The Internal Medicine End of Rotation (EOR) exam is the most cardiopulmonary-heavy of the seven. Cardiovascular and pulmonary together account for a third of the exam. This page explains what the exam tests, what changed in the 2026 blueprint update, and what is inside the PAtopia Internal Medicine EOR review. There is a free 25-question sample quiz and unlocked study library chapters below.
5 practice exams · 600 questions · complete study library · 27 months of access · $39.99
What is on the Internal Medicine EOR exam?
The Internal Medicine EOR exam is 120 multiple-choice questions with a two-hour limit and a ten-minute break between sections. Only 100 of the 120 are scored — the remaining 20 are unscored pretest items, and you cannot tell which is which.
Every question is classified twice: by content area and by task area. Questions arrive as clinical vignettes, not isolated recall.
The 2026 Internal Medicine EOR blueprint update
PAEA publishes updated End of Rotation exams on July 27, 2026. Legacy versions remain available through July 2027, so ask your clinical coordinator which blueprint your program is using.
Two headline changes: Critical care is gone as a content area, and Psychiatric/behavioral health has been added.
Content areas — current vs. updated
| Content area | Current | Updated |
|---|---|---|
| Cardiovascular | 20% | 20% |
| Pulmonary | 15% | 15% |
| Gastrointestinal | 12% | 12% |
| Endocrine | 8% | 10% |
| Neurologic | 8% | 10% |
| Renal/genitourinary | 8% | 10% |
| Rheumatologic/musculoskeletal | 12% | 8% |
| Hematologic | 5% | 5% |
| Infectious diseases | 5% | 5% |
| Psychiatric/behavioral health (NEW) | — | 5% |
| Critical care | 7% | REDISTRIBUTED |
Task areas — current vs. updated
| Task area | Current | Updated |
|---|---|---|
| Diagnosis | 25% | 22% |
| Clinical Therapeutics | 20% | 18% |
| History & Physical | 15% | 15% |
| Diagnostic Studies | 10% | 14% |
| Clinical Intervention | 10% | 10% |
| Health Maintenance | 10% | 7% |
| Scientific Concepts | 10% | 7% |
| Professional Practice (NEW) | — | 7% |
What this means for how you study
Musculoskeletal is the big loser, down from 12% to 8%. If you were planning to spend heavy time on rheumatology, redistribute it.
Endocrine, neurology, and renal all rise to 10%. Together they are now 30% of the exam — as much as cardiovascular and pulmonary combined were under the old weighting. Diabetes, thyroid, stroke, seizure, AKI, CKD, and electrolyte disorders all deserve serious time.
Critical care did not disappear — it was redistributed. You will still see septic shock, DKA, and respiratory failure. They are now classified under the relevant organ system rather than a separate bucket, so do not skip them.
Psychiatric/behavioral health is a brand-new content area at 5%. Depression, anxiety, substance use, and delirium in the medical inpatient. Roughly six questions on material that was not previously tested here at all.
Cardiovascular holds at 20% — still the single largest content area, and still where your time goes first.
What is in the PAtopia Internal Medicine EOR review
- 5 full-length practice exams — each 120 questions, for 600 unique board-style questions with no repeats.
- Every question fully explained — why the answer is right, why each distractor is wrong, and a primary-source reference.
- Blueprint-weighted — question distribution matches the PAEA Internal Medicine blueprint.
- Complete study library — written review with high-yield tables and exam pearls, organized by content area.
- 27 months of access — covers your rotation, the EOC, and the PANCE.
Try it free — 25 questions and unlocked library chapters
Below is a free 25-question sample quiz pulled straight from Practice Exam 1 — same questions, same explanations, same references. Underneath, the study library is open with the first chapters unlocked so you can judge the depth. No account, no email, no card.
Free 25-question sample quiz
Look inside the study library
The first chapters are unlocked so you can judge the depth. The remaining chapters are locked — click any to see what is included.
How to study for the Internal Medicine EOR
Cardiopulmonary first, always. Cardiovascular (20%) and pulmonary (15%) are 35% of the exam between them — roughly forty scored questions. Nothing else comes close.
Do not neglect the newly-weighted trio. Endocrine, neuro, and renal at 10% each are another 30%. Under the old blueprint they were 8% each. That is a real shift.
Learn the workup, not just the diagnosis. Diagnostic Studies rose from 10% to 14% while Diagnosis dropped to 22%. Expect more “which test next?” and “what does this result mean?”
Read every explanation, including for questions you got right. A correct answer for the wrong reason is one you will miss next time in a different form.
Frequently asked questions
How many questions are on the Internal Medicine EOR exam?
120 questions, of which 100 are scored and 20 are unscored pretest items. Two hours.
What happened to critical care?
It was removed as a standalone content area and its topics redistributed across the organ-system content areas. The material is still tested.
Is psychiatry really on the Internal Medicine exam now?
Yes. Psychiatric/behavioral health was added as a content area at 5% on the updated blueprint. It did not exist on the legacy version.
Which blueprint will my exam use?
Exams published from July 27, 2026 use the updated blueprint. Legacy versions remain available through July 2027. Ask your clinical coordinator.
Will this help with the PANCE?
Substantially. Internal medicine content overlaps the NCCPA PANCE blueprint heavily.
About the author
Jeremy Boroff, MPAS, PA-C is a practicing Emergency Medicine Physician Assistant with 24 years of clinical experience and more than 20 years as an APC Director of an emergency department. He founded CME Review Courses and created the PAtopia app to help PA students prepare for the PACKRAT, all seven End of Rotation exams, the End of Curriculum exam, and the PANCE.
Blueprint figures are taken from PAEA’s official 2025 Internal Medicine Blueprint Crosswalk. PAtopia and CME Review Courses are not sponsored by, endorsed by, or affiliated with PAEA or NCCPA.
Other PAtopia exam reviews
PAtopia covers every standardized exam of the PA clinical year. Each review includes free sample questions and unlocked study library chapters — no account required.
- Emergency Medicine EOR — free sample quiz & library preview
- Family Medicine EOR — free sample quiz & library preview
- Pediatrics EOR — free sample quiz & library preview
- Psychiatry EOR — free sample quiz & library preview
- General Surgery EOR — free sample quiz & library preview
- GSR / Women’s Health EOR — free sample quiz & library preview
- PACKRAT — free sample quiz & library preview
- End of Curriculum (EOC) — free sample quiz & library preview
- PANCE — free sample quiz & library preview
Browse all PA student exam prep →
Read: 2026 PAEA EOR Blueprint Changes — A Complete Guide for PA Students →