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At which intercostal space and location is the mitral valve best auscultated?
2nd intercostal space at the left sternal border
5th intercostal space at the left midclavicular line
5th intercostal space at the left anterior axillary line
4th intercostal space at the left midclavicular line
The mitral valve is best heard at the 5th intercostal space in the left midclavicular line, often referred to as the cardiac apex. This location allows clear auscultation of S1 and any mitral murmurs. Other intercostal spaces are used for different valves such as aortic or pulmonic. Learn more here.
What is the normal resting respiratory rate for a healthy adult?
16-28 breaths per minute
12-20 breaths per minute
20-24 breaths per minute
8-12 breaths per minute
A normal adult respiratory rate ranges from 12 to 20 breaths per minute at rest. Rates below or above this range can indicate underlying pulmonary or systemic issues. Consistent monitoring helps in early detection of respiratory distress. Source.
Which cranial nerve is primarily responsible for facial expression movements?
Glossopharyngeal nerve (CN IX)
Accessory nerve (CN XI)
Trigeminal nerve (CN V)
Facial nerve (CN VII)
The facial nerve (CN VII) innervates the muscles of facial expression and conveys taste from the anterior two-thirds of the tongue. Damage to this nerve leads to facial paralysis on the affected side. Other cranial nerves have different primary functions. Reference.
Which immunoglobulin is most abundant in human serum?
IgA
IgE
IgM
IgG
IgG is the most abundant immunoglobulin in the serum and plays a crucial role in secondary immune responses. It can cross the placenta and provides passive immunity to the fetus. IgA is predominant in mucosal areas, while IgM is the first responder in primary immune responses. Learn more.
Which imaging modality is considered first-line for evaluating suspected acute appendicitis in adults?
Magnetic resonance imaging (MRI)
Abdominal CT scan with contrast
Plain abdominal X-ray
Abdominal ultrasound
A contrast-enhanced CT scan of the abdomen is the most sensitive and specific imaging test for suspected acute appendicitis in adults. It accurately identifies inflammation, abscess, or perforation. Ultrasound is often used in children and pregnant patients to avoid radiation. Source.
Beta-adrenergic blockers primarily exert their therapeutic effect by antagonizing which receptor subtype?
Beta-1 adrenergic receptor
Muscarinic acetylcholine receptor
Beta-2 adrenergic receptor
Alpha-1 adrenergic receptor
Selective beta-1 blockers target cardiac beta-1 adrenergic receptors, reducing heart rate and contractility. This mechanism decreases myocardial oxygen demand and is beneficial in treating hypertension and arrhythmias. Nonselective blockers also affect beta-2 receptors. More info.
Which electrolyte disturbance is most commonly associated with muscle weakness and cardiac arrhythmias?
Hypernatremia
Hypokalemia
Hypermagnesemia
Hypocalcemia
Hypokalemia can cause muscle weakness, cramps, and predispose to various arrhythmias including U-waves on ECG. It is often due to diuretic use or gastrointestinal losses. Prompt recognition and replacement are essential. Reference.
An irregularly irregular heartbeat without distinct P waves on ECG is characteristic of which arrhythmia?
Ventricular tachycardia
Sinus tachycardia
Atrial flutter
Atrial fibrillation
Atrial fibrillation presents as an irregularly irregular rhythm on ECG with absent P waves and variable R-R intervals. It increases the risk of thromboembolism and requires rate or rhythm control and anticoagulation. Learn more.
Which adverse effect is most associated with ACE inhibitor therapy?
Neutropenia
Hyperglycemia
Dry cough
Tinnitus
ACE inhibitors commonly cause a persistent dry cough due to increased bradykinin levels in the respiratory tract. Other side effects include hyperkalemia and angioedema. Monitoring and switching to an ARB may alleviate the cough. Source.
Deficiency of which vitamin leads to pernicious anemia?
Vitamin C
Vitamin B6
Folate
Vitamin B12
Pernicious anemia results from autoimmune destruction of gastric parietal cells leading to intrinsic factor deficiency and impaired vitamin B12 absorption. This causes macrocytic anemia and neurologic deficits. Treatment is with B12 supplementation. Reference.
Which cell type is primarily responsible for antibody-mediated (humoral) immunity?
Natural killer cells
T helper cells
Macrophages
B lymphocytes
B lymphocytes differentiate into plasma cells that produce antibodies targeting specific antigens. This humoral response is critical for neutralizing pathogens and facilitating opsonization. T helper cells assist B cell activation. Learn more.
What is the first-line pharmacologic treatment for an acute anaphylactic reaction?
Albuterol nebulization
Diphenhydramine IM
Epinephrine intramuscular
Methylprednisolone IV
Intramuscular epinephrine is the first-line treatment for anaphylaxis due to its rapid alpha- and beta-adrenergic effects, which reverse airway edema, hypotension, and bronchospasm. Adjunctive therapies include antihistamines and steroids. Reference.
Which laboratory value is most closely monitored to assess warfarin therapy efficacy?
Prothrombin time/international normalized ratio (PT/INR)
Activated partial thromboplastin time (aPTT)
Bleeding time
Thrombin time
Warfarin inhibits vitamin K - dependent clotting factors, prolonging the PT/INR. Maintaining an appropriate INR range (often 2.0 - 3.0) reduces the risk of thrombosis without excessive bleeding. aPTT is used for heparin monitoring. Learn more.
ST-segment elevation in leads V2 through V4 on ECG suggests infarction in which coronary artery territory?
Right coronary artery
Left circumflex artery
Posterior descending artery
Left anterior descending artery
St elevations in V2 - V4 indicate an anteroseptal myocardial infarction, most commonly due to occlusion of the left anterior descending (LAD) artery. Rapid reperfusion therapy is critical. Source.
What is the recommended combination therapy for treating cerebral toxoplasmosis in immunocompromised patients?
Clindamycin plus primaquine
Itraconazole plus amphotericin B
Trimethoprim-sulfamethoxazole alone
Pyrimethamine plus sulfadiazine
Pyrimethamine plus sulfadiazine with leucovorin is the recommended first-line therapy for cerebral toxoplasmosis in HIV patients. This combination inhibits folate metabolism in Toxoplasma gondii. Alternative regimens are used for sulfa-allergic patients. Reference.
Which diagnostic test is most appropriate for evaluating sporadic palpitations occurring over several days in an outpatient?
Event recorder implant
Tilt-table testing
24-hour Holter monitor
Exercise stress test
A 24-hour Holter monitor provides continuous ECG monitoring for daily activities and is ideal for detecting intermittent arrhythmias causing palpitations. Event recorders are for less frequent events. Source.
What is the initial screening test for suspected Cushing syndrome?
24-hour urinary free cortisol
Serum cortisol at noon
Dexamethasone suppression test
Plasma ACTH level
A 24-hour urinary free cortisol is one of the first-line tests for screening Cushing syndrome by measuring cortisol over an extended period. Low-dose dexamethasone suppression test is also used. ACTH level helps differentiate primary from secondary causes. Reference.
What acid-base disturbance is expected in a patient with persistent vomiting?
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
Prolonged vomiting leads to loss of gastric acid, causing metabolic alkalosis characterized by elevated bicarbonate. Compensation occurs via hypoventilation. Identifying the cause is important for appropriate fluid replacement. Source.
A holosystolic murmur heard best at the left lower sternal border that increases with inspiration is most consistent with which pathology?
Hypertrophic cardiomyopathy
Tricuspid regurgitation
Mitral regurgitation
Aortic stenosis
A holosystolic murmur at the left lower sternal border that intensifies with inspiration suggests tricuspid regurgitation due to increased right-sided venous return. Mitral regurgitation is heard at the apex and radiates to the axilla. Learn more.
Which agent inhibits vitamin K epoxide reductase, affecting clotting factor synthesis?
Dabigatran
Heparin
Warfarin
Enoxaparin
Warfarin inhibits vitamin K epoxide reductase, reducing active vitamin K and impairing synthesis of clotting factors II, VII, IX, and X. Monitoring via PT/INR is required. Heparins act on antithrombin. Reference.
Which combination of hormone replacement is most appropriate for primary adrenal insufficiency?
Fludrocortisone only
Hydrocortisone only
Hydrocortisone and fludrocortisone
Prednisone and spironolactone
Primary adrenal insufficiency (Addison disease) requires both glucocorticoid replacement (hydrocortisone) and mineralocorticoid replacement (fludrocortisone) due to loss of cortisol and aldosterone. Single therapy is insufficient. Source.
Which antibody test has the highest specificity for rheumatoid arthritis diagnosis?
Rheumatoid factor (RF)
Anti - double-stranded DNA antibody
Antinuclear antibody (ANA)
Anti - cyclic citrullinated peptide (anti-CCP) antibody
Anti-CCP antibodies have high specificity and predictive value for rheumatoid arthritis, often appearing early in disease. RF is less specific and can be positive in other conditions. Learn more.
Which class of antibiotics is associated with an increased risk of Achilles tendon rupture?
Macrolides
Tetracyclines
Fluoroquinolones
Aminoglycosides
Fluoroquinolones have been linked to tendinopathy and tendon rupture, particularly the Achilles tendon, due to effects on collagen synthesis. Risk increases in older patients and those on corticosteroids. Reference.
Toll-like receptor 4 (TLR4) primarily recognizes which pathogen-associated molecular pattern?
Lipopolysaccharide (LPS)
Double-stranded RNA
Peptidoglycan
Flagellin
TLR4 recognizes lipopolysaccharide (LPS) on Gram-negative bacterial cell walls, initiating MyD88-dependent signaling and cytokine release. Other TLRs detect different PAMPs. Source.
Which surface marker is most commonly used to identify monocytes and macrophages?
CD56
CD14
CD3
CD19
CD14 is a pattern recognition receptor on the surface of monocytes and macrophages that binds LPS. It serves as a co-receptor for TLR4. CD3 is on T cells, CD19 on B cells, and CD56 on NK cells. Reference.
What is the mechanism of action of omeprazole?
Anticholinergic receptor blockade
Proton pump (H+/K+ ATPase) inhibition
H2 receptor blockade
Neutralization of gastric acid
Omeprazole irreversibly inhibits the H+/K+ ATPase proton pump in gastric parietal cells, reducing gastric acid secretion. It is used to treat peptic ulcer disease and GERD. Its effect lasts until new pumps are synthesized. Learn more.
A patient has a prolonged PTT but a normal PT. Which clotting factor deficiency is most likely?
Factor VII
Factor X
Factor VIII
Factor II
Factor VIII deficiency (hemophilia A) prolongs the PTT because it is part of the intrinsic coagulation pathway. PT remains normal since the extrinsic pathway is unaffected. Source.
Which diagnostic criterion is required to define Acute Respiratory Distress Syndrome (ARDS)?
Elevated BNP levels
WBC count >15,000
PaO2/FiO2 ratio <300
PCO2 >50 mm Hg
ARDS is defined by acute onset of hypoxemia with a PaO2/FiO2 ratio less than 300, bilateral opacities on chest imaging, and non-cardiogenic pulmonary edema. It requires exclusion of cardiac failure. Learn more.
Duchenne muscular dystrophy follows which pattern of genetic inheritance?
Mitochondrial
Autosomal dominant
Autosomal recessive
X-linked recessive
Duchenne muscular dystrophy is inherited in an X-linked recessive pattern, affecting primarily males with the mutated dystrophin gene on the X chromosome. Female carriers may have mild symptoms. Reference.
If a control event rate is 40% and a treatment event rate is 20%, what is the number needed to treat (NNT)?
5
10
2
20
NNT is calculated as the inverse of the absolute risk reduction (ARR). Here, ARR = 0.40 - 0.20 = 0.20; NNT = 1/0.20 = 5. It indicates five patients must be treated to prevent one event. Source.
Which medication is known for a high hepatic first-pass metabolism requiring sublingual or IV administration for efficacy?
Nitroglycerin
Furosemide
Digoxin
Propranolol
Nitroglycerin undergoes extensive hepatic first-pass metabolism, reducing its oral bioavailability. Sublingual or transdermal routes bypass the liver initially, providing effective dosing for angina. Learn more.
Which enzyme is responsible for hydrolyzing triglycerides in chylomicrons during lipid metabolism?
Hormone-sensitive lipase
Pancreatic lipase
Hepatic lipase
Lipoprotein lipase
Lipoprotein lipase, located on the endothelial surface, hydrolyzes triglycerides in chylomicrons and very-low-density lipoproteins into free fatty acids. This process is essential for lipid uptake by tissues. Source.
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Study Outcomes
Understand Key PA Exam Concepts -
After completing the quiz, you will understand fundamental topics covered in the PA practice exam, including clinical medicine and pharmacology.
Apply Test-Taking Strategies -
Learn to use effective pa school test strategies such as time management and question analysis to improve your exam performance.
Analyze Personal Strengths and Weaknesses -
Identify which pa practice questions you excel at and pinpoint areas that require further study for targeted improvement.
Evaluate Knowledge Retention -
Track your quiz scores to assess how well you retain critical information and reinforce learning gaps before the actual exam.
Identify Areas for Improvement -
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Boost Exam Confidence -
Gain confidence in your readiness for the physician assistant practice exam through simulated pa test questions that mirror real certification challenges.
Cheat Sheet
Pharmacokinetics & Pharmacodynamics -
Review absorption, distribution, metabolism, and excretion (ADME) processes and understand how they affect drug plasma levels. Use the half-life equation (t/₂ = 0.693 × Vd / Cl) to calculate dosing intervals for medications like vancomycin. Remember the mnemonic "ADME" to keep key steps in mind (PubMed, FDA).
Cardiovascular Physiology & Hemodynamics -
Master the Frank-Starling law by visualizing how ventricular preload affects stroke volume, and practice interpreting pressure-volume loops. Recall that increased venous return stretches myocardial fibers, enhancing contractility. Resources from the American Heart Association provide detailed loop diagrams and clinical correlates for heart failure scenarios.
Clinical Assessment & SOAP Notes -
Hone your history-taking and physical exam skills with the SOAP format: Subjective, Objective, Assessment, Plan. For example, use "OLD CARTS" (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, Severity) to structure symptom inquiries. The University of California San Francisco's guidelines outline key exam maneuvers for cardiovascular, pulmonary, and abdominal systems.
Laboratory Interpretation & Acid-Base Balance -
Memorize normal BMP values and calculate anion gap using AG = [Na+] - ([Cl - ] + [HCO₃ - ]) to identify metabolic acidosis (normal AG = 8 - 16 mEq/L). Practice differentiating respiratory vs. metabolic disorders with the Henderson-Hasselbalch equation (pH = pKa + log [HCO₃ - ]/(0.03 × pCO₂)). The National Institutes of Health offers clinical case studies on acid-base disturbances.
Medical Ethics & Professionalism -
Internalize the four ethical principles: autonomy, beneficence, nonmaleficence, and justice when facing patient dilemmas. Use the "Four-Box Method" (medical indications, patient preferences, quality of life, contextual features) to systematically analyze cases. Trusted references include the American Academy of Physician Associates' ethical guidelines and the AMA Code of Medical Ethics.
