- What This Cheat Sheet Covers (and What It Doesn't)
- Format, Fees, and Test-Day Rules at a Glance
- Eligibility Snapshot: The Numbers You Must Memorize
- Blueprint Weights: All 18 Domains on One Page
- The Ten Task Categories That Cut Across Every Domain
- High-Yield Topics Inside the Heaviest Domains
- Attestation, Scores, and Award Timeline
- Ten-Year Cycle and Maintenance Facts
- Mapping Domains to a Study Calendar
- Version Caveats and Things to Confirm with NCCPA
- Frequently Asked Questions
- The exam is 120 multiple-choice questions in two 60-question, 60-minute blocks, closed book, at a Pearson VUE test center.
- Initial cost is $350 total: $100 registration/administration plus $250 examination.
- Cardiovascular, Gastrointestinal/Nutrition, and Pulmonary are the heaviest domains at 9% each.
- Eligibility requires 3,000 EM hours and 75 Category I CME credits, both within six years.
What This Cheat Sheet Covers (and What It Doesn't)
This one-page-style review is built for physician assistants preparing for the Certificate of Added Qualifications in Emergency Medicine, awarded by the National Commission on Certification of Physician Assistants (NCCPA) and designated PA-C, CAQ-EM. "PA-CEM" is the identifier used on this site; it is not NCCPA's own abbreviation. If you want the naming background, see What Is PA-CEM? and What Does PA-CEM Stand For?.
Just as important is what this credential is not. It is not the PANCE, it is not an emergency-medicine end-of-rotation exam, and it is not an ABEM physician-board examination. The CAQ supplements your existing PA-C certification; it does not replace it. Everything below is specific to the CAQ-EM exam.
Format, Fees, and Test-Day Rules at a Glance
| Item | Fact |
|---|---|
| Issuer | NCCPA |
| Testing provider (initial exam) | Pearson VUE test centers |
| Questions | 120 multiple-choice |
| Structure | Two blocks of 60 questions, 60 minutes each |
| Testing time | Two hours (a 15-minute tutorial and 15-minute break are additional) |
| Resources allowed | None: closed book, no personal notes, books, or calculators |
| Block navigation | A submitted or expired block cannot be revisited |
| Initial fee | $350 total ($100 registration/administration + $250 examination) |
| Official practice exam | $50 through NCCPA Practice Exams; one form, 180-day completion window |
What the format means for your pacing
Sixty questions in sixty minutes works out to about one minute per item. Because a finished or expired block is locked, there is no going back to fix an early guess once you submit. Practice committing to an answer, flagging within the block if the interface allows, and using spare seconds on the hardest items before you submit. The block lock rewards candidates who make a clean first-pass decision rather than those who plan to "come back later" across blocks.
For a candid look at where candidates struggle, read How Hard Is the PA-CEM Exam?. For a full dollar breakdown that includes the practice exam and renewal costs, see PA-CEM Certification Cost.
Eligibility Snapshot: The Numbers You Must Memorize
Before you pay anything, confirm you meet every requirement. The details live on the PA-CEM Requirements page; here is the compressed version.
- Certification and licensure: current PA-C status, plus unrestricted U.S. PA licensure (or unrestricted government-agency practice privileges). All licenses you hold must be unrestricted.
- Experience: 3,000 hours of emergency-medicine PA experience within the six years before you attest that the experience requirement has been satisfied.
- CME: 75 emergency-medicine Category I CME credits earned within the six years before application, with at least 25 of them in the preceding two years.
- Attestation: a procedural/patient-case attestation signed by an appropriate supervising professional (see below).
- Completion window: the initial CAQ process has a six-year completion limit.
Who can sign the attestation?
The attestation form assesses relevant knowledge and skills; it does not create a separate practical exam.
- A collaborating physician or lead/senior PA who works in emergency medicine and knows your practice, or
- A physician/PA postgraduate program director, if you are enrolled in or graduated from that program.
- It may be submitted before the exam or within 90 days after score notification.
Blueprint Weights: All 18 Domains on One Page
The retrieved NCCPA content blueprint lists eighteen medical content categories. These are the exam's scope lines, not a ready-made curriculum, and the detailed examples under each are illustrative rather than exhaustive. For a deeper domain-by-domain walkthrough, see PA-CEM Exam Domains: Complete Guide to All 18 Content Areas.
| # | Domain | Weight |
|---|---|---|
| 1 | Cardiovascular System | 9% |
| 2 | Dermatologic System | 2% |
| 3 | Endocrine System | 4% |
| 4 | Eyes, Ears, Nose, & Throat | 5% |
| 5 | Gastrointestinal System and Nutrition | 9% |
| 6 | Genitourinary System | 5% |
| 7 | Hematologic System | 4% |
| 8 | Musculoskeletal System | 5% |
| 9 | Neurologic System | 6% |
| 10 | Psychobehavioral Disorders | 5% |
| 11 | Pulmonary System | 9% |
| 12 | Renal System | 5% |
| 13 | Obstetrics and Gynecology | 5% |
| 14 | Systemic Infectious Disorders | 5% |
| 15 | Environmental and Toxicologic Disorders | 6% |
| 16 | Traumatic Disorders | 6% |
| 17 | Procedures and Skills | 5% |
| 18 | Emerging Topics and Legal/Ethical Issues | 5% |
Reading the distribution
Three domains (Cardiovascular, Gastrointestinal System and Nutrition, and Pulmonary) each carry 9%, together about 27% of the exam. Neurologic, Environmental and Toxicologic, and Traumatic each carry 6%. Most of the remainder sits at 4-5%, and Dermatologic is the lightest at 2%. Dermatology will rarely decide your result, but a wide spread of mid-weight domains means no single system can be ignored.
Key Takeaway
Because the blueprint is broad and relatively flat, a candidate who is strong in cardiac and respiratory emergencies but weak in toxicology, trauma, OB/GYN, and environmental emergencies will leave points on the table. Prioritize the 9% trio first, then close gaps across the 5-6% block.
The Ten Task Categories That Cut Across Every Domain
The same blueprint also classifies questions by task. These ten categories cross-classify the same 120 questions; they are not extra medical domains. A single cardiology question, for example, might be tagged to the Cardiovascular domain and to the Pharmaceutical Therapeutics task.
| Task Category | Weight |
|---|---|
| History Taking and Performing Physical Examination | 15% |
| Ordering and Interpreting Diagnostic and Laboratory Studies | 15% |
| Formulating Most Likely Diagnosis | 16% |
| Patient Education and Preventive Measures | 5% |
| Clinical Intervention | 16% |
| Pharmaceutical Therapeutics | 15% |
| Applying Scientific Concepts | 7% |
| Cultural Competency and Social Determinants of Healthcare | 3% |
| Public Health (Population/Society) | 3% |
| Emerging Topics and Legal/Ethical Issues | 5% |
Notice the pattern: the clinical-reasoning tasks (history/exam, diagnostics, diagnosis, intervention, therapeutics) total roughly 77% of the exam. That is where scenario-based practice pays off most. The softer categories (patient education, cultural competency, public health) add up to only about 11%, but they are reliably testable and easier to learn than a new pharmacology class.
High-Yield Topics Inside the Heaviest Domains
The blueprint's detailed examples are illustrative, so use the following as an emergency-medicine-flavored prompt list rather than an official syllabus. These are topics a practicing emergency PA should be able to reason through under time pressure.
Cardiovascular System (9%)
Expect scenario questions that blend recognition, testing, and first-line management.
- Acute coronary syndromes: ECG pattern recognition, risk stratification, and initial therapy
- Dysrhythmias, including unstable versus stable presentations and ACLS-style decision points
- Heart failure exacerbation, hypertensive emergencies, and aortic emergencies
- Pericardial disease, valvular emergencies, and venous thromboembolism pathways
Gastrointestinal System and Nutrition (9%)
The abdomen is a classic emergency-medicine diagnostic challenge.
- Acute abdomen differentials: appendicitis, cholecystitis, pancreatitis, obstruction, perforation
- GI bleeding: upper versus lower, resuscitation priorities, and risk stratification
- Hepatobiliary disease, hernias, and mesenteric ischemia as a can't-miss diagnosis
- Nutritional and electrolyte-related presentations that reach the ED
Pulmonary System (9%)
Airway and breathing problems sit at the core of emergency practice.
- Asthma and COPD exacerbations, including escalation of therapy and ventilatory support decisions
- Pneumonia, pulmonary embolism, pneumothorax, and respiratory failure
- Interpreting chest imaging and blood gases in an acutely dyspneic patient
- Foreign-body, inhalational, and aspiration problems
The 5-6% block that separates strong candidates
Environmental and Toxicologic Disorders (6%) and Traumatic Disorders (6%) are the domains most specific to emergency practice and often the least familiar to PAs who work in urgent-care-adjacent or mixed settings. Review toxidromes and antidotes, overdose management, heat and cold injuries, envenomation, drowning, and the primary/secondary trauma survey. Pair these with Neurologic (6%): stroke pathways, seizures, headache red flags, and altered mental status workups.
Procedures and Skills (5%) and Emerging Topics and Legal/Ethical Issues (5%) deserve a deliberate review slot too. Think indications, contraindications, and complications for airway management, vascular access, wound closure, joint reduction, and similar bedside procedures, plus consent, capacity, EMTALA-style obligations, documentation, and emerging clinical issues. These are conceptual questions, so you can gain points here without a long study block.
Attestation, Scores, and Award Timeline
- Award requires two things: a passing NCCPA examination result and completion of the non-exam requirements (including the attestation).
- Score timing: results are generally released eight to ten weeks after administration, following validation.
- Passing threshold: a numeric passing score and an official specialty-specific pass rate were not verified for this credential. Be wary of any site claiming a precise cut score or guaranteed pass. Our PA-CEM Passing Score and PA-CEM Pass Rate articles explain what is and isn't known.
- Scheduling: for deadlines, testing windows, and booking logistics, see PA-CEM Exam Dates.
Ten-Year Cycle and Maintenance Facts
| Maintenance Item | Fact |
|---|---|
| Credential length | Ten years, as long as PA-C status and licensure remain current |
| CME requirement | 125 specialty Category I CME credits within the cycle, submitted by the maintenance-exam application |
| Maintenance exam | A passing specialty exam |
| Attempts | Three maintenance attempts in years nine and ten under the May 2026 governing policy |
| Online maintenance option | 120 questions, five-minute limit per question, about six weeks to finish; references permitted, collaboration not permitted |
One policy wrinkle worth knowing: the May 2026 governing policy says a maintenance exam passed before year nine resets the cycle, while the online-maintenance policy says before year ten. If you plan to test in year nine, get written confirmation from NCCPA about the cycle effect rather than assuming either reading.
Mapping Domains to a Study Calendar
Rather than a generic template, anchor your calendar to the blueprint. This sample eight-week rhythm weights time roughly in line with the exam and front-loads the heaviest domains. Adjust it using your own weak spots, and consult the PA-CEM Study Guide for a fuller approach.
The 9% trio
- Cardiovascular: ECGs, ACS, dysrhythmias, aortic and thromboembolic emergencies
- Pulmonary: dyspnea differentials, PE, pneumothorax, ventilatory decisions
- Gastrointestinal: acute abdomen and GI bleeding algorithms
Emergency-specific 6% domains
- Environmental and Toxicologic: toxidromes, antidotes, heat/cold injury
- Traumatic: trauma survey, imaging choices, fracture and head injury management
- Neurologic: stroke, seizures, altered mental status
The 4-5% systems
- GU, Renal, OB/GYN, Infectious, Psychobehavioral, EENT, Musculoskeletal, Endocrine, Hematologic
- Emphasize ED presentations: ectopic pregnancy, torsion, DKA, sepsis, acute psychiatric emergencies
Procedures, legal/ethical, and light domains
- Procedures and Skills indications and complications
- Legal/ethical and emerging topics; Dermatologic review
Simulation and consolidation
- Timed two-block practice, one minute per question, no notes
- Take the official NCCPA practice form inside its 180-day window and review misses by domain and task
You can add timed scenario drills from the main practice test site during weeks 5-8 to build the one-minute-per-question rhythm.
Version Caveats and Things to Confirm with NCCPA
This cheat sheet uses the NCCPA-hosted Content Blueprint for the Emergency Medicine CAQ Examination (an eight-page, undated document). A few cautions:
- No effective date is inferred. The blueprint is undated, and a "2026" in an article title is an editorial publication year, not a claim that a new exam version launched.
- Legacy blueprint conflicts. An older blueprint link on the specialty page could not be retrieved in our check, and publicly visible legacy reproductions use different headings and weights (for example, 10% for the largest systems and 2% for Procedures & Skills). We did not mix those figures with the current distribution above.
- Confirm before you rely on it. If your study plan depends on exact weights, verify the applicable blueprint with NCCPA for your specific testing window.
- No pay promises. We do not assume the credential causes a salary premium. If you're weighing the investment, read Is the PA-CEM Certification Worth It? and PA-CEM Salary Guide, and compare job-market realities in PA-CEM Jobs.
Key Takeaway
Print the format table, the 18-domain table, and the ten task weights, then keep them beside your study log. When a practice question exposes a weakness, label it by domain and task so you can see whether your gap is knowledge (a system) or reasoning (a task type).
If you are still orienting yourself, the overview pages PA-CEM Certification and What Is PA-CEM Certification? are useful starting points, and you can find more question practice on the PA-CEM Exam Prep practice test site.
Frequently Asked Questions
The initial exam has 120 multiple-choice questions, divided into two 60-question blocks of 60 minutes each. The 15-minute tutorial and 15-minute break are additional to the two hours of testing time, and a submitted or expired block cannot be revisited.
The initial fee is $350 total, made up of $100 for registration/administration and $250 for the examination. The optional NCCPA practice exam is a separate $50 purchase.
Cardiovascular System, Gastrointestinal System and Nutrition, and Pulmonary System each carry 9% on the retrieved NCCPA blueprint. Dermatologic System is the lightest at 2%. Confirm the applicable blueprint with NCCPA, since older reproductions use different weights.
A numeric passing threshold and an official specialty-specific pass rate were not verified, so no specific cut score is stated here. Treat any commercial pass-rate figure or guarantee with skepticism, and see our passing score and pass rate articles for what can be said responsibly.
The CAQ lasts ten years while your PA-C certification and licensure remain current. Renewal requires 125 specialty Category I CME credits within the cycle and a passing specialty maintenance exam, with three attempts available in years nine and ten under the May 2026 governing policy.