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100+ Free CAQ-EM Practice Questions

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A patient with cellulitis has rapidly spreading erythema, severe pain out of proportion, crepitus, and bullae. Diagnosis?

A
B
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D
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Key Facts: CAQ-EM Exam

120

Total Items

NCCPA CAQ

3 hrs

Exam Time

NCCPA

$350

Exam Fee

NCCPA

3,000 hrs

Practice Required

Prior 6 yrs EM-PA

NCCPA CAQ-EM is the PA subspecialty credential for emergency medicine. 120 items, 3 hours, $350. Eligibility: 3,000 hours EM practice + 150 EM CME. Master ATLS primary survey, sepsis bundle (Hour-1), STEMI activation criteria, stroke tPA window (4.5h) and EVT extended window (24h DAWN/DEFUSE-3), and toxidrome recognition.

Sample CAQ-EM Practice Questions

Try these sample questions to test your CAQ-EM exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man presents with crushing substernal chest pain for 45 minutes. ECG shows 3 mm ST elevation in leads II, III, and aVF. The hospital has 24/7 PCI capability. What is the maximum acceptable door-to-balloon time?
A.30 minutes
B.60 minutes
C.90 minutes
D.120 minutes
Explanation: For STEMI patients presenting to a PCI-capable hospital, the goal door-to-balloon time is 90 minutes or less per ACC/AHA guidelines.
2A 62-year-old woman presents to a non-PCI capable hospital with anterior STEMI. The nearest PCI center is 3 hours away. What is the most appropriate management?
A.Administer fibrinolytics within 30 minutes
B.Transfer immediately without intervention
C.Admit for medical management only
D.Wait to confirm with troponin before treatment
Explanation: At a non-PCI capable hospital where transfer would exceed 120 minutes, fibrinolytic therapy should be administered within 30 minutes of arrival (door-to-needle), assuming no contraindications.
3A 55-year-old man with chest pain has a HEART score of 3. Initial high-sensitivity troponin is below the 99th percentile. What is the most appropriate disposition?
A.Admit to telemetry
B.Discharge with outpatient stress test
C.Cardiac catheterization
D.Observation with serial troponins
Explanation: A HEART score of 0-3 indicates low risk (~1.7% MACE at 6 weeks) and supports early discharge with outpatient follow-up including stress testing.
4A 70-year-old presents with NSTEMI. Which finding most strongly supports an early invasive strategy (within 24 hours)?
A.GRACE score >140
B.Single elevated troponin
C.Age greater than 65
D.Prior MI history
Explanation: A GRACE score >140 identifies high-risk NSTEMI patients who benefit from early invasive strategy within 24 hours.
5A 67-year-old with acute decompensated heart failure has BP 90/60, cool extremities, and lactate 4.5. What is the most appropriate initial therapy?
A.Aggressive IV fluid bolus
B.Inotropic support with dobutamine
C.High-dose IV furosemide
D.Beta-blocker initiation
Explanation: This patient has cardiogenic shock (cold and wet) with hypoperfusion. Inotropic support (dobutamine or milrinone) is indicated to improve cardiac output.
6A patient with new-onset atrial fibrillation has heart rate 165, BP 80/50, and altered mental status. What is the most appropriate immediate management?
A.IV diltiazem
B.IV metoprolol
C.Synchronized cardioversion
D.Adenosine 6 mg IV
Explanation: Atrial fibrillation with hemodynamic instability (hypotension, altered mental status) requires immediate synchronized cardioversion per ACLS.
7A 45-year-old with palpitations has a regular narrow-complex tachycardia at 180 bpm, BP 120/70. Vagal maneuvers fail. What is next?
A.Synchronized cardioversion
B.Adenosine 6 mg rapid IV push
C.Amiodarone 150 mg
D.Diltiazem 0.25 mg/kg
Explanation: Stable SVT unresponsive to vagal maneuvers is treated with adenosine 6 mg rapid IV push, followed by 12 mg if needed.
8Which ECG finding is most consistent with acute pericarditis?
A.ST elevation in a single coronary distribution
B.Diffuse ST elevation with PR depression
C.T wave inversions in V1-V4
D.Q waves in inferior leads
Explanation: Acute pericarditis classically shows diffuse concave-up ST elevation with PR depression, distinguishing it from STEMI.
9A 75-year-old with sudden severe tearing chest pain radiating to the back has BP 200/110 in the right arm and 160/90 in the left. What is the diagnostic test of choice?
A.CT angiography of chest
B.Transthoracic echocardiogram
C.D-dimer
D.Cardiac catheterization
Explanation: Aortic dissection is suspected based on tearing pain and BP differential. CT angiography of the chest is the diagnostic test of choice in stable patients.
10A patient with type A aortic dissection requires what initial management?
A.IV beta-blocker to target HR <60 and SBP <120
B.Immediate thrombolytics
C.IV nitroprusside alone
D.Antiplatelet therapy
Explanation: Type A dissection requires immediate impulse control with IV beta-blockers (esmolol/labetalol) targeting HR <60 and SBP 100-120 mmHg, plus emergent surgical consultation.

About the CAQ-EM Exam

NCCPA Certificate of Added Qualifications in Emergency Medicine — for PAs practicing in EDs. Covers high-acuity resuscitation (ACLS/PALS, sepsis, shock), trauma (ATLS, primary/secondary survey, MTP), cardiovascular emergencies (STEMI, dissection, PE), pulmonary emergencies, neurologic emergencies (stroke window, status), GI/GU emergencies, peds and OB emergencies, toxicology and environmental, infectious/sepsis, airway and procedures, and EM professional practice.

Questions

120 scored questions

Time Limit

3 hours

Passing Score

Scaled (NCCPA-set)

Exam Fee

$350 (NCCPA)

CAQ-EM Exam Content Outline

15%

Cardiovascular Emergencies

STEMI activation, dissection, PE, AFib RVR, decompensated HF, tamponade

12%

Trauma

ATLS primary/secondary survey, MTP, FAST, blunt vs penetrating, pelvic binder

12%

Resuscitation & Shock

ACLS, septic vs cardiogenic vs distributive shock, REBOA, ROSC care

11%

Toxicology & Environmental

Toxidromes, antidotes (NAC, fomepizole, atropine/2-PAM), heat/cold, envenomations

9%

Abdominal/GI/GU

Appendicitis, SBO, ectopic, testicular torsion, AAA, mesenteric ischemia

8%

Pulmonary

Asthma/COPD exacerbation, PE, pneumothorax, ARDS, NIV vs intubation

8%

Pediatrics & OB Emergencies

Bronchiolitis, intussusception, NAT, preeclampsia/HELLP, postpartum hemorrhage

8%

Neurologic

Stroke (4.5h tPA, 24h EVT), status epilepticus, meningitis, ICH, SAH (Hunt-Hess)

7%

Infectious / Sepsis

Hour-1 sepsis bundle, source control, necrotizing fasciitis (LRINEC)

5%

Procedures & Airway

RSI, US-guided central line, chest tube, lateral canthotomy, CSF/joint tap

5%

Professional Practice

Documentation, EMTALA, handoffs, ethics, observation vs admission

How to Pass the CAQ-EM Exam

What You Need to Know

  • Passing score: Scaled (NCCPA-set)
  • Exam length: 120 questions
  • Time limit: 3 hours
  • Exam fee: $350

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

CAQ-EM Study Tips from Top Performers

1Memorize the Hour-1 sepsis bundle and qSOFA/SIRS triggers — high-yield repeated content
2Master ATLS primary survey (ABCDE) and reversible shock causes (Hs and Ts in ACLS)
3Know stroke timing: tPA ≤4.5h, EVT ≤24h with imaging mismatch (DAWN, DEFUSE-3)
4Drill toxidromes (cholinergic, anticholinergic, sympathomimetic, opioid, sedative-hypnotic) and matched antidotes
5Know EMTALA medical screening exam requirements and stable-transfer rules

Frequently Asked Questions

What is the Hour-1 sepsis bundle?

Surviving Sepsis Campaign Hour-1 bundle: measure lactate (re-measure if >2 mmol/L), obtain blood cultures BEFORE antibiotics, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, vasopressors (norepi first-line) to maintain MAP ≥65 mmHg if persistent hypotension. All actions ideally within first hour of recognition.

When is tPA still indicated for stroke?

Alteplase 0.9 mg/kg (max 90 mg) within 4.5 hours of last-known-well in eligible ischemic stroke patients without contraindications (recent surgery, active bleeding, INR >1.7, BP >185/110 unresponsive). Tenecteplase 0.25 mg/kg increasingly used. Endovascular thrombectomy extends to 24h in carefully selected LVO patients (DAWN, DEFUSE-3) with favorable imaging mismatch.

How is necrotizing fasciitis recognized?

Clinical features: pain out of proportion, rapid spread, systemic toxicity, crepitus (late), bullae, skin necrosis. LRINEC score (CRP, WBC, Hgb, Na, Cr, glucose) flags risk; ≥6 suggests nec fasc but cannot rule out. Imaging (CT) shows gas in tissue planes. Treatment: emergent surgical debridement + broad-spectrum antibiotics (vanco + pip-tazo + clinda for toxin suppression).

How should I study for CAQ-EM?

Plan 80-120 hours over 10-14 weeks. Work the NCCPA CAQ Emergency Medicine content blueprint, drill weighted-domain practice questions, complete required Category 1 CME, and submit experience requirements (typically ≥3,000 hours specialty practice in the prior 6 years and ≥150 specialty CME) before sitting the exam.