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Physician Assistant Certification

NCCPA Hospital Medicine CAQ Examination Practice Test

Hospital medicine practice centers on evaluating and treating adults with acute illness during inpatient stays. Cases in this question bank touch on time-sensitive infection management, respiratory failure, heart failure, venous thromboembolism, cirrhosis complications, transfusion reactions, and safe transitions from hospital to home. Clinical reasoning includes choosing diagnostic tests, interpreting findings, and balancing timely treatment with patient-specific risks.

Exam overview

Exam providerNational Commission on Certification of Physician Assistants
Exam codeNot listed
CategoryPhysician Assistant Certification

About the NCCPA Hospital Medicine CAQ Examination Exam

Inpatient decisions often depend on urgency and stability: clinicians may need to start antimicrobials before delayed testing, obtain cultures or joint fluid promptly when feasible, or select imaging based on pulmonary embolism probability and contrast suitability. Other tasks include assessing oxygenation beyond a single pulse-oximetry value, distinguishing volume overload from transfusion-related lung injury, and interpreting ascitic-fluid results. Medication decisions span diuresis for congestion, antimicrobial stewardship in severe pneumonia, treatment of C. difficile infection, and safer opioid prescribing at discharge. These scenarios exercise synthesis of history, examination, laboratory data, and response to treatment, alongside recognition of when diagnostic clarification should precede therapy and when delay could be harmful.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

A hospitalized patient with suspected acute bacterial meningitis has fever, headache, neck stiffness, and altered mental status. Lumbar puncture is delayed for neuroimaging. What is the most appropriate approach to antimicrobial treatment?

  1. AObtain blood cultures promptly and start empiric intravenous antimicrobials without waiting for imaging or lumbar puncture
  2. BWait for lumbar puncture results before giving any antimicrobial therapy
  3. CGive oral antibiotics and defer further treatment until the next day
  4. DWait for neuroimaging to be completed before obtaining cultures or starting therapy
Show answerCorrect answer: A

When bacterial meningitis is suspected and lumbar puncture is delayed, obtain blood cultures promptly if this does not cause meaningful delay, then start empiric intravenous antimicrobials. Treatment should not be postponed for imaging or a delayed lumbar puncture.

Question 2

A hospitalized adult has severe community-acquired pneumonia and is admitted to the intensive care unit. There is no history of MRSA or Pseudomonas infection, and no validated risk factors for either organism. Which antimicrobial principle is most appropriate?

  1. AUse guideline-concordant empiric therapy for severe community-acquired pneumonia without adding MRSA or antipseudomonal coverage solely because of ICU admission
  2. BAdd vancomycin and an antipseudomonal agent to every severe pneumonia regimen
  3. CUse antifungal therapy as routine empiric treatment for severe pneumonia
  4. DWithhold all antibiotics until sputum culture results are finalized
Show answerCorrect answer: A

Empiric treatment should cover likely community-acquired pathogens and be tailored to severity, local practice, allergies, and patient-specific risk factors. ICU admission alone does not establish a need for MRSA or Pseudomonas coverage; unnecessary broad-spectrum therapy increases harm and resistance. Cultures and clinical response can support later adjustment.

Question 3

A hospitalized patient has fever and a painful, swollen knee. The patient is stable, and septic arthritis is suspected. Which diagnostic step is most important before antibiotics when it can be performed promptly?

  1. AObtain synovial fluid by arthrocentesis for cell count, Gram stain, and culture
  2. BOrder serum uric acid and treat presumed gout if it is elevated
  3. CObtain a plain radiograph and defer joint sampling unless it is abnormal
  4. DStart systemic glucocorticoids to reduce inflammation before sampling
Show answerCorrect answer: A

Septic arthritis is a time-sensitive diagnosis, and synovial fluid analysis with culture is central to confirming it and guiding therapy. In a stable patient, arthrocentesis should generally be performed before antibiotics if this does not create a clinically important delay. Serum uric acid and radiographs cannot reliably exclude joint infection.

Question 4

A hospitalized patient with acute decompensated heart failure has elevated jugular venous pressure, pulmonary crackles, and peripheral edema. Blood pressure is stable, and kidney function is near baseline. Which initial medication approach is most appropriate?

  1. ABegin intravenous loop diuretic therapy
  2. BGive a rapid isotonic saline bolus
  3. CStart a non-dihydropyridine calcium-channel blocker
  4. DWithhold diuresis until the edema resolves spontaneously
Show answerCorrect answer: A

Intravenous loop diuretics are used to relieve clinically significant congestion in acute decompensated heart failure. Volume expansion would generally worsen congestion, and treatment should be monitored for response, renal function, and electrolytes.

Question 5

A hospitalized patient with cirrhosis has an upper gastrointestinal bleed and develops a new increase in oxygen requirement with bilateral pulmonary opacities. Which test is most useful to help distinguish transfusion-associated circulatory overload from transfusion-related acute lung injury?

  1. ASerum B-type natriuretic peptide, interpreted with the clinical volume assessment
  2. BSerum lipase
  3. CUrine culture
  4. DSerum ammonia
Show answerCorrect answer: A

Both transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) can cause acute hypoxemia and bilateral opacities. Evidence of elevated cardiac filling pressures or volume overload, supported by BNP or NT-proBNP and the clinical assessment, favors TACO; no single test is definitive.

Question 6

A hospitalized patient with suspected pulmonary embolism is hemodynamically stable and has a high clinical pretest probability. Renal function is adequate, and there is no contrast allergy. Which diagnostic test is generally most appropriate?

  1. ACT pulmonary angiography
  2. BD-dimer testing as the sole confirmatory test
  3. CChest radiography as the definitive test
  4. DSpirometry
Show answerCorrect answer: A

For a stable patient with high pretest probability and no contraindication, CT pulmonary angiography is generally an appropriate diagnostic study. D-dimer is most useful for excluding pulmonary embolism in patients with low or intermediate pretest probability when interpreted in context.

Question 7

A hospitalized patient with cirrhosis is being evaluated for new-onset ascites. Which ascitic-fluid finding most strongly supports portal hypertension as the cause?

  1. ASerum-ascites albumin gradient (SAAG) of at least 1.1 g/dL
  2. BAscitic-fluid neutrophil count of at least 250 cells/mm³
  3. CAscitic-fluid glucose lower than serum glucose
  4. DAscitic-fluid amylase markedly elevated above serum
Show answerCorrect answer: A

A SAAG of at least 1.1 g/dL indicates a pressure gradient consistent with portal hypertension. It is calculated by subtracting ascitic-fluid albumin from serum albumin obtained at approximately the same time.

How to use this practice test

The free practice bank contains 50 questions. A session presents up to 20 random questions, and results appear after the session. Use the cases to identify gaps in inpatient assessment, diagnostic selection, urgent treatment, medication safety, and discharge planning; revisit missed decisions by tracing how stability, risk factors, and test findings affect management.

Preparation tips

  • For suspected meningitis or septic arthritis, compare the risks of delaying treatment with the value of obtaining imaging, blood cultures, or synovial fluid first.
  • Practice selecting pulmonary embolism imaging from clinical probability, hemodynamic status, kidney function, and contrast history.
  • Review inpatient oxygenation assessment and compare findings that help distinguish transfusion-associated circulatory overload from transfusion-related acute lung injury.
  • Work through decompensated heart failure and cirrhosis cases by linking volume status, ascitic-fluid findings, and treatment choices to the clinical presentation.
  • For discharge scenarios, check opioid safety and distinguish treatment approaches for nonfulminant C. difficile infection from severe or complicated disease.
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