Practice Test Geeks(NCCPA) National Commission on Certification of Physician Assistants Practice Test
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Clinical Medicine Flashcards

7 cards from real NCCPA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Clinical Medicine flashcards as text

  1. A 60-year-old woman with type 2 diabetes and CKD stage 3b (eGFR 32) requires better glycemic control. Which antidiabetic agent should be avoided due to risk of lactic acidosis?

    Answer: Metformin

    Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to accumulation and risk of lactic acidosis; it should be used cautiously with eGFR 30–45.

  2. A 35-year-old woman develops bilateral ptosis, diplopia, and generalized weakness that worsens with repetitive muscle use and improves with rest. Anti-AChR antibodies are positive. What is the most likely diagnosis?

    Answer: Myasthenia gravis

    Myasthenia gravis is an autoimmune disorder with antibodies against acetylcholine receptors, causing fatigable weakness that worsens with activity.

  3. A 70-year-old man presents with progressive dysphagia to solids, 15-lb weight loss over 3 months, and iron-deficiency anemia. He drinks alcohol daily and smokes 2 packs/day. Upper endoscopy reveals a mid-esophageal mass. Which histology is most expected?

    Answer: Squamous cell carcinoma

    Squamous cell carcinoma arises in the mid-esophagus and is strongly associated with smoking and alcohol use, while adenocarcinoma arises in the distal esophagus from Barrett's.

  4. A 28-year-old pregnant woman (32 weeks) presents with sudden-onset severe headache, visual changes, BP 160/110 mmHg, and 3+ proteinuria. Platelet count is 85,000/µL, LDH is elevated, and AST is 3x normal. Which syndrome does she have?

    Answer: HELLP syndrome

    HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia requiring urgent delivery.

  5. A patient with long-standing GERD develops Barrett's esophagus. Which cellular change characterizes this condition?

    Answer: Squamous to intestinal-type columnar metaplasia

    Barrett's esophagus is defined by replacement of normal squamous epithelium with specialized intestinal columnar metaplasia (goblet cells) due to chronic acid exposure.

  6. A 50-year-old man with HIV (CD4 count 60 cells/µL) presents with ring-enhancing brain lesions on MRI, headache, and hemiparesis. Toxoplasma IgG is positive. What is the first-line empiric treatment?

    Answer: Pyrimethamine + sulfadiazine + leucovorin

    Empiric treatment for cerebral toxoplasmosis is pyrimethamine plus sulfadiazine with leucovorin (to prevent bone marrow suppression) for at least 6 weeks.

  7. A 42-year-old woman presents with episodic hypertension, headache, diaphoresis, and palpitations. 24-hour urine shows elevated catecholamines and metanephrines. CT reveals a 4-cm right adrenal mass. What is the next step before surgery?

    Answer: Start alpha-blocker first, then beta-blocker

    In pheochromocytoma, alpha-blockade (phenoxybenzamine) must be established before beta-blockade to prevent unopposed alpha-adrenergic vasoconstriction and hypertensive crisis.