So, I seem to have actually finally fixed this problem. In the process I've learned a LOT about the various tweaks I was applying to fsx.cfg. I've also made a few compromises in sliders along the way with minimal impact to what I care about. My final fsx.cfg is posted below. Basically compared to the original one, especially after reading an older (end of 2009 post) from Nick N (the Nhancer guy) I went back tonight and did some revision to sliders and a few in config file settings. One big thing is I set LOD radius to 4.5 instead of 6.5 (and really didn't notice a difference). Also after reading his description of how autogen works in SP2 and that higher settings can actually increase FPS and/or smoothness I bumped AG from normal to dense. I also removed ALL airport vehicles (slider to none). I wasn't really impressed with them anymore anyway. I guess they were "cool" at first when FSX was new but they're kinda pointless now and it seems like half the time you never have them at your gate anyway. I also reduced cloud distance to 60 from 90 after seeing from 28K that there wasn't a hugely noticeable difference in distance. 60 miles is still really far away towards the horizon.
Other tweaks were got rid of AC cast shadows on itself and replaced with cast shadow on ground, bumped ai traffic UP to 25 from 20 for commercial and GA, bumped ferries and whatever the 3rd one is UP to 10 from none, cars to 4 from 6. Also I gained about 1-2fps or so by going from max scenery density to one notch down. I will ONLY use that last tweak for OrbX PNW though (for now at least). It seemed to only get rid of cargo cranes at the port in Seattle. After doing all this I'm much more consistent at being close to or at 30fps and flight is MUCH smoother, less stutters etc. Even better is after these changes I could NOT get the gpu spike to come back. I literally flew between KSEA and downtown for 15 minutes switching views and it would NOT happen.
[bufferPools]
BufferPools=1
PoolSize=10485760
RejectThreshold=524288
//RejectThreshold=131072
[VirtualCopilot]
VirtualCopilotActive=0
[sOUND]
AmbientUI=0
AmbientUIMusic=FSX01
AmbientUIMusicVolume=-6.000000
PrimaryDevice={DEF00000-9C6D-47ED-AAF1-4DDA8F2B5C03}
SOUND=1
SOUND_FADER1=0.260000
SOUND_FADER2=0.490000
SOUND_FADER3=0.490000
SOUND_FADER4=0.760000
SOUND_LOD=1
SOUND_QUALITY=2
UISound=1
VoiceDevice={DEF00002-9C6D-47ED-AAF1-4DDA8F2B5C03}
[slewTextInfo.1]
AirSpeed=1,5
Altitude=1,3
Heading=1,4
Latitude=1,1
Longitude=1,2
[AContain]
LabelColor=FFFF0000
LabelDelay=1000
ShowLabelAirline=0
ShowLabelAirlineAndFlightNumber=0
ShowLabelAirspeed=0
ShowLabelAltitude=1
ShowLabelContainerId=0
ShowLabelDistance=1
ShowLabelFlightPlan=0
ShowLabelHeading=0
ShowLabelManufacturer=1
ShowLabelModel=1
ShowLabelTailNumber=0
ShowLabels=0
ShowUserLabel=0
[ATC]
AutoOpenAirTrafficWindow=1
COMM_MSG_AI_ATC_COLOR=FFFF7840
COMM_MSG_ATC_AI_COLOR=FF00FF00
COMM_MSG_ATC_USER_COLOR=FFB6FFB6
COMM_MSG_NONE_COLOR=FFFFFFFF
COMM_MSG_USER_ATC_COLOR=FFFFD21B
PilotVoice=196608
ShowATCText=1
UsePilotVoice=1
[TextInfo.1]
AirSpeed=1,5
Altitude=1,3
Heading=1,4
Latitude=1,1
Longitude=1,2
WindDirectionAndSpeed=1,6
[AccelerationPack]
ControlsFirstRun=0
HomePageFirstRun=0
[iNTERNATIONAL]
ASLAT=2
ASLON=0
MEASURE=0
[CONTROLS]
Controls_Current=Standard
Controls_Default=Standard
KBDAIL=64
KBDELEV=64
KBDRUD=64
[FACILITIES]
CITY=
COUNTRY=
GTL_BUTTON=1295
STATE=
[TextInfo.3]
AirSpeed=1,5
Altitude=1,3
FrameRate=2,1
FuelPercentage=2,4
GForce=2,3
Heading=1,4
Latitude=1,1
LockedFrameRate=2,2
Longitude=1,2
WindDirectionAndSpeed=1,6
[PointOfInterestSystem]
CycleSetting=0
[GRAPHICS]
AC_SELF_SHADOW=0
AIRCRAFT_REFLECTIONS=1
AIRCRAFT_SHADOWS=1
ALLOW_SHADER_30=1
COCKPIT_HIGH_LOD=1
D3D10=0
EFFECTS_QUALITY=2
GROUND_SHADOWS=0
HIGHMEMFIX=1
IMAGE_QUALITY=0
LANDING_LIGHTS=1
NUM_LIGHTS=8
See_Self=1
TEXTURE_MAX_LOAD=2048
TEXTURE_QUALITY=3
Text_Scroll=1
SHADER_CACHE_PRIMED_10=1693500672
SHADER_CACHE_PRIMED=1693500672
[TrafficManager]
AIRPORT_SCENERY_DENSITY=0
AirlineDensity=25
FreewayDensity=4
GADensity=25
IFROnly=0
LeisureBoatsDensity=9
ShipsAndFerriesDensity=9
utbAirlineDensity=0
[DynamicHeadMovement]
HeadMoveTimeConstant=1.000000
LonAccelOnHeadLon=-0.020000
LonAccelOnHeadPitch=-0.010000
MaxHeadAngle=5.000000
MaxHeadOffset=0.300000
RollAccelOnHeadLat=0.010000
RollAccelOnHeadRoll=0.100000
YawAccelOnHeadLat=-0.100000
[REALISM]
AllowEngineDamage=False
AutoCoord=False
AutoTrim=False
CrashDetection=False
CrashTolerance=1.000000
CrashWithDyn=False
GEffect=False
General=1.000000
GyroDrift=False
GyroEffect=0.000000
ManualLights=True
PFactor=0.000000
RealMixture=False
StressDamage=False
Torque=0.000000
TrueAirspeed=False
UnlimitedFuel=False
[Weather]
AdjustForMagVarInDialog=1
CLOUD_COVERAGE_DENSITY=7
CLOUD_DRAW_DISTANCE=3
DETAILED_CLOUDS=1
DisableTurbulence=1
DownloadWindsAloft=0
DynamicWeather=0
MaxGustRampSpeed=200
MaxGustTime=500
MaxVarRampSpeed=75
MaxVarTime=50
MinGustRampSpeed=1
MinGustTime=10
MinVarRampSpeed=10
MinVarTime=5
THERMAL_VISUALS=0
TurbulenceScale=1.000000
WeatherGraphDataInDialog=0
WeatherServerAddress=fs2k.zone.com
WeatherServerPort=80
WindshieldPrecipitationEffects=1
[Misc]
Com_Rate=7
[Main]
HideMenuFullscreen=1
HideMenuNormal=0
Location=0,0,1679,1050,\\.\DISPLAY1
Maximized=1
SimObjectPaths.0=SimObjects\Airplanes
SimObjectPaths.1=SimObjects\Rotorcraft
SimObjectPaths.2=SimObjects\GroundVehicles
SimObjectPaths.3=SimObjects\Boats
SimObjectPaths.4=SimObjects\Animals
SimObjectPaths.5=SimObjects\Misc
User Objects=Airplane, Helicopter
ProcSpeed=7029
PerfBucket=7
DisablePreload=1
[DISPLAY.Device.NVIDIA GeForce GTX 560 Ti .0]
Mode=1680x1050x32
TriLinear=1
[Trusted]
D:\Microsoft Flight Simulator X\GAUGES\Bendix_King_Radio.DLL.niabqwihwhthwhwnbezoikoaczkwbhkhrcbtolzz=2
D:\Microsoft Flight Simulator X\GAUGES\Magnetic_Compass.DLL.trliiahabalrhknkbuubauiocrkwhkazkruabilw=2
D:\Microsoft Flight Simulator X\Modules\FSUIPC4.dll.bqbuetnzziznnwqhwqlawhkukntktlwzcrwkbhoe=1
D:\SquawkBox\sbaicontrol10.dll.ibernreeoikaeuiwcrklekktkccozrknwhbtoqbw=1
D:\SquawkBox\sbmod10.dll.kraiwebtwbqrnbzhizobqonbwtzulrweznooierz=1
D:\SquawkBox\sbtrans10.dll.ekcuklirkhhaowebtewoilanzwnkblohkahlnowz=1
D:\Microsoft Flight Simulator X\GAUGES\737-400.DLL.btknrulkewqltootlkriakeiuobbqacklkilnwut=2
D:\Microsoft Flight Simulator X\SimObjects\Airplanes\B737_800\panel
\GPWS_Sound.GAU.abzlhrehkeulrubleeioarrbqarobkuhwralncwt=0
D:\Microsoft Flight Simulator X\SimObjects\Airplanes\FSND_FSX_Citation X_Ultra_Package\panel\737-
400s.DLL.knnlqczebzltknbuczoocruqlewtcrzhwhbqbrqh=2
D:\Microsoft Flight Simulator X\SimObjects\Airplanes\FSND_FSX_Citation X_Ultra_Package\panel
\Magnetic_Compass.DLL.trliiahabalrhknkbuubauiocrkwhkazkruabilw=2
D:\Microsoft Flight Simulator X\GAUGES\QWBae146.GAU.zeintlruchckaeqkqocnawckbocizwolqbtatoin=2
D:\Microsoft Flight Simulator X\GAUGES\QwBAe146_TCAS.GAU.tzutrnthhkukeucurneatbhhinzqbbbzaznbieaq=2
D:\Microsoft Flight Simulator X\Modules\FSUIPC4.dll.ohhrbrkrrwltquknbccrtqnoqnarlzniuqiaciab=1
D:\Microsoft Flight Simulator X\GAUGES\Mooney_Bravo.DLL.botzkzkbehiouzqhbuaclceqrrqnzzlluuruqtkz=2
[TextInfo.2]
FrameRate=1,1
FuelPercentage=1,4
GForce=1,3
LockedFrameRate=1,2
[uSERINTERFACE]
Map_Orientation=2
OpenATCOnCreate=0
PAUSE_ON_LOST_FOCUS=0
PROMPT_ON_EXIT=1
PageID=1
SHOW_MISSION_CAPTIONS=0
SITUATION=removed for posting
ShowAllACPaintSchemes=1
SelectAircraftManufacturer=British Aerospace-QWSim
SelectAircraftPublisher=All
SelectAircraftType=All
DisplayFuelAsWeight=1
[sIM]
SYSCLOCK=1
[Display]
ActiveWindowTitleBackGroundColor=0,28,140,64
ActiveWindowTitleTextColor=255,255,255
BLOOM_EFFECTS=0
ChangeTime=4.000000
InfoBrakesEnable=True
InfoLowerLeftBackGroundColor=255,0,0,128
InfoLowerLeftTextColor=255,255,255
InfoLowerRightBackGroundColor=255,0,0,128
InfoLowerRightTextColor=255,255,255
InfoOverspeedEnable=True
InfoParkingBrakesEnable=True
InfoPauseEnable=True
InfoSlewEnable=True
InfoStallEnable=True
InfoUpperRightBackGroundColor=0,0,0,0
InfoUpperRightTextColor=255,0,0
NonActiveWindowTitleBackGroundColor=24,33,87,64
NonActiveWindowTitleTextColor=255,255,255
SKINNED_ANIMATIONS=1
TEXTURE_BANDWIDTH_MULT=40
TextureMaxLoad=30
TransitionTime=4.000000
UPPER_FRAMERATE_LIMIT=0
WideViewAspect=True
[JOBSCHEDULER]
AffinityMask=84
//AffinityMask=14
[slewTextInfo.3]
AirSpeed=1,5
Altitude=1,3
FrameRate=2,1
Heading=1,4
Latitude=1,1
LockedFrameRate=2,2
Longitude=1,2
[PANELS]
DEFAULT_VIEW=0
IMAGE_QUALITY=1
PANEL_MASKING=1
PANEL_OPACITY=100
PANEL_STRETCHING=1
QUICKTIPS=0
UNITS_OF_MEASURE=0
[sTARTUP]
DEMO=0
LoadWindow=1
SHOW_OPENING_SCREEN=1
STARTUP_DEMO=0
[slewTextInfo.2]
FrameRate=1,1
LockedFrameRate=1,2
[TERRAIN]
AUTOGEN_DENSITY=3
DETAIL_TEXTURE=1
LOD_RADIUS=4.500000
MESH_COMPLEXITY=100
MESH_RESOLUTION=23
TEXTURE_RESOLUTION=29
WATER_EFFECTS=4
[sCENERY]
DAWN_DUSK_SMOOTHING=1
IMAGE_COMPLEXITY=5
LENSFLARE=1
MAX_ASYNC_BATCHING_JOBS=3
[MAPVIEW_MAP]
SHOW_AIRPORTS=1
SHOW_VORS=1
SHOW_NDBS=0
SHOW_APPROACHES=1
SHOW_INTERSECTIONS=0
SHOW_VICTOR=0
SHOW_JET=0
SHOW_AIRSPACE=1
SHOW_FLIGHTPLAN=1
SHOW_WEATHERSTATIONS=1
SHOW_WEATHERSYSTEMS=1
SHOW_DATATAGS=1
SHOW_TERRAIN=1
show_flight_history=1
[FlightPlanMap]
LineWidth=2
SHOW_AIRPORTS=1
SHOW_VORS=1
SHOW_NDBS=0
SHOW_APPROACHES=1
SHOW_INTERSECTIONS=1
SHOW_VICTOR=0
SHOW_JET=1
SHOW_AIRSPACE=1
SHOW_FLIGHTPLAN=1
SHOW_WEATHERSTATIONS=1
SHOW_WEATHERSYSTEMS=1
SHOW_DATATAGS=1
SHOW_TERRAIN=1
show_waypoints=1
show_airways=1
show_markers=1
show_volume_boundaries=1
show_ac_twr=1
[RWW_WEATHER_MAP]
SHOW_AIRPORTS=0
SHOW_VORS=0
SHOW_NDBS=0
SHOW_APPROACHES=0
SHOW_INTERSECTIONS=0
SHOW_VICTOR=0
SHOW_JET=0
SHOW_AIRSPACE=0
SHOW_FLIGHTPLAN=1
SHOW_WEATHERSTATIONS=1
SHOW_WEATHERSYSTEMS=1
SHOW_DATATAGS=1
SHOW_TERRAIN=1
[MULTIPLAYER]
condAccoutPassword=0
VoiceVolume=1.520000