's presentation is consistent with Panic Disorder. Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine or sertraline, are considered first-line for long-term management due to their efficacy and safety profile. Alprazolam is a benzodiazepine that may be used for acute symptoms but carries a risk of dependence and is not first-line for maintenance. Propranolol is often used for performance-related social anxiety but is not effective for panic disorder. Buspirone is used for Generalized Anxiety Disorder (GAD) but has not shown significant efficacy in treating panic disorder.

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Transitioning to Professional Practice: PANRE and CME

Preparing for EOR exams is the foundation for your future career as a PA-C. Once you enter professional practice, maintaining your certification and staying current on clinical guidelines remains a priority. CME Review Courses offers comprehensive resources for every stage of your career.

PANRE Review Course

For practicing PAs, our PANRE Review Course provides 100 hours of AAPA Category 1 CME credit. This course is designed to be the most efficient way to prepare for the NCCPA Blueprint while simultaneously satisfying your credit requirements. The content is written by PAs, for PAs, covering essential systems including Cardiology, Pulmonology, and Orthopedics.

Pharmacology Review

In addition to broad review courses, we offer a specialized Pharmacology Review CME. This course is eligible for Category 1 AAPA credit and focuses on the high-yield pharmacological principles necessary for safe and effective prescribing.

Maximize Your CME Budget

We understand the logistical side of professional development. We offer an efficient way to utilize your employer-provided CME funds. Our packages allow you to add on Amazon or Apple Gift Cards (ranging from $100 to $1500) to your CME purchase. This allows you to acquire the necessary technology, medical equipment, or educational materials to further enrich your practice.

Whether you are securing the "P" on your Psychiatry EOR or preparing for your ten-year recertification, our clinical review materials provide the authoritative information you need to succeed.

Purchase Ace the Psychiatry & Behavioral Health EOR on Amazon today.

Product: Emergency Medicine EOR Exam Prep Guide
Format: Digital and Print Study Guide
Deliverables: 120-Question Practice Exam, High-Yield Fact Sheets, Comparison Tables
Alignment: PAEA Emergency Medicine Blueprint

Preparing for the Emergency Medicine End of Rotation (EOR) exam requires a strategic approach. The volume of information in the EM rotation is vast, ranging from life-threatening cardiovascular emergencies to acute orthopedic injuries. For the Physician Assistant student, time is the most valuable resource. Dense textbooks often contain "fluff" that distracts from the core concepts tested on the exam.

The Emergency Medicine EOR Exam Prep guide is designed to provide a concise, high-yield review that mirrors the exact distribution of the PAEA blueprint. This ensures that your study hours are focused on the 20% of the exam dedicated to Cardiovascular topics and the 15% dedicated to Orthopedics and Rheumatology. You can view it here: Emergency Medicine EOR Exam Prep Guide on Amazon.

Blueprint-Driven Content Distribution

To succeed on the EM EOR, you must prioritize your study based on the weight of each category. This guide follows the PAEA distribution:

• Cardiovascular (20%): ACS, STEMI vs. NSTEMI, dysrhythmias, and heart failure.
• Orthopedics/Rheumatology (15%): Fracture management, compartment syndrome, and joint dislocations.
• Pulmonology (10%): PE, tension pneumothorax, asthma, and COPD.
• Gastrointestinal (10%): Acute abdominal pain, GI bleeds, and bowel obstructions.
• Neurology (8%): Stroke management, meningitis, and GBS.

High-Yield Cardiovascular Mastery

Cardiovascular medicine represents one-fifth of your total score. You must be able to rapidly identify ECG changes and initiate the appropriate ACLS protocols.

When a patient presents with chest pain, your clinical priority is ruling out Acute Coronary Syndrome (ACS). You must differentiate between a STEMI, where immediate reperfusion is mandatory, and an NSTEMI or unstable angina. The guide provides simplified tables to distinguish between these based on cardiac biomarkers and ECG findings.

Orthopedic and Rheumatologic Emergencies

With 15% of the exam focused here, you cannot afford to miss "can't-miss" diagnoses like compartment syndrome or neurovascular compromise secondary to a dislocation.

A common point of confusion for students is differentiating wrist fractures.

• Colles Fracture: Distal radius fracture with dorsal displacement (dinner fork deformity). Usually results from a fall on an outstretched hand (FOOSH).
• Smith Fracture: Distal radius fracture with ventral/palmar displacement (garden spade deformity). Usually results from a fall onto a flexed wrist.

Practice Assessment: Clinical Vignettes

Question 1
Your patient is a 64-year-old male presenting to the emergency department with sudden onset of substernal chest pain radiating to the left jaw. He is diaphoretic and nauseated. Vital signs show HR 110, BP 145/95, and SaO2 94% on room air. The initial ECG reveals ST-segment elevation in leads II, III, and aVF. Which of the following is the most appropriate next step in management?

A) Administer a beta-blocker immediately
B) Obtain an urgent chest X-ray
C) Activate the cardiac catheterization lab for primary PCI
D) Order a STAT CT of the chest with IV contrast

Explanation: C is the correct answer.
Activation of the cardiac catheterization lab is the priority for a patient with an inferior STEMI (ST-elevation in II, III, aVF). The goal for primary percutaneous coronary intervention (PCI) is a door-to-balloon time of less than 90 minutes. A chest X-ray should not delay reperfusion therapy. Beta-blockers (Choice A) should be used with caution in the acute phase of an inferior MI if there is bradycardia or heart block. A CT of the chest (Choice D) is used to evaluate for aortic dissection but is not the primary intervention for a STEMI.

Question 2
Your patient is a 24-year-old female who was brought in by EMS after a high-speed motor vehicle collision (MVC). She is complaining of severe right lower leg pain. On exam, the leg is swollen and tense. Pain is elicited with passive stretch of the toes. Distal pulses are 2+ and sensation is intact. What is the most appropriate next step?

A) Apply a fiberglass splint and discharge with orthopedic follow-up
B) Measure intracompartmental pressures
C) Obtain an MRI of the lower extremity
D) Administer IV antibiotics

Explanation: B is the correct answer.
Measuring intracompartmental pressures is necessary to confirm the diagnosis of compartment syndrome, which is suggested by the "wood-like" feeling of the limb and pain with passive stretch. While pulses are present (pulselessness is a late finding), the clinical suspicion remains high. A fasciotomy is indicated if the pressure is within 30 mmHg of the diastolic blood pressure (delta pressure). Discharging the patient (Choice A) would lead to permanent nerve damage and muscle necrosis. MRI (Choice C) is too slow for an acute surgical emergency.

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Clinical Assessment: Practice Scenarios

Use the following vignettes to test your knowledge of the NCCPA Blueprint categories in Cardiology, Emergency Medicine, and Internal Medicine.

Scenario 1: Cardiology

Your patient is a 64-year-old male with a history of hypertension and tobacco use who presents to the clinic for a routine follow-up. He reports recent episodes of "chest tightness" that occur when he is mowing his lawn and resolve after five minutes of rest. He denies syncope, orthopnea, or lower extremity edema. His vital signs are: BP 148/92, HR 78, RR 16, SaO2 98% on room air. Physical exam reveals a normal S1 and S2 with no murmurs or gallops.

Which of the following is the most appropriate next step in the diagnostic workup for this patient?

A) Coronary Angiography
B) Exercise Stress Echocardiogram
C) 24-hour Holter Monitor
D) Troponin I and CK-MB levels

Scenario 2: Emergency Medicine

Your patient is a 28-year-old female brought to the Emergency Department by EMS after being found unresponsive in a park. On arrival, she is lethargic but arousable to painful stimuli. Her vital signs are: BP 102/64, HR 52, RR 6, SaO2 88% on room air. Physical exam reveals pinpoint pupils and track marks on her bilateral antecubital fossae.

After securing the airway, which of the following is the most immediate pharmacological intervention?

A) Flumazenil
B) Naloxone
C) Dextrose 50%
D) Atropine

Scenario 3: Internal Medicine

Your patient is a 72-year-old female hospitalized for a hip fracture repair. On postoperative day three, she develops sudden onset shortness of breath and pleuritic chest pain. Her vital signs are: BP 110/70, HR 112, RR 24, SaO2 91% on 2L nasal cannula. Her surgical site is clean, but her right calf is erythematous and tender to palpation.

Which of the following is the gold standard for confirming the suspected diagnosis?

A) D-dimer assay
B) Ventilation-Perfusion (V/Q) scan
C) CT Pulmonary Angiography (CTPA)
D) Venous Duplex Ultrasound

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Explanations and Rationales

Scenario 1: Cardiology

Correct Answer: B) Exercise Stress Echocardiogram

The patient’s presentation is classic for stable angina, characterized by predictable chest discomfort with exertion that is relieved by rest. In a patient with an intermediate pre-test probability of coronary artery disease (CAD) who is able to exercise and has a baseline ECG that is likely interpretable, an exercise stress echocardiogram is an appropriate initial non-invasive test to evaluate for inducible ischemia.

• Coronary Angiography (A) is an invasive "gold standard" typically reserved for patients with high-risk features on non-invasive testing or unstable presentations.
• Holter Monitor (C) is used for evaluating palpitations or suspected arrhythmias, not exertional ischemia.
• Troponins (D) are markers of acute myocardial necrosis; they are not indicated in a stable outpatient setting where the symptoms have resolved.

Scenario 2: Emergency Medicine

Correct Answer: B) Naloxone

The clinical triad of coma, respiratory depression (RR 6), and miosis (pinpoint pupils) is pathognomonic for opioid overdose. Naloxone is a competitive opioid antagonist that should be administered immediately to reverse respiratory depression.

• Flumazenil (A) is used for benzodiazepine overdose but carries a high risk of inducing seizures in chronic users or mixed ingestions.
• Dextrose (C) is indicated for hypoglycemia; while it may be part of a "coma cocktail," the respiratory rate and pupils point specifically to opioids.
• Atropine (D) is used for symptomatic bradycardia, but the bradycardia in this patient is secondary to respiratory failure and hypoxia caused by the opioid.

Scenario 3: Internal Medicine

Correct Answer: C) CT Pulmonary Angiography (CTPA)

The patient presents with signs and symptoms of a Pulmonary Embolism (PE) following major orthopedic surgery, which is a significant risk factor. CT Pulmonary Angiography (CTPA) is currently the preferred diagnostic "gold standard" (more accurately, the first-line definitive imaging) for PE due to its high sensitivity and specificity.

• D-dimer (A) has a high negative predictive value but is non-specific, especially in a postoperative patient where it will likely be elevated regardless of a clot.
• V/Q scan (B) is an alternative when CTPA is contraindicated (e.g., renal failure or contrast allergy).
• Venous Duplex (D) can confirm a DVT but does not confirm the presence of a PE.

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Clinical Application: Practice Questions

Question 1: Cardiovascular Medicine

Patient Presentation: Your patient is a 64-year-old male presenting to the emergency department with a 2-hour history of crushing substernal chest pain that radiates to his left jaw. He is diaphoretic and nauseated.
Vitals: BP 105/62 mmHg, HR 110 bpm, RR 22 bpm, SaO2 94% on room air.
Diagnostics: The initial ECG reveals 3mm ST-segment elevation in leads II, III, and aVF.

What is the most appropriate next step in the management of this patient?

A. Administer 325 mg of aspirin and arrange for emergent percutaneous coronary intervention (PCI).
B. Obtain a STAT portable chest X-ray to rule out aortic dissection.
C. Administer sublingual nitroglycerin and wait for initial troponin results.
D. Perform a 12-lead ECG every 30 minutes to monitor for evolution.

Correct Answer: A. Administer 325 mg of aspirin and arrange for emergent percutaneous coronary intervention (PCI).

Explanation: The patient is presenting with a classic ST-elevation myocardial infarction (STEMI) of the inferior wall. According to standard clinical guidelines, "time is muscle." Immediate reperfusion therapy via PCI is the gold standard for management when available within 90 minutes of medical contact. Aspirin should be administered immediately for its antiplatelet effects. Nitroglycerin (Option C) must be used with extreme caution in inferior MIs due to the risk of severe hypotension if right ventricular involvement is present. Waiting for troponin results (Option C) or repeat ECGs (Option D) unnecessarily delays definitive treatment and increases myocardial necrosis.

Question 2: Pulmonary / Emergency Medicine

Patient Presentation: Your patient is a 24-year-old female with a history of asthma who presents with acute shortness of breath and wheezing. She has been using her rescue inhaler every 20 minutes for the past two hours without significant relief.
Vitals: HR 118 bpm, RR 28 bpm, SaO2 91% on room air.
Physical Exam: You note the use of accessory muscles of respiration and loud expiratory wheezing throughout all lung fields.

Which of the following pharmacological interventions is indicated first?

A. Intravenous magnesium sulfate.
B. Inhaled short-acting beta-agonist (SABA) via nebulizer and oral or IV corticosteroids.
C. Prophylactic intubation and mechanical ventilation.
D. Subcutaneous epinephrine.

Correct Answer: B. Inhaled short-acting beta-agonist (SABA) via nebulizer and oral or IV corticosteroids.

Explanation: In an acute asthma exacerbation, the primary goal is to reverse airway obstruction and reduce inflammation. Inhaled SABAs provide rapid bronchodilation. Corticosteroids are essential for reducing the underlying airway inflammation and preventing relapse; their systemic administration (oral or IV) is indicated in patients who do not respond completely to initial SABA treatment. Magnesium sulfate (Option A) is typically reserved for severe cases that are refractory to initial treatment. Intubation (Option C) is a last resort for impending respiratory failure. Epinephrine (Option D) is generally reserved for anaphylaxis or cases where inhaled therapies are not feasible.

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