NCCPA Clinical Medicine 2 — Questions and Answers
Question 1: A 58-year-old man presents with sudden-onset tearing chest pain radiating to his back. BP is 180/100 mmHg in the right arm and 150/85 mmHg in the left arm. Which diagnosis must be excluded first?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Esophageal rupture
Correct answer: Aortic dissection
Aortic dissection classically presents with tearing/ripping back pain and a blood pressure differential between arms greater than 20 mmHg.
Question 2: A 45-year-old woman with SLE develops a butterfly rash, arthritis, and proteinuria. Serology shows low complement (C3, C4) and high anti-dsDNA. Which renal lesion is most likely?
- Focal segmental glomerulosclerosis
- Membranous nephropathy
- Diffuse proliferative glomerulonephritis (Correct answer)
- IgA nephropathy
Correct answer: Diffuse proliferative glomerulonephritis
Diffuse proliferative glomerulonephritis (ISN/RPS Class IV) is the most severe and common form of lupus nephritis, associated with low complement and high anti-dsDNA.
Question 3: A 72-year-old man is found to have a PSA of 28 ng/mL. Biopsy reveals Gleason score 9 prostate adenocarcinoma. Bone scan shows multiple metastases. Which is the most appropriate initial treatment?
- Radical prostatectomy
- External beam radiation alone
- Androgen deprivation therapy (Correct answer)
- Watchful waiting
Correct answer: Androgen deprivation therapy
Androgen deprivation therapy (ADT) is the standard first-line treatment for metastatic prostate cancer, as prostate cancer growth depends on androgens.
Question 4: A 30-year-old woman has episodic headaches lasting 4–72 hours with nausea, photophobia, and phonophobia. She notices flashing lights 20 minutes before each headache. Which prophylactic medication is most appropriate?
- Sumatriptan
- Acetaminophen
- Topiramate (Correct answer)
- Caffeine
Correct answer: Topiramate
Topiramate is a first-line prophylactic agent for migraine with aura, reducing frequency and severity of attacks.
Question 5: A 55-year-old man with a 30 pack-year smoking history presents with a 3-cm right upper lobe lung mass, hypercalcemia, and no bone metastases. Which histologic type is most likely responsible for the hypercalcemia?
- Small cell carcinoma
- Adenocarcinoma
- Squamous cell carcinoma (Correct answer)
- Large cell carcinoma
Correct answer: Squamous cell carcinoma
Squamous cell carcinoma of the lung produces PTHrP, causing hypercalcemia of malignancy without bone metastases.
Question 6: A 40-year-old woman presents with painless jaundice, weight loss, and a palpable, non-tender gallbladder. CT shows a mass in the head of the pancreas. This clinical scenario is best described by which eponym?
- Murphy's sign
- Courvoisier's sign (Correct answer)
- Charcot's triad
- McBurney's sign
Correct answer: Courvoisier's sign
Courvoisier's sign refers to a palpable, non-tender gallbladder in the setting of painless jaundice, suggesting malignant biliary obstruction rather than gallstones.
Question 7: A 25-year-old man presents to the ER with confusion, fever (39.8°C), and neck stiffness. CSF analysis shows glucose 30 mg/dL (serum glucose 90), protein 180 mg/dL, WBC 1200 cells/µL with 90% neutrophils. Which organism is most likely?
- Cryptococcus neoformans
- Listeria monocytogenes
- Neisseria meningitidis (Correct answer)
- Herpes simplex virus
Correct answer: Neisseria meningitidis
Neisseria meningitidis is the most common cause of bacterial meningitis in young adults, presenting with the classic triad of fever, neck stiffness, and altered mental status.
NCCPA Clinical Medicine 2
A 58-year-old man presents with sudden-onset tearing chest pain radiating to his back.
BP is 180/100 mmHg in the right arm and 150/85 mmHg in the left arm.
Which diagnosis must be excluded first?