10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The PA-CEM exam has 120 questions and runs 2 hours.
These 10 free PA-CEM questions are organized by exam domain, so you can see how each part of the Certificate of Added Qualifications in Emergency Medicine blueprint is tested. Reveal the answer and explanation under each question.
Chest pressure and diaphoresis persist in a 62-year-old man whose first high-sensitivity troponin is below the assay's upper reference limit. His ECG shows horizontal ST depression confined to V1-V3, tall R waves in those leads, upright T waves, and a narrow QRS complex. Which investigation would most rapidly clarify whether an acute coronary occlusion is being missed?
Correct answer: B - Obtain an immediate ECG with posterior leads V7-V9.
A 51-year-old woman taking empagliflozin for type 2 diabetes has vomiting and deep, rapid respirations after two days of poor intake. Glucose is 184 mg/dL, beta-hydroxybutyrate 5.6 mmol/L, venous pH 7.21, bicarbonate 11 mmol/L, and potassium 3.1 mmol/L. Renal function and urine output are preserved. Isotonic IV fluid has been started. Which treatment sequence is appropriate?
Correct answer: D - Replace potassium before starting IV insulin.
A 44-year-old reports that the left ear suddenly felt blocked on awakening, with markedly reduced hearing but no pain or vertigo. Both ear canals and tympanic membranes appear normal. With a 512-Hz tuning fork, Weber lateralizes to the right; Rinne shows air conduction greater than bone conduction in both ears. What type of hearing loss do these findings support?
Correct answer: C - Left-sided sensorineural hearing loss.
An 11-month-old has episodes of sudden crying and pallor, followed by periods of unusual sleepiness. Ultrasound demonstrates an ileocolic intussusception with preserved bowel-wall perfusion. After IV fluid, the infant has normal perfusion and stable vital signs. The abdomen is soft between episodes, without guarding; radiographs show no free air. Pediatric surgery and radiology are available. What is the preferred initial approach to this obstruction?
Correct answer: A - Image-guided pneumatic enema with surgical backup.
A 17-year-old arrives with abrupt left scrotal pain and vomiting that began 90 minutes ago. He recalls two shorter episodes that resolved without treatment. The left testis is high-riding and horizontal, and the left cremasteric reflex is absent. He has no fever, dysuria, or pyuria. Doppler imaging reports preserved intratesticular arterial flow. Pain remains severe. What is the appropriate response to the apparent conflict between the examination and ultrasound?
Correct answer: C - Obtain emergency urologic evaluation for surgical exploration.
Four hours after splinting a closed tibial fracture, a patient develops escalating pain despite analgesia and marked pain with passive toe extension. The splint and circumferential dressings are removed, but symptoms persist. Pedal pulses remain palpable. Blood pressure is 98/52 mm Hg, and the symptomatic compartment pressure is 36 mm Hg. Which interpretation should determine the next action?
Correct answer: A - Delta pressure is 16 mm Hg; urgent surgical decompression is indicated.
"She was managing her usual routine two days ago," says the daughter of an 81-year-old with mild Alzheimer disease who now has agitation and visual hallucinations. The patient recently started diphenhydramine for sleep. Which additional finding would most strongly favor delirium over progression of dementia?
Correct answer: D - Marked fluctuation in the ability to sustain attention.
A 76-year-old woman is evaluated for pleuritic chest discomfort. She is hemodynamically stable, oxygen saturation is 97% on room air, and her two-level Wells score is 0. A highly sensitive D-dimer assay returns 620 ng/mL FEU; the laboratory flags values above its fixed 500 ng/mL FEU cutoff. She is not taking anticoagulants. Using an age-adjusted D-dimer strategy, how should this result guide the pulmonary embolism evaluation?
Correct answer: C - Exclude pulmonary embolism using a 760 ng/mL FEU cutoff.
Why is IV calcium given promptly to a patient with severe hyperkalemia and QRS widening, even when insulin with dextrose and definitive potassium removal are also planned?
Correct answer: A - It stabilizes cardiac cell membranes.
Six days after an uncomplicated delivery, a previously normotensive patient develops a severe persistent headache and blurred vision. Blood pressure remains 174/116 mm Hg on repeat measurement 18 minutes later. Platelet count, creatinine, and liver enzymes are normal, and urine testing shows no proteinuria. IV labetalol is being administered, and obstetric consultation is underway. Which additional medication is indicated for seizure prophylaxis?
Correct answer: B - IV magnesium sulfate.
The PA-CEM exam also covers these domains. Drill them in the full free practice test:
The full bank has 1,020 more PA-CEM questions with explanations.
Continue in the free practice test →
View plans