NCCPA Clinical Medicine 2

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?

Accepted Answer

Aortic dissection

Answer

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?

Accepted Answer

Diffuse proliferative glomerulonephritis

Answer

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?

Accepted Answer

Androgen deprivation therapy

Answer

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?

Accepted Answer

Topiramate

Answer

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?

Accepted Answer

Squamous cell carcinoma

Answer

Squamous cell carcinoma of the lung produces PTHrP, causing hypercalcemia of malignancy without bone metastases.

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

NCCPA Clinical Medicine 2